The following guide is provided by
The State of New York Department of Health

What It's About

This guide is about pregnancy and becoming a parent. Are you:

• Pregnant?
• A Father-to-be?
• Planning to start a family?
• Or, planning to add a new child to your family?

Read this guide carefully. It has good advice to help you make sure your baby gets a healthy start.

Thoughts About Parenthood

Is this your first pregnancy? Then the thought of becoming a parent may be scary! If you already have children, you know that raising a child is a big job. Keeping your family happy and healthy will keep you very busy. Parenting is important work that has many rewards. You will feel love and joy as you help your child grow and develop.

Different Families

Today there are many kinds of families. Moms and dads may live together…or they may live apart. Grandparents, aunts and uncles may be nearby---or far away. Both parents may work at jobs outside the home…or one parent may be home. Whatever your family is like, you will need help. As you go through pregnancy and childbirth, you will need a support person. This can be the baby's father, a friend, or relative. Think about the people you trust and who can help you.

When Parenting Begins

Your job as a parent begins with good planning - even before you become pregnant! Why do you need to plan for a pregnancy? Because you must take care of yourself to have a healthy baby. Your good health is very important - especially in the first three months of pregnancy. This is when your baby's brain, heart, lungs, eyes, ears…al the major organs…are formed. And, you may not even know you're pregnant right away!

Many women don't know they're pregnant for at least three weeks. So, if you're planning to have a baby, or think you may be pregnant, take good care of yourself:

• Don't smoke.
• Don't drink alcoholic beverages.
• Don't take any drugs without a doctor's advice.

These things can hurt your developing baby. They can cause mental retardation, physical deformities or serious health problems in your baby.

Your good health is very important - especially during the first three months of pregnancy.

In addition to "don'ts," there are "do's" - good health practices - that are important before and during pregnancy:

• Get regular medical check-ups.
• Watch your weight.
• Eat nutritious foods.
• Get regular exercise.
• Take care of your teeth and gums.
• See a dentist for regular check-ups.

You need to eat a variety of foods that keep you healthy and nourish your growing baby.

If you need help to pay for your health care, call your city or county social services and health departments to find out about health care programs you may qualify for.

Signs of Pregnancy

For most women, the first signs of pregnancy are:

• Missed period
• Nausea, possibly with vomiting
• Frequent urination
• Tender, swollen breasts

Pregnancy Testing

These symptoms won't always mean that you are pregnant. You need a pregnancy test to be sure you are pregnant. You can buy "in-home" pregnancy tests, but they are expensive, and are not always accurate. It is best to have a pregnancy test done by a health professional. To get a pregnancy test, make an appointment with your doctor, nurse-midwife, or a family planning clinic.

Start Prenatal Care Early

Prenatal care is the health care a woman receives during her pregnancy. Early and regular prenatal care is very important to help you have a healthy pregnancy and a healthy baby. Don't delay - start today!

Choosing a Care Provider

You and your baby can get good prenatal care from many types of health care providers:

Obstetricians - are doctors who have special training in women's health, pregnancy and childbirth.

Certified Nurse-Midwives - are registered professional nurses who have special training in prenatal care and childbirth. Nurse-midwives can take very good care of women who have normal pregnancies. If a problem arises, or you have special needs, a nurse-midwife will refer you to an obstetrician.

Family Practice Physicians - are doctors who have special training in family health care. These doctors can take care of women who have normal pregnancies. If a problem arises, or you have special needs, he or she will refer you to an obstetrician.

Be sure to choose the type of caregiver that's right for you! Find a caregiver:

• Who's easy to talk with
• Who makes you feel relaxed
• Who will consider your special needs and wants.

Meet with your caregiver in person before you make a final decision. Ask questions. Remember, there is no such thing as a dumb question.

Questions for Care Providers

It is a good idea to bring a list of questions with you. Here are some questions you may want to ask:

• Can my partner or another support person come with me to my prenatal care visits? Can he or she help me during labor and delivery?
• How long is a normal visit? Is there time for questions and answers during each visit?
• Do you provide nutrition counseling?
• Will I see you at every visit? If I will be seeing more than one caregiver, who will be my "care coordinator?" When can I meet him/her?
• Where will I deliver my baby? Do I have a choice of hospitals?
• Will I have choices about my care? Will you try to consider these choices in my prenatal care and childbirth experience?

Prenatal Care Visits

The average pregnancy lasts about nine months. Throughout your pregnancy you will have regular check-ups, called prenatal visits. During the early part of your pregnancy, you should visit your caregiver once a month. At the beginning of the eighth month, you should see your caregiver every two weeks. During the ninth month, you should see your caregiver every week.

The First Visit

Your first visit will probably be your longest. You'll be asked a lot of questions about your health. Your caregiver will want to know the date of the first day of your last period. This will be used to estimate your "due date" - the approximate date your baby will be born. And you will probably want to ask a lot of questions yourself about your pregnancy, your health care, and childbirth. Make a list of the things you want to ask or say.

Here's what will happen during your first visit:

• You will be weighed.
• You will be asked to give a sample of urine.
• Your blood pressure will be taken.
• A blood sample will be taken and tested.
• An internal pelvic exam will be done. Your caregiver will feel the size of your womb and judge the age of your baby.
• A Pap test will be done to check for any abnormal cells on the cervix (opening to the womb) that might be a sign of a problem.

Your first visit will include a syphilis test. But other sexually transmitted diseases (STDs) can also be dangerous for your baby. If you think you may have an STD, ask to be tested and treated.

Later Visits

Later prenatal visits are shorter. Your weight, urine and blood pressure will be taken. Your caregiver will feel your abdomen to check your baby's position and growth. And, he or she will listen to your baby's heartbeat. You'll be able to listen to the heartbeat, too. If your caregiver doesn't offer to let you listen, be sure to ask!

Again, ask any questions that you have. Talk about anything that is worrying you. Talking with your caregiver during prenatal visits is just as important as the examinations and tests.

Hepatitis B

In New York State, all pregnant women are tested for hepatitis B. Hepatitis B is a serious liver disease caused by a virus. The virus is passed from person to person through sexual intercourse or contact with infected blood or other body fluids. Symptoms of hepatitis B are.

• Yellow coloring of the skin and eyes
• Dark urine
• Fever
• Loss of appetite

Tell your doctor if you have any of these symptoms.

You can have hepatitis B and not feel sick. The virus can cause long-term damage to your liver even if you feel fine. Routine checkups can catch problems early.

Anyone can get hepatitis B. However, some people are at greater risk. You may be at high risk for hepatitis B, if:

• You are of Asian, Caribbean, Pacific Island, Native American, Native Alaskan, or South American origin.
• You are a health care worker.
• You live with someone of kidney dialysis or who had hepatitis.
• You have shared needles to shoot drugs.
• You have had a number of sexual partners.
• You have had a sexually transmitted disease.

If you are a carrier of the virus, you can pass the virus to your baby during birth. Like adults, babies can get very sick from hepatitis B. babies can also have hepatitis B and feel fine. But these babies could have liver problems as they get older.

All babies exposed to hepatitis B must be immunized at birth. If you baby has the virus, talk with your baby's doctor. Make sure your baby gets:

• Two shots within 12 to 48hours of birth, a vaccine and immune globulin shot to give your baby immediate protection.
• One shot of vaccine at one and six months of age.
• A blood test at one year to be sure the child is protected.

In addition, the New York State Department of Health recommends that all children be immunized for hepatitis B at one to two months of age, at four months, and between six and 18 months.

Immunization will keep your baby safe from this harmful disease.

Sickle Cell Anemia

"He's got his father's eyes." "She's going to be tall like her mother." We all know that children get their looks from their parents. But children can also inherit diseases from their parents. One of these is sickle cell anemia.

Sickle cell anemia changes the body's red blood cells. Usually, red blood cells are round and flow easily through the body. In people with sickle cell anemia, some of the red blood cells twist into a crescent, or sickle shape. Sickle cells can sometimes block blood vessels like a log jam in a river.

There is a test for sickle cell anemia and its trait. For a child to get sickle cell anemia, both parents must have a sickle cell gene. A person with the sickle cell trait has one sickle cell gene and one normal gene. You can get a simple blood test to tell you if you have the sickle cell trait or the disease. The same test will tell if you have other inherited blood problems or carry a gene for those disorders. A prenatal test can tell you if your baby will have sickle cell anemia, carry the trait or be healthy.

Sickle cell anemia is a serious disease. But it can be treated. Early and regular treatment is very important. If your baby has sickle cell anemia or sickle cell trait:

• Be sure your baby gets treatment as soon as possible.
• Treatment should begin no later than 3 months of age.
• Join a special sickle cell program for children and their families.
• Ask your doctor about sickle cell anemia.

AIDS

Pregnant women who have AIDS can give it to their babies, even if they have not symptoms.

You may have been exposed to AIDS if you have:

• Shared needles or works to shoot drugs.
• Had sex with a man who shoots drugs.
• Had sex with a bisexual man (a man who has had anal sex with another man).
• Had sex with men whose health, drug use, or sexual histories are not known to you.

If there is even the slightest chance that you have been exposed to AIDS, ask your caregiver to give you a test for the AIDS virus. For free advice and confidential testing, call the state's toll-free hotline: 1-800-541-AIDS.

If you plan to breastfeed, be sure you know how to protect you and your baby from AIDS. If you have AIDS, don't breastfeed. The AIDS virus can be passed through breast milk, and infect your baby.

Keep Your Appointments

Go to all your appointments. If you can't make an appointment, try to call your caregiver at least 24 hours in advance. Always be sure to make a new appointment. If you have a problem getting to your appointment, or need care for other children during appointments, ask for help. Your caregiver may have good suggestions for dealing with these problems.

Take Care of Yourself

In between your prenatal care visits, you need to take good care of yourself to keep you and the baby well.

Eat the Right Foods

You need to eat a variety of foods that keep you healthy and nourish your growing baby. Check the chart below for the kinds of foods you need.

Weight Gain

Weight gain varies from one woman to another. Expect to gain 20 to 30 pounds during the nine months. Follow your caregiver's advice on how much weight you should be gaining.

Essential Nutrients & Their Sources

These are the nutrients that you and your baby need for good health:

Nutrients	Sources
Protein	Fish, poultry, eggs, mild, cheese, lean meats, nuts and dried beans
Calcium	Milk, cottage cheese, cheese, yogurt and other milk products
Carbohydrates	Fruit, whole grain cereals and breads, potatoes, pasta and dried beans
B Vitamins	Brown rice, cracked or whole wheat, rye and wheat germ
Vitamin C	Green peppers, potatoes, grapefruit, oranges, orange juice, cantaloupe, strawberries, tomatoes and papaya
Vitamin D	Milk, salmon, sardines, eggs, butter, margarine and liver
Vitamin E	Vegetable oils, whole grain cereals and breads, wheat germ and leafy vegetables
Iron	Liver, prunes, raisins, kidneys, black strap molasses, green leafy vegetables, lean meat and fortified cereals

Smoking

If you smoke, stop now! Smoking can cause great harm to you and your baby. Here are some tips on how to quit.

• Don't think about never having another cigarette. Take it one day at a time.
• Drink lots of water and other fluids.
• When you feel like reaching for a cigarette, reach for a carrot stick instead.
• Take a walk and get some fresh air.
• Ask your caregiver for help.

What's that baby doing inside you?

First Trimester
(first 12 weeks of pregnancy)

Your Baby:

• During the first month of pregnancy, the developing baby is called an embryo. From months 2 through 9, he or she is called a fetus.
• The fetus grows to 3 inches in length and one ounce in weight during the first three months.
• All the major organs are forming, and the heart is beating.
• The fetus begins to move its hands, legs, and head and begins to develop into a boy or girl.

Your Body:

• You may not notice any physical changes during this time. You probably will not gain much weight, or look different.
• During the first month, you may have some slight vaginal bleeding, and an increase in vaginal mucous discharge. Always tell your doctor about any vaginal bleeding.
• You may urinate more often, and move your bowels less often.
• You may feel sick to your stomach.
• Your breasts may be bigger and feel sore. As the bones in your pelvis move to make room for the fetus, you may have pain in your lower back and legs.

Second Trimester
(13^th to 26^th week)

Your Baby:

• The fetus grows to 14 inches and 1 ½ pounds.
• The umbilical cord carries blood and nourishment to the fetus.
• Eyelashes and nails grow.
• The fetus can now kick, cry, and suck his or her thumb.
• His or her heartbeat can be heard through a stethoscope.

Your Body:

• The fetus is less than the length of your hand, but your waist starts to thicken. You outgrow your clothes. You can feel the baby move.
• You should be gaining weight now - an average of 3 to 5 pounds per month.
• Your stomach gets big. The skin over your stomach feels stretched. Pink or reddish lines may appear.
• Your nipples may darken and leak a thin, yellow fluid called colostrums. It is not milk.

Third Trimester (27^th to 38^th week)

Your Baby:

• By the end of the seventh month, your baby's growth is nearly complete. You can feel him or her moving and kicking.
• Your baby's eyes open, hair gets longer, and fingers have fingernails!
• In the eight or ninth month, the baby usually moves into the birth position - that is, head down - in the womb.
• Just before birth, the baby weighs approximately 7 pounds and is about 20 inches long.

Your Body:

• Your womb is now very large and firm. You may feel it hardening from time to time. These normal contractions become more frequent as you become more pregnant. The baby moves lower, making your breathing easier.
• You are still gaining weight. Your navel will probably be pushed out.
• Ankle swelling is common. Rest, with your feet raised, whenever you can.
• The baby's movement and position can make it hard to sleep.

Alcohol

When you drink alcohol, your baby is drinking, too. Alcohol passes into your bloodstream, crosses the placenta (sac that surrounds the baby) and is fed to your baby. Drinking alcohol can cause your baby to be born mentally retarded and physically deformed. A drink is not worth it! The best advice is to not drink alcohol at all while you are pregnant and breastfeeding.

If you need help to stop drinking alcohol, ask your caregiver for help. Or, check under "Alcoholism Information" in the Yellow Pages of your telephone book.

Drugs and Medicines

All street drugs can harm your baby. Even some over-the-counter and prescription medicines can harm a baby during pregnancy. If you have been taking drugs, tell your caregiver. Ask him or her for help to stop using the drugs.

Rest

Your body is working hard to nourish the baby growing inside you. You will need more rest now. Go to bed a little earlier at night. Rest with your feet u p when you can. Take a nap during the day.

Exercise

You'll need some exercise while you're pregnant. You and your caregiver should decide how much exercise is good for you. Here are some tips:

• Keep to the routine you followed before you became pregnant.
• Don't start any new strenuous physical activities.
• Walking is a good exercise during pregnancy.
• Don't let yourself get tired or overheated.
• Stop when you feel uncomfortable.

Sex During Pregnancy

Most women can continue to have sexual intercourse right through pregnancy. It doesn't hurt the baby. Talk with your caregiver if you have any worries or concerns. During later pregnancy, sex may be uncomfortable. It may help to try some different positions.

Hazardous Substances

There are some things commonly found at home or work that won't hurt you but can hurt your baby. Here are some things all pregnant women should avoid.

At Home

Raw meat and cat feces may contain bacteria that will cause toxoplasmosis. This disease can cause mental retardation in the baby. Do not eat any raw meat. If you have a cat, have someone else change the litter. Always wash your hands well after playing with a cat and before meals.

Be sure to read labels on cleaning products and other household chemicals. Avoid using things that can be harmful to pregnant women.

Exposure to lead from paint, water, dust and soil may harm mother and baby. Avoid exposure, both before and after your baby's birth.

If you live in an older home, its paint may be lead based. Damp mop and damp dust frequently to remove any dust which may contain lead, even if the paint is not cracking or peeling.

Do not try to remove lead paint yourself. Your local health department can help you find a trained expert to do this. You and your baby should stay away from the house until all work and clean-up are finished.

If any family members work with lead, make sure they do not bring it home on their clothes or shoes. Work clothes should be washed separately from the rest of the family's.

At Work

Most pregnant women can work until their babies are born. But it could be risky for you to work while you're pregnant if:

• You work with chemicals or lead.
• You are exposed to radiation.
• Your work is very strenuous and tiring.

Your caregiver, your personnel department and your union representative can help you check on any risks. If you job is not safe for you and your baby, ask to be moved. For information on the health risks of specific substances, speak with your caregiver.

The Birth of a Parent

It's normal to have different feelings as your pregnancy progresses and you prepare for childbirth. You are going through many changes right now. The birth of a baby is only half of the "big event" that will soon happen. There will also be the birth of a parent - you! At times you may feel very excited and happy about the upcoming birth. Other times you may worry about things.

Talk With Others

It's natural to have some worries during pregnancy. You may feel low from time to time. It helps to talk with your partner or someone close to you. Be sure to discuss your worries and concerns with your health care provider. Getting answers to your questions will make you feel better. The more you know, the less you will fear!

Some questions and worries that many pregnant women have are:

• Will childbirth be painful? Will I be able to cope?
• Will my baby be normal and healthy?
• What will my baby look like?
• How will I take care of my baby and still do all the other things I have to do?
• Will my relationship with my partner change:
• Why don't I feel happier?

Childbirth

Childbirth is a natural event. Millions of women have experienced it! Labor is painful, but it is not more than you can bear. The more prepared you are, the easier childbirth will be. Ask your caregiver about how to register for childbirth preparation classes. Then attend them! You will learn what happens during childbirth and how you can make it easier for you and your baby.

Learning to Love Your Baby

Once your baby is born, you will feel:

• Proud - because you have worked hard to have a healthy pregnancy and birth. Congratulate yourself!
• Relieved - that the pregnancy and birth are over.
• Tired - from the hard work you did during labor and delivery.
• Happy - as you hold your new baby.
• Worried - about whether you will be a good parent.

Many women think they will love their babies "at first sight." Don't worry if you don't. It may take some time for you and your baby to adjust to life together.

You and your baby started to get to know each other while you were pregnant. After your baby is born, you'll learn to love each other by:

• Holding your baby often.
• Breastfeeding your baby, or holding your baby close to you when bottle feeding.
• Gently rocking your baby.
• Singing and talking to your baby.

Getting Help at Home

Life at home with your baby will be fun a times. But it will also be hard work. Get help when you need it. You'll need a break from time to time - to go shopping, get your hair done, have lunch with a friend, or to spend time alone with your partner. Find someone you trust to take care of your baby. Ask people who are close to you - your partner, friends and relatives-to help.

If you need to get out, but can't find help, take the baby with you. Never leave your baby alone.

Your Baby's Health Care

Your baby should start getting regular health care right after birth. Ask about child health programs offered by your local health department. These programs can give:

• Regular check-ups to make sure your baby is growing and developing.
• Immunizations (shots) to keep your baby safe from childhood diseases.

Call your baby's doctor whenever you have questions about your baby's care.

Newborn Screening Program

Some babies are born with health problems that can harm growth and development. Early treatment can keep babies healthy and further their development.

In New York State, all babies are tested at birth for seven health problems. To do this, a tiny blood sample will be taken from your baby's heel before he/she goes home.

You will get your baby's test results only if there is a problem. You may be asked to have your baby retested. Don't panic. It's more likely a problem with the blood test, not the baby.

If you are contacted for additional blood tests, have them done right away. Early treatment helps make a difference. For more information, contact your baby's doctor or the hospital where your baby was born.

Infant Health Assessment Program (IHAP)

IHAP is a free program for babies who might have problems with:

• Health
• Physical growth
• Hearing and vision
• Communication
• Learning ability
• Social and emotional development
• Adaptive development (self-help skills)

If you and your baby are eligible for IHAP, a public health nurse will:

• Contact you after your baby's birth.
• Explain IHAP to you.
• Provide information and support for your baby's care.
• Tell you about local services for your baby and family
• Help you and your baby get the services you need.
• Check your baby's development on a routine basis.
• Refer your baby for a full evaluation, if problems are suspected.

Immunizations

Immunizations are important to your baby's good health. They keep your baby from getting the measles, mumps and other serious illnesses.

If you have hepatitis B, your baby will receive a shot while still in the hospital. If not, the pediatrician will start your baby's shots at the two-month check-up. Keep a record of your baby's shots. Your baby will need proof of immunizations when starting daycare or nursery school. Bring the record with you to your baby's check-ups.

Remember, your baby's good health depends on YOU.

Welcome to Parenthood

The more you know about taking care of a baby, the easier your job as a parent will be. Do you know what to do when your baby cries? Or, if a baby's sick? "Welcome to Parenthood: A Family Guide" will help. This book is written for new parents and is being given, free to all parents by hospitals. Be sure to ask for your copy. It has tips for coping with a new baby and a list of services in your community. Don't leave the hospital without it.

You can also take classes in parenting and baby care offered by your hospital or local social services department. Ask your health care provider about available classes.

With Best Wishes . . .

Congratulations on your pregnancy and best wishes for the future. Remember, be good to your baby before and after your baby is born. When you need help, call on those closest to you. May you have a happy, healthy baby!

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