Stages of Life > Pregnancy and Postpartum Life

The Facts About Pregnancy and Postpartum Life

From conception to taking your baby home, here's what you need to know about pregnancy.

The dark silhouette of a pregnant woman is behind a frosted wall.

There is a growing movement to recognize pregnancy as four trimesters long, a departure from the traditional and historical three-trimester, gestation-only version. Dr. Harvey Karp coined the phrase. Why add those extra three months postpartum? To give your family time to absorb and adapt to the physical and emotional adjustments of caring for a newborn.

Here's what you can expect from the journey of preconception to life with a little one.

Getting pregnant

If you've always dreamed about carrying a child, you probably have preconceived (pun intended) notions about what the experience will entail. For some women, pregnancy seems to happen instantaneously, but people often underestimate how long or complicated getting pregnant can be.

Unrealistic notions about the ease of conception may stem from "accidental" pregnancy stories that are more readily shared than infertility issues. Everyone's heard about that cousin or friend who was a "surprise baby," but we don't always know when loved ones are undergoing in vitro fertilization (IVF).

Under typical circumstances, the initial steps of pregnancy take place in the following sequence:

  1. An ovarian follicle produces a mature egg.
  2. In response to the luteinizing hormone, the egg is released.
  3. The egg makes its way to the uterus by traveling down the fallopian tube.
  4. Progesterone levels go up and thicken the uterine lining in preparation.
  5. During intercourse, a healthy sperm cell enters the vagina and swims to the uterus.
  6. The sperm penetrates the egg and fertilizes it.
  7. The fertilized egg continues down the fallopian tube, growing and dividing along the way.

Once the fertilized egg makes it to the uterus, it's about 100 cells large and is technically a blastocyst. Next, the blastocyst attaches to the uterine lining (known as the endometrium) through a process called implantation. An influx of estrogen and progesterone further thickens the endometrium to supply nutrients to the developing blastocyst and begin growing the placenta. Since the endometrium needs to be preserved, menstrual shedding doesn't happen. That's why pregnancy results in a missed period.

Making sense of the process of unassisted conception can help explain common fertility barriers. Experts define infertility as the absence of pregnancy despite one year of consistent, unprotected intercourse. Age plays a crucial role in fertility, and an evaluation is recommended after six months for women older than 35. If you're over 40, the sooner you talk to your OB-GYN about your pregnancy plans, the better your chances of success.

Several factors can contribute to infertility, including problems with:

  • Chromosomes (DNA)
  • Endometrium
  • Egg reserve or quality
  • Implantation
  • Ovulation process
  • Sperm count, shape or motility (movement)

About a third of infertility cases are caused by a combination of male and female issues. Sometimes lifestyle changes, such as quitting smoking or losing weight, can be enough to improve fertility. In addition to age, underlying medical conditions also play a crucial role in fertility. Assisted reproductive technology (ART), such as IVF or intrauterine insemination (IUI), may be needed to overcome these barriers to natural conception.

Pregnancy symptoms

Pregnancy symptoms vary widely from person to person and from one pregnancy to the next. Some people have intense symptoms from the moment of conception, while others can go about their day forgetting that they're pregnant.

Significant changes, including the formation of fetal body systems and organs, occur during the first trimester of pregnancy. Breast changes, a higher pulse rate, mood swings, nausea, constipation and fatigue are common issues related to the hormonal shifts and physical changes of pregnancy. Staying hydrated, finding opportunities to rest and eating a healthy diet that includes plenty of fiber can help.

During the second trimester (around week 20), you may start to notice fetal movement. Some women describe this sensation as having butterflies in their stomach. The second trimester is when most women feel their best, because nausea has often subsided and signs of the growing baby become more apparent. Other symptoms in the second trimester can include:

  • A bigger appetite
  • Frequent urge to urinate
  • Hemorrhoids
  • Increased vaginal discharge
  • Itchy belly skin related to stretching
  • Nasal congestion, nosebleeds and sensitive gums
  • Varicose veins

The third trimester can bring new aches and pains, and trouble sleeping. Changes in how your body weight is distributed and hormonal loosening of your joints can make you more prone to balance issues. Weight gain happens more rapidly in the third trimester.

Braxton Hicks contractions, or false labor pains, will give you a preview of early labor. These contractions can feel like menstrual cramps. Swollen breasts, leg cramps, hair changes, water retention, heartburn and backaches become more pronounced as you approach your due date.

Always talk to your doctor before using any over-the-counter medications or herbal supplements to manage pregnancy symptoms, as these may not be safe.

Staying healthy through pregnancy

Unfortunately, getting pregnant doesn't guarantee a healthy, live birth. It's essential to take extra precautions to reduce your risk of early pregnancy loss, stillbirth or other complications.

Start by taking a prenatal vitamin every day. Prenatals provide some nutritional insurance to give your developing fetus the micronutrients necessary for healthy development. Ideally, you'll want to begin prenatals as you start trying to conceive. Otherwise, try to get started as soon as you realize you're pregnant. Your OB-GYN may be able to provide a free sample of vitamins during your first prenatal visit.

Avoid alcohol and tobacco (including secondhand smoke) to protect your baby throughout pregnancy. If you have a cat or other pets in the home, have someone else change the litter to reduce your exposure to harmful bacteria. You'll also want to be mindful of potential sources of food poisoning—such as undercooked, unpasteurized or prepared foods—that raise the risk of miscarriage.

Labor and birthing options

For low-risk pregnancies, giving birth in the hospital may not be necessary (but know that a low-risk pregnancy can become a high-risk one in an instant). While many people prefer having access to the medical resources in a large hospital, others want the more intimate environment of giving birth at home. Birthing centers can offer the best of both worlds: a relaxed atmosphere affiliated with a hospital. Explore your options with your healthcare provider and make sure you have a qualified nurse-midwife or obstetrician present since you never know if complications may arise.

Keep a couple of things in mind. A certified nurse-midwife (CNM) has undergone more rigorous training and has oversight to ensure competency. Midwives that are not properly trained (lay midwives) are less likely to recognize a true emergency and transfer you to a hospital in time. Many midwives are not properly trained, and their outcomes are not tracked, so they may have poor outcomes and never have peer review or any other oversight.

Ultimately, it's up to the expectant parents to choose, but you need to do extensive research and ask lots of questions.

Some of the questions you'll want to consider include:

  • Do you prefer a midwife or a medical doctor to facilitate the birth and why?
  • Do you plan to breastfeed or bottle-feed?
  • What pain management options do you want to try during labor?
  • Which birthing positions do you want to use?
  • Who will cut the umbilical cord?
  • Who would you like to be in the room with you as you're giving birth?
  • Would you like the baby to spend some time sleeping in the nursery or elsewhere while you're in the hospital? (Many hospitals no longer have a nursery and instead encourage rooming in, where the baby stays with the mom. If a mom has had a prolonged labor, or a cesarean section, often the nurse can give them some respite for a few hours at night.)

Options for controlling pain during delivery can range from an epidural block to nothing at all. In the United States, an epidural is the most popular choice for pain management during labor. To administer an epidural, your doctor will insert a tube in your lower back. A combination of medications that block pain and feeling in your lower body is continuously supplied to provide comfort while giving birth. You won't necessarily lose muscle control with an epidural, but to be on the safe side, you won't be allowed to stand or walk until it wears off and your healthcare provider gives you the green light.

In most cases, an epidural is a low-risk way to significantly reduce pain and make giving birth a more pleasant experience. For a C-section, you'll be given a spinal block, a single pain-relief shot in the spine that lasts one to two hours.

If you want to attempt birthing positions other than lying on your back, you'll need to opt for a different form of pain control. Some women prefer to give birth in a squatting position or want the option to walk around during labor. Talk to your doctor to determine if nitrous oxide (laughing gas) or local anesthesia is available. If you plan to go without pain control, you may want to attend birthing classes to learn about breathing techniques to help you cope with the pain through the experience.

Some women are interested in having a water birth, which can offer some benefits during labor (such as reducing the need for an epidural and shortening delivery) but no additional benefits for the baby, according to the American College of Obstetricians and Gynecologists. Water submersion may be considered for the first stage of labor but is discouraged during the actual birth due to infection risks, the potential for the fetus to inhale water, trouble regulating the baby's body temperature and a greater likelihood of cord damage.

If you choose to give birth at a hospital, familiarizing yourself with hospital policies will help you know what to expect as you plan your stay. Take time to pack your hospital bag in the weeks leading up to your due date. Include personal items such as pajamas, glasses, a cellphone charger, deodorant, clothing and a toothbrush. You'll also need to bring an outfit for the baby and have a car seat ready for when you drive the baby home.

Thinking about the details of your birth plan can give you some sense of control as you prepare for the big day. Since you're not usually guaranteed to have a specific provider on the day you give birth, a birth plan acts as a guideline to share your preferences with an on-call physician. Of course, if you or your baby are in danger of medical complications, your healthcare team may need to take steps that weren't part of the original plan, such as a C-section, induction or assisted vaginal delivery.

Whenever possible, obstetricians will opt for an assisted vaginal delivery over a C-section, which poses more significant risks of infection and a longer recovery time. Forceps or a "vacuum" (a suction cup with a handle) are used to assist vaginal birth. Both devices help guide and gently pull the baby through the birth canal as you push. If the baby still isn't coming out despite assistance, you may need to have an emergency C-section.

If your birthing experience doesn't go as imagined, try not to let it bother you. Childbirth can be unpredictable, even if it's not your first time. Ultimately, all that matters is that you and your baby make it through the process safely.

Staying healthy through postpartum

Taking prenatal vitamins isn't only important during early pregnancy. You should continue taking them throughout the pregnancy and in the months after giving birth unless your doctor advises otherwise. Growing a baby requires key nutrients such as calcium, iron and more. Prenatals can help your body recover from the physical stress of giving birth, along with providing the nutrition necessary for producing breast milk if you choose to breastfeed.

Depending on the circumstances around your birthing experience, you'll need to follow your doctor's guidelines for healing in the early days postpartum. For significant blood loss or a C-section, you may require extra help or a longer hospital stay to ensure your health and safety.

Along with physical changes, pregnancy often takes an intense emotional toll. Even for women who don't suffer from the classic signs of postpartum depression, it's normal to go through ups and downs as your hormone levels return to baseline and you bond with your new addition. Strained relationships, body image concerns, lack of sleep, feeding issues and anxiety about caring for a baby can all add to the hardships associated with early parenting.

It's not unusual to be emotional after giving birth, so feel free to talk as much about your feelings as you want. Confiding in a supportive community, either in person or online, can help. If you're concerned about your well-being or the safety of your child, seek immediate help from your OB-GYN. Postpartum depression is a reality for many parents, but solutions are available.

Resources you can use

The best resource for information about your pregnancy is your healthcare provider. Signing up for prenatal care as soon as you suspect you may be pregnant will ensure that you receive the necessary screenings and support throughout your pregnancy.

To research the basics of pregnancy, delivery and postpartum, you can refer to the American College of Obstetricians and Gynecologists. For information about breastfeeding, La Leche League International is considered a trusted source. Your doctor can also provide a referral to a lactation consultant to assist you with breastfeeding positions, advice and support.

If you suspect you may be struggling with postpartum depression, you can find information from the American Psychological Association. Ask your doctor or insurance carrier about mental health services or telehealth options.