Trying to Get Pregnant? 10 Proven Sperm Killers

Sperm and fertility

When it comes to conceiving a child, there are lots of things that can go wrong—sperm allergies, poor egg quality, and ineffective sperm. Of the approximately 1 in 10 couples who are infertile, it has been estimated that male factors alone contribute to 30% of these cases.

Though men produce millions of sperm a day (compared to the 300–400 eggs that women release during their lifetime), external factors (like temperature) can affect the health of these little swimmers. And because sperm cells take about 75 days to grow to maturity, harming them can affect your fertility.

Here are 10 surprising factors that may affect a man’s sperm.

Overheating

Human testes cannot function properly unless they are able to stay cooler than the rest of the body. Thankfully, the male anatomy is designed to create distance between the testes and the core body temperature.

If the temperature of the testicles is raised to 98˚, sperm production ceases, according to Hal Danzer, MD, a Los Angeles fertility specialist. When production is interrupted, sperm can be negatively impacted for months.

But what happens if heat exposure does wreak havoc on a man’s reproductive capabilities? “The overall number [of sperm] can be lower, as well as the motility and morphology,” says Paul Shin, MD, a urologist in Washington, D.C.

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Hot tubs

There is a grain of truth in the myth about hot tubs preventing pregnancy. “Wet heat” isn’t good for the testes, and, according to a study published in 2007, even 30 minutes in a Jacuzzi or hot tub can temporarily decrease sperm production.

However, this study also showed that the negative effects of wet heat on sperm may be reversible.

Dr. Shin counters that wet heat exposure can impact a man’s sperm for a surprisingly long time. Because sperm takes so long to mature, “any interventions [to reduce exposure] will usually take at least three, if not six to nine, months to show any benefit,” he says.

RELATED: 8 Ways Sex Affects Your Brain

Fevers

“When I know that a man hasn’t been in a hot tub, smoking dope, or wearing bicycle pants, and that the collection technique for his semen analysis was good, my first question is, ‘Were you sick three months ago?’” says Kurt Wharton, MD, a San Francisco ob-gyn specializing in infertility. Often, he says, these men will acknowledge a recent virus.

A high fever can have the same effect as wet heat on a man’s sperm—with the same lasting effects. And depending on the timing in the sperm production process, sperm concentration can decrease by up to 35% following a fever, according to a 2003 study.

Laptops

Can a laptop computer really affect a man’s ability to reproduce? According to researchers at the State University of New York at Stony Brook, there is a direct correlation between laptop use and increased scrotum temperature—up to 35˚ in certain positions!

This increase has a well-documented harmful effect on spermatogenesis (the process of male gamete formation), so if you’re trying to conceive, leave the laptop on the desk.

Briefs

Why do you think Scots brag about their fertility? “It’s their kilts,” says Dr. Wharton, though he admits the difference between boxers and briefs is usually not great enough to merit a change in sperm count.

“Boxers are better than briefs, if a man’s sperm count is on the low side. But it probably has little effect if the sperm count is normal,” says Dr. Danzer.

However, wearing tight bicycle shorts for an extended period of time is a bad idea as well, Dr. Wharton adds. The more constricted a man’s pants are, the less hospitable an environment he creates for sperm production.

RELATED: 11 Drugs That Affect Your Sex Drive

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Varicose veins

Approximately 15% of men have varicoceles, or enlarged varicose veins in the scrotum, usually in the left testicle. When a man is experiencing a low sperm count, doctors may recommend varicocele repair, a procedure that repairs enlarged varicose veins in the scrotum surgically or via percutaneous embolization, a nonsurgical procedure using a catheter.

Though it’s not clear, a varicocele may interfere with sperm production by interrupting blood flow, overheating the scrotum, or causing blood to back up in the veins supplying the testes. Though there is little proof that fertility improves after varicocele embolization, some doctors believe the surgery may improve semen quality.

Cell phones

The advice about cell phones in proximity to a man’s reproductive organs varies.

“A 2008 study found that men with the highest cell phone usage (more than four hours per day) had significantly lower sperm counts, motility rates, and morphology (normal shapes),” says Dr. Shin. He recommends patients carry their phones in their briefcases rather than pockets in order to limit radiation exposure.

However, because the studies have been small, some doctors disagree. “I don’t advise a man to carry a microwave in his front pocket,” says Dr. Wharton. “But otherwise, it is not a problem.”

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Obesity

“Obesity has been associated with increased production of female hormones (estrogen), decreased sperm counts, sexual dysfunction, and infertility,” says Daniel A. Potter, MD, of the Huntington Reproductive Center in California, who is a fellow of the American College of Obstetricians and Gynecologists.

Compared to normal and overweight men, obese fertile men have reduced testicular function and significantly lower sperm counts, according to a 2009 study by the World Health Organization.

Although obesity reduces sperm count, only extreme levels of obesity may negatively influence male reproductive potential, according to a 2009 study.

A party lifestyle

“Tobacco, alcohol, and marijuana can impair sexual function,” says Dr. Potter, who recommends that his patients limit or avoid all of these when trying to conceive.

Alcohol abuse negatively affects semen quality and production, while cigarette smoking impairs sperm’s motility, according to a 2010 study.

In addition to slowing sperm down, other studies show that cigarette smoking can damage sperm DNA and increase erectile dysfunction.

Marijuana isn’t safe either. Smoking pot has been shown to reduce sperm count, sperm function, and overall male fertility.

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More trouble for sperm

According to Dr. Potter, some physiological situations that could negatively affect sperm include:

Blockages. “Whether it’s caused by a birth defect, infection, trauma, or vasectomy, a blockage prevents the sperm from entering the semen,” says Dr. Potter.

Genetic disorders. “Chromosome abnormalities can cause severely diminished or no sperm production,” says Dr. Potter. For example, one form of cystic fibrosis can cause the vas deferens not to form.

Other detrimental factors. Anti-sperm antibodies, hormonal imbalance, testicular cancer, undescended testicles, and sexual problems can affect sperm.

Unsolicited Pregnancy Advice, Examined

Truth vs. fiction

Does anyone receive more unsolicited advice than a pregnant woman? Now that my pregnancy is obvious to anybody, I’m getting it from all sides. Although it may be well-intentioned, most of the advice I receive from anyone but my doctor sounds like bunk. Here are five of the more bothersome bits of “wisdom” I have been told—and the truth behind them.

Get out of the hot tub! You’ll roast your baby!

To some extent, this one is true. Most hot tubs are set somewhere between 100 and 105 degrees, and if you soak in a tub that hot, it may spell trouble. “More than a few minutes in a hot tub can raise maternal core temperature, which is associated with impaired brain development,” says Charles Lockwood, MD, the chief of obstetrics and gynecology at Yale-New Haven Hospital.

In addition, pregnancy makes it more likely that a woman would pass out from the heat—also not a good scenario. But what if you’re in a cooler hot tub?

Dr. Lockwood advocates staying out of hot tubs altogether. “If you stay in long enough, even at 98 degrees, it may raise your body temperature.”

However, the West Coast doctors I consulted did not share his view. My own doctor has leagues of pregnant patients who have soaked in hot tubs with no ill effect. Keeping both sets of advice in mind, I feel safe finding nirvana drifting around in the backyard Jacuzzi for a few minutes with the temperature set low.

The bottom line: Don’t get overheated. It’s bad for you, and might be bad for the baby. Period.

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You’re not eating licorice, are you? You’re going to go into preterm labor!

In 2001, the American Journal of Epidemiology published a study linking the consumption of licorice and premature births. This study involved Finnish women who ate glycyrrhizin (pure licorice root) each week throughout their pregnancies.

The good news is that you would really have to try to eat that much pure licorice, particularly since it’s only found in a few specialty brands of black licorice.

And if you did consume licorice containing glycyrrhizin, you are still at no risk, according to this study, unless you ate 500 mg or more each week throughout your pregnancy.

Dr. Lockwood also points out that licorice containing glycyrrhizin “does have a mild diuretic effect and could cause dehydration, which could trigger contractions.”

The bottom line: Limit yourselves, ladies, but eating Twizzlers is not going to make you go into labor.

If someone presses the wrong part of your foot, you’ll go into labor!

This one is based on the idea that certain reflexology points on the foot can trigger miscarriage or premature labor. But not one OB-GYN I spoke to, and not one study, can back up this theory.

There is currently no evidence that this is true, although an experienced foot reflexologist may help alleviate some of the swelling and pain experienced through a pregnancy-specific treatment.

The bottom line: There’s no reason to turn down a husband-powered foot rub.

Whatever you do, don’t vacuum!

Perhaps I will be pilloried by the pregnant women of America who have used this piece of advice to inspire husbandly tidiness, but there is nothing to this theory, either. Vacuuming won’t harm a pregnancy.

To be fair, intense physical activity, causing temperatures to rise and energy stores to be depleted, is associated with reduced infant birth weight and spontaneous abortion. However, this physical activity is more along the lines of marathon running, not house cleaning.

The bottom line: Like every other activity, if you start getting Braxton Hicks contractions and feeling light-headed whenever you vacuum, then let the dust bunnies accumulate.

Don’t smell anything scented, it will make you go into labor!

Apparently, smelling some essential oils—e.g., lemongrass, peppermint, and rosemary—used in aromatherapy has been purported to be dangerous for pregnant women. Therefore, massage therapists tend to use scent-free oils during prenatal massages. The National Association for Holistic Aromatherapy suggests using well-diluted oils such as chamomile, jasmine, and lavender.

As with the foot rub question, none of the OBs I surveyed gave this any credence. My own doctor said that smelling these things might make me throw up, but that was about it.

10 Foods Pregnant Women Shouldn’t Eat

Eating for two

When you’re pregnant, there are a lot of new things to think about, especially when it comes to healthy eating. You may need to drop some long-established eating habits and learn how to walk a fine balance between getting enough nutrition for your baby, and avoiding foods that can harm the both of you. Here are 10 foods that you need to be cautious about eating while you’re expecting.

RELATED: Pregnant? Diet Changes to Make Right Now

Unpasteurized dairy

Pregnant women should aim to get three to four daily servings of dairy. It’s packed with calcium, protein, and vitamin D to help build your baby’s developing bones, teeth, heart, and nerves. But there is one caveat: not all dairy products are safe to eat when you’ve got a bun in the oven. “Avoid raw milk and other raw dairy products,” says Sarah Krieger, RDN, a registered dietitian who specializes in maternal and prenatal nutrition. Check the label to see if your milk and cheese has been pasteurized. “[The process] kills bacteria, which can be harmful if consumed,” she says. Certain varieties of soft cheese are considered risky, such as Brie, Camembert, blue cheese, and feta. These are often (but not always) unpasteurized, and can carry Listeria, a germ that can cause miscarriages.

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Processed meats

For a quick-and-easy meal on the go, sandwiches are an excellent choice for most people. But if you’re pregnant, you will want to take a closer look at the ingredient list. Because of the risk of Listeria, you will need to avoid deli meats such as ham, turkey, chicken, bologna, and salami. “It’s the only bacteria that continues to grow at chilled temperatures,” says Krieger. “Most healthy adults don’t react to it, but it definitely is risky for pregnancy.” There is a silver lining, though. You should be able to find prepackaged, pasteurized lunchmeats at the supermarket. You can also use processed meats when you prepare your own food at home. “They need to be heated to 165 degrees to kill the pathogen Listeria,” says Krieger.

Salad bars and prepared salads

Salads are often prepared with fresh fruits and vegetables, making them one of the healthiest meals you can eat—so you may be surprised to learn that you will need to avoid salad bars and prepared salads at delis and cafeterias. “There are several concerns here,” says Krieger. “Has the temperature been consistently less than 40 degrees? Has the food been sitting out for less than two hours? And is there any unpasteurized cheese in the food?” If the answer is yes to any of these, the food may have been exposed to Salmonella, Listeria, or E. Coli. It’s much safer to prepare your own salads at home, after giving the leafy greens a thorough wash.

RELATED: Feed the Belly: Recipes for a Healthy Pregnancy

Unpasteurized juice

Drinking juice is a convenient way to pack more servings of fruit and vegetables into your diet. However, not all juices are safe, since they can harbor E. Coli or Listeria. These can endanger a developing baby. “Avoid freshly squeezed juices at fairs and farmer’s markets where it may be unknown how long a juice has been away from the fruit,” Krieger says. “But it’s okay to squeeze your own juice at home and consume it right away.” Packaged juices are also safe, as long as they have been pasteurized.

Undercooked meat and raw fish

Say goodbye to rare steak and sushi while you’re pregnant. “Bacteria and other pathogens thrive in undercooked meat and seafood,” says Krieger, so expectant women need to take extra care that their meats are heated to a high enough temperature. “You will need to cook meat to at least 145 degrees and leftovers to at least 165 degrees.” If you’re a meat lover, grab a food thermometer and use this handy chart as a guide.

RELATED: Unsolicited Pregnancy Advice, Examined

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Undercooked eggs

Eggs are an excellent source of protein, vitamins, and minerals. But if you’re pregnant, you’ll need to make sure that your eggs are cooked all the way through, with whites and yolks firm throughout. Surprising sources of raw eggs include homemade and fresh-made ice cream, mayonnaise, Caesar salad dressing, raw cookie dough, eggnog, and hollandaise sauce. (Store-bought is fine as long as you see “pasteurized” on the label.) “Salmonellais the bacterial risk here,” says Krieger. You will also want to check the sell-by date on any eggs you buy, and keep them refrigerated.

Coffee

“Caffeine is a concern,” says Krieger. Consuming very high amounts has been linked to miscarriages, so you may want to cut down on coffee during pregnancy. But here’s good news: you don’t need to go cold turkey. Consuming up to 200 mg of caffeine per day is generally considered to be safe. This is equivalent to one to two cups of coffee. “However, some women may feel more sensitive to caffeine during pregnancy,” says Kreiger. If you do choose to indulge, you will need to keep track of other sneaky sources of caffeine, such as chocolate and energy drinks.
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High-mercury fish

Pregnant women need to avoid high-mercury fish, since this chemical has a tendency to accumulate in the body. “It may cause damage to the nervous system,” says Krieger. Avoid shark, swordfish, tilefish, king mackerel, and canned albacore tuna, since these larger fish tend to contain more mercury. The good news is that you can stock up on high-quality protein and omega-3 fatty acids by limiting yourself to low-mercury fish. According to Krieger, safe choices include tilapia, salmon, shellfish, and canned light tuna.

RELATED: 12 Ways to Soothe Heartburn in Pregnancy

Liver

Vitamin A is an essential nutrient for a baby’s embryonic growth, and it also helps with tissue repair after labor and delivery. Most women are able to get more than enough vitamin A from prenatal vitamins, as well as from the fruits and vegetables, meat, dairy, and eggs that a person would normally eat. Too much vitamin A, however, is bad for baby: “It may cause birth defects,” Krieger says. A serving of beef liver contains 431% of your recommended daily intake, so it’s best to avoid it after you give birth.
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Alcohol

Most experts agree that women should avoid alcohol during pregnancy to prevent fetal alcohol syndrome (FAS). Some doctors say an occasional glass of wine is fine, but the CDC and the U.S. Surgeon General still advise against it. Though there’s no evidence that drinking a small amount of alcohol will harm a baby later in pregnancy (the most dangerous time to drink appears to be later in the first trimester), there’s also no evidence that it won’t hurt the baby. Krieger’s take: “Avoid all alcohol during all trimesters of pregnancy.”

12 Ways to Soothe Heartburn in Pregnancy

Pregnancy-related heartburn

Heartburn plagues most moms-to-be at some point because progesterone, the hormone that relaxes muscles in pregnancy, also relaxes the stomach valve that keeps acid out of the esophagus. In addition, the growing uterus crowds the stomach, forcing acid into the esophagus.

But there are safe, effective ways to stop it. “Pregnant women really don’t need to suffer with heartburn anymore,” says Adrienne Einarson, RN, assistant director of clinical services at Motherisk, a Toronto-based program that investigates the effects of prenatal exposures on maternal and fetal health.

Eat small meals

If you’re suffering from morning sickness, eating just a little at a time is probably no problem for you. But if your appetite is healthy, be sure to avoid eating so much that you feel full.

Just as it does when you’re not pregnant, an overly stuffed stomach can contribute to heartburn. Instead of three square meals a day, try five or six smaller ones.

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Take it slow

Bolting down your food can also lead to heartburn and indigestion.

Try to relax and enjoy your meals, which will also help you avoid overeating.

Sip liquids

Rather than drinking a big glass of milk with dinner, you may be better off just sipping liquids during meals.

Try to get most of your fluid intake by drinking beverages between, rather than during, meals.

Sit or stand after a meal

After a meal, take a leisurely walk, do a little housework, sit down and read a book—just don’t lie down, and don’t do anything that requires you to bend over.

Both of these activities can help wash acid back up into your esophagus.

Don’t eat right before bed

Having a hearty meal and then heading to bed is a recipe for heartburn, warns Joel Richter, MD, director of the division of gastroenterology and nutrition and the esophageal diseases center at the University of South Florida, in Tampa, who has studied heartburn during pregnancy. He recommends trying not to eat for at least three hours before you go to sleep.

You should also try to avoid liquids starting a few hours before bedtime.

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Keep your head and upper chest elevated at night

Many people with acid reflux swear by their “bedges,” wedge-shaped pillows that gently slant your upper body upwards to keep stomach acid where it belongs.

And there’s no need for buying a pricey special product, Dr. Richter says. “You can get these at places like Bed, Bath and Beyond for about $25,” he says.

An even cheaper option? Put blocks underneath the legs at the head of your bed.

Know your triggers

Fat, caffeine, chocolate, citrus—pregnant women with heartburn have been advised to avoid all of the above at one time or another. But what causes reflux in one woman might not be a trigger for another.

Rather than tell his pregnant patients to avoid a specific food, Dr. Richter says he advises them to stay away from foods that specifically aggravate them. Everybody’s different, Dr. Richter says. Some pregnant women can chow down on spicy Mexican food or a plate of spaghetti and meatballs with no ill effects.

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Wear loose-fitting clothes

Wearing tight clothing is only going to put more pressure on your already crammed abdomen, and could possibly worsen acid reflux.

Opt for the loose-fitting maternity wear, especially if you’re trying to stamp out heartburn.

Try ginger

Some women find that ginger—ginger ale or ginger candies, for example—can help ease an upset tummy.

This spice can also combat nausea and vomiting, which often go hand-in-hand with heartburn.

Although there’s not much scientific evidence for ginger as a remedy for pregnancy woes, Einarson says, it is safe to consume when you are pregnant.

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Consider an antacid

If lifestyle changes don’t cut it, over-the-counter antacids may quell your heartburn symptoms.

Antacids containing calcium or magnesium should be safe to take during pregnancy. In fact, the extra calcium in antacids like Tums is good for mom and baby.

But avoid antacids that contain aluminum because it can cause constipation and be toxic at high doses. Steer clear of sodium bicarbonate (baking soda) as well—it can cause swelling.

Discuss H2 blockers

If an antacid isn’t working, it may be time to consider stronger medications.

Your first option will likely be an H2 blocker like Tagamet or Zantac. These drugs suppress stomach-acid production. All four H2 inhibitors on the market are now available without a prescription and considered to be safe during pregnancy. But talk to your doctor before taking them.

“They really work,” says Einarson. “You only have to take one or two a day.”

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Proton pump inhibitors

If other medications don’t help, there are also proton pump inhibitors (PPIs), such as Prevacid. These have a more powerful acid-suppressing effect than H2 blockers, and most are available over the counter.

Although PPIs are, in general, safe for pregnant women, animal studies have raised concerns that omeprazole (Prilosec) could harm a developing fetus, Dr. Richter says. “My recommendation to

patients would be to avoid that one because there are about five or six out there on the market, with the H2 blockers,” he says. “All of them look to be safe during pregnancy.”

Be sure to discuss any medications with your doctor.

Preparing for Fatherhood

The Second Trimester of Pregnancy

What Is the Second Trimester?

A pregnancy lasts for about 40 weeks. The weeks are grouped into three trimesters. The second trimester includes weeks 13 through 27 of a pregnancy.

In the second trimester, the baby grows larger and stronger and many women begin showing a larger belly. Most women find that the second trimester is a lot easier than the first, but it’s still important to be informed about your pregnancy during the second trimester. Understanding your pregnancy week by week can help you make informed decisions and prepare for the big changes that lie ahead.

BODY CHANGES

What Happens to a Woman’s Body During the Second Trimester?

During the second trimester of pregnancy, symptoms that you may have experienced during the first trimester begin to improve. Many women report that nausea and fatigue begin to lessen and they consider the second trimester the easiest and most enjoyable part of their pregnancy.

The following changes and symptoms may occur.

the uterus expands
a woman begins to show a larger abdomen
dizziness or lightheadedness due to lower blood pressure
feeling the baby move
body aches
increased appetite
stretch marks on the stomach, breast, thighs, or buttocks
skin changes, like darkening of the skin around your nipples, patches of darker skin
itching
swelling of the ankles or hands
Call your doctor if you experience any of the following.

nausea
vomiting
jaundice (yellowing of the whites of the eyes)
extreme swelling
rapid weight gain

FETAL DEVELOPMENT

What Happens to the Fetus During the Second Trimester?

The baby’s organs become fully developed. It can also start to hear and swallow. Small hairs become noticeable. Later on in the second trimester, the baby will begin to move around. It will develop sleeping and waking cycles that a pregnant woman will begin to notice.

According to the American Pregnancy Association, by the end of the second trimester the baby will be around 14 inches in length and weigh a little over two pounds.

DOCTOR VISITS

What Can Be Expected at the Doctor?

Women should see a doctor about every two to four weeks during the second trimester of pregnancy. Tests that the doctor may perform during a visit include:

measuring your blood pressure
checking your weight
ultrasound
diabetes screening
birth defect and other genetic screening tests
amniocentesis: testing the liquid (amniotic fluid) that surrounds a growing baby to help find clues about the baby’s health (not commonly done)
During the second trimester, your doctor can use an ultrasound test to determine whether or not your baby is a boy or a girl. Deciding whether or not you want to know the sex of the baby before you give birth is your own choice.

STAYING HEALTHY

How Can You Stay Healthy During the Second Trimester?

It’s important to be aware of what to do and what to avoid as your pregnancy continues. This will help you in taking care of yourself and your developing baby.

What to Do

Continue to take prenatal vitamins.
Exercise regularly.
Work out your pelvic floor by doing kegel exercises.
Eat a diet high in fruits, vegetables, low-fat forms of protein, and fiber.
Drink lots of water.
Eat enough calories (about 300 calories more than normal).
Keep your teeth and gums healthy. Poor dental hygiene is linked to premature labor.
What to Avoid

strenuous exercise or strength training that could cause an injury to your stomach
alcohol
caffeine (no more than one cup of coffee or tea per day)
smoking
illegal drugs
raw fish or smoked seafood
shark, swordfish, mackerel, or white snapper fish (they have high levels of mercury)
raw sprouts
cat litter, which can carry a parasite that causes toxoplasmosis
unpasteurized milk or other dairy products
deli meats or hot dogs
the following prescription drugs: isotretinoin (Accutane) for acne, acitretin (Soriatane) for psoriasis, thalidomide (Thalomid), and ACE inhibitors for high blood pressure
Ask your doctor if you have any concerns about the prescription drugs or supplements you are taking.

PREPARING FOR BIRTH

What Can You Do During the Second Trimester to Prepare for Birth?

Although there are still several weeks left in the pregnancy, a woman may want to plan for delivery earlier to help make their third trimester a bit less stressful. Some things that can be done now to prepare for birth include:

taking education courses like Lamaze classes, first aid classes, and parenting classes
touring the hospital or birth center where you will be giving birth
building a nursery or making space in your house or apartment for the newborn baby
considering whether or not you want to take medication for the pain during delivery
Article resources

Life After Delivery

Overview

After months of anticipation, meeting your baby for the first time will surely be one of the most memorable experiences of your life. In addition to the big adjustment of becoming a parent, you’ll also encounter a new set of physical and emotional symptoms that begin once your baby is born. These symptoms will be unlike any you’ve experienced before.

The most common symptom that women experience after birth is a discharge called “lochia.” This bloody discharge looks similar to a menstrual period and can last up to eight weeks after birth. Women also typically experience strong sensations of uterine cramping as the uterus shrinks back to the size it was before pregnancy.

Other symptoms will vary from person to person, depending on your method of delivery and whether or not you decide to breastfeed. Bleeding, discharge, breast swelling, and uterine pain are all part of what happens after delivering a baby. Many women feel unsure about what to expect and wonder what’s considered normal after delivery. Most women make a full recovery after childbirth. Nevertheless, there are some complications and less common symptoms you should be aware of.

HEADING HOME

Heading home after giving birth

The length of your stay at the hospital will depend on your birth experience. Some birthing centers allow women who experience natural childbirth to leave on the same day that they deliver. Most hospitals, however, require a stay of at least one night. Women who have cesarean births should expect to stay in the hospital for up to three nights, unless other complications are present.

While you’re at the hospital, you’ll have access to pediatricians, maternity care nurses, and lactation consultants. They will all have plenty of information and advice for you about the physical and emotional journey ahead. Try to use this opportunity to ask questions about postpartum body changes and breastfeeding. Hospitals with labor and delivery units have nurseries where your baby will be supervised and kept clean. Though it’s tempting to keep your baby by your side 24/7, use this resource to try to get a couple of hours of rest, if you can.

Many hospitals will require that you have a bowel movement before you’re able to leave the facility. You’ll be offered a stool softener after delivery to ease the pain of the first bowel movement after birth. If you show any signs of infection, such as a fever, you may have to stay at the facility until those symptoms resolve. Your midwife or delivery doctor may perform a brief exam before you leave, just to make sure that you’ve started the healing process.

If you opt for a home birth, your midwife will be the primary overseer of your care after delivery. Your midwife will examine you and your baby to make sure everyone is healthy before periodically checking in during the weeks after your delivery.

YOUR BABY’S HEALTH

Your baby’s health

The first medical test that your baby will have at the hospital is called the APGAR test, and it takes place as soon as the baby is born. APGAR tests taken 5 to 10 minutes after birth are the most accurate. However, most physicians also regularly record the one-minute APGAR score. The APGAR score is based on five factors:

Appearance
Pulse
Grimace
Activity
Respiration
The maximum score is 10, and any score between 7 and 10 is considered normal. A low APGAR score could indicate that the baby may have been stressed during the end of the birth process.

While in the hospital, your baby’s hearing and eyesight will also be tested. Your baby will also be tested for their blood type. Some states have laws or recommendations that mandate babies receive certain vaccines or medications before they leave the hospital.

The rest of your baby’s experience in the hospital will depend on their birth weight and how they’re doing after birth. Some babies that aren’t considered full-term (born before 37 weeks) or are born with a low birth weight are kept for observation in a neonatal intensive care unit (NICU) to ensure that they can adjust to life after the womb.

Newborn jaundice, which involves a yellowing of the skin, is fairly common. Around 60 percent of newborn babies experience jaundice, according to the March of Dimes. Babies with jaundice will need to be treated in an incubator. In their first few weeks of life, they might also need to have formula as a dietary supplement to breastfeeding.

Before you leave the hospital, you’ll need to make an appointment with a pediatrician outside the hospital to weigh and examine the baby. This one-week appointment is standard practice.

FEEDING YOUR BABY

Feeding your baby

The American Academy of Pediatrics recommends that children be breastfed exclusively through their first six months of life. Breastfeeding is an intensely physical experience for both mother and child. During your pregnancy, you may notice your areolae darkening and your nipples growing in size. Babies can’t see well when they’re first born, so this will help your baby find your breast and eat for the first time. The first milk that enters your breast is called “colostrum.” This milk is thin and has a cloudy color. The liquid contains valuable antibodies that will help establish your baby’s immune system.

Within the first four days of your baby’s life, the rest of your milk will “come in,” causing your breasts to swell. Sometimes milk ducts can become clogged, causing a painful condition called mastitis. Continuing to feed your baby and massaging your breast with a hot compress can unclog the duct and reduce the risk of it becoming infected. Newborn babies tend to “cluster feed.” This means that at times it may feel that they’re eating almost constantly. You may choose to pump your breastmilk and feed it to your baby from a bottle or to feed your baby formula.

Not every woman is able to breastfeed. Some women have breast or nipple abnormalities that prevent adequate lactation or proper latching on. Sometimes certain chronic medical conditions prohibit breastfeeding. Many times, there are social factors such as jobs and family situations that prevent breastfeeding. Each mother needs to make what she feels to be the best decision for her infant and herself.

Feeding your baby from a bottle will require keeping a close eye on how much the baby eats and how often. If you’re unable to breastfeed, or if you choose to formula feed your baby for another reason, discuss this decision with your pediatrician. Make sure that you know how much and what kind of formula is best to use for your infant.

Learn more: Pros and cons of breastfeeding vs. bottle-feeding »

MOTHER’S DIET

Postpartum diet

The La Leche League, an organization devoted to the promotion of breastfeeding, points out that the best diet for a breastfeeding mother is a diet that would be healthy for any human being. Fresh vegetables, a variety of grains, and low-fat proteins are the ideal staples in your diet as you recover from delivery. If you’re breastfeeding, you may find yourself feeling hungry often. This indicates that you need to consume extra calories to make up for the calories lost to making milk for your baby. Continue taking your prenatal vitamins while you breastfeed. Drinking plenty of water will increase your milk supply.

You should also continue to restrict the substances you limited or avoided during pregnancy, in particular:

alcohol
caffeine
fish that contains mercury, such as tuna and swordfish
While you don’t have to avoid alcohol or caffeine completely, the Mayo Clinic advises being mindful of the amount that you consume and the timing of your consumption. This will help keep your baby from being exposed to too much of these potentially harmful substances.

You may want to jump right into a dietary regimen that will restore your “pre-baby body.” But the most important thing you can do for the first few weeks after childbirth is to heal and restore the vitamins and minerals you may have lost during delivery.

PHYSICAL ACTIVITIES

Physical activities

During the healing process, make sure your body is ready to resume certain physical activities. If you had an episiotomy, vaginal tear, or cesarean delivery during birth, the time before you can resume certain activities may vary. Speak to your midwife or OB-GYN at your follow-up appointment about the following topics.

Exercise

The American Congress of Obstetricians and Gynecologists states that most women can resume exercise within a few days of giving birth. Moderate aerobic activity, such as jogging and swimming, can even decrease your chances of developing postpartum depression. But if you had any complications during delivery, speak to your medical practitioner and get cleared before you resume any exercise routine. Don’t pressure yourself to exercise before you feel like your body is ready.

Sex

Doctors generally advise women to wait at least six weeks after a vaginal birth, and eight weeks after a cesarean birth, before having sexual intercourse. Hormone changes during pregnancy and the act of giving birth itself might make sex uncomfortable at first. You should also be aware that immediately following childbirth and before your menstrual cycle resumes, you’re especially likely to get pregnant again. Make sure you’ve chosen a method of birth control before having sex with a partner of the male sex.

MENTAL HEALTH

Mental health after baby

One symptom of postpartum life that many women may not anticipate is mood swings. Hormones from giving birth and breastfeeding can combine with the exhaustion and responsibility of parenting to make for a difficult psychological experience. While the “baby blues” and clinical postpartum depression share many symptoms, they’re not the same thing.

It’s normal to feel tearful, emotionally fragile, and tired during the first few weeks after your baby is born. Eventually, you really will begin to feel like yourself again.

If you begin to have suicidal thoughts or thoughts of harming your new baby, you may be suffering from postpartum depression (PPD). Anxiety that keeps you awake or makes your heart race, or overwhelming feelings of guilt or worthlessness, could also indicate that you need to seek help. Give yourself permission to reach out to others. Around one in seven women experience postpartum depression, according to the American Psychological Association. You are not alone.

Rarely, postpartum depression can accompany a condition called postpartum psychosis. This is an emergency situation and is characterized by delusions and paranoia. If you feel at any time like you’re experiencing symptoms of postpartum depression or postpartum psychosis, you should ask for help. If you live in the United States, the National Suicide Prevention Lifeline can be reached at 800-273-8255. They can advise you 24 hours a day, seven days a week.

Read more: Recovery and care after delivery »

OUTLOOK

Outlook

By the time you’re ready for your post-birth exam six to eight weeks after delivery, you may start to feel more like yourself physically. But if at any time after leaving the hospital your bleeding becomes heavier, you experience a fever over 100.4°F (15°C), or you see a pus-like discharge coming from one of your incisions, you should contact your doctor.

Fitness in Your First Trimester

What Exercises Are Safe in the First Trimester?

Staying fit during early pregnancy

Staying healthy and fit when you’re pregnant is one of the best things you can do for yourself and your baby. Even if you have morning sickness or other discomforts of early pregnancy, getting up and moving around will often help you feel better. You should rest when you need to rest, however.

Exercise will also help you regulate weight gain, prepare you for bearing more weight, and get you in shape for childbirth. It’s good for mood and sleep, too.

You probably aren’t noticing many major bodily changes yet, other than feeling like you need a little more rest. The most important rules for first trimester exercise are to pay attention to those new limits on your energy and to avoid falls. Make sure your doctor knows what exercise you’re undertaking, and talk to them about anything new you start.

Now is a good time to add a low-impact exercise that you’ll be able to do as your pregnancy progresses. For example, if you run for exercise three times a week now, substitute one session of water exercise for one weekly run during your first trimester. That way, you’ve got a head start on water workouts if and when you give up running.

WHERE TO START

Where to start

If you didn’t exercise regularly before you got pregnant, now is the time to get in a habit that could serve you for a lifetime. Begin with a low level of exertion and work up to 30 minutes per day, 3 to 5 times per week. If possible, work with a trainer who has expertise in working out during pregnancy.

Don’t forget to enjoy yourself. If going to the gym isn’t for you, don’t beat yourself up about it. Go dancing with friends or splash around in the pool. Any exercise is better than none.

PILATES

Pilates

Pilates can help you address two of the challenges you’ll experience during pregnancy: balance and lower back pain.

Pilates builds core muscles through a series of equipment and floor exercises. Your first sessions will focus on building strength. Later sessions challenge that strength and your balance.

Avoid poses where you lie on your back as well as any twisting of your midsection. Don’t overexert yourself during Pilates or other belly-focused exercise, or you could cause diastasis recti, a condition in which the parallel panels of your abdominal muscles temporarily separate.

How much?

A prenatal Pilates workout once per week will help you build strength and balance.

YOGA

Yoga

Welcome to one of the best exercises you can do for yourself during pregnancy and for the rest of your life. Yoga builds strength and balance, keeps muscles limber, reduces blood pressure, and teaches you breathing rhythms that will help during delivery. Long after childbirth, as you enter menopause, yoga can help prevent osteoporosis by building bone mineral density, according to research.

If you already practice yoga and your prepregnancy routine is comfortable in your new condition, keep it up.

You should avoid:

backbends
poses that twist the abdomen
any position where your feet are over your head, such as headstands
lying on your back
Bikram or “hot” yoga
How much?

Any amount of yoga is healthy, as long as you’re not overexerting by pulling muscles or getting overheated. A half hour of yoga per day is great, as is one 30-minute session per week.

WALKING

Walking

Walking is what our bodies are made for and it makes for great pregnancy exercise. An easy stroll gets you moving, and you can build upper body strength by swinging your arms. Get your heart pumping by picking up the pace.

How much?

If you aren’t already an exercise walker, start with 10 minutes per day, 3 to 5 times a week. Work up to 30 minutes a day. To help prevent falling, stay off any broken sidewalks or rocky pathways.

SWIMMING

Swimming and water aerobics

The pool is your friend during pregnancy. The water is soothing, the exercise is low-impact, and you won’t fall over. Water exercise expert Sara Haley has a helpful series of prenatal exercises that focus on building core strength.

If you’re already doing water exercise, there’s no need to change your routine. As in all exercise, avoid twisting your middle too much, and pay attention to your energy limits. If you get tired, it’s not time to push yourself — it’s time to get out of the pool. If you’re starting water exercise during pregnancy, ask a swim coach or trainer at your pool about safe routines.

How much?

Try 3 to 5 times per week, 30 minutes at a time.

RUNNING

Running

If you’ve never been a runner, consider other pregnancy exercise. While it’s very unlikely that running in your first trimester will cause a pregnancy problem, you will eventually need to give it up in the next several months, and there are many other ways to get a healthy workout.

If you were a runner before pregnancy, you can probably continue to follow your safe running routine in your first trimester. The same cautions apply about falls and energy: Run on flat tracks or a treadmill with safety bars to prevent falls, and stop when you’re tired, not after. Now is not the time to push yourself.

How much?

If your prepregnancy routine still feels good, keep it up, aiming for 30 minutes of running at least 3 days per week.

WEIGHT TRAINING

Weight training

Weight training will help build strength throughout your body to prepare you for carrying more pregnancy weight and to help you deliver. You can lift free weights and work out on weight machines at a gym. Avoid any maneuvers that hold weights over your belly and that have you lying on your back. You should also take care not to strain your breathing. Work with a trainer on a prenatal routine.

How much?

A study in the Journal of Physical Activity and Health reported that low to moderate intensity strength training twice per week was safe and helpful for pregnancy.

BIKING

Stationary bike and spin class

The problem during pregnancy is not getting on a bike — it’s falling off. Or, in the case of riding a bike on the streets, having an accident. That’s why stationary bikes and spin class are good options during your first trimester. Both are low-impact and get your heart moving without the dangers of the road.

Be careful not to fall prey to the competitive atmosphere of some spin classes. Go at a pace that feels right for you.

Late in your first trimester, you may notice your center of gravity changing. Whether you’re on a stationary bike or spinning, check to see if the height of your handlebars is properly supporting your back, and adjust if needed.

How much?

Try 2 or 3 sessions on a bike or spin classes per week in sessions of 30 minutes to an hour.

TAKEAWAY

Exercising safely in the first trimester

In your first trimester, you probably don’t look pregnant yet, so make sure your exercise coaches and workout buddies know that you’re expecting.

It can help to do a warm up. Five minutes of stretching before your workout will help your muscles prepare for exertion. You should also do a cool down. For the last 5 minutes of a 30-minute workout, switch to slower exercise and stretch any tight muscles.

You should take a break from exercising if you:

feel nauseated
get too hot
feel dehydrated
experience any vaginal discharge, bleeding, or abdominal or pelvic pain
Hydrate regularly during pregnancy, whether you’re exercising or not. Eat quality snacks after exercising. There isn’t any recommendation for the ideal heart rate during first trimester exercise, but a good rule of thumb is that you should work at a pace where you’d able to carry on a normal conversation.

Healthy Pregnancy Basics

Maintaining a Healthy Pregnancy

Health

A woman’s health is essential to the good health of her baby. Women who eat well and exercise regularly along with regular prenatal care are less likely to have complications during pregnancy. They’re also more likely to successfully give birth to a healthy baby.

NUTRITION

Nutrition

Eating a nutritious diet during pregnancy is linked to good fetal brain development, a healthy birth weight, and it reduces the risk of many birth defects.

A balanced diet will also reduce the risks of anemia, as well as other unpleasant pregnancy symptoms such as fatigue and morning sickness. Good nutrition is thought to help balance mood swings and it may improve labor and delivery as well.

A well-balanced pregnancy diet includes:

protein
vitamin C
calcium
fruits and vegetables
whole grains
iron-rich foods
adequate fat
folic acid

WEIGHT GAIN

Weight gain

A simple way to satisfy your nutritional needs during pregnancy is to eat a variety of foods from each of the food groups every day.

Many women are concerned about how much weight they will gain during pregnancy. If your weight was in the normal range before you got pregnant, a weight gain of 25 to 35 pounds is recommended. It’s important to discuss and monitor your weight and nutritional needs with your doctor throughout the pregnancy. Weight gain recommendations will vary for women who are underweight before conceiving, for those who are obese, and for those with a multiple pregnancy, such as twins.

WHAT NOT TO EAT

What not to eat

To protect mom and baby from bacteria or parasitic infection, such as Listeriosis, make sure that all milk, cheese, and juice are pasteurized. Don’t eat meat from the deli counter or hot dogs unless they are thoroughly heated. Also avoid refrigerated, smoked seafood and undercooked meat, poultry, and seafood. If you or someone in your family has had a history of allergies, speak to your doctor about any foods to avoid.

VITAMINS

Prenatal vitamins

Most nutrients needed during pregnancy should come from food, but prenatal vitamin supplements play an important role. Pregnant women are often too busy to plan three nutrient-filled meals every day, and a vitamin supplement can provide the extra nutrition that the developing fetus needs.

Folic acid (folate) is a B vitamin that is very important for pregnant women. Folic acid supplements taken several weeks prior to pregnancy and for the first 12 weeks of pregnancy have been found to lower the risk of having a child with a neural tube defect such as spina bifida.

Most prenatal vitamins contain 1 milligram of folic acid. Talk to your doctor before you start taking prenatal vitamins. They can help you decide which type is best for you.

EXERCISE

Exercise

Moderate exercise is not only considered safe for pregnant women, it’s encouraged and thought to benefit both mom and growing baby. Exercising 30 minutes a day is proven to help circulation, strengthen muscles, and decrease stress. However, it’s important to talk to your doctor before starting any exercise regime, particularly if you are in a high-risk category. If you were not physically active before getting pregnant, talk with your doctor about what exercise you can do during your pregnancy.

For the majority of normal pregnancies, exercise can:

increase energy levels
improve sleep
strengthen muscles and endurance
reduce backaches
relieve constipation
Aerobic exercises, such as walking, jogging, and swimming, stimulate the heart and lungs as well as muscle and joint activity, which help to process and utilize oxygen. Aerobic activity also improves circulation and increases muscle tone and strength.

There are many exercise classes designed specifically for pregnant women that help to build strength, improve posture and alignment, and promote better circulation and respiration.

Squatting and Kegel exercises should be added to the exercise routine. Kegel exercises focus on the vaginal and perineal muscles. The exercise is done in the same way a woman stops and starts the flow of urine. The perineal muscle is tightened for a count of three and then the muscle is slowly relaxed. The period of time the muscle is contracted can be increased over time as muscle control becomes easier. Relaxing the perineal muscles can help during the birth of the baby. Kegel exercises are thought to help women maintain good muscle tone and control in the perineal area, which can aid in delivery and recovery after birth.

CUT BAD HABITS

Cutting out bad habits

Making good lifestyle choices will directly impact the health of a growing fetus. It’s important to cut out smoking, drug use, and alcohol consumption. These have been linked to serious complications and risks for both mother and baby.

Drinking alcohol during pregnancy is linked with a wide range of problems in the developing baby. Any alcohol that is consumed by the mother enters the fetal bloodstream in approximately the same concentrations as in the mother’s bloodstream. Drinking throughout pregnancy can result in fetal alcohol syndrome (FAS). The American Academy of Pediatrics warns that FAS can cause your baby to be underweight and have abnormalities in their central nervous system.

Alcohol consumption during pregnancy can also lead to complications, such as:

miscarriage
premature labor and delivery
stillbirth
There’s no evidence that cigarette smoking before a pregnancy has started will harm a developing baby. However, there is plenty of proof that smoking during pregnancy is hazardous. Smoking affects blood flow and oxygen delivery to a baby, and therefore their growth.

Cigarette smoking is the single most common cause of low birth-weight babies, which in turn is the most common cause of death and illness in the first few weeks of life. Smoking is also linked to a wide variety of pregnancy complications, including:

vaginal bleeding
ectopic pregnancy
premature placental detachment
premature labor and delivery
GETTING SICK

Getting sick during pregnancy

Besides all of the symptoms that go along with pregnancy, pregnant women are more susceptible to certain infections, like the common cold or flu. A pregnant woman is more likely to become very ill if she catches a cold or flu. Though such illnesses can make you feel very unwell, most will not affect your developing baby.

Some of the more common illnesses include:

common cold
seasonal flu
runny nose
upset stomach
It’s important to talk to your doctor about treatments that are safe to use for any illnesses during pregnancy. Many common medications and supplements such as aspirin and ibuprofen are not recommended during pregnancy.

Prevention is the best way to avoid getting sick. A healthy diet and exercise as well as plenty of rest and good hand-washing should help to ensure good health. A seasonal flu shot is the best line of defense during the flu season. It’s recommended for those who will be in their second or third trimester during this time. Pregnant women are at a much greater risk of developing complications from both the seasonal flu virus, as well as from swine flu (H1N1).

Talk to your doctor about your health history. They can tell you whether or not there are risks to your baby’s health.

Some women who have a history of asthma may find that their symptoms worsen during pregnancy. This is partly due to the increasing amounts of hormones in the system, as well as the enlarging uterus, which presses up against the lungs and restricts the amount of air left in your lungs after exhaling.

PRENATAL CARE

Prenatal care

Attending all prenatal care checkups will help your doctor carefully monitor you and your growing baby throughout your pregnancy. It will also give you a scheduled time to ask your doctor about any concerns you’re having about your pregnancy.

29 Things Only a Pregnant Woman Would Understand

1. What it feels like to be completely terrified and excited at the same time.

2. Morning sickness that lasts. All. Damn. Day.

3. That pantiliners aren’t just for periods.

4. That sometimes you get diaper rash even when you don’t wear diapers.

5. Mucus plugs. ‘Nuff said.

6. What Dolly Parton must feel like.

7. Cankles that engulf your entire leg.

8. How to waddle like a penguin.

21 Things You Should Never Say to A Pregnant Woman »

9. The awesomeness that is the ability to grow a freakin’ human being.

10. Willing the worst pain of your life to come. SOON.

11. How you can be hot when there is ice dripping from the air conditioner.

12. What it is like to have to pee every 15 minutes. All. Night. Long.

13. Crying because the fast food worker got your order wrong.

14. The urge to punch complete strangers in the neck when they comment on how big you are.

15. The need to organize. ALL THE THINGS.

 

16. The first time you feel the life growing inside of you move.

17. How to trim the hedges when you can no longer see them…

18. How Jabba the Hutt really feels.

19. The importance of fiber.

20. When a baby does a flip off your cervix and lands on your bladder.

21. That you plan every trip out of the house around access to clean restrooms.

22. What it feels like to be punched in the stomach from the inside.

23. Getting excited when you get diarrhea because it means the baby might be coming soon.

24. What it’s like to pee a little when you cough. Or sneeze. Or breathe.

25. The reason ASPCA commercials make you cry.

26. What that dude in the movie Alien felt like.

27. Sleeping in a fortress of pillows.

28. Why you put dirty dishes in the cupboard and mayonnaise in the dishwasher.

29. Loving someone deeply before you even meet them.

 

How Is Smoking Harmful During Pregnancy?

Overview

Smoking cessation is one of the most attainable measures in ensuring a healthy pregnancy. Still, according to the Centers for Disease Control and Prevention (CDC), about 13 percent of women smoke within the final three months of their pregnancies. Smoking at any point during pregnancy can result in lifelong implications for your baby.

It’s important to quit smoking if you haven’t quit before becoming pregnant. With determination and support, you can be successful.

SMOKING DURING PREGNANCY

Why Is Smoking Harmful During Pregnancy?

Smoking increases the risk of:

low birth weight delivery
preterm birth (before 37 weeks)
miscarriage
intrauterine fetal death (stillbirth)
cleft palate and other birth defects
respiratory issues
Smoking during pregnancy is also associated with serious conditions that can affect your child during infancy and childhood. These can include:

sudden infant death syndrome (SIDS)
learning disabilities
behavioral problems
asthma attacks
frequent infections
There is some evidence to suggest that smoking habits are linked between generations. Some studies have shown increased rates of smoking in daughters of women who smoked during pregnancy. This indicates that some biologic factor may be determined in utero when a mother smokes during pregnancy. In other words, smoking during pregnancy puts your baby at risk of becoming a smoker when they grow up.

WHY QUIT NOW?

Why Quit Now?

The smoker who becomes pregnant may think that the harm has already been done and that there’s no benefit to the baby in quitting during the second or third month of pregnancy. This isn’t true. According to Smokefree Women, quitting during any stage of pregnancy decreases the risk for lung defects and low birth rate. Also, patients are likely to be more determined to quit early in pregnancy and can more easily set a quit date.

All pregnant women who smoke are encouraged to quit, even when they’re in their seventh or eighth month of pregnancy.

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HOW TO QUIT

How Can I Quit?

Before you attempt to quit smoking, spend some time analyzing when and why you smoke. It’s important for you to understand your smoking patterns so you can plan for events and situations that will be tempting or stressful for you. Do you smoke when you are tense or anxious? Do you smoke when you need to energize yourself? Do you smoke when others around you are smoking? Do you smoke when you drink?

When you understand your smoking patterns, you can begin to devise alternate activities. For example, if you smoke with co-workers on work breaks, consider taking walks with other work friends instead. If you smoke when you drink coffee, consider changing to another beverage to break the association.

Plan for times when you’ll be tempted. Find someone to be your support person during those trying times when you want to have a cigarette. Give yourself positive reinforcement for quitting. Once you have a plan, set a quit date and tell your doctor about it.

Remove all the tobacco and related products from your home, your work, and your car before your quit date. This is an important step in becoming smoke-free.

Consult your doctor for help in setting your quit date, for strategies to stay off cigarettes, and for sources of positive reinforcement as you go through this important process. Some people need more help than others, depending on how much the habit is ingrained and how much they’re addicted to nicotine.

QUITTING DIFFICULTY

How Hard Will It Be for Me to Quit?

The level of difficulty in quitting smoking depends on a number of factors and varies among women. The less you smoke and the more you have tried to quit smoking, the easier it will be. Having a nonsmoking partner, exercising, and having very strong beliefs about the risks of smoking during pregnancy will also make it easier to quit.

The more you smoke, the harder it will be to quit. Women who smoke more than a pack a day and women who consume caffeine may find it more difficult to stop smoking. Women who are depressed or who experience a lot of difficulties in life may also find it more difficult to quit. Those who are isolated from social support experience more difficulty quitting. Interestingly, no association with alcohol use predicts continued smoking or abstinence.

CAREGIVER AIDS

Additional Aids in Quitting Smoking Available Through Your Caregiver

If you’re trying to quit smoking, your doctor may provide monitoring as reinforcement. This may be done with the use of tests that measure expired carbon monoxide or nicotine metabolites.

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NICOTINE REPLACEMENT

Is Nicotine Replacement Safe During Pregnancy?

Smoking cessation aids, such as nicotine replacements, are commonly used by people looking to quit. Examples include a nicotine patch, gum, or inhaler. However, these aids shouldn’t be used during pregnancy unless the benefits clearly outweigh the risks. The amount of nicotine delivered by the gum or patch is usually substantially less than what you would receive with continued smoking. However, nicotine decreases blood flow to the uterus and is potentially harmful to the developing fetus and placenta, regardless of the method of delivery. Such concerns are outlined by the American Congress of Obstetricians and Gynecologists (ACOG), who also state that there is no clinical evidence to show that these products really help pregnant women quit smoking for good.

Nicotine gum has been labeled Pregnancy Category C by the Food and Drug Administration. This means that risk to the fetus can’t be ruled out. The nicotine patch has been labeled Pregnancy Category D, meaning that there is positive evidence of risk.

BUPROPION

Is Bupropion Safe During Pregnancy?

Bupropion (Zyban) has been helpful for smokers who have difficulty with depressed moods when they stop smoking. It probably acts as an antidepressant, helping with withdrawal symptoms of depressed mood, sleep disturbance, anxiety, and increased appetite. Bupropion is probably as effective as nicotine replacement in helping patients quit smoking. Increased success rates are observed when patients also receive behavioral therapy or guidance.

Unfortunately, there are no data available on the safety of bupropion during pregnancy. This drug is marketed as Wellbutrin for treatment of depression and can be used during pregnancy for that indication. Bupropion is labeled as Category B for treatment of depression during pregnancy. Still, there is a high risk of transmission of the drug to breast milk.

RELAPSE

Who Is Most Likely to Restart Smoking?

Unfortunately, women who quit smoking while pregnant often relapse during pregnancy or in the postpartum period. Risk factors for relapse during pregnancy include the following:

decreasing, but not actually quitting tobacco
announcing that one has quit before going a week without tobacco
having little confidence in one’s ability to remain tobacco-free
being a heavy smoker
In addition, if you’re not bothered much by nausea and have delivered before, you’re more likely to start smoking again.

Whether a woman’s family, friends, and co-workers smoke seems to be one of the main predictors of long-term success in smoking cessation. Women who quit smoking during pregnancy need continued support to remain smoke-free during the entire pregnancy. It’s important that quitting smoking be perceived as a process and not as a one-time event. If your partner smokes you’re much more likely to relapse. Continued association with individuals who smoke can mean easy availability of cigarettes and increased chances of relapse.

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RELAPSE AFTER DELIVERY

Why Do Women Resume Smoking After Delivery?

The CDC estimates that more than 50 percent of women who stopped smoking during pregnancy will begin smoking again within six months of delivery. Many women view the postpartum period as a time to pursue the activities enjoyed before becoming pregnant — for many, this means returning to smoking. Some women seem particularly concerned with weight loss and stress management and this also contributes to relapse.

Unfortunately, self-help materials, individual counseling, and physician advice have not shown any improved rates in postpartum relapse. It’s important to have a coach or someone in your life to help motivate you to stay tobacco-free.

STAY SMOKE-FREE

Reasons Not to Resume Smoking After the Baby Is Born

There’s compelling evidence to remain smoke-free after delivery. Studies show that if you smoke more than 10 cigarettes per day, the amount of milk you produce decreases and the make-up of your milk changes. Also, women who smoke are more likely to think that their milk supply isn’t good enough and may be less motivated to breastfeed. Also, babies who’ve been breastfed by mothers who smoke tend to be more colicky and cry more, which may encourage early weaning.

Additionally, infants and young children have more frequent ear infections and upper respiratory tract infections when there’s a smoker in the home. There’s also evidence to suggest that asthma is more likely to develop in children whose parents smoke.