my pregnancy journey is not easy

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Pregnancy: Everything you need to know for your journey

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Key takeaways:

Arm yourself with tips, tricks and information to prepare for your pregnancy journey., find out what to do before you get pregnant., learn about early pregnancy., see what to expect during pregnancy. .

[7 MIN READ]

Whether you’re a new or experienced parent, you may have a lot of questions about your pregnancy. At Providence, we are devoted to creating a patient-centered, caring and open environment designed to celebrate your pregnancy and help you find joy while relieving your anxiety.

Before you get pregnant

If you’re planning on having a baby, you’ll have nine months to prepare for motherhood but what about getting ready for pregnancy? There are important steps to take before you try to conceive. Read on and make sure you’re as healthy as can be — for yourself and your baby.

7 things to do before you get pregnant

See your physician Schedule a doctor’s appointment to discuss your family’s health history and any ongoing conditions, such as diabetes or asthma. Ensure that your  immunizations  are up to date and inform your provider of any medications or supplements you’re taking. If you need to find a doctor, you can use our provider directory or search for one in your area.

Stop smoking and drinking Smoking and drugs, including alcohol, may make it more difficult to get pregnant. If you do get pregnant, these substances can increase the risk of miscarriage, SIDS (sudden infant death syndrome),  preterm birth , fetal alcohol spectrum disorders and other disabilities. Don’t be afraid to tell your doctor if you need help quitting. Also, it’s a good idea to dial down your caffeine consumption. Drinking too much caffeine (more than two cups of coffee or five cans of soda daily) may make it harder to conceive.

Eat a nutritious diet Cut back on empty calories, such as  sugary drinks  and junk food. Fill up on high-protein foods, produce, whole grains and low-fat dairy. Seafood contains mercury, which may cause birth defects. Limit your seafood to 12 ounces of fish a week and avoid large ocean fish, such as shark.

Reach a healthy weight Ideally, you want to hit your target weight before you get pregnant. To boost your chances of having the healthiest pregnancy possible, it’s best not to be underweight or overweight. Regardless of how much you weigh when you get pregnant, don’t try to lose weight during pregnancy.

Take vitamin B Folic acid, a B vitamin, decreases the risk of birth defects, particularly in the baby’s brain and spinal cord. Start taking a daily vitamin with at least .4 milligrams (400 mcg) of folic acid before you get pregnant, as a baby’s brain and spinal cord begin to develop early in the pregnancy.

Exercise regularly Exercise can help your body better handle the changes and stress that pregnancy brings. If you already exercise, you can probably stick with the same program for the majority of your pregnancy. If you don’t exercise, aim for 30 minutes of brisk activity five days a week and continue that schedule while you’re pregnant.

Kick back Try to minimize the stress in your life. Get as much rest and relaxation as you can. You’ll miss those peaceful moments once the baby comes!

Learn what to do before you get pregnant .

Early pregnancy

Are you pregnant? Pregnancy symptoms can vary, but one of the most significant signs of pregnancy is a missed period. Other possible symptoms include:

• Swollen or tender breasts
• Spotting or light bleeding
• Fatigue or tiredness

To be sure, take a pregnancy test at home. Simply knowing for sure will bring you some peace of mind and allow you to start planning for a healthy future. At-home  pregnancy tests are up to 99 percent accurate  when they’re done properly and at the right time. They can be purchased at most grocery stores, pharmacies and even some discount stores.

All at-home tests work by measuring the amount of HCG hormone in a woman’s urine. HCG levels increase as a pregnancy matures. You’ll get the most accurate results if you take the test five days or more after you ovulate. The closer you are to the date when your next period should start, the more accurate the results will be. If you take the test too soon, the HCG level may be too low to indicate pregnancy.

If you get a positive result on an at-home test, make an appointment with your health care provider as soon as possible. For most women, this first visit takes place between the eighth and tenth week of pregnancy. The sooner you see a health care provider, the sooner you can get prenatal care for you and your baby.

Learn more about early pregnancy.

Choosing a healthcare provider

When it comes to prenatal care, you have choices. These health care providers are experts in caring for pregnant women and their unborn babies, but each type of specialist has a different skill set.

Certified nurse-midwife Certified nurse-midwives or CNMs are registered nurses who have advanced training in women’s health and maternity care. Along with female reproductive care, such as annual exams and Pap tests, CNMs offer prenatal, labor and postpartum care.

CNMs usually treat women with uncomplicated pregnancies but, if they consult with an OB-GYN, they can treat women who have high-risk pregnancies. If you choose a CNM as your prenatal care provider, you may be able to deliver your baby at home, at a birth center or in a hospital. Ask your CNM where she delivers babies and tell her if you have a preference.

Family medicine / Family practice doctors Family practitioners are doctors who specialize in preventive health and medical care for people of all ages. Some family physicians deliver babies, but many do not. If you have a family physician, be sure to ask if he or she delivers babies. Also, they are not surgeons, so if a mother needs to deliver her baby by cesarean section, the family physician will call a surgeon to deliver the baby.

If you select a certified nurse-midwife or an OB-GYN for your prenatal care, you can transfer to a family practitioner after your baby is born. The family practitioner can provide all primary care you and your family, including your new baby, need now and in the future.

OB-GYNs The abbreviation, OB-GYN, stands for obstetrics and gynecology. An obstetrician is a doctor who delivers babies. A gynecologist is a doctor who treats diseases of the female reproductive organs. OB-GYNs offer prenatal care, manage labor and delivery, and provide postpartum care for mothers. Roughly 85 percent of women receive prenatal care from OB-GYNs,  according to the Centers for Disease Control and Prevention .

If an OB-GYN delivers your baby, you will need to select a pediatrician, a family practitioner or a nurse practitioner to be your baby’s primary care provider after he or she is born.

Doulas A doula is a woman trained to provide physical comfort and emotional support to expectant moms before, during and after childbirth. Doulas are not medical personnel, but they can provide information, help during labor and advocate for the mother.

Some women hire doulas months before their babies are born. If you do this, you can expect the doula to spend time getting to know you, answering your questions about pregnancy and labor, and helping you create a birth plan. If you have a doula, she will stay with you during labor. She will help you change positions and use relaxation techniques to ease labor pains. Doulas may also support the new family at home during the postpartum period.

Many doulas undergo training and complete certification programs in order to provide support to patients during labor and delivery. Research studies show that having a doula present during labor can be associated with health benefits, such as shorter deliveries, fewer c-sections, less use of medications, increased breastfeeding and more satisfying birth experiences for mothers. The benefits vary, however, based on the doula’s training and skills, the cultural setting, and family support available to the mother among other factors.

7 bodily changes to expect during pregnancy

Everyone knows the main sign of pregnancy: an expanding waistline. Some of the other physical and emotional changes that occur during pregnancy take mothers-to-be by surprise. Pregnancy actually affects every part of a woman’s body, from head to toe. Here are seven of those changes you might expect when you’re expecting.

Women undergo a range of dramatic changes when pregnancy hormones are released into the body. Led by estrogen and progesterone, this potent cocktail of hormones is responsible for mood changes, the skin “glow” of pregnancy, nausea, fatigue, blemishes and a host of other side effects. Of course, these hormones are also critical for the development of a healthy baby, from the moment of conception to birth. If you’re planning to become pregnant, it’s important to learn how hormonal changes might affect you before they kick in. If your mood seems out of balance, consult your doctor for advice.

Hair and nails

It is not uncommon for women to experience changes in their hair and nails during pregnancy. Hormonal changes can cause both hair loss and hair thickening. You may even see hair start to grow where it doesn’t belong. Most of these changes return to normal after the baby is born, but excess hair on the face, for example, can be removed cosmetically. Nails often grow faster during pregnancy. While this may be a welcome change, they may also become more brittle or misshapen. Changing your diet to include foods that boost nail strength, such as lean proteins and leafy green vegetables, can help prevent nail breakage without resorting to chemical nail strengtheners.

During pregnancy, some women experience vision changes, such as increased blurriness, nearsightedness, dryness or eye sensitivity. The specific causes of these changes aren’t entirely understood, but it is thought that hormones, fluid retention and blood circulation all play a role. Vision typically returns to its pre-pregnancy state after the baby is born, but some pre-existing vision conditions can worsen – or improve! Be sure to see an ophthalmologist during and after your pregnancy if you have any concerns about pre-existing conditions or have unusual symptoms.

Mouth and teeth

Here, again we can thank hormones for pregnancy-related changes, in this case affecting the mouth and teeth. Some women experience gum disease or tooth decay because increased hormones can affect resistance to bacteria in the mouth. And, if the mom doesn’t get enough calcium in her diet, the growing baby may “steal” the calcium it needs from the mom’s bones and teeth. If you’re pregnant, get your teeth and gums checked regularly and observe good dental hygiene by flossing and brushing at least twice a day.

Breasts go through a series of changes during pregnancy. As breasts grow larger in preparation for feeding the baby, they typically feel tender and may leak an early form of milk called colostrum. The areola may enlarge and darken. Veins may darken. Stretch marks may develop, and the nipples may protrude more than they did before pregnancy. Be sure to wear a well-fitting bra to support your breasts. If you develop small, painful lumps in your breasts, they may be caused by blocked milk ducts. Massage and warm compresses (applying a warm washcloth) may help clear the ducts. If the lumps don’t go away after a few days, have them examined during your next doctor visit.

Weight gain and fluid retention

As the unborn baby grows and the pregnant woman gains weight, she tends to move less. This leads to fluid retention, which can account for 25 percent of pregnancy weight gain. This additional weight slows down the circulation of blood and other bodily fluids, especially in the lower limbs. Swelling of the legs, feet, hands and even face can result. To ease the discomfort of fluid retention and swelling, avoid standing for long periods, eat more potassium, and reduce the amount of caffeine and sodium in your diet.

Many women experience changes in the appearance of their skin during pregnancy. Most of these changes are temporary although some, like stretch marks, can be permanent. Stretch marks are caused by the physical stretching of the skin combined with the effects of hormonal changes on the skin’s elasticity. They may appear on the breasts and abdomen during the third trimester. Another change is called hyperpigmentation. It occurs when areas of the body or face develop a deeper color. Sun exposure worsens the discoloration, so be sure to use a broad spectrum UVA/UVB sunscreen daily during pregnancy. Also, the color of moles and freckles can darken, and you might develop pregnancy-specific rashes or boils. While these are generally harmless, it’s a good idea to have your skin checked if you see something unusual.

Learn more about bodily changes during pregnancy .

During pregnancy

You might have a lot of questions when it comes to exercising during pregnancy. Is it safe? Do I have to? The truth is, exercise is important during pregnancy — it can help with some common discomforts and even prepare your body for childbirth.

According to the American Pregnancy Association , exercising for 30 minutes on most or all days can benefit your health during pregnancy. In fact, exercising for just 20 minutes, 3 or 4 days a week is still beneficial. All you need to do is be active and get your blood flowing. Benefits include:

• Reducing backaches, constipation, bloating and swelling
• Helping prevent or treat gestational diabetes
• Increasing your energy
• Improving your mood
• Helping you sleep better
• Keeping you fit during pregnancy

If you are doing a certain type of exercise regularly before becoming pregnant, it’s probably fine to continue to participate during your pregnancy, according to the American Pregnancy Association. But it’s important to avoid high-impact exercise and not to overdo it.

Your baby is surrounded by amniotic fluid in the amniotic sac, which is nestled in the uterus and surrounded by organs, muscles and your physical body. This creates a safe environment for your developing baby.

Health and nutrition

During pregnancy, it’s important to make sure you’re getting the nutrients both you and your baby need. Healthy eating during pregnancy is critical to your baby’s growth and development, which is why it’s important to eat from a variety of food groups. According to the American Pregnancy society, you should consume an extra 300 calories a day.

Make sure you’re getting enough foods from the following food groups:

• Fruits and vegetables: These contain important nutrients like Vitamin C and Folic Acid. You should have at least 2-4 servings of fruit and 4 or more servings of vegetables daily.
• Bread and grains: These are the body’s main source of energy. These contain nutrients like iron, B Vitamins, fiber and some protein. You should consumer between 6-11 servings of bread and grains daily.
• Protein: Things like meat, poultry, fish, eggs and beans contain protein, B vitamins and iron. However, fish that contain high levels of mercury should be avoided. You should consume three servings of protein daily.
• Dairy: Calcium is found in dairy products and is essential for building strong teeth and bones, normal blood clotting, and muscle and nerve function. You should aim to consume at least 1,000 mg daily to support a pregnancy. This equals about four servings of dairy products daily.

While your main source of vitamins and nutrients should come from your diet, a daily prenatal vitamin can help fill small gaps. Prenatal vitamins should be taken up to three months before conception, if possible.

The 5 most common misconceptions about pregnancy

“As an expectant mother, you need to learn what truly is and isn’t safe for you and your developing baby, based on the best available medical evidence,” says  Lina Wong, DO , a board-certified OB/GYN at  St. Jude Heritage Medical Group . “With all of the frequently poor advice and even misleading material about pregnancy found online and in popular books, it's important that you ask questions and listen to your OB/GYN or perinatologist, your primary care physician and other trusted, medically-trained experts you may have on your care team, such as a laborist, certified nurse midwife or obstetrical nurse.”

Dr. Wong dispels some common misconceptions about pregnancy:

Don't get vaccinated when pregnant

Centers for Disease Control  guidelines generally recommend certain vaccines, like Tdap and inactivated flu vaccine, for use in pregnant women. In fact, many vaccinations you get while pregnant help  protect your baby  until he or she can be vaccinated after being born. Other "live vaccines" for human papillomavirus (HPV) and measles, mumps, rubella (MMR) are not generally given to women known to be pregnant. Dr. Wong says, "It's imperative that you to talk to your doctors to see which vaccines you should receive to safeguard your health and the health of your baby from serious diseases like hepatitis A, hepatitis B and influenza."

Be sure to talk to your doctor about the COVID-19 vaccine and what is safe for you during your pregnancy .

Expectant mothers don't have to worry about drinking alcohol during pregnancy, as long they drink in moderation.

A recent report from the American Academy of Pediatrics recommends that  pregnant women avoid alcohol  completely. Aside from potentially measuring low on the growth curve for height and weight, babies who have mothers who abuse alcohol during pregnancy are at risk of damage in their speech, learning and neurological development, or any other number of extremely serious conditions on the spectrum of fetal alcohol disorders.

Exercise during pregnancy will send you into premature labor

You may have heard that exercise during pregnancy could harm your baby or cause premature birth. However, regular daily exercise can help you manage the common discomforts of pregnancy and increase your chances of having a vaginal delivery free of complications. Exercise can also aid in postpartum recovery.

You can't eat any fish and cheese until after the baby is born

Many pregnant women have been told that they should avoid fish and cheese altogether, but there are some safe options. Salmon and other fish rich in  omega-3 fatty acids  like DHA help your baby’s mental and visual development. Avoid larger fish that tend to be  higher in mercury , like swordfish, shark, king mackerel and tuna steaks. Cheese is a terrific source of calcium, and hard cheeses like cheddar, Gouda and Parmesan are generally considered safe for pregnant women to eat. It’s best to avoid soft cheeses like Gorgonzola, Brie and goat cheese because they are more likely to contain  listeria , a type of germ. If you become infected with listeria while pregnant, your baby could become infected as well, and you could be at increased risk of miscarriage or premature delivery.

When you're pregnant, you need to eat for two

Carrying a baby does not require you to double your caloric intake. "There are certain nutrients you need more of, like folic acid, but overeating isn't good for either of you," says Dr. Wong. "If you  gain too much weight while pregnant , you are at increased risk of gestational diabetes and high blood pressure. You may also be more likely to need a C-section due to having a larger baby."

Learn more about misconceptions about pregnancy .

Stay tuned for additional information that we will add regarding childbirth and the postpartum period.

Find a doctor.

If you have questions about your pregnancy, talk to your OB/GYN or another member of your care team. If you’re thinking about starting a family and want to speak to a professional, you can find a compassionate expert through our  provider directory  or search for one in your area:

Related resources

Early pregnancy: So many choices

This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

About the Author The Providence Women's Health team is committed to providing useful and actionable insights, tips and advice to ensure women of all types can live their healthiest lives. More Content by Providence Women's Health Team

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11 Pregnancy Myths and Facts Every Woman Needs to Read

Pregnancy and childbirth can be both exciting and scary. A woman’s body will go through many physical and emotional changes throughout her entire pregnancy journey.

However, there are many pregnancy myths circulating the internet, confusing what is best for both you and your baby. This article addresses 11 common pregnancy myths, discussing topics ranging from infertility to postpartum depression.

Myth #1: You’re Eating for Two

A pregnant woman should only consume an additional 200 calories a day and focus on developing healthy eating habits. Your baby needs nutrients to grow and develop, and you should aim to eat a balanced diet of nutrient-rich foods like vegetables, fruits, whole grains, lean proteins, and calcium-rich foods. 

It’s also important to talk to your OB-GYN about supplementing important vitamins like folic acid and iodine, which can be difficult to attain at adequate levels through diet alone.

Myth #2: It’s Okay to Have an Occasional Glass of Wine

You should never drink any alcohol while pregnant. There is no safe amount or type of alcohol during pregnancy, and even moderate intake can lead to lifelong problems for your baby. These problems can be less obvious than those caused by heavy drinking and can include coordination, attention, and learning issues. 

Alcohol-related congenital disabilities are entirely preventable. Your OB-GYN can offer advice on avoiding alcohol while pregnant and provide the resources you need if you find it a struggle to stop drinking.

Myth #3: It’s Dangerous if You’re Past Your Due Date

Your due date is a calculated estimate of when your baby will hit 40 weeks. It’s normal to give birth before or after your set due date. In fact, you must go two weeks past your due date to be considered a post-term pregnancy. 

You may fall into a post-term pregnancy if: 

• This is your first pregnancy 
• Your baby is a boy 
• You have a body mass index of 30 or higher (obesity) 
• Your due date was calculated wrong due to confusion of your last menstrual period (LMP) 

If you do go past your due date, your OB-GYN will closely watch the baby’s size, heart, weight, and position. Your OB-GYN may recommend a labor induction to help promote a vaginal birth if the health of the mother or fetus is at stake. 

Learn more about what to expect during labor and delivery ! 

Myth #4: If My Periods Are Irregular, I Will Not Be Able to Get Pregnant

Another pregnancy myth—irregular periods mean I am infertile. The occasional irregular cycle is more common than women think, and it does not mean you will struggle with infertility. The hormonal balance that regulates the menstrual cycle is very delicate — sleep disruptions, exercise routine, and stress levels can all alter your period. Although, if you are consistently irregular, conceiving may be more challenging due to the inability to predict ovulation correctly.

If you experience irregular periods, especially if you have gone three or four months without a period, talk to your OB-GYN. They can help determine if there is an underlying health issue and discuss treatment options and lifestyle changes that can help increase the chances of conceiving. 

Polycystic Ovarian Syndrome (PCOS) is one of the most common conditions that affect a woman’s menstrual cycle and fertility. Learn about the symptoms and treatment options here ! 

Myth #5: All Bleeding During the First Trimester Means a Miscarriage

While any bleeding during any stage of pregnancy can be alarming and scary, it is not always associated with a miscarriage. In fact, vaginal bleeding is extremely common in the first trimester, occurring in 20% to 40% of women. However, it’s still important to talk to your OB-GYN if you experience any bleeding during pregnancy to assess what’s going on. 

Learn more about what to expect during your first trimester of pregnancy .

Myth #6: If You’re Over 35, Then Your Pregnancy Will Be High-Risk

A pregnancy that begins after a woman is 35 is considered a “high-risk pregnancy” because certain risks are slightly higher, not inevitable. Most moms 35 or older have a normal pregnancy and healthy baby. Pregnancy myth, debunked! There are even some advantages to being an older mom, including financial stability and having more life experience that can help during your parenting journey. 

Talk to your OB-GYN about the types of complications that can occur. These complications can result from underlying health issues that arise more often as we age, including diabetes and high blood pressure. Getting proper treatment for these issues can better your chances of having a healthy pregnancy. 

If you’re 35 or older, schedule an appointment with your OB-GYN consider the benefits of a preconception consultation, a visit when you start trying to conceive and make sure to keep every appointment throughout your pregnancy. 

Read more about common myths surrounding high-risk pregnancies .

Myth #7:  Breastfeeding Comes Naturally

Read our breastfeeding advice and 10 Tips for Breastfeeding Success !

The decision to breastfeed is a personal one, and it should also be an informed one. Read ‘ Your Guide to Breastfeeding ’ from the U.S. Department of Health & Human Services Office on Women’s Health to read more common breastfeeding myths.

Myth #8: You Can’t Get Pregnant if You’re on Your Period

​​While it’s uncommon for a woman to get pregnant while she is on her period, it is not impossible. Sperm can survive in the uterus for up to five days, so if you have sex near the end of your period, there is a possibility that sperm can fertilize an egg after it's released during ovulation. This is most likely to occur if a woman experiences shorter menstrual cycles.

Myth #9: You Shouldn’t Drink Coffee if You’re Pregnant

While a pregnant woman should not drink any alcohol, she can enjoy a cup of coffee. Although, this is where moderation is key. Research suggests moderate caffeine consumption (200 milligrams or less per day) does not cause miscarriage or preterm birth. This is equivalent to about a 12-ounce cup of coffee. If you do opt to enjoy a cup of coffee, it’s important to limit other caffeine consumption from soft drinks, tea, and chocolate.

Myth #10: Once You Have a C-Section, You Will Have a C-Section For All Your Future Pregnancies

Many women believe that once they have delivered a baby by Cesarean section, or C-Section, they will have to schedule a C-Section for their future pregnancies. This is not always the case. A Vaginal Birth After a Cesarean (VBAC) is now considered an option for many women. Depending on your health history, the reason for the initial C-Section, and C-Section scar location, your OB-GYN may give the “OK” to try a VBAC. 

Risks associated with a VBAC include infection, blood loss, and the rupture of your previous cesarean scar (a very rare but serious risk). You and your OB-GYN must be prepared to go into an emergency C-Section at any moment during a VBAC if you or your baby’s health is at immediate risk.

Myth #11: All Mothers are Blissful and Happy After Childbirth

Some women experience the “baby blues” about 2 -3 days after childbirth and may feel depressed, anxious, or upset. The sudden change in hormones may cause this, and it usually gets better within a few days or 1 - 2 weeks after childbirth. 

The first three months after childbirth are often referred to as the “ fourth trimester .” You may experience shifts in emotions and physical abilities during this time, and your OB-GYN is available to talk with you through any of your questions. 

If a new mother is dealing with intense feelings of sadness, extreme anxiety, and despair that are preventing her from completing daily tasks, she may be experiencing postpartum depression. Postpartum Depression is a serious condition, and it’s important to talk to your OB-GYN if you have any of these symptoms. 

Do not wait to get help, Moreland OB-GYN is here to support and help you through your journey into motherhood. For more information on postpartum mental health, click here .

One Last Myth to Remember! I No Longer Need to See My OB-GYN When I’m Done Having Children 

If you are done having children, it does not mean you should skip your annual OB-GYN visit . Your OB-GYN will still want to continue performing essential health screenings for cervical cancer, breast cancer, and ovarian cancer. They can also continue to be an excellent resource during any stage of your life, including menopause . 

Moreland OB-GYN will be your caring provider throughout your pregnancy journey, whether you just started trying to conceive or you’re in the early weeks of pregnancy. Our caring providers will take the time to listen to your needs and concerns and can help talk with you about pregnancy myths, facts, and the important things you should know. 

As your trusted, local medical partner, we’re here to help you feel safe and confident about your health and the health of your baby. Schedule a visit today!

Ready to plan your pregnancy and birthing experience? Download our Pregnancy Planning Kit by clicking the image below to get started! 

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Pregnancy Symptoms Week by Week

Your body experiences a wide range of changes throughout pregnancy, from breast tenderness in the first trimester to backaches in the third trimester. For parents-to-be, these pregnancy-related symptoms can be expected or surprising.

Though every person and every pregnancy is different, some symptoms are more common than others. Use this list of pregnancy symptoms by week to prepare for what might be on the horizon, but don't worry if your pregnancy doesn't follow this precise timeline. Much like life and the new baby you're welcoming, pregnancy can be unpredictable.

Of course, if you have questions or concerns about your pregnancy symptoms week by week, talk to a prenatal health care provider.

Illustration by Zoe Hansen for Parents

Pregnancy Trimesters

Pregnancy is broken down into three trimesters, and symptoms will vary during each one.

• First Trimester: Weeks 1 to 13
• Second Trimester: Weeks 14 to 27
• Third Trimester: Weeks 28 to 40

Pregnancy Symptoms by Week

Are you looking for more information about first trimester pregnancy symptoms? How about second trimester or third trimester pregnancy symptoms? We've got you covered with our week-by-week guide.

Keep in mind that every pregnant person will have their own unique experience, so you should take these guidelines with a grain of salt.

Since doctors calculate your due date from the first day of your last menstrual period, week one begins with the start of the last period you have before you conceive. That's to say that you're not technically pregnant yet. You can, however, expect to experience your typical menstrual symptoms including bleeding, cramping, sore breasts, mood swings, etc.

Ovulation typically occurs during what's considered week two . Your ovary will release a mature egg that travels into the fallopian tube, where it awaits fertilization with sperm. Not everyone experiences signs of ovulation , but symptoms might include twinging lower abdominal pain (mittelschmerz), breast tenderness, slippery discharge that resembles raw egg whites, and increased basal body temperature.

During week three of pregnancy , the fertilized egg implants into the uterine lining. Some people experience mild abdominal cramping or light spotting known as implantation bleeding . Call a health care provider if you're bleeding heavily or have intense pain; this could indicate an ectopic pregnancy where the embryo implants outside of the uterus (usually in the fallopian tube).

Your at-home pregnancy test can come back positive as early as this week—congratulations! Breast tenderness, one of the earliest signs of pregnancy in some people, might make your bra feel extra uncomfortable at this time. Some also experience a heightened sense of smell or taste, fatigue, constipation, bloating, and mood swings. But don't worry if you don't have any pregnancy symptoms at all; they might take a few extra weeks to show up.

Hormone-induced mood swings can bring on a lot of feelings starting at week five . Your emotions may change from happy to depressed to angry for no conceivable reason. Other early pregnancy symptoms—like fatigue, breast tenderness, and even nausea—can kick in this early too.

For some, week six brings one of the most dreaded pregnancy symptoms: morning sickness (although it may start further along in your pregnancy or not at all). Your heightened sense of smell can further exacerbate this queasiness, which sets the stage for food cravings and aversions. Morning sickness might stick around until the second trimester, so it's best to find ways to cope now, such as eating smaller meals, consuming ginger, wearing acupressure wristbands, and avoiding triggering foods.

Frequent urination is another early pregnancy symptom. It's caused by a few factors: the pregnancy hormone hCG, increased fluids in your body, your kidneys working extra hard to eliminate waste, and eventually, your growing uterus compressing your bladder. Plan for plenty of bathroom breaks!

For many people, pregnancy symptoms appear in full force by now: nausea, breast tenderness, fatigue, frequent urination, mood swings, bloating, etc. Another unusual symptom is extra saliva in your mouth, which sometimes lasts until the end of the first trimester. Headaches are also common thanks, in part, to hormonal surges.

Did you know that pregnancy can affect your digestive system? Pregnancy hormones can change the motility of your intestines, leading them to move more slowly than usual. Many people experience constipation and excess gas, in addition to the nausea that accompanies morning sickness. Plus, as your baby grows, the more your digestive system slows, so talk to a health care provider about stool softeners if needed.

Are you glowing? Some people will experience a radiant "pregnancy glow" as a first trimester symptom, but it's also common to experience hormone-induced acne . You'll also notice your breasts—and your belly—getting bigger each week.

Your growing baby bump might cause aches and cramping around your abdomen. This round ligament pain can be mildly uncomfortable or downright painful. You might also notice a clear or creamy discharge (known as leukorrhea) in your underwear that signals your body is attempting to clear bacteria, which is a normal during pregnancy.

Did you know that blood volume increases by about 50% during pregnancy? One side effect is visible veins on the skin, which are especially noticeable in lighter-skinned people.

As you near the end of the first trimester, many early pregnancy symptoms will diminish. You might start to notice, however, that you feel dizzy throughout the day. You can thank hormonal shifts, reduced blood flow, and lower blood pressure for these dizzy spells. Combat them by hydrating well and changing positions slowly.

Bailey Mariner

You're officially in the second trimester of pregnancy, which most deem to be the "easiest" trimester. Many people report increased appetite, renewed energy, and higher sex drive during the next few weeks. If that's you, take advantage of this "feel good" trimester by starting a doctor-approved fitness routine and preparing your house for the baby.

The second trimester can also come with a few strange pregnancy symptoms each week. You might experience a stuffy nose (thanks to an increase of blood in the mucus membranes), leg cramps , and sensitive gums. As the hormone relaxin loosens your ligaments, you might also feel extra clumsy at this stage of pregnancy.

About 90% of pregnant people experience a darkening of the skin around the nipples, inner thighs, armpits, and navel. Sometimes the darkening extends to the cheeks and nose (known as "the mask of pregnancy")—especially if you have a darker complexion.

Backaches are very common while expecting (you can thank pregnancy hormones yet again!). And if you're feeling more forgetful than normal, blame the so-called "pregnancy brain" that some experience. As a plus, many expectant parents start feeling their baby kick between weeks 16 and 22, so be on the lookout!

By now, your belly likely looks pregnant (but not always to others). Also, your breasts have begun to increase in size to prepare for making breast milk. Expect to gain weight regularly until delivery (usually about one-half pound to 1 pound per week). Even foot size can increase during pregnancy!

During the second trimester, some pregnant people experience heartburn . This is because pregnancy hormones relax the muscles of your lower esophageal sphincter (LES). If you experience this uncomfortable symptom, try eating smaller meals, staying upright after eating, and avoiding anything acidic, greasy, or spicy. Constipation might also occur as your baby presses against your intestines.

By now, your little one might be kicking up a storm! The first kicks feel like fluttering in your stomach. Also common during this time are leg cramps, dry eyes, and trouble sleeping. If you haven't already, try using a pregnancy pillow for a better night's rest.

Although you might've had round ligament pain for a while, it tends to increase as the baby grows. You may feel sharpness in your hip, groin, and abdomen as they stretch to accommodate your growing uterus.

Pregnancy often results in thicker, shinier hair and fast-growing nails, thanks to increased progesterone and your body stocking up on extra nutrients (so don't forget to continue taking your prenatal vitamin ). You might notice your locks feel stronger and more bountiful than usual. But you might also get dry, irritated skin on your stomach, since it's constantly being stretched.

Your ever-growing belly can turn an "innie" belly button into an "outie," but rest assured it will return to its normal state after delivery. During this time, you'll probably continue dealing with leg cramps, brain fog, backaches, increased vaginal discharge, constipation, headaches, stretch marks , and other second trimester pregnancy symptoms.

While some pregnant people still have high sex drives, others notice a dwindling libido. They might feel too sore and tired to do the deed. Other pregnancy symptoms include tingling hands and bleeding gums , as well as snoring from nasal hypertrophy and pregnancy weight gain.

Do your hands and fingers feel tingly? You may be experiencing carpal tunnel syndrome , which is often a result of normal swelling and fluid retention. This numb sensation should go away after you give birth. In the meantime, avoid sleeping on your hands, and try shaking out your wrists throughout the day.

Sleep might not come easily as you near the third trimester, whether it's because of anxiety, leg cramps, frequent urination, or general discomfort. You might also experience itchiness in your hands and feet. Mild itchiness is usually benign, and it can be treated with antihistamines, ointments, or calming lotions. Intense itching, however, could signal a liver disorder called cholestasis of pregnancy that requires medical care.

As if backaches and leg cramps weren't bad enough, some people get hemorrhoids during the second trimester. These itchy, swollen veins pop up in the rectum because of increased blood flow and pressure, and they can get worse with the straining that often accompanies constipation. Relieve hemorrhoid pain and bleeding with a high fiber diet and plenty of fluid intake, hemorrhoidal ointment, sitz baths, or witch hazel pads.

Welcome to the third trimester! As you near the finish line, you may start feeling physically exhausted and generally uncomfortable. Aches and pains are commonplace, and some people might have symphysis pubis dysfunction (SPD) , which happens when the ligaments around the pubic bone become soft and unstable, stretching further apart than normal.

As your body prepares to feed your baby after birth, you might notice yellowish colostrum leaking from your breasts within the next few weeks. This fluid serves as a precursor to mature breast milk, and it helps your little one's body adjust to life outside the womb. Also, blood pressure starts to rise after 28-32 weeks of pregnancy.

If you've experienced itchiness, swelling, aching, and heartburn, it probably hasn't subsided yet. If you have stretch marks like the majority of pregnant people, they're probably getting more pronounced as well. These red, pink, purple, or even dark brown streaks can't be prevented—in fact, they are usually genetically determined—but they'll fade significantly with time.

Perhaps you were thrilled to put first trimester pregnancy symptoms behind you, but now some of them might make a comeback. For some people, they may have never left. For example, your breasts may become tender again as they start producing colostrum; you'll likely need to pee frequently because of the pressure of your uterus against your bladder; and you may become extremely exhausted after only minimal effort. Hang in there.

After 20 weeks of pregnancy, your body might produce "practice" contractions called Braxton Hicks. They're characterized by a sporadic hardening or tightening of the uterus, and they come more often as the pregnancy progresses. Braxton Hicks contractions usually last between 30 seconds and two minutes, and they often come irregularly. While Braxton Hicks are expected, call a health care provider if you experience contractions that get stronger and more frequent, as that can be a sign of premature labor.

Your baby is getting bigger, and they're still pressing against your internal organs. The result? The potential for a leaky bladder, shortness of breath , heartburn, and general discomfort. Also, a lot of people get upper abdominal pain near the top of their uterus around this time, which is a normal symptom of the abdominal wall being stretched by the growing uterus. Talk to your OB if you have concerns it may be something else. Usually this sort of pain is tender to the touch and worse when the baby kicks.

You're getting closer to delivery, but remember: Every day counts for your baby's development during the last few weeks of pregnancy, so you'll want to let them continue growing as long as it's medically safe. You may notice some change in the intensity of movement as your baby grows and gets into position for birth, but always contact a health care provider if you have any concerns or notice significantly less fetal movement .

As labor quickly approaches, you'll notice more regular Braxton Hicks contractions. Make sure you know how to differentiate these practice pains from actual contractions. Around this time, many people find that insomnia comes in full force as a third trimester pregnancy symptom.

Your little one is on the move! About two to four weeks before delivery, your baby will begin "dropping" into your lower pelvis (also called lightening or engagement). This move may take some pressure off your internal organs, allowing you to breathe easier.

Your little one's new position might lead to pelvic discomfort and increased abdominal pressure. You might notice a little spotting after sex, but you shouldn't worry: This is probably a result of your sensitive, enlarged cervix. Call a doctor if you're bleeding like a period, though, since this could indicate a problem with the placenta .

Around week 37 or 38, some pregnant people lose their mucus plug . The mucus plug blocks the opening to your cervix to protect your baby from germs. It typically gets released anywhere from a few days to a couple of weeks before labor, and it looks like thick pink or blood-tinged discharge.

If your water breaks, you may notice a gush of fluid or a slow trickle. Other early signs of labor include regular contractions, pelvic pressure, dull back pain, and a feeling of restlessness. Early labor tends to last for hours. Many health care providers recommend that first-time parents wait this phase out and head to the hospital when contractions come every four or five minutes, last for one minute, and continue in this pattern for an hour (the 4-1-1 or 5-1-1 rule), but your provider may have a different recommendation for you.

You'll likely keep experiencing pregnancy symptoms like insomnia, swelling, frequent urination, and pelvic discomfort until your baby arrives. If you've scheduled an induction or C-section, it may happen within the next few days or weeks. After 40 weeks, an ultrasound may be recommended to monitor your baby's position , size, and fluid levels to ensure all is still going well.

After 40 weeks, your baby is considered "overdue" as they've passed their due date, but in most cases, this is perfectly fine and it's actually quite common. Even so, an overdue baby can cause some anxiety and restlessness, but hang in there and watch for signs of labor. Your little one will be here soon! Consider using movement (walking, dancing, squatting, etc.) to help the baby engage in the pelvis and improve your chances of going into labor.

Most babies are born within two weeks of their due date (before or after), and while reaching week 42 might be exhausting, it's also pretty uncommon. Most providers advise an induction prior to 42 weeks. In the meantime, continue to take care of yourself—your baby will be in your arms before you know it.

Progesterone inhibitory role on gastrointestinal motility . Physiol Res . 2022.

Cardiovascular Physiology of Pregnancy . Circulation . 2014.

Physiologic changes of pregnancy: A review of the literature . Int J Womens Dermatol . 2017.

Fetal Movement .  StatPearls . 2023.

Pregnancy Intrahepatic Cholestasis . StatPearls [Internet]. Updated 2023.

Braxton Hicks Contractions . StatPearls [Internet]. Updated 2023.

How To Tell When Labor Begins .  American College of Obstetricians and Gynecologists . 2023.

What does it mean to lose your mucus plug? .  American College of Obstetricians and Gynecologists.  2020.

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10 Early Signs The Pregnancy Will Be Easy (And 10 Signs It'll Be Hard)

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Every woman experiences pregnancy differently. Some ladies are lucky enough to sail through all nine months, while others find pregnancy uncomfortable and gruelling. Most women have good and bad phases during the three trimesters. This list is designed to help women figure out if they're going to have rough pregnancies or not.

Even the roughest pregnancy may get easier when a woman gets proper medical care and practices appropriate self-care. For example, a woman who's plagued with severe morning sickness may want to talk to her ob-gyn about what she should eat to ease morning sickness (dry toast, crackers), or experiment with the Sea-Band wristband, or other medication-free therapies that are proven to soothe nausea.

Pregnancy is a journey. It brings significant changes. It's all worth it. Women who've really had it rough during pregnancy often forget their aches, pains and illnesses when they see their beautiful babies for the first time. Women often forget their labor pains, too. Motherhood is the greatest, but getting there is sometimes tough. Pregnancy takes its toll. Now, let's look at ten signs that women are going to have an easy time of it while they're expecting...and ten signs that things may be harder for them.

20 No Morning Sickness: Pregnancy Will Be Easy

If you're pregnant and you're not having any morning sickness, and your ob-gyn is happy with the way that your pregnancy is going...you're lucky! I know from personal experience that morning sickness can be intense. It really sucks, especially if you need to get yourself to work in the a.m.

So, what causes morning sickness, anyway? Well, it's triggered by higher-than-average hormone levels during the initial weeks of pregnancy. Some women, such as Salma Hayek, had to deal with morning sickness the whole time that they were pregnant.

If you're not getting sick in the morning, you may be one of those fortunate women who is going to be blessed with an easy pregnancy.

19 Normal Growth: Pregnancy Will Be Easy

If you're pregnant and gaining weight just as you should be, that's a good sign. When you're in the normal range, it bodes well for an easy (or relatively easy) pregnancy. Women who gain too much or too little may be in line for more problems.

Of course, there are plenty of other variables which play a role in whether a pregnancy is easy or not. That being said, weight gain is one thing that ob-gyns do keep an eye on.

To boost the odds of a smooth pregnancy, figure out how much weight you're supposed to gain. Most women gain between 25 and 35 pounds during their pregnancies.

18 Good Energy Levels: Pregnancy Will Be Easy

Pregnant ladies who feel energetic, just like they did before they became pregnant, have a high likelihood of enjoying easy pregnancies. It's quite common to get exhausted during pregnancy. Growing a baby is a big job and it's hard on a woman's body. If you're not falling asleep all of the time, or wishing that you could get away from your everyday responsibilities and just lie on the couch with the remote control for a few days, you're one of the lucky ones.

Even if you have lots of energy, remember to rest. Conserve this precious energy. Don't do too much.

17 No Swelling and Bloating: Pregnancy Will Be Easy

Water retention is not uncommon in pregnancy and it can make pregnant women feel mighty uncomfortable. If you're not experiencing this type of swelling and bloating, which is also known as edema, congratulations. Maybe you're drinking lots of pure water and other healthy fluids, and flushing out sodium and/or impurities that contribute to bloating. Your healthy hydration habits may be paying off.

2.3 litres of fluid per day is the recommended amount of hydration for a pregnant women. That equates to ten cups of fluid. Drinking a lot of water is definitely the best way to avoid bloating. It's also a good way to keep energy levels high.

16 Very Few Mood Swings: Pregnancy Will Be Easy

Pregnancy hormones tend to trigger some wild mood swings. Women who aren't moody during pregnancy, at least sometimes, are few and far between. If your mood isn't going up and down like a Yo-Yo, it may be sign that your pregnancy isn't going to be too stressful.

Emotional equilibrium during pregnancy makes it easier to handle the other challenges that pregnancy brings, from swollen ankles to lower back pain to heartburn. When a pregnant woman is moody, it's tougher for her to handle discomfort and other pregnancy issues. Whatever you're doing to keep your mood on an even keel, keep doing it.

15 No Cramps: Pregnancy Will Be Easy

Pregnancy sometimes triggers cramps. These cramps are generally caused by the expansion of the uterus. When the uterus does expand, muscles and ligaments that support it start to stretch out. This is something that many women feel, and it doesn't feel particularly good.

While cramping is possible anytime, it's actually most common during the second trimester, so it may strike later, even if you don't experience cramps during trimester one. However, some women don't get cramps, and you may be one of the lucky ones. No cramps early on is a good sign. Every woman knows that cramps are the worst.

14 No Lower Back Pain: Pregnancy Will Be Easy

When the front of the body gets heavier, the lower back has to carry more weight and this can lead to lower back pain. Normal, non-pregnancy weight gain may cause a woman to develop back problems, even if they are minor back problems. This is why exercise experts and doctors advise non-pregnant woman to stay in the normal weight range and strengthen their cores through exercise.

During pregnancy, weight gain is inevitable, but keeping it within normal ranges may shield you from lower back pain. If you're not feeling it yet, maybe you won't get hit with this common pregnancy symptom.

13 No Weird Pregnancy Food Cravings: Pregnancy Will Be Easy

Some women develop some bizarre food cravings during pregnancy. There are pregnant women who feel compelled to eat dirt or paper or very odd food combinations. Obviously, a woman should never eat non-food items, even if her pregnant brain is telling her to do it. Also, a woman shouldn't gorge on weird food combos a lot while she's pregnant, or she might get sick.

If you don't have any strange food cravings, it's possible that you're going to be one of those fortunate ladies who has the easiest pregnancy ever. One tip is to avoid eating a lot of high-sugar fruit during pregnancy, as eating too much fruit may boost the odds of gestational diabetes.

12 You’re Not Getting Headaches: Pregnancy Will Be Easy

Headaches can sometimes be a bad sign during pregnancy. Usually, they are caused by hormone shifts, and hormone-related headaches are typically harmless, if extremely annoying. Women who get a lot of headaches during pregnancy may be dealing with pre-eclampsia, which is quite serious. Pre-eclampsia happens when blood pressure rises and a lot of protein is found in urine.

So, it's a good sign if you're headache-free.

Any woman who is concerned about headaches during pregnancy should definitely talk to her ob-gyn. Frequent headaches while expecting a baby are something that a doctor should know about. A doctor will be able to help.

11 No bathroom Problems: Pregnancy Will Be Easy

Constipation is one of the irritating side effects of being pregnant, but you may escape this tiresome symptoms. Eating a diet that's high in soluble fiber is a good way to stay regular while you're expecting a baby.

If you have healthy eating habits, and do get fiber from whole grains and other sources, you may find that your good eating habits help you to enjoy an easy pregnancy.

Some pregnant women get hit with constipation even when they do all of the right things, such as drinking lots of water and getting enough fiber. It usually happens because hormones which relax the muscle in the intestine are affected by hormones.

10 You’re Feeling Really Nauseous: Pregnancy Will Be Hard

Nausea isn't a small thing. When pregnant women feel nauseated every morning, or all day long, it saps their strength and makes them feel miserable. Hormones in pregnancy trigger nausea and it can be extreme. If you don't have nausea, you're missing out on morning sickness and this means that you're missing out on one of the very worst pregnancy symptoms. If you're lucky, you'll sail through pregnancy, from trimester one to labor.

Women who do have severe morning sickness should definitely talk to their docs. They should never have to deal with it in silence. A Sea-Band wristband or change in diet may help.

9 Your Chest Is Very Tender: Pregnancy Will Be Hard

When we're pregnant, we all get a lot more...voluptuous. Changes to the size of our chests tends to trigger a lot of tenderness. When parts of the body change so much, we're going to feel it. If this is happening to you, you will find that wearing a bra that's more supportive is very helpful. Also, go for clothes that aren't too snug in the chest area.

Some women benefit from putting cold compresses on their chests, or find relief when they take warm baths or showers. If these tips don't help, talk to your ob-gyn about pregnancy-safe pain relief.

8 You Have Aversions To Certain Foods: Pregnancy Will Be Hard

Aversions to certain foods during pregnancy is a sign that you have a sensitive system. It doesn't mean that anything is wrong. It's just one more thing that you'll need to worry about while you're expecting. It's another layer of stress, because it may make it harder to eat a balanced diet.

In general, pungent foods cause the most intense aversions. For example, I personally found that strong-smelling cheeses, such as Romano and Parmesan, were truly yucky while I was expecting. I could not stomach them and still can't, because my aversion during pregnancy was so intense. It's wild how those cheeses grossed me out so badly while I was expecting.

7 Some Odours Make You Feel Sick: Pregnancy Will Be Hard

I couldn't eat Romano or Parmesan cheeses while pregnant, and the mere smell of them was enough to make me feel sick. You may find that certain odors make you feel ill, too. Usually, it's food odors that make pregnant women feel ill, but they may be sensitive to other scents, too, such as perfumes or body lotions. Even cleaning products or air fresheners may make you react.

It's a good time to shield yourself from gross-out odors, as much as you can. Turn your home into a safe space where you can escape from strong odors. Consider using green cleaning products and fragrance-free personal care products.

6 Your Back Hurts A Lot: Pregnancy Will Be Hard

If your back is killing you while you're pregnant, it's likely to get worse, because you are going to continue putting on weight as your unborn baby gets bigger. It's unfortunate that you're dealing with back pain, but it's not uncommon. Women who are carrying big babies may get hit with the worst back pain, just because their bellies are bigger.

To deal with back pain, try to get healthy exercise. It should be pregnancy-safe exercise, such as prenatal yoga or swimming. It should be exercise that isn't too aggressive or intense. Talk to your ob-gyn to find out which forms of exercise will be best for your back.

5 You Have Zero Energy: Pregnancy Will Be Hard

Pregnancy often brings intense fatigue. It's often very difficult for pregnant woman to stay awake. Their bodies are crying out for sleep. It's natural to need more sleep at this time. It's restorative. It gives the body a chance to recover from all of the changes that it is going through. Unfortunately, some women really don't have time to rest as much as they should.

For example, a woman who's pregnant and has a toddler to care for, as well as a job, may feel stretched way too thin during pregnancy, and feel very burnt out. Pregnant women who are exhausted need to reach out for help from their support networks. This is so important.

4 You’re Feeling Really Moody: Pregnancy Will Be Hard

If you're feeling moody while you're pregnant, you're not alone. Those hormones are wreaking havoc. Don't feel bad if you have the urge to cry once in a while, or feel angrier than usual over little things that irritate you. Try to stay calm. Let the people around you know that you're dealing with mood swings. Ask them to be patient with you.

Of course, being pregnant isn't an excuse to take out your bad moods on everyone else. You'll have to dig deep to remain mature as your moods ebb and flow. Meditation will be really helpful. Also, giving yourself space to rest and just be alone for a while is a good idea.

3 Your Food Cravings Are Out Of Control: Pregnancy Will Be Hard

If you have the urge to eat weird things while you're pregnant, which don't even classify as food, talk to your ob-gyn. Also, obviously, don't eat the weird things. There is a disorder that some pregnant women have that compels them to eat non-food items. It's called Pica. This disorder is not a good sign, and it's something that you should seek out medical attention for. A doctor will help you to handle it. In terms of food cravings, indulge, as long as the food isn't too bad for you. I wanted McChickens and other chicken sandwiches. I craved chicken. Maybe my baby wanted the heme iron in the meat.

2 You’re Getting bigger: Pregnancy Will Be Hard

If you're gaining a lot of weight rapidly, you may want to talk to your ob-gyn. Of course, we will gain weight in pregnancy, but it shouldn't be too excessive. We're supposed to gain between 25 and 35 pounds over the course of our pregnancies. Lots of women gain more.

If you're eating for three or four, rather than two, you may need to set limits. Eating too much may cause weight gain that makes you feel very uncomfortable. Here is a general guideline to follow: during trimester one, eat 1800 calories. During trimester two, eat 2,200 calories. During the final trimester, eat 2400.

1 You’re Not getting big enough: Pregnancy Will Be Hard

Gaining too much can be bad. Gaining too little can be worrisome. We're all built differently and our pregnancies differ, too. This is why an ob-gyn is the best resource when it comes to assessing your weight gain and whether it's normal or not. Our tips are helpful, but they aren't designed to be a substitute for medical advice from a licensed ob-gyn. If you're worried that your baby bump is too small, talk to your doc. He or she has years of training and education and will be able to let you know if your pregnancy is going well, or whether you need to eat more calories, or whatever.

References: Parenting.com, Webmd.com, Fitpregnancy.com

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Home / Pregnancy / Keeping yourself and your baby healthy early in pregnancy

Keeping yourself and your baby healthy early in pregnancy

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Pregnancy: It’s the most excited you’ll ever be. And it’s the most scared you’ve ever been. Myra J. Wick, M.D., Ph.D., Mayo Clinic obstetrician, gynecologist and medical geneticist, joins co-hosts Angela Mattke, M.D., and Nipunie Rajapakse M.D., to discuss the often-conflicted feelings of expectant parents. Questions tackled include:

*          What factors make a pregnancy “high risk?” How much does age matter? What can I do to lower that risk?

*          What can I do during pregnancy to give my baby her best chance at being born healthy, and staying that way?

*          Should we consider genetic testing?

*          How should we plan our lives — work, relationships — with a needy new addition joining our ranks?

Listen: Keeping yourself and your baby healthy early in pregnancy

Read the transcript:

Dr. Angela Mattke

Welcome to the “Mayo Clinic Moms” podcast. We’re having candid conversations and answering difficult questions about pregnancy, raising kids, and everything mom-related. I’m Dr. Angela Mattke, and I’m a mom of two and a pediatrician at Mayo Clinic Children’s Center in Rochester, Minnesota–and my co-host is Dr. Nipunie Rajapakse, who’s a pediatric infectious disease doctor also at Mayo Clinic and is also pregnant.

First off, if you’re listening to this podcast, it means you’re probably pregnant or you know someone who’s pregnant — so congratulations — whether this was a planned pregnancy or a really pleasant surprise! You might have some questions or some worries about whether or not your baby is healthy, and how to you keep yourself healthy during this pregnancy over the coming months. During this episode, along with my co-host Dr. Nipunie Rajapakse, we are going to be joined by special guest, Dr. Myra Wick, an obstetrician gynecologist and medical geneticist at Mayo Clinic. She is also the medical editor of Mayo Clinic’s Guide to a Healthy Pregnancy , so she has some serious street cred when it comes to answering these questions. We’re going to be asking her questions like: What might put you at a higher risk for complications during pregnancy, and does your age during pregnancy really matter? And what about your infant? Are they at risk for special medical challenges during pregnancy or after birth? What about genetic testing?

Dr. Wick is a geneticist as well. We’ll also be asking about that little thing you’ve got going on right now–called ‘your life’–or maybe your career or your job, and how you can make a baby work with all of that. So let’s dive right in today. First of all, I want to congratulate Dr. Rajapakse on her pregnancy.

Dr. Nipunie Rajapakse:

Great. Thank you, Angie. We’re super excited.

Dr. Myra Wick:

So how far along are you?

We’re 31 weeks along now, so partway through the third trimester. Things are starting to get real as we get closer to the end here.

Dr. Angela Mattke:

Yeah, definitely getting real. And as a pediatrician, I’m sure you’re really excited that you’re 31 weeks; we always think one extra week is a little bit better for the baby and for you as well. So congrats.

Every week makes a difference at this point, for sure.

Yeah. How are you feeling?

I’ve been feeling pretty good; starting to feel some of the fatigue, and I’m definitely getting bigger so it’s harder to move around. But I think mostly it’s just been the usual pregnancy discomforts, so things are going pretty well so far.

Yeah. Have you gotten to the point where you’re never sleeping?

Yes! That’s already started, which was a bit of a surprise to me. Honestly, I knew after baby came that the sleep deprivation would be a big thing. But I was hoping I might get a few weeks of good sleep leading up to it, and that definitely is not the case. I’m having to work through that for sure.

Definitely. Okay. One of my favorite things to hear about is the pregnancy ‘story’. What’s your journey been like so far?

My partner Thomas and I, we knew we wanted to start a family. Like many women with professional careers who have long training, we kind of put things off for a while. The time never quite seemed perfect–we wanted to get through the training part and get established in our career. We started on this journey pretty late; I’m 37 and he is turning 40 in a month — later than maybe most people might think about starting a family. Being in medicine, we had a lot of conversations with friends and colleagues who had similar paths and also struggled in many ways, either with getting pregnant or with recurrent pregnancy losses. That was really at the forefront of my mind going into this journey, and knowing that there were certain things that were going to be outside of my direct control.

We went into it with the mindset of ‘if this happens for us, that’s great’. If not, then we might need to look at other options. But we were really excited back in the spring to find out that we were pregnant. I was four days late and I’d had pretty regular periods before, so it was notable to be a few days late. It was a super busy time at work and I actually was only notified by my watch (that was tracking my cycles) that I was late. I ended up taking a test and it was positive and we were very excited, but I think also a little bit nervous knowing some of the risks related to having a baby at my age, both for myself and for the baby.

It’s been quite a journey so far for us, in learning and going through this. In that first month before we knew, I think I managed to do a lot of things off of that list of things we know probably shouldn’t be done during pregnancy. That was a time that we decided to get a bike. Thomas is a big road biker. And so he encouraged me to get a bike, and I ended up riding the bike and falling off twice. During that time, we also had sushi, rare steak–all sorts of different things. Thankfully, I think things will end up being fine, but in retrospect, I think back through all of those things and wonder whether they will have an impact or not. The first trimester, I think, went reasonably smoothly. I definitely had some morning sickness, which is really a misnomer, because I mostly had it in the evening.

All day sickness.

Yeah, yeah, exactly. That has thankfully passed now. And then the second trimester was feeling pretty good, and now the third trimester has been going good as well. Just some of the usual discomforts and things associated with a growing belly and not being able to sleep as well, but we’ve been pretty fortunate to have no major complications or issues thus far. A couple of minor things that I think we’ll talk about through this, but yeah, we’re now getting ready for the next step.

You mentioned some of the things that you did before you knew you were pregnant. I think every pregnant woman can relate to that. But you mentioned that you’re a little bit older and I want to talk about some of the challenges that come along with pregnancy. And to do that, I want to bring in our special guest, Dr. Myra Wick, as we mentioned, in the introduction of today’s episode. I also mentioned that she has some serious street credibility! She’s also a mom of four. She’s done this once or twice, so hopefully she can give us some words of wisdom. Dr. Wick, thank you for joining us today.

Thank you for inviting me. It’s a pleasure to be here.

Yeah. So mom of four! And your kids are mostly grown, is that right?

Yeah. Yep. The oldest one’s actually an orthopedic surgery resident out in California. And then the second one is in his mid-twenties, he’s been back home with us quite a bit during the pandemic. And then our older daughter is working out in DC, and we just sent our baby off to college, which was a little traumatic for Mom, and she’s out in Maine, which seems like a really long ways away from Minnesota.

It is a really long ways away from Minnesota. So you’re an empty nester almost for the first time, it sounds like!

Yeah, we have one that’s home most of the time, and then we have two fur babies also.

Awesome! So as Nipunie mentioned, she’s 37. Let’s talk a little bit about what this means for the health of her pregnancy, or for the health of the infant compared to someone in their twenties or even in their teens. Are there different challenges? Would you approach Nipunie’s pregnancy a little bit different if you were seeing her in the office?

Well, fortunately, most moms do well, even moms that are older and it’s always hard to know what exactly that definition is. Some people use 35. But one of the things that we think about is the increasing risk for chromosome problems or chromosome aneuploidy as moms age. And probably the most familiar chromosome aneuploidy is Down syndrome or trisomy 21, which is an extra copy of chromosome 21. There are a couple of other chromosome conditions that we can see; one’s called trisomy 13, which is an extra copy of chromosome 13, and trisomy 18, an extra copy of chromosome 18. So there are different screening tests that we can use to screen for the chance that the pregnancy might be affected by one of those conditions. And those tests have really evolved over the years.

Back when I was pregnant, there was a screen that had only a blood test that looked at three different protein markers in the mom’s blood. And that test is still around. We can still use it. It’s now called the quad screen because we use four different markers. And we use that test usually in the second trimester. But the test that most moms, or the screening that most moms have heard about, is something called cell-free fetal DNA screening or some people call it noninvasive prenatal screening. And that test allows us to screen for those three chromosome conditions but also will let us know about the gender of your baby. And we can do that as early as 10 weeks. So that’s one of the things that we talk about with all moms, but especially for moms who are a little bit older. And a lot of women are interested in the test because they can learn the gender of their baby early.

Really early on. Yeah.

Yeah. But the test was really designed to screen for trisomy 21 or Down syndrome. So we think as geneticists and obstetricians, it’s really important that moms understand what they’re doing when they have that screening test done; it’s not just the gender test. You might get some other information from the testing, and maybe you weren’t anticipating that information or you didn’t want that information. And then what do you do once you have that information?

Yeah. This was one of the things that was new to me, because when I went through med school, that test wasn’t available. That was something I learned about early on when we went for our first prenatal visit. And I had assumed that we’d have to wait until the 20-week ultrasound to find out the sex of the baby, and so that was kind of interesting information to learn early on for us. We wanted to find out, so we know that we’re having a girl. And the other thing was understanding the difference between the types of testing offered. I know there were screening tests that can be done. And then there’s diagnostic tests. Maybe, Dr. Wick, can you talk a bit about what the difference between what a screening test is and what a diagnostic test is, when it comes to these genetic tests?

Sure. Screening tests are tests that tell us about the risk. They don’t give a definitive answer as to whether or not the baby has a chromosome problem. The screening tests are really accurate. So, for example, the detection rate for the cell-free DNA screening for Down syndrome is about 99%. And the false positive rate is low. It’s about 2–4%. So they’re great screening tests, but if the test comes back abnormal, it doesn’t mean for certain that the baby has that condition. In order to determine whether or not the baby actually has that condition, we’ll recommend additional invasive testing like a CVS, which is a chorionic villus sampling or an amniocentesis. And both of those tests involve a long, skinny needle and ultrasound guidance.

With a CVS, that’s a test that we typically do between about 11 and 14 weeks. Long skinny needle. We take a little tiny sample of the placenta that’s forming, and the placenta almost always represents the genetics of the baby. So we can send the cells from the CVS to our cytogenetics laboratory across the street. And they can do some different studies, like what we call a karyotype, where they look at all the chromosomes, or a chromosome microarray, where they look at the chromosomes in even finer detail than a karyotype. And so, again, we do that at about 11 to 14 weeks. So depending on when the test results or the screening results come back, if you’re in that window and the results are abnormal, then we can offer you the CVS.

If a patient is after 14 weeks and we need to do invasive testing, then we’ll do an amniocentesis. And that involves taking a little sample of the amniotic fluid. The baby sheds cells into that fluid, and we can send those cells to the cytogenetics laboratory, and they can do the same kinds of studies. So that’s definitive testing and it also gives us more information. It gives us information about all the baby’s chromosomes, not just 13, 18, 21, X, and Y. Traditionally we’ve talked about the risk of invasive testing. We’ve traditionally quoted that there may be a risk of loss from CVS on the order of about one in 300 to one in 500. That risk is a little bit lower with amnio; about one in 900 pregnancies could be lost by the procedure.

There are some more recent papers that have shown that those risks may not really be there. And the procedures are very, very safe. Here in our practice, we have very experienced providers that are doing the procedures, so things usually go extremely well and without complication. It’s always important to remember too that the invasive tests are available to everybody. So every once in a while, I’ll have, you know, a 23-year-old low-risk patient come in and say, “I want everything. I want to know everything there is to know about my baby’s chromosomes.” And if that’s the case, then maybe the right test for her is an invasive test from the get-go, rather than using it in a stepwise manner where you would use the invasive test only if there was an abnormality with the screening test.

Great. So that maybe answers my next question, which was: does the testing offered kind of vary by how old you are at all, or would most of these tests be an option for anyone?

Yeah. Most of the tests are an option for anybody and we should really be offering them and describing the testing to all patients. And then we’re supposed to give non-directive counseling–so we tell the patients about all of their options and then help guide them in their decision-making process.

INTERMISSION

Are you thinking about getting pregnant or maybe you’re a current mom-to-be, or you’re like myself and you’re in the midst of raising kids, and you’re looking for practical evidence-based advice from Mayo Clinic experts? Mayo Clinic Press has got you covered. We have a series of four books, starting from Fertility and Conception to Guide to a Healthy Pregnancy , Guide to Your Baby’s First Years , and the last book in this series, the one I was the medical editor of, Guide to Raising a Healthy Child . You can find these amazing books from Mayo Clinic Press wherever books are sold or on the Mayo Clinic Press website.

BACK TO THE SHOW

Angie, I’m curious, did you have any testing done during your pregnancies?

I was going to ask you the same question, because I’m curious! I didn’t have any testing done because I think testing has changed so much, and my kids are a little bit older. Some of the testing was just coming out about then; but also, my husband’s a radiologist, and we did a lot of ultrasounds because he was in training, and they were encouraged to do lots of ultrasounds — on friends or on themselves just to practice. And who’s a better person to practice your OB ultrasound on than your wife! We were constantly checking on the baby, and I have to say, we found out the sex of our baby at 13 weeks from our ultrasound. And most of the time, you can’t really tell definitively that early. We thought that’s what it was. And we obviously confirmed it with our repeat ultrasounds that were done on a ridiculously frequent basis. How about you? Did you have any genetic testing done?

I think I have gone into this pregnancy wanting to have as much information as I could. I thought that that would help with my nervousness or anxiety about things, just to at least know what to prepare for. After hearing about some of the different options, we did decide to do the fetal cell-free DNA testing. We had that done around 10 weeks along, and thankfully it showed that we were low-risk for all of the different chromosomal abnormalities that it tests for. And then that was also how we were able to find out that we were having a girl early as well. But I will say you don’t have to find out the sex. When they send you the result, there’s a version that has the sex on it and there’s one without. You can just open the one without if you want it to be a surprise.

Awesome. Yeah. I didn’t really want it to be a surprise. I wanted to know because I am like the world’s most type-A planner, and so it helps me prepare mentally for the arrival of my little bundle of joy. How about you guys? Was there a a question about finding out the sex of the baby or not?

No, we hadn’t talked about it before. We both knew that we wanted to find out. I thought we’d have to wait until a bit later. So it was a surprise for me that we could find out as early as 10 weeks.

Yeah. Dr. Wick, is that as early as you can do that blood test?

Okay. And what’s the range on that? Like between what weeks can you get that test done?

Really any time after 10 weeks. Sometimes after 36 weeks, you’ll get some strange results back. I think it’s just because if you look on the report, it gives you the answer of whether everything’s normal or not. It tells you the gender. And then when I’m thinking about Nipunie’s result, way on the right hand side, it gives you a fetal fraction. And I think when I saw your report, it said, like, 11%, and that’s an important part of the report. So when we take the blood sample from the mom to do the testing, there’s a mixture of DNA from the mom and from the baby. And so that fetal fraction has to be at least 3% in order for the laboratory to reliably give us a test result.

If we do it before 10 weeks, that fraction of fetal DNA might be too low for the laboratory to give you a report back. We call that a no-call result, and that always makes people a little bit anxious because you can see a low fetal fraction when there’s a chromosome problem as well. When you see that [at ten weeks], we need to counsel the patient about their options. Usually, we’ll wait another two weeks because that fetal fraction should go up as the pregnancy goes on. We try to get that testing done at 10 weeks so that we’re sure that we’re going to have an adequate fetal fraction. One of the other reasons why we might see a low fetal fraction is if a mom has a really high BMI or if she has a high weight; there seems to be a dilutional effect. For a mom with a BMI of 40 or 50, you might actually want to wait a couple of weeks beyond 10 weeks, just so that you’re sure that that fetal fraction is high enough to get a result back. That was probably more technical information than you wanted.

No, I think that’s helpful.

And why would we use that test at 30 weeks or 31 weeks? I think probably the most common reason is if the baby’s growth has fallen off, and we just want to make sure that it’s not a chromosome problem, that’s causing the growth to be decreased or to be lower than we would’ve expected. And I just wanted to point out, Angie, you brought up a good point–that ultrasound is also a genetic screening tool. Sometimes we forget about that, but we probably pick up at least 90% of trisomy 13 and trisomy 18 with the anatomy ultrasound. We see findings that are characteristic. Down syndrome can be a little bit trickier. We pick up maybe 50% of Down syndrome cases. And it’s primarily the babies that have a cardiac condition–a congenital cardiac condition that we would pick up. But yeah, ultrasound is another great genetic screening tool.

It is. Especially if you’re getting it at ridiculous frequencies like I did. And then with my babies, I was always measuring really small. There were always concerns that my babies weren’t growing well, and then they do ultrasounds, and my kids were really huge — unfortunately for me at the time of delivery! But still there’s a lot of testing that’s done during pregnancy. We’ve talked about genetic testing; we’ve talked about the anatomy ultrasound that you just mentioned. What other things would you be watching as an OBGYN during the pregnancy to monitor the health of the mom and health of the baby?

Another set of tests that we do somewhere between about 24 and 28 weeks is testing for gestational diabetes. We have the mom drink a sugar solution and we all remember how horrible that is! Then you get to sit in the laboratory for an hour and the lab draws a blood sample to see how your body is handling that sugar load, if you will. And in our practice, we use a cutoff of 140. If the mom’s blood sugar is 140 or higher after that one hour, then she gets to do another test–a three-hour test, where she comes in fasting, and they do four blood draws. One’s a fasting blood draw, and then the mom gets to drink another sugar solution.

Oh, goodie!

Then we do a one-hour, two-hour, and three-hour blood draw. And if two of the four of those blood draws are elevated, then we diagnose the mom with gestational diabetes. The first step is to try to manage with diet and exercise and a lot of moms do just fine with that. We don’t need to think about any medications, but if we’re still having trouble, the mom’s monitoring her blood sugars, and we’re seeing about 15–20% of those blood sugars are elevated, then we’re going to talk about starting insulin or another oral medication called Metformin to help control the sugar levels. And there are a couple of reasons why we want to do that. The first is that we don’t want you to have a huge baby. So if blood sugar levels are out of control, the baby might grow really big and you might end up with an 11-pound baby.

Who struggles with their sugars after birth, as well.

That’s what I take care of in the hospital.

Yep, and we worry about difficulties with birth when there’s a large baby; oftentimes when mom has diabetes that’s uncontrolled, the babies will have a larger abdominal circumference and that can cause trouble during labor. Something called a shoulder dystocia where the baby’s shoulder gets stuck under mom’s pubic bone, and that can an obstetrical emergency. So that can be a scary thing that we don’t want to see happen. Anyway, we look for blood sugar levels at 24 to 28 weeks. We are also checking the mom’s hemoglobin again just to make sure that the mom doesn’t become anemic. It’s really common for the hemoglobin to drop a little bit. It’s just part of the physiology of pregnancy. But if it drops below a certain value, I usually use about 10.5.

Then we might recommend that mom take an iron supplement if she can tolerate it, just to make sure that that her hemoglobin and her iron are in good shape going into labor because labor and delivery is a time when we often see a lot of bleeding and it’s really common to lose blood during labor and delivery. We’re also testing at 24 to 28 weeks for syphilis. Our patients are being tested twice for syphilis in pregnancy – once at the new OB visit, and then again at the 24 to 28 weeks. And that’s a recommendation of the Minnesota Department of Public Health. We’re seeing more syphilis cases apparently in our state. It’s kind of taken a backseat to other infectious diseases right now, but that’s another thing that we’re testing for.

The last benchmark, if you will, is testing for group beta strep, which is a bacteria that is present in about 25–30% of women in the rectal vaginal area. It’s part of the normal bacteria. Doesn’t usually cause any trouble for the mom. But there’s a small chance that during delivery, the baby could contract the group beta strep and become really sick, as both of you know–you care for those babies. If mom is positive, then we treat her prophylactically with antibiotics – usually penicillin, if she’s not penicillin allergic–during labor. Those are the main tests that we think about. For some women, if they have thyroid disease, we want to make sure that that they’re taking appropriate thyroid medication replacement. We might be following TSH levels, thyroid stimulating hormone levels, during pregnancy as well.

So many of those things, Dr. Wick, that you mentioned, like gestational diabetes, are a higher risk for women of advanced maternal age. But obviously that’s not a factor that I can change. Are there things that you recommend women can do if they are older and going into a pregnancy to reduce their risk of some of these types of complications?

I think some of the same things that we recommend for all of our patients, really. If you can go into pregnancy with a healthy weight, if you happen to have diabetes, we have some patients with type one or type two diabetes, to make sure that’s well-controlled going into pregnancy. If you have blood pressure issues–and most of our patients don’t have blood pressure issues; they’re young and healthy and have nice low blood pressures. But we do have a few patients that have blood pressure issues, which can complicate things in pregnancy like worsening hypertension at the end of pregnancy or something called preeclampsia, which can be serious. If we can get those kinds of things managed before you even get pregnant, that’s awesome and helps to reduce risks during pregnancy. Exercise, diet, trying to have all those things under control – which I’m sure we all did, right? – before going into pregnancy. But you’re right. Older moms do have slightly increased risk for some of those common complications, like gestational diabetes and gestational hypertension during pregnancy.

The last thing that I really want to pick your brain about, Dr. Wick, and I also have some nuggets to share, but I mentioned in our intro that oftentimes you think you know that your life is going to change when you have a baby, but I feel like you don’t really understand until you have a kid. I don’t know if we can really prepare because everyone’s going to have their own journey and everyone’s going to have their own experience, but life really changes–especially if you’re trying to have a career too. All three of us have busy careers, trying to take care of patients. You have four kids. I have two; so far they’re still alive, and I think they’re mostly healthy. So I’m managing okay. And they’re happy, and they know they’re loved, but what kind of tips would you give to her or knowledge about things that you didn’t realize, or you wish you would’ve known about trying to balance your new life after the baby?

Boy, I wish I had some magic answers. I’m a planner, but yet my husband and I are kind of go-with-the-flow. We weren’t great about planning. We just kind of had kids. And I think a support system is so important. My husband works in the medical field, but he’s not a medical professional, and his schedule was always a lot more flexible than mine. It was nice to know that if I couldn’t get home until six o’clock, he was going to be there. We also had huge support from my parents. They live in the area, and they really were second parents to my kids. And that was a huge support. I don’t know, honestly, what we would’ve done without them.

I know that not everybody has that luxury. But I think building a good support system was key for me and for our family. I don’t know how helpful that is, but it does change. And, you know, there are periods in your life where you feel like all you’re doing is going to work and then going home and doing a second job. It can be very tiring sometimes and hard to remember to do things for yourself. It’s important to get out and get a walk or just take a little time to go shopping or get your hair cut.

Nipunie, I think my biggest advice for you is try to let the mommy guilt go, and I’m still working on this. I am not good at it, but after having kids, my standards for myself definitely changed. And they had to because it wasn’t sustainable to keep kind of practicing at the level that I was and giving as much as I was to my clinical practice and stuff because there wouldn’t have been anything left to give to my family and my kids. I had to let the guilt go about not being able to do everything like I wanted it done. And just being satisfied with “good enough”– everyone’s alive, everyone’s knows that they’re loved. And you know, at the end of the day, everything’s getting taken care of eventually.

Great. Thank you both for that advice. I know, I think it’s hard. I feel like I should know as a pediatrician kind of what I’m in for, but everything that I’ve heard from colleagues and friends is that until you kind of go through it yourself, you have no idea what it truly is like, so I appreciate it.

Well, I mean, even now my kids are older and it’s still like I don’t know what to expect. Every age is different and everyone’s just trying their best. I think one other piece of advice is, you will become a lot less judgmental of other people, and, as much as possible, to let that go and not become one of the “Judgy McJudgy” people that are judging everyone for their kids. You know, how their kid’s acting at Target or the meltdowns they have in the office. I feel like parents are always apologizing to me, and I’m like, oh my gosh, this is life. This is what my kids do, too. We’re people, too. I think we’re experiencing the exact same things that everyone else is going through. So, Dr. Wick, thank you so much for joining us. And I look forward to you joining us on our future episode.

Thanks everyone for joining today. Make sure you don’t miss any of our upcoming episodes by subscribing and following along on either Apple Podcasts or Spotify. If you enjoyed this episode, and you want other moms out there to hear this valuable information, make sure that you leave a review wherever you listen. Thanks for joining us. We’ll see you next time.

Relevant reading

Mayo Clinic Guide to Fertility and Conception, Second Edition

Mayo Clinic Guide to Fertility and Conception, 2nd Edition is the ultimate guide to expanding your family through pregnancy, with clear information and tips for getting pregnant as well as inclusive expertise on options available for all individuals and families.

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The surprising science of how pregnancy begins

Selena Simmons-Duffin

Meredith Rizzo

Pregnancy is often talked about as though it's a light switch. You're a regular person walking around and then a switch flips — presto, you're pregnant.

The reality is more nuanced.

"Sex ed really oversimplified it: 'The egg has been fertilized and it has implanted,'" says Carmel Shachar , who runs the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. "What people don't realize is that there's a whole, very complex journey before that, that honestly usually is invisible."

Lots of steps need to happen, she says, from the time an egg and sperm meet to the moment a person tests positive on a pregnancy test.

The more scientists learn, the more they realize that the start of pregnancy isn't a moment, but a process that often ends before it really begins. As many as 1 in 3 fertilized eggs either won't implant or will end in miscarriage. In fact, most pregnancy loss happens before the fertilized egg implants.

Defining exactly when a pregnancy begins is a hot topic in some state legislatures and U.S. courts at the moment. While federal law has long said pregnancy starts after a fertilized egg has implanted in the uterus, state law in Kentucky, for example , calls someone pregnant as soon as a sperm meets the egg.

With so much riding on biology that's often misunderstood, let's break down what is known: Here's how the run-up to a pregnancy begins in that very first week of action, from the minute a single egg, the size of a grain of table salt, bursts forth from an ovary.

Starting at puberty, a process called ovulation begins. That's when — roughly once a month — a single mature egg breaks through its surrounding capsule, or follicle, and is released from one of the ovaries.

If you were born with ovaries, you were born with all the eggs you'll ever have — roughly 1 million to 2 million. Each month, about 1,000 eggs are activated but never develop further, while one (or sometimes a couple) fully matures. This happens until menopause, usually several decades later, when there aren't many eggs left.

After it's released from the follicle, the egg is scooped up and enveloped by the nearby, fingerlike projections (also known as fimbriae) at the end of one of the two slender uterine tubes (sometimes called fallopian tubes) that lead to the uterus.

The egg is protected by two layers. The inner one is called the zona pellucida, a jelly cushion of protein. The outer layer is called the corona radiata — a sunlike array of helper cells that have been nurturing the egg inside the ovary. These protective layers become even more important later.

Anatomy of the human egg

(Assisted reproductive technologies have greatly expanded how ovulation and fertilization can happen so that many more people can have babies. What we're describing here is what happens when that assistance isn't needed.)

The uterine tube acts as a kind of pulsing walkway; it's lined with cilia (small hairlike structures) that beat rhythmically, moving the egg along. Once the egg leaves the ovary, there's only a short window — less than 24 hours — for fertilization to happen.

Meanwhile, a lot has been happening in the uterus. For weeks, rising levels of the hormone estrogen have prompted a thickening of the endometrium — that's the cushiony lining of the uterus. The endometrium is one of the fastest-growing tissues in the body — in a monthlong menstrual cycle, it can grow to eight times its initial thickness.

The 28-day cycle of the endometrium

If sexual intercourse happens the same day as ovulation (or even several days beforehand), that's when sperm may enter the picture.

Every ejaculation contains tens of millions of sperm, and sperm can survive up to five days or so inside the uterus or uterine tubes.

Anatomy of a sperm

Now, despite what you may have heard, sperm cells are not a mighty infantry on a self-propelled mission to get to the passive egg .

Those little tails do give sperm some mobility by moving in a corkscrew motion, but sperm don't have enough energy or directional ability to get to an egg on their own.

In fact, most sperm don't get very far. Crossing the uterus to get to the egg in whichever uterine tube it is in means navigating an immense distance with lots of crevices to get lost in and immune cells to evade.

Scientists think waves of fluid inside the uterus, body heat, chemical signals, beating cilia and muscular contractions of the uterus (possibly from sex) play a role in how quickly sperm get to one of the uterine tubes. Some can get there within an hour of intercourse!

Only a small percentage of the sperm make it that far.

Fertilization

Once inside the uterine tube, the sperm become hyperactivated (for reasons researchers still don't understand) and begin to move more vigorously.

When they reach the egg, the sperm still aren't done. There are those two layers that encapsulate the egg — the corona radiata and the jellylike zona pellucida — to get through before fertilization can happen.

Enzymes released by the sperm help break down these layers. When the first sperm gets through the corona radiata, through the zona pellucida and, finally, through the membrane of the egg itself, the egg releases enzymes that quickly harden the zona. No other sperm can get in at this point. The first sperm that reaches the egg and attaches to its outer membrane releases its genetic material into the egg.

This is the moment of fertilization, otherwise known as conception. It has been less than a day since the egg was released from the ovary, and there are still many uncertainties to overcome before this fertilized egg becomes an embryo.

The egg and sperm each have 23 chromosomes (most other cells in the body have 46 — in 23 pairs). Through the process of fertilization, the 23 chromosomes from the egg and the 23 from the sperm join together and mix a bit to create a new, unique genetic blueprint.

The egg, now fertilized and containing its new set of 23 pairs of chromosomes, is called a zygote. The genes that will influence hundreds of characteristics — ranging from biological sex to hair color and eye color — are determined instantly.

Very quickly, the one-celled zygote starts to divide and travel again through the uterine tube. One cell becomes two, then four, then eight, then 16. The cells of the corona radiata that had been surrounding the egg start to fall off, disperse and eventually disappear.

DAYS 3 and 4

Travel time.

The eight-to-32-cell stage looks kind of like a berry, so the bundle is called a morula, which is Latin for mulberry.

Even as the morula continues to divide into dozens of cells and then hundreds, its outer case, the now-hardened zona, keeps it from expanding in size — so it's still only about as big as a grain of salt. That's crucial to keep the little ball of cells from getting stuck as it moves through the slender uterine tube.

Entering the uterus

Four days after fertilization, the fertilized egg has become a blastocyst — a bundle of cells with certain structures. Some will become the placenta, and others the embryo.

The blastocyst has now traveled all the way down the uterine tube. Around this time, the bundle of cells breaks out of its zona covering so it's able to implant in the lining of the uterus — the endometrium.

Now inside the uterus, a week or so after ovulation, the blastocyst has about four days to implant in the soft-tissue lining of the uterus.

Implantation begins

Voilà — this is implantation, considered the start of pregnancy under U.S. federal law.

At this point — about a week after ovulation — the person who has had all these changes happening inside their body still has no idea it has been going on. It will take an additional week after implantation (at the earliest) before there's enough of a hormone called hCG in their urine to turn a home pregnancy test positive. That's right around the time some people with very regular cycles might notice that their period is late.

For all the fascinating things scientists know about how all this happens, there's still so much that's not yet well understood. Early pregnancy remains something of a black box. At the moment, there's limited technology to be able to observe — let alone intervene — in very early pregnancy, which is why so many of the details are still unknown. "It's happening inside a person, and it's very difficult to study without disturbing the pregnancy," notes Shachar, the Harvard bioethicist.

That's a challenge for laws that try to regulate pregnancy, Shachar says. "The take-away is that a lot of legislation in this area doesn't reflect scientific knowledge, especially because laws don't work well with scientific uncertainty."

As science and politics continue to clash over when life begins , understanding the process of early pregnancy as fully as possible is more important than ever.

We created a printable version of this guide. Download and print it here.

Thanks to the many scientists who offered guidance and advice for this story, including Ripla Arora of Michigan State University, David Miller of the University of Illinois Urbana-Champaign and Joanne Muter of the University of Warwick, among others.

Illustrations by LA Johnson; edited by Meredith Rizzo and Deborah Franklin; visual design by LA Johnson, Meredith Rizzo, Alyson Hurt; researched and fact-checked by Will Chase; copyedited by Preeti Aroon.

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Health coverage, dental, vision and supplemental, member support, health guide, additional resources, infographic: your pregnancy health care journey.

For first-time moms, pregnancy is chock full of surprises. Like powerful cravings for oddball food combinations or the strange feeling of being kicked from the inside. Other things that catch moms-to-be off guard are the many doctor appointments and prenatal tests that are a normal part of pregnancy. And then there are all the unfamiliar bills and explanation of benefits statements you receive from your health insurance provider.

Our health care guide to pregnancy will arm you with the information you need to make sense of the paperwork. So you can focus on other things, like enjoying those first kicks.

Transcript: Your healthy road through pregnancy

Understanding major health care milestones.

It’s one of the very best reasons to visit a doctor: You’re pregnant. And you’re taking the right steps to monitor your health and the health of your growing baby. Check out the major health care milestones along your pregnancy journey below.

Deciding you want to conceive

Congratulations! You’ve decided you want to have a baby.  Now’s a great time to visit your Ob/Gyn.  Find out whether any medications you’re taking are safe during pregnancy. Ask for help with health challenges, such as giving up smoking or managing diabetes. Your doctor may also recommend prenatal vitamins or booster vaccinations.

If you or your partner is at risk of passing on certain disorders, such as Cystic Fibrosis or Tay-Sachs disease, you should pursue genetic counseling before getting pregnant. Families can prevent transmission of some disorders by using preimplantation genetic diagnosis (PGD) and in vitro fertilization (IVF).

First trimester

Your first prenatal visit.

Once you believe you’re pregnant, make an appointment with your Ob/Gyn to confirm the happy news. Your first visit will include a  physical and pelvic exam, Pap test, blood/urine labs, and maybe a flu shot.  Your doctor can also answer questions about weight and nutrition.

How many visits?

Your prenatal care provider will likely request that you schedule monthly check-ups until your 28th week of pregnancy, then bi-monthly check-ups until week 36. In the last month, you’ll be visiting your doctor every week.

11-14 weeks

Your Ob/Gyn will typically perform a  first-trimester screening : This includes a blood test and an ultrasound exam called a nuchal translucency scan. It assesses risks for chromosomal disorders and other problems. Women at higher risk of passing on genetic disorders may be offered a “cell-free DNA test” and a chorionic villus sampling (CVS), in which a small sample of cells is removed from the placenta for testing.

Second trimester

15-20 weeks.

You may undergo a blood test called a  maternal serum screen — also known as a quad screen or multiple market screen—to check for chromosomal disorders and neural tube defects like spina bifida.

18-20 weeks

The most famous and common second-trimester test is the  18- to 20-week ultrasound appointment . This checks the health of your baby’s organs and may also reveal the baby’s gender.

Amniocentesis test

Between weeks 14 and 20, mothers age 35 and older and those with genetic risks may undergo an amnio. In this procedure, a thin needle is inserted into the mother’s uterus to withdraw amniotic fluid. Genetic testing is performed on the fluid.

Third trimester

26-28 weeks.

You’ll likely be  checked for gestational diabetes . If your pregnancy is considered high-risk, you might need additional tests such as a biophysical profile (BPP) or another ultrasound. Your doctor may also discuss birth classes and delivery planning.

Near the very end

At about week 36 or 37, your Ob/Gyn may perform a Group B streptococcus test. This entails collecting cells through vaginal and rectal swabs to test for the presence of bacteria that can cause infection in the newborn. Mothers who test positive are treated with antibiotics during childbirth to protect the baby.

Labor and delivery

Congratulations: It’s time for your baby to enter the world! While most women have vaginal deliveries, some need to deliver through Cesarean section. Anesthesia is the norm for Cesareans, but more than half of women who deliver vaginally also receive epidural or spinal anesthesia. If your due date passes and you haven’t delivered (39 weeks is full-term), your doctor may talk to you about inducing labor.

Baby’s turn for testing

After delivery, your newborn will undergo a round of  blood, hearing and heart screenings . Your pregnancy journey has come to an end, but your baby’s journey is just getting started!

Sources: Office on Women’s Health, U.S. Department of Health and Human Services, March of Dimes.

Your out-of-pocket costs for maternity care and childbirth will vary widely depending on where you live, which services you require and your insurance plan. The best way to save on your care is to choose providers and hospitals in your insurance plan's network. If you’re an Aetna member, you may also be able to get an estimate of your costs through the Member Payment Estimator .

Related content

5 health care questions to ask when you’re starting a family

5 things no one told me about life with a newborn

For Aetna Members

Our Maternity Support Center can help. Log into your member portal at Aetna.com/maternity.

Also of interest:

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Your NHS pregnancy journey

See a midwife or GP as soon as you find out you're pregnant. This is so they can book your pregnancy (antenatal) care and make sure you get all the information and support you need to have a healthy pregnancy.

Your first appointment with a midwife should happen before you're 10 weeks pregnant.

If you're more than 10 weeks pregnant and have not seen a GP or midwife, contact a GP or midwife as soon as possible. They'll see you quickly and help you start your pregnancy (antenatal) care.

What is pregnancy (antenatal) care?

This is the care you have while you're pregnant to make sure you and your baby are as well as possible.

The NHS in England will offer you:

• 10 pregnancy appointments (7 if you've had a child before) to check the health and development of you and your baby
• screening tests to find out the chance of your baby having certain conditions, such as Down's syndrome
• blood tests to check for syphilis, HIV and hepatitis B
• screening for inherited blood disorders (sickle cell and thalassaemia)

You'll be offered more appointments if you or your baby need them.

Depending on your health and where you live, you may see:

• a midwife for all your appointments
• a midwife for some appointments and a GP for others

How do I start my pregnancy care?

As soon as you find out you're pregnant you can book an appointment with:

• local midwife services ( find maternity services near you )
• your GP (if you're not registered with a GP you can find local GPs )

Your first midwife appointment

This appointment lasts around an hour.

Your midwife will ask questions to make sure you get the care that's right for you.

They will ask about:

• where you live and who you live with
• your partner, if you have one
• the baby's biological father's medical history
• any other pregnancies or children
• smoking, alcohol and drug use
• whether you've had fertility treatment
• your physical and mental health, and any issues or treatment you've had in the past
• any health issues in your family
• your job, if you have one

Find out more about what happens at your first midwife appointment .

When and where will my appointments be?

Find out more about when you'll have your antenatal appointments .

Your appointments can take place at:

• a Children's Centre
• a GP surgery

You'll usually go to the hospital for your pregnancy scans.

What can I do now for me and my baby?

It's important not to miss any of your antenatal appointments. Some of the tests and measurements that can find possible problems have to be done at specific times.

There are also things you can do to keep you and your baby as healthy as possible in pregnancy, including:

• not smoking
• not drinking alcohol
• getting some exercise that's safe in pregnancy
• having a healthy pregnancy diet
• knowing which foods to avoid in pregnancy
• taking a folic acid supplement and thinking about taking a vitamin D supplement
• knowing how to avoid infections that may harm your unborn baby , and symptoms to look out for
• knowing which vaccinations you should get
• knowing about baby movements in pregnancy
• knowing how to cope with feelings, worries and relationships in pregnancy

What if I have a health condition?

If you have a health condition, for example diabetes or asthma, these can affect your pregnancy. Pregnancy can also affect any conditions you have.

Do not stop taking your medicine until you've talked with your doctor.

Page last reviewed: 1 August 2022 Next review due: 1 August 2025

The Best Pregnancy Journals For Recording Your Bump-To-Baby Journey (And Even Beyond!)

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Pregnancy journals — or planners, diaries, or scrapbooks — are a wonderful way to document and reflect on this momentous time in your (or a loved one’s) life. From the time you crunch numbers on a due date calculator to the development of the “third-trimester waddle,” pregnancy can feel like it goes on forever — especially if you’re dealing with some uncomfortable symptoms . But here’s the thing: It’s not forever. In fact, it will be over before you know it and the whole experience can feel like a blur amid the excitement and anxiety. That’s why having a journal to keep track of all the memories and milestones is a pregnancy essential , because one day, you’ll look back and cherish them. And if it’s not you who’s pregnant but someone special in your life is, keep in mind that the best pregnancy journal would make a fantastic present for expecting moms .

Keep the memories and mementos from these precious months organized and preserved forever with one of these great pregnancy journals , pregnancy diaries, and pregnancy scrapbooks. You’ll end up with a keepsake you (and your future baby) will treasure forever. Open it to relive your journey from bump to baby whenever you like — minus the back pain and acid reflux!

Pregnancy Planners

This keepsake journal would be a beautiful gift for either an expecting friend or yourself. Jot down all of your memories in separate segments, which include “We're Pregnant,” “Medical Log,” First Trimester, Second Trimester and Third Trimester,” and “Baby's First Year.” This would make a great keepsake to look back on, especially if you’re enjoying pregnancy.

One Reviewer Says: “This book is amazing! It has everything, I was looking at different journals they had one for pregnancy, then another book for baby then another book for keeping on track with exercise. This book has everything. It has nice tabs to jump to different sections. They have a list to fill out to keep on track of baby shower gifts, what to pack in the hospital bag, what to avoid eating, it has so much information. Spots for pictures. You really just fill in the blanks”

Every pregnancy is different — but the first one is extra special. Consider this book to be your pregnancy pal — it has trimester checklists, a section to help brainstorm the perfect baby name, and even a scrapbook section to help you save those incredible ultrasound photos.

One Reviewer Says: “I took a chance because this was one of the more affordable journals, and I hit the jackpot! This journal is extremely thorough and has room for pictures, includes [a] checklist and information from week to week, and has lots of journaling information and even activities each month! I recommend this to anybody who is expecting a baby! And it's much thicker and sturdier than I ever expected. It is perfect for documenting all of the important events along the way during my pregnancy.”

Pregnancy Journal Books

If you’ve been thinking about writing an actual book about your pregnancy, this Pearhead journal makes it even more simple. Starting with a table of contents, you can easily page through special moments of your pregnancy that you want to look back on. Available in seven different designs, you can even choose a similar-yet-different book for each pregnancy.

One Reviewer Says: “I bought this for my daughter who is expecting her first child. This journal is so well done and laid out. It is not a huge-sized journal like she had found at some of the big box bookstores its perfect for her to take with her and write her thoughts and feelings about her pregnancy and [a] great spot to add pictures and keepsakes. She loves that it starts from the time of taking your first pregnancy test all the way until delivery. What a great memory keepsake.”

If you want a pregnancy journal that’s incredibly well designed, then As You Grow might be the right match for you. This journal is also special since it goes all the way up to year five. There’s also ample space to write letters to your child.

One Reviewer Says: “ I’ve seriously never seen a more sweet baby book. This book goes all the way from a family tree, to finding out about the pregnancy, milestones, first holidays and seasons up to five years old!! It has pockets every so often and little spots for pictures. I am obsessed. The calligraphy and modern pictures are beautiful on the pages.”

Pregnancy Diaries

This keepsake journal is meant to be carried with you. You can throw it in a purse or bag, and take it out whenever a thought strikes. Since baby kicks (and nausea) can happen anywhere, who knows when you’ll be inspired to jot things down?

One Reviewer Says: “My sister is expecting her [first] baby and the dad is not involved. I decided to find her a journal since she likes writing. She is 3 months in and really enjoys writing to her baby in the journal. She cried when I gave it to her and still talks about how helpful it has been to document the milestones. The greatest thing about this journal compared to others I looked at is that it is inclusive. A single mom can use it and not be reminded that the father isn't involved because it doesn't include "Mommy and Daddy" titles. What a great concept!”

This book is a must-have if you’re looking for some inspiration for how to plan your pregnancy. It includes trackers, a hospital bag checklist, a doctors appointment tracker, and even gives some guidance on what to eat during your pregnancy.

One Reviewer Says: “My daughter loves her journal. It has helped her keep track of belly size , maternity pictures, and journal weekly. She is truly excited.”

Pregnancy Scrapbooks

Sometimes, the hardest thing about getting journals is remembering to fill them up. Luckily, this one from Unconditional Rosie has bright colorful pages that’ll inspire you to keep writing. Prompts help you remember when you learned you were expecting, and will help guide you as to how big your baby is month by month.

One Reviewer Says: “Wonderful gift for my daughter and our first grandchild! Love the detailed pages.”

This one’s for the parent-to-be who’s always colored outside the lines. Create your own pregnancy scrapbook without the constraints of prefab prompts using this blank album — which is popular, highly-reviewed, and accessibly priced. Acid-free pages protect from oxidation, and a linen cover (available in 12 colors) makes it look as important and fancy as its contents deserve.

One Reviewer Says: “This is a great quality photo album for the price! I bought it keep sentimental notes in, and it serves its purpose very well. The pages are easy to use and have a good amount of adhesive, but I'm still able to easily reposition even thin papers without damage. There's room to add more pages, but I have yet to try that feature, myself. Overall, it's very well designed and exceeded my expectations in both appearance and functionality. I'd definitely purchase this again!”

One of the coolest parts of this pregnancy journal is the “Namestorm” page, where you can see what names your partner preferred, and which ones you liked. For a child, that’ll be fun to look at down the road. There are plenty of prompts for either you or your partner, and the book itself is so well done that you’ll want to check out the company for other milestone journals down the road.

One Reviewer Says: “I purchased this book as soon as I found out I was pregnant. I wanted to be able to capture all that I was feeling throughout my pregnancy. This book could not be more perfect! It provides prompts relevant to both mom and dad from prepregnancy to delivery, family history/tree, calendars, what to expect, some advice, and it even has space for a few pics and memorabilia. My husband and I would definately buy this again for a friend's first pregnancy. It helps to relieve any jitters, and it's very gender neutral. Love!”

Pregnancy is a wonderful thing, but it can also be scary at times. Use the humor in this book title to try and remember that the whole process can be... strange. With this book, you can bookmark what your bump looked like throughout the pregnancy.

One Reviewer Says: “The prompts/questions were by far the best of all the books I saw. I also like that the book is organized by weeks, not months, and has space for belly bump pictures and ultrasound photos. There is a page for each prenatal visit and for each week. There are also other pages regarding how we told family, etc. I feel like this book covers all the essentials in a fun yet diplomatic way.”

SHOP THE STORY

This article was originally published on April 13, 2021

• Pregnant Workers Fairness Act – The Journey and Final Destination

There has been a lot of talk about the Pregnant Workers Fairness Act (PWFA). So, where are we now? What do you need to know? This newsletter provides a snapshot of what it took to get the PWFA and its regulations finalized, where we have landed, and the major takeaways. 

Timeline of PWFA and Focus on Accommodations

The EEOC has been signaling for some time that pregnancy is on its radar. Thus, it’s no surprise that the EEOC spent considerable time and effort getting the PWFA down the line. The PWFA officially went into effect on June 27, 2023. The EEOC, responsible for issuing regulations and other resources for compliance with certain workplace discrimination laws, published its preliminary PWFA regulations on August 11, 2023, followed by a 60-day public comment period. After receiving over 98,000 comments, the EEOC issued final regulations on April 15, 2024, and they went into effect on June 18, 2024.

The PWFA was modeled after the Americans with Disabilities Act (ADA). The ADA is notoriously different than other federal discrimination statutes because it not only prohibits treating employees less favorably based on their disabilities but also requires employers to help employees with disabilities in certain circumstances. In other words, the ADA prohibits employers from discriminating against employees with disabilities and at the same time requires employers to treat them favorably and provide what is commonly known as “reasonable accommodations.” This is different than statutes such as Title VII of the Civil Rights Act and the Age Discrimination in Employment Act, which simply prohibit discrimination.

The previous Pregnancy in Discrimination Act (a 1978 amendment to Title VII) already prohibits discrimination based on pregnancy and requires covered employers to treat pregnant employees the same as others similar in their ability or inability to work. Enter the PWFA, which, like the ADA, requires that employers provide “reasonable accommodations” for a worker’s known limitations related to pregnancy, childbirth, or related medical conditions. Now employers have an affirmative duty to accommodate an employee’s known pregnancy-related needs, just as they must accommodate known needs of an employee with a disability.

EEOC Guidance – Before the Regulations

The EEOC issued some guidance on the PWFA. The EEOC’s examples of potential accommodations include things such as flexible hours, additional breaks, leave for healthcare appointments, providing stools for sitting, excusing employees from lifting and other strenuous activities, and adjustments to the employee’s uniform.

Notably, the EEOC also includes more significant examples of accommodations, such as leave, telework, and temporary reassignment to another vacant position for which the employee is qualified. While the ADA has occasionally provided for such accommodations under certain circumstances, courts have also been hesitant to hold that leave and remote work are reasonable, often because they excuse an “essential job function” of workplace presence and are therefore unreasonable. However, in its list of potential PWFA accommodations, the EEOC goes further, stating that the “[t]emporary suspension of one or more essential functions of a job” could be a reasonable accommodation.

Additionally, the EEOC states that “[l]eave to recover from childbirth or other medical conditions related to pregnancy or childbirth” may be required. There is currently no federal requirement to provide paid parental leave post-childbirth, although the Family and Medical Leave Act requires some unpaid leave, and the EEOC guidance does not state whether such a leave accommodation should be paid or unpaid.

PWFA Regulations

The PWFA regulations are the last thing we have from the EEOC regarding the PWFA, and they will serve as a guiding light for employers and courts trying to figure out what exactly the PWFA requires. We’ve blogged on these regulations twice , noting that they are broad and perhaps more employee-friendly than expected. Here are the highlights:

• With the PWFA’s broad language of “limitations related to pregnancy, childbirth, or related medical conditions,” the EEOC intends for the PWFA to have broad coverage, potentially covering conditions related to fertility and termination of a pregnancy.
• On the other hand, the regulations state that you must only accommodate employees and applicants, as the employee must be the one experiencing the condition. PWFA accommodations are not required “when an employee’s partner, spouse, or family member—and not the employee themselves—has a physical or mental condition related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions.”
• Comparable to the ADA, a complaining PWFA employee must be a “qualified employee” (or applicant) and a “qualified employee” must be able to perform the essential functions of the job. However, unlike under the ADA, there is a caveat: If the employee cannot perform the essential functions, that is acceptable as long as she is able to do so “in the near future” and the inability to perform the essential functions can be reasonably accommodated.
• Consistent with the ADA, employers must engage in the interactive process and cannot require an employee to accept an accommodation without first going through the interactive process. Also similar to the ADA, employers may only deny accommodations if they would cause an undue hardship.
• Employers are only permitted to seek supporting documentation if it is reasonable under the circumstances.

Action Items

Now that we have the PWFA statute and EEOC regulations, employers have the guidance they are going to get (for now) regarding application of the PWFA. Just as with claims under the ADA and Title VII, employees may bring EEOC charges alleging violations of the PWFA and must do so if they plan to subsequently file their own private PWFA lawsuit. Once filed, courts will provide their interpretations of the PWFA and its regulations, and the law will begin to fully take shape.

What can you do now to protect yourself if these charges and lawsuits come knocking?

• Perhaps the most important action item is to revise any written policies and ensure they provide a process for requesting accommodations due to pregnancy.
• You should review job descriptions to make sure they reflect the actual duties of the position and include the position’s essential functions, as these may become important in litigation over what constitutes a reasonable accommodation. Consider including whether the position needs to be done in person and why.
• As part of the above review, revisit the physical requirements of the job. Often times material job changes have taken place, but the job description has not been modified. Employers have gotten tripped up under the ADA by insisting that certain physical requirements, like “no sitting down,” are essential functions of the job only to find out in litigation that employees actually can and/or do sit, or have in the past, while performing some of their job duties.
• You will not want to delay in responding to any employee who indicates they need job assistance due to pregnancy or a related condition, and there is no magic language for the employee’s request. Accordingly, remind your supervisors and managers that they now have a duty to refer to Human Resources any employee who mentions needing an accommodation or other help related to their pregnancy.
• Lastly, the EEOC has published a “Know Your Rights” poster that you should download and post in your workplace, on your intranet, and the like.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations. Attorney Advertising.

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