Chapter One
The First Month Approximately 1 to 4 Weeks
Congratulations-and welcome to your pregnancy! Though you almost certainly don't look pregnant yet, chances are you're already starting to feel it. Whether it's just tender breasts and a little fatigue you're experiencing, or every early pregnancy symptom in the book (and then some), your body is gearing up for the months of baby-making to come. As the weeks pass, you'll notice changes in parts of your body you'd expect (like your belly), as well as places you wouldn't expect (your feet and your eyes). You'll also notice changes in the way you live-and look at-life. But try not to think (or read) too far ahead. For now, just sit back, relax, and enjoy the beginning of one of the most exciting and rewarding adventures of your life.
What You Can Expect at Your First Prenatal Visit
Your first prenatal visit will probably be the longest you'll have during your pregnancy, and definitely will be the most comprehensive one. Not only will there be more tests, procedures (including several that will be performed only at this visit), and data gathering (in the form of a complete medical history), but there will be more time spent on questions (questions you have for the practitioner, questions he or she will have for you) and answers. There will also be plenty of advice to take in-on everything from what you should be eating (and not eating) to what supplements you should be taking to whether (and how) you should be exercising. So be sure to come equipped with a list of the questions and concerns that have already come up, as well as with a pen and notebook (or What to Expect When You're Expecting Pregnancy Organizer) to take notes with.
One practitioner's routine may vary slightly from another's. In general, the examination will include:
Confirmation of your pregnancy. Your practitioner will want to check the following: the pregnancy symptoms you are experiencing; the date of your last normal menstrual period to determine your estimated date of delivery (EDD) or due date (see page 8); your cervix and uterus for signs and approximate age of the pregnancy. A pregnancy test (urine and blood) will most likely be ordered.
A complete history. To give you the best care possible, your practitioner will want to know a great deal about you. Come prepared by checking records at home or calling your primary care doctor to refresh your memory on the following: your personal medical history (chronic illness, previous major illness or surgery, known allergies, including drug allergies); nutritional supplements (vitamins, minerals, herbal, and so on) or medications (over-the-counter, prescription) you are presently taking or have taken since conception; your family medical history (genetic disorders, chronic diseases, unusual pregnancy outcomes); your personal gynecological history (age at first menstrual period, usual length of menstrual cycle, duration and regularity of menstrual periods); your personal obstetrical history (past live births, miscarriages, abortions2), as well as the course of past pregnancies, labors, and deliveries. Your practitioner will also ask questions about your social history (such as your age and occupation) and about your lifestyle habits (how you eat, whether or not you exercise, drink, smoke, or take recreational drugs) and other factors in your personal life that might affect your pregnancy (information about the baby's father, information on your ethnicity).
A complete physical examination. This may include assessment of your general health through examination of heart, lungs, breasts, abdomen; measurement of your blood pressure to serve as a baseline reading for comparison at subsequent visits; notation of your height and your weight (prepregnancy and present); inspection of arms and legs for varicose veins and edema (swelling from excess fluid in tissues) to serve as a baseline for comparison at subsequent visits; examination of external genitalia and of your vagina and cervix (with a speculum in place, as when you get a Pap smear); examination of your pelvic organs bimanually (with one hand in the vagina and one on the abdomen) and also possibly through the rectum and vagina; assessment of the size and shape of the bony pelvis (through which your baby will eventually try to exit).
A battery of tests. Some tests are routine for every pregnant woman; some are routine in some areas of the country or with some practitioners, and not others; some are performed only when circumstances warrant. The most common prenatal tests include:
A blood test to determine blood type and Rh status (see page 29), hCG levels, and to check for anemia (see page 187)
Urinalysis to screen for glucose (sugar), protein, white blood cells, blood, and bacteria
Blood screens to determine antibody titer (levels) and immunity to such diseases as rubella
Tests to disclose the presence of infections such as syphilis, gonorrhea, hepatitis B, chlamydia, and, very often, HIV
Genetic tests for cystic fibrosis, sickle-cell anemia, Tay-Sachs, or other genetic disease, if appropriate (see page 45)
A Pap smear for the detection of cervical cancer
A blood sugar level test to check for any tendency toward diabetes in women with a family history of diabetes and those who have high blood pressure, have previously had an excessively large baby or one with birth defects, or who had gained excessive weight with an earlier pregnancy. (All women receive a glucose screening test for gestational diabetes at around 28 weeks; see page 266.) An opportunity for discussion. Here's the time to bring out that list of questions and concerns.
What You May Be Feeling
You may experience all of these symptoms at one time or another, or only one or two.
What's important to keep in mind from now on is that every woman and every pregnancy is different; few pregnancy symptoms are universal.
Physically
Absence of menstruation (though you may stain slightly when your period would have been expected or when the fertilized egg implants in the uterus, around seven to ten days after conception)
Fatigue and sleepiness
Frequent urination
Nausea, with or without vomiting, and/or excessive salivation
Heartburn, indigestion, flatulence, bloating
Food aversions and cravings
Breast changes (most pronounced in women who have breast changes prior to menstruation, and possibly somewhat less pronounced if you've had babies before): fullness, heaviness, tenderness, tingling; darkening of the areola (the pigmented area surrounding the nipple). Sweat glands in the areola become prominent, looking like large goose bumps; a network of bluish lines appears under the skin as blood supply to the breasts increases (though, in some women, these lines may not appear until later).
Emotionally
Instability comparable to premenstrual syndrome, which may include irritability, mood swings, irrationality, weepiness
Misgivings, fear, joy, elation-any or all of these
What You May Be Concerned About Breaking the News
"When should we tell friends and family that we are expecting?"
This is one question only you can answer. Some expectant parents can't wait to tell everyone they know the good news (not to mention a fair number of strangers who happen to pass them in the street or sit next to them on the bus). Others tell only selectively at first, starting with those nearest and dearest (close relatives and friends, perhaps), and waiting until the condition is obvious before making the pregnancy common knowledge. Still others decide they'd rather put off issuing announcements until the third month has passed, just in case of miscarriage (especially if there's been a previous pregnancy loss).
So talk it over, and do what feels most comfortable. Just remember: in spreading the good news, don't forget to take the time to savor it as a twosome.
Telling the Boss
"No one at work knows I'm pregnant yet-and I'm not sure when and how I should tell them, especially my boss. I'm not sure how they'll react."
Since most expectant mothers are also members of the workforce, pregnancy protocol on the job has become an important issue for employees and employers alike. Official leave policies and benefits vary widely from company to company, as do unofficial policies of family-friendliness. In deciding when and how to broach the subject of your pregnancy with the powers that be at your company, you'll need to consider the following:
How you're feeling and whether you're showing. If morning sickness has you spending more time hovering over the toilet than sitting at your desk; if first trimester fatigue has you barely able to lift your head off your pillow in the morning; or if you're already packing a paunch that's too big to blame on your breakfast, you probably won't be able to keep your secret long. In that case, telling sooner makes more sense than waiting until your boss (and everyone else in the office) has come to his or her own conclusions. If, on the other hand, you're feeling fine and still buttoning your waistband with ease, you may be able to hold off on the announcement until later.
What kind of work you do. If you work under conditions or with substances that could be harmful to your pregnancy or your baby (see page 76), you'll need to make your announcement-and ask for a transfer or change of duties-as soon as you find out you're pregnant.
How work is going. A woman announcing her pregnancy at work may unfortunately-and unfairly-raise many red flags, including "Will she still have the stamina to produce while pregnant?" and "Will her mind be on work or on her belly?" and "Will she leave us in the lurch?" You may head off some of those concerns by making your announcement just after finishing a report, scoring a deal, winning a case, coming up with a great idea, or otherwise proving that you can be both pregnant and productive.
Whether reviews are coming up. If you're afraid your announcement might influence the results of an upcoming performance or salary review, wait until the results are in before spilling the beans. Keep in mind that proving you've been passed up for a promotion or raise based solely on the fact that you're expecting (and that you'll soon be a worker and a mother, not necessarily in that order) may be difficult.
Whether you work in a gossip mill. If gossip is one of your company's chief products, be especially wary. Should word-of-mouth of your pregnancy reach your boss's ears before your announcement does, you'll have trust issues to deal with in addition to the pregnancy-related issues. Make sure that your boss is the first to know-or, at least, that those you tell first can be trusted not to squeal.
What the family-friendliness quotient is. Try to gauge your employer's attitude toward pregnancy and family. Ask other women who have been pregnant on the job, if there are any (but keep your inquiries discreet). Check the policies on pregnancy and maternity leave in your copy of the company handbook (if there is one). Or set up a confidential meeting with someone in human resources or the person in charge of benefits. If the company has had a history of being supportive of mothers and mothers-to-be, you may be inclined to make your announcement sooner. Either way, you'll have a better sense of what you'll be facing.
Once you've decided when to make your announcement, you can take some steps to ensure that it's well received:
Know your rights. Pregnant women-and parents in general-have fewer rights in the United States than in most every other industrialized country. Still, some strides have been made on the federal level through the Pregnancy Discrimination Act and the Family Medical Leave Act (see box above), and many others have been made voluntarily by forward-thinking, family-friendly companies. Become familiar with what the law and your company's policies say you're entitled to, so you'll know what you can and probably can't ask for. For instance, some companies offer paid leave, others unpaid. Still others allow you to use sick days or vacation days as part of your leave. All of this should be detailed in a company handbook, if there is one. Or, set up a confidential meeting with someone in human resources or whoever is in charge of benefits.
Put together a plan. Efficiency is always appreciated on the job, and being prepared invariably impresses people. So before you go in to make your announcement, have a detailed plan that includes how long you plan to stay on the job (barring any unforeseen medical problems, including premature labor), how long your maternity leave will be, how you plan to finish up business before you leave, and how you propose that any unfinished business be handled by others. If you would like to return part-time at first, now is when you should propose that. Writing up your plan will ensure you won't forget the details.
Set aside the time. Don't try to tell your boss the news when you're in a taxi on the way to a meeting or when she's got one foot out the door Friday night. Make an appointment to meet, so no one will be rushed or distracted. Try to make it on a day and at a time that is usually less stressful at your office. Postpone the meeting if things suddenly take a turn for the tense.
Accentuate the positive. Don't start your announcement with apologies or misgivings. Instead, let your boss know that you are not only happy about your pregnancy, but confident in your ability and committed in your plan to mix work and family.
Be flexible (but not spineless). Have your plan in place, and open it up to discussion. Then be ready to compromise (make sure there is room for negotiation built into your plan), but not to back down completely. Come up with a realistic bottom line and stick with it.
Set it in writing. Once you've worked out the details of your pregnancy protocol and your maternity leave, confirm it in writing so there won't be any confusion or misunderstanding later (as in "I never said that ...").
Never underestimate the power of parents. If your company is not as family-friendly as you'd like, consider joining forces to petition for better parental perks. Realize, however, that you and other parents may be met with hostility by childless employees; as family policies become more generous, resentment tends to build among those who can't take advantage of these. Making sure that similar allowances are made for employees who must take time off to care for sick spouses or parents may help unite, rather than divide, the company.
Fatigue
"I'm tired all the time. I'm worried that I won't be able to continue working."
It would be surprising if you weren't tired.
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Excerpted from What to Expect When You're Expecting by Heidi E. Murkoff Copyright © 2002 by Heidi E. Murkoff. Excerpted by permission.
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