perinatal

Childbirth is the process of giving birth to a baby. It includes labor and delivery. Usually everything goes well, but problems can happen. They may cause a risk to the mother, baby, or both. Some of the more common childbirth problems include:

• Preterm (premature) labor, when your labor starts before 37 completed weeks of pregnancy
• Premature rupture of membranes (PROM), when your water breaks too early. If labor does not start soon afterwards, this can raise the risk of infection.
• Problems with the placenta, such as the placenta covering the cervix, separating from the uterus before birth, or being attached too firmly to the uterus
• Labor that does not progress, meaning that labor is stalled. This can happen when
  • Your contractions weaken
  • Your cervix does not dilate (open) enough or is taking too long to dilate
  • The baby is not in the right position
  • The baby is too big or your pelvis is too small for the baby to move through the birth canal
• Abnormal heart rate of the baby. Often, an abnormal heart rate is not a problem. But if the heart rate gets very fast or very slow, it can be a sign that your baby is not getting enough oxygen or that there are other problems.
• Problems with the umbilical cord, such as the cord getting caught on the baby's arm, leg, or neck. It's also a problem if cord comes out before the baby does.
• Problems with the position of the baby, such as breech, in which the baby is going to come out feet first
• Shoulder dystocia, when the baby's head comes out, but the shoulder gets stuck
• Perinatal asphyxia, which happens when the baby does not get enough oxygen in the uterus, during labor or delivery, or just after birth
• Perineal tears, tearing of your vagina and the surrounding tissues
• Excessive bleeding, which can happen when the delivery causes tears to the uterus or if you are not able to deliver the placenta after you give birth to the baby
• Post-term pregnancy, when your pregnancy lasts more than 42 weeks

If you have problems in childbirth, your health care provider may need to give you medicines to induce or speed up labor, use tools to help guide the baby out of the birth canal, or deliver the baby by Cesarean section.

NIH: National Institute of Child Health and Human Development

If you are pregnant or planning to get pregnant, it's important to get tested for HIV as soon as possible. If you find out that do have HIV, you can start treatment right away to protect your health and the health of your baby.

If you are pregnant and have HIV, there is a risk of passing HIV to your baby. It can happen in three ways:

• During pregnancy
• During childbirth, especially if it is vaginal childbirth
• During breastfeeding

But having HIV doesn't mean that you can't have children. Treatment with a combination of HIV medicines can help prevent passing HIV to your baby and protect your own health.

There are several different steps you can take to help prevent passing HIV to your baby:

• Taking HIV medicines. HIV medicines reduce the amount of HIV in the body (viral load) to a very low level. The goal is to get your viral load so low that a standard lab test can't detect it. This is called having an "undetectable viral load." Having an undetectable viral load is the best thing you can do to stay healthy and prevent your baby from getting HIV. These medicines will also help protect your health. Most HIV medicines are safe to use during pregnancy. They don't usually raise the risk of birth defects. But it is important to talk with your health care provider about the risks and benefits of the different medicines. Together you can decide which medicines are right for you. Then you need to make sure you take your medicines regularly.
• If needed, having a cesarean delivery. If your viral load is not reduced enough by the medicines, having a cesarean delivery (C-Section) can help prevent passing HIV to your baby.
• Giving HIV medicines to the baby. Your baby will get HIV medicines as soon as possible after birth. The medicines protect your baby from infection from any HIV that passed from you during childbirth. Which medicine your baby gets depends on several factors, including what your viral load was just before you gave birth. Your baby will need to take medicines for 4 to 6 weeks. He or she will get several HIV tests over the first few months.
• Not breastfeeding. Breast milk can have HIV in it. In the United States, infant formula is safe and readily available. So the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend that if you have HIV, you should feed your baby formula instead of breastfeeding.

If you are trying to get pregnant, it's important for your partner to also get tested for HIV.

If your partner does have HIV and you do not, talk to your provider about taking PrEP. PrEP stands for pre-exposure prophylaxis. This means taking medicines to prevent HIV. The PrEP helps to protect both you and your baby from HIV.

Many women have the baby blues after childbirth. If you have the baby blues, you may have mood swings, feel sad, anxious or overwhelmed, have crying spells, lose your appetite, or have trouble sleeping. The baby blues most often go away within a few days or a week. The symptoms are not severe and do not need treatment.

The symptoms of postpartum depression last longer and are more severe. You may also feel hopeless and worthless and lose interest in the baby. You may have thoughts of hurting yourself or the baby. Very rarely, new mothers develop something even more serious. They may have hallucinations or try to hurt themselves or the baby. They need to get treatment right away, often in the hospital.

Postpartum depression can begin anytime within the first year after childbirth. The cause is unknown. Hormonal and physical changes after birth and the stress of caring for a new baby may play a role. Women who have had depression are at higher risk.

If you think you have postpartum depression, tell your health care provider. Medicines, including antidepressants, and talk therapy can help you get well.

Dept. of Health and Human Services Office on Women's Health

Anxiety is a feeling of fear, dread, and uneasiness. It might cause you to sweat, feel restless and tense, and have a rapid heartbeat. It can be a normal reaction to stress. For example, you might feel anxious when faced with a difficult problem at work, before taking a test, or before making an important decision. It can help you to cope. The anxiety may give you a boost of energy or help you focus. But for people with anxiety disorders, the fear is not temporary and can be overwhelming.

Anxiety disorders are conditions in which you have anxiety that does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships.

There are several types of anxiety disorders, including:

• Generalized anxiety disorder (GAD). People with GAD worry about ordinary issues such as health, money, work, and family. But their worries are excessive, and they have them almost every day for at least 6 months.
• Panic disorder. People with panic disorder have panic attacks. These are sudden, repeated periods of intense fear when there is no danger. The attacks come on quickly and can last several minutes or more.
• Phobias. People with phobias have an intense fear of something that poses little or no actual danger. Their fear may be about spiders, flying, going to crowded places, or being in social situations (known as social anxiety).

The cause of anxiety is unknown. Factors such as genetics, brain biology and chemistry, stress, and your environment may play a role.

The risk factors for the different types of anxiety disorders can vary. For example, GAD and phobias are more common in women, but social anxiety affects men and women equally. There are some general risk factors for all types of anxiety disorders, including:

• Certain personality traits, such as being shy or withdrawn when you are in new situations or meeting new people
• Traumatic events in early childhood or adulthood
• Family history of anxiety or other mental disorders
• Some physical health conditions, such as thyroid problems or arrhythmia

The different types of anxiety disorders can have different symptoms. But they all have a combination of:

• Anxious thoughts or beliefs that are hard to control. They make you feel restless and tense and interfere with your daily life. They do not go away and can get worse over time.
• Physical symptoms, such as a pounding or rapid heartbeat, unexplained aches and pains, dizziness, and shortness of breath
• Changes in behavior, such as avoiding everyday activities you used to do

Using caffeine, other substances, and certain medicines can make your symptoms worse.

To diagnose anxiety disorders, your health care provider will ask about your symptoms and medical history. You may also have a physical exam and lab tests to make sure that a different health problem is not the cause of your symptoms.

If you don't have another health problem, you will get a psychological evaluation. Your provider may do it, or you may be referred to a mental health professional to get one.

The main treatments for anxiety disorders are psychotherapy (talk therapy), medicines, or both:

• Psychotherapy can help you recognize and change troubling emotions, thoughts, and behaviors. To be effective, it should focus on your specific anxieties and needs. There are many types; some of the types used for anxiety disorders include:
  • Cognitive behavioral therapy (CBT), which teaches you different ways of thinking and behaving. It can help you change how you react to the things that cause you to feel fear and anxiety. It may include exposure therapy. This therapy focuses on having you confront your fears so that you will be able to do the things that you had been avoiding.
  • Acceptance and commitment therapy may help with some anxiety disorders. It uses strategies such as mindfulness and goal setting to reduce discomfort and anxiety.
• Medicines to treat anxiety disorders include anti-anxiety medicines and certain antidepressants. Some types of medicines may work better for specific types of anxiety disorders. You should work closely with your provider to identify which medicine is best for you. You may need to try more than one medicine before you can find the right one.

Support groups and stress management techniques may also be helpful.

NIH: National Institute of Mental Health

A cesarean delivery, also called a cesarean section or c-section, is surgery to deliver a baby. The baby is taken out through your abdomen (belly). In the United States, almost one in three babies are born this way. Some cesarean deliveries are planned. Others are emergency cesarean deliveries, which are done when unexpected problems happen during delivery.

You may need a cesarean delivery because:

• You have health problems, including infection
• You are carrying more than one baby
• Your baby is too big
• Your baby is in the wrong position
• Your baby's health is in danger
• Labor is not moving along as it should
• There are problems with your placenta (the organ that brings oxygen and nutrients to your baby)

Not everyone who has had a cesarean delivery before will need another one next time. You may be able to have a vaginal birth after cesarean (VBAC). Talk to your health care provider about what is right for you.

Before the surgery, you will be given pain medicine. Depending on your circumstances, you might get:

• An epidural block, which numbs the lower part of the body through an injection in the spine.
• A spinal block, which numbs the lower part of the body through an injection directly into the spinal fluid.
• General anesthesia, which makes you unconscious during the surgery. This is often used during emergency cesarean deliveries.

During the surgery, the surgeon will:

• Make a cut in your abdomen and uterus. The cut is usually horizontal, but in some cases it may be vertical.
• Open the amniotic sac and take out your baby.
• Cut the umbilical cord and the placenta.
• Close the uterus and abdomen with stitches that will later dissolve.

A cesarean delivery is relatively safe for you and your baby. But it is still a major surgery, and it carries risks. They may include:

• Infection
• Blood loss
• Blood clots in the legs, pelvic organs, or lungs
• Injury to surrounding structures, such as the bowel or bladder
• A reaction to the medicines or anesthesia used

Some of these risks do also apply to a vaginal birth. But it does take longer to recover from a cesarean delivery than from a vaginal birth. And having a cesarean delivery can raise the risk of having difficulties with future pregnancies. The more cesarean deliveries you have, the more the risk goes up.

NIH: National Institute of Child Health and Human Development

When you are ready to have your baby, you'll go through labor. Labor is the process of giving birth. Signs that you might be going into labor include:

• Contractions that are regular then start to come closer together
• Leaking fluid or bleeding from the vagina
• Low, dull backache
• Abdominal cramps

Call your health care provider if you have any of these signs, even if it is before your due date. Preterm labor can start before 37 completed weeks of pregnancy.

Labor happens in three stages. The first stage begins with contractions. It continues until your cervix has become thinner and dilated (stretched) to about 4 inches wide. The second stage is the active stage, in which you begin to push downward. Crowning is when your baby's scalp comes into view. Shortly afterward, your baby is born. In the third stage, you deliver the placenta. The placenta is the organ that supplied food and oxygen to your baby during pregnancy.

Mothers and babies are monitored closely during labor. Most women are able to have a baby through normal vaginal delivery. If there are complications, the baby may need to be delivered surgically by a Cesarean section.

NIH: National Institute of Child Health and Human Development

A miscarriage is an unexpected loss of pregnancy before the 20th week of pregnancy. Most miscarriages happen very early in the pregnancy, often before a woman even knows she is pregnant.

Factors that may contribute to miscarriage include:

• A genetic problem with the fetus
• Problems with the uterus or cervix
• Chronic diseases, such as polycystic ovary syndrome

Signs of a miscarriage include vaginal spotting, abdominal pain or cramping, and fluid or tissue passing from the vagina. Bleeding can be a symptom of miscarriage, but many women also have it in early pregnancy and don't miscarry. To be sure, contact your health care provider right away if you have bleeding.

Women who miscarry early in their pregnancy usually do not need any treatment. In some cases, there is tissue left in the uterus. Doctors use a procedure called a dilatation and curettage (D&C) or medicines to remove the tissue.

Counseling may help you cope with your grief. Later, if you do decide to try again, work closely with your health care provider to lower the risks. Many women who have a miscarriage go on to have healthy babies.

NIH: National Institute of Child Health and Human Development

During pregnancy, there are many things you can do to keep yourself and your baby healthy. They include getting regular prenatal care, eating healthy, and staying active. But it's also very important to avoid substances that could be harmful to you and your baby, such as tobacco, alcohol, and drugs.

Tobacco

Smoking during pregnancy passes nicotine, carbon monoxide, and many other harmful chemicals to your baby. Nicotine is not only a health danger for you, but it can also damage your developing baby's brain and lungs. Carbon monoxide can keep the developing baby from getting enough oxygen.

If you smoke while pregnant, it raises the risk of your baby being born too small, too early, or with birth defects. During the first year of life, there is a higher risk of your baby dying from sudden infant death syndrome (SIDS). And later in life, your child may be more likely to have health problems, such as asthma and obesity.

Other tobacco products, including e-cigarettes, also contain nicotine and are not safe to use during pregnancy. And some of the flavorings used in e-cigarettes may be harmful to developing babies.

You will also want to try to avoid secondhand smoke, which has some of the same risks as smoking during pregnancy.

Alcohol

There is no known amount of alcohol that is safe for you to drink during pregnancy and while trying to get pregnant. All types of alcohol are equally harmful, including all wines and beer. The risks from drinking during pregnancy include problems with the growth of the developing baby and fetal alcohol spectrum disorders (FASD). FASD is a life-long condition that can cause a mix of physical, behavioral, and learning problems.

Illegal drugs

Using illegal drugs, such as cocaine, methamphetamines, and club drugs, during pregnancy can cause problems for both you and your baby. They may cause low birth weight babies, birth defects, or miscarriage. Your child may be more likely to have learning and developmental disabilities. And if you are injecting the drugs, that puts you at risk for HIV. HIV can be passed along to your baby during pregnancy.

Prescription drug misuse

Misusing prescription drugs can also be harmful. Misuse can include taking more than your prescribed dose or taking it more often, using it to get high, or taking someone else's medicines. The possible effects of misusing a medicine during pregnancy will depend on which medicine you are misusing.

Opioids

One type of drug that is a concern during pregnancy is opioids. Opioids include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid. Taking opioids during pregnancy can cause problems for you and your baby. The risks include birth defects, preterm birth, the loss of the baby, and neonatal abstinence syndrome (NAS). NAS causes withdrawal symptoms in newborn babies.

If you have pain and your health care provider suggests that you take prescription opioids during pregnancy, first discuss the risks and benefits with the provider. Then if you both decide that you need to take the opioids, you can work together to try to minimize the risks.

Cannabis (marijuana)

Getting help

If you are taking opioids or are addicted to drugs, don't stop taking them suddenly. That can be dangerous to you and the baby. Instead, contact your provider for help with getting off the drugs safely.

Almost 1 of every 10 infants born in the United States are premature, or preemies. A premature birth is when a baby is born before 37 completed weeks of pregnancy. A full-term pregnancy is 40 weeks.

Important growth and development happen throughout pregnancy - especially in the final months and weeks. Because they are born too early, preemies weigh much less than full-term babies. They may have health problems because their organs did not have enough time to develop. Problems that a baby born too early may have include:

• Breathing problems
• Feeding difficulties
• Cerebral palsy
• Developmental delay
• Vision problems
• Hearing problems

Preemies need special medical care in a neonatal intensive care unit, or NICU. They stay there until their organ systems can work on their own.

Centers for Disease Control and Prevention

Prenatal care is the health care you get while you are pregnant. It includes your checkups and prenatal testing. Prenatal care can help keep you and your baby healthy. It lets your health care provider spot health problems early. Early treatment can cure many problems and prevent others.

Your doctor or midwife will give you a schedule for your prenatal visits. If you are over 35 years old or your pregnancy is high risk because of health problems like diabetes or high blood pressure, your doctor or midwife will probably want to see you more often. You can also expect to see your health care provider more often as your due date gets closer.

Dept. of Health and Human Services Office on Women's Health