In general, ovulation occurs about 14 days before the start of the next menstrual flow, for example, day 10 of a 24 day cycle, day 14 of a 28 day cycle, or day 18 of a 32 day cycle. It is a good idea to track your menstrual period over several months to determine when ovulation is occurring. Day 1 is considered to be the start of your menstrual flow. For many women, menstrual periods may vary slightly from one month to the next; therefore, the precise day of ovulation may be variable from month to month.

Some other ways to determine ovulation include:

• Immediately following a menstrual period, there is usually no obvious vaginal discharge. Close to ovulation a woman begins to sense a feeling of wetness as the amount of mucus increases. Close to ovulation the mucus becomes watery, clear, and slippery. Sperm deposited in this type of mucus can survive until ovulation occurs.

Measurement Of Basal Body Temperature

• A special thermometer that measures temperature in tenths of a degree is used. The women records her oral temperature each morning upon awakening. During the early part of the cycle a woman's temperature remains fairly constant, and just prior to ovulation the temperature will fall about .3 of one degree. This fall in body temperature is followed by a rise in temperature of about .5-1.0 degree. Ovulation is likely to be occurring when the temperature first rises. Normally the woman's body temperature stays elevated until the next menstrual period begins.

How Soon Can I Tell If I Am Pregnant?

Pregnancy can be diagnosed about 2 weeks after conception, which is about the day that your period is expected, though you are more likely to get accurate results if you wait at least another three to four days. When pregnancy occurs, the embryo releases a hormone called human chorionic gonadotrpohin (HCG) into your bloodstream. This hormone also spills over into your urine and can be detected with a home pregnancy test. Depending on which pregnancy kit you are using, the home pregnancy test can be performed between one and four days after your period was due. If a false reading is obtained, but your menstrual period does not follow, the test should be repeated, since you may have tested your urine before enough of the detectable hormone was present. It is recommended that you use your first voided specimen of the morning for testing, since your urine tends to more concentrated at this time.

If I Am Pregnant, When Should I Begin Seeing A Doctor?

You should contact your health care provider when you suspect or know that you are pregnant. They will schedule a visit for somewhere between six to eight weeks after your last menstrual period. In the meantime, you will be advised to start taking pre-natal vitamins. Other immediate concerns and questions that you may have can be discussed when you schedule your appointment.

During your first pre-natal visit a family and personal health history will be obtained. An internal examination will be performed to determine the size and contour of your uterus. A PAP smear is taken. Your weight and blood pressure will be recorded. Several vials of blood are taken for various laboratory tests. These results will be discussed with you on subsequent return visits. Urine is routinely checked at each pre-natal visit.

In the early months of pregnancy, one visit per month is usually adequate. During the last half, visits will be increased to every two to three weeks, and during the last month every week.

How Can I Determine When The Baby Is Due?

Using the following formula, you can estimate the date that your baby is due:

• Add seven days to the first day of your last menstrual period
• Subtract three months and add one year

This formula assumes that the woman has a 28 day cycle and that the pregnancy occurred on day 14. Your practitioner may make an adjustment to this date if your cycles are longer or shorter than 28 days. Research shows that only 4-10% of women deliver on their due date, but the majority of women will deliver in the period extending from 7 days before to 7 days after the due date.

How Is The Baby's Sex Determined?

A women's egg cells and a man's sperm cells each contain 23 single chromosomes, which are not paired until they meet their opposite number. Of the 23 single chromosomes, one is always a sex chromosome. Each egg always has an X (female) sex chromosome, but the sex chromosome present in any sperm can be either X (female) or Y (male). Hence, the sex of the baby is dependent on which type of sperm cell fertilizes the egg. The sex of the baby is determined at conception.

How Much Weight Should I Gain During Pregnancy?

Most practitioners agree that a weight gain between 25 and 30 pounds. is recommended during pregnancy. Some women may gain more with no ill effects.

Weight gain in pregnancy begins slowly, only to pick up steadily later on. The timing of your total weight gain will be approximately:

• 0-12 weeks - little or no weight gain
  12-20 weeks - 25% of weight gain
  20-30 weeks - 50% of weight gain
  30-36 weeks - 25% of weight gain
  36-40 weeks - little or no weight gain

• Breast Changes. Breast changes in preparation for milk production begin early in pregnancy. The brown circles around the nipples (areolae) become darker. The blood vessels become more prominent. Your breasts may feel tender and heavy. Many women note an increase in breast size early on.
• Fatigue. While your body is undergoing enormous metabolic changes to adjust to your growing baby, it is not surprising that during the first eight to ten weeks many women complain of extreme tiredness. As your body adjusts to the pregnancy, many women report that fatigue lessens during the second trimester.
• Nausea. Nausea is another common sign of pregnancy. It more commonly occurs in the morning and may or may not be accompanied by vomiting. Both tiredness and an empty stomach are thought to contribute to nausea. Small frequent snacks of bland food may help.
• Frequent urination. The growing uterus stretches the base of the bladder, resulting in a feeling of fullness.
• Abdominal Enlargement. The pregnancy may begin to "show" anywhere from the twelfth week, depending on the women's height, weight and previous pregnancies. The growth in the size of the uterus is proportional to the gestational age of the baby. Your practitioner will routinely measure the height of the uterus, as a way to evaluate fetal growth. The diagram gives an illustration of how the uterus expands in pregnancy:
• Gum softening. Gums often bleed during pregnancy even with mild irritation from a toothbrush. This is normal and will disappear after pregnancy.
• Constipation.Constipation is a common complaint in pregnancy. It can be due to the slowed action of the intestines and pressure on the rectum by the growing baby.
• Dizziness.Lightheadedness, especially when standing up too quickly, is common. It is related in part to the delay in the return of blood to the heart because of the pressure the uterus exerts on the veins in the abdomen.
• Swelling. This commonly occurs in the feet and ankles toward the end of pregnancy but swelling may be present in other body parts due to the accumulation of fluid in the tissues. Mood swings. Many women report wide mood swings and unusual sensitivity to their surrounding environment. Crying episodes may be common and occur with little provocation.
• Quickening. This refers to the active movements of the baby that are felt by the mother. They usually begin somewhere between 16-20 weeks of pregnancy and are often described as a "fluttering" sensation.
• Fetal heartbeat. With the aid of ultrasound techniques the heartbeat of the baby can be detected through the abdominal wall as early as seven weeks. Your practitioner will begin listening for the heartbeat during your routine office visits by the third or fourth month.

Do I Need To Modify My Activity And Exercise Routines During Pregnancy?

Experts have varying opinions on their recommendations for exercise during pregnancy. The amount of exercise that a pregnant women can comfortably and safely carry out is usually related to what she has been accustomed to before pregnancy. During any form of exercise it is especially important for a pregnant women to "listen to her body" and rest when she begins to feel fatigued, or stop exercising during any routine that causes pain or strain. Activities that involve sudden and excessive jolting motions, along with those that impose a danger of falling (horseback riding, skiing, roller blading) are best avoided, especially as the abdomen enlarges.

Employment of the pregnant women can continue up until the time of delivery, as long as there are no complications. A job may need to be modified if it involves significant physical labor.

How Do My Nutritional Needs Change During Pregnancy?

Your baby depends on what you eat and drink for adequate nourishment in the uterus. If a women is nutritionally deprived, her baby is deprived. Although you need to make good food choices, you do not need "to eat for two." Most pregnant women require about 300 extra calories per day during pregnancy. These extra calories should be used to increase your protein and calcium intakes. Foods rich in protein include: lean meats, fish, beans, nuts, milk yogurt, cheeses and other dairy products. Increases in milk consumption are usually recommended for the pregnant women since milk is an obvious source of calcium. Consumed in large quantities, whole milk is fattening, so lowfat milk is a good alternative. Experts recommend the equivalent of about 1 pint of milk per day.

A pre-natal multi-vitamin is recommended during pregnancy. If you are already taking a daily vitamin, check with your practitioner to be sure you are getting enough iron and mineral supplements. Most daily vitamins do not contain the recommended number of vitamins and minerals for pregnancy.

What Drugs Or Medications Can I Safely Take During Pregnancy?

It is wisest to take the fewest possible medications during pregnancy, since the full range of substances to which the embryo and fetus may be vulnerable is not yet known. What is known is that drugs can cross the placenta and affect the baby. The best policy in pregnancy seems to be to use drugs only if there is no alternative, and the symptoms are annoying, disruptive or dangerous. Both prescription and over the counter drugs should be treated this way. You will need to consult with your practitioner, who can balance the benefits of the drug versus the risks to the baby, before taking any medications during pregnancy.

Experts agree that alcohol is best avoided during pregnancy.

How Will I Know When Labor Has Begun?

The onset of labor is usually indicated by one of the following:

• A bloody show. This is the bloodstained mucus discharge that appears when the cervix (the opening of the uterus) begins to stretch. Until labor, this plug in the cervix seals off the uterus. The bloody show can precede the onset of labor by several weeks, so your practitioner will not have you come to the hospital unless other signs of labor are also present.
• The water bag breaks. When the membranes surrounding the baby have been pressed to the point where they can no longer withstand the pressure, the bag pops. It may occur suddenly with a gush of water, or more slowly. Your practitioner may want to be notified when this happens, even if you are not yet having contractions.
• Contractions begin. Contractions usually feel like a tight elastic belt over the lower portion of the abdomen and around into the back. They usually increase in intensity over 15-20 seconds, and then ease up. Once you begin to feel several contractions in a row, they should be timed. Once contractions get going well, they have a regular rhythm and last longer, while the interval between them is reduced. Many women experience what are referred to as Braxton-Hicks, or rehearsal contractions, before the true onset of true labor. Your practitioner will give you precise instructions about when to call if you begin having contractions.

Once labor is underway, it is divided into three stages:

• Stage 1. This begins with dilation of the cervix and ends when the cervix is fully dilated at 10 centimeters. It is the longest stage of labor, beginning with mild contractions and ending with progressively stronger contractions. Typically stage 1 is longer in first pregnancies and shorter in subsequent ones.
• Stage 2. This begins once the cervix has fully dilated. It is the stage where expulsion or birth of the baby occurs. It is usually shorter than stage 1, and is accomplished by the women's bearing down with each contraction in an effort to push out the baby. Stage 2 ends with delivery of the baby.
• Stage 3. This is the final stage of labor and it involves the expulsion of the placenta or afterbirth. It is the shortest stage, usually lasting about 15 minutes. There is little pain associated with this stage. Vaginal bleeding is normal during this stage, with most women averaging about ½ pint of blood loss.

How Can I Deal With The Pain Of Labor?

Understanding the pain of labor is an important component in dealing with it. Women and their partners are encouraged to partake in prenatal childbirth classes, where much effort goes into explaining what to expect and how to deal with the pain of childbirth. There are a variety of pain relieving drugs available, and different drugs will suit different women. Whether or not you have drugs in childbirth and how much you have is up to you. Keep in mind that all drugs for pain relief pass through the mother's bloodstream and into the baby. They will all affect the baby some more than others. Examples of some of the common drugs given during labor include:

Narcotics. These are the most widely used drugs during labor. They can be given intravenously or by injection and take effect in 2-15 minutes. They will "take the edge off" of the pain, and some women report that they help them to cope with the difficult contractions.

Local anesthetics. These drugs can either be injected into the area around the vagina and perineum or they can be given directly into the spinal region. (see diagram) When given into the spinal region, these drugs can provide complete relief of pain, while allowing you to remain conscious during the birth. Epidural anesthetics are widely used in the U.S. and are administered by anesthesiologists.

It is wise to discuss your wishes about pain management with your practitioner before the onset of labor, keeping in mind that your actual labor experience may cause you to change your plan once labor is under way.

In order to take an active part in your pregnancy and birth experience, it helps to prepare yourself well in advance. Many publications are available that will explain the physiological changes that your body goes through during pregnancy and in preparation for delivery. When selecting a health care provider, keep in mind the choices that he or she will make available to you. All said and done, pregnancy is an exciting, inspiring, and deeply satisfying experience. Make the most of it by developing your understanding to the fullest.