In Labour

Massage

How does massage help relieve pain?

Massage stimulates the body to release endorphins which are natural pain-killing and mood-lifting substances. Endorphins are responsible for the "feel-good" factor - the "high" you feel after a vigorous game of squash or a good laugh with your friends during your coffee-break. In labour, massage is important because it brings you close to the person who is caring for you, be this your husband or your birth companion. The touch of someone who loves you and wants to help you is very empowering when you're coping with contractions, and are perhaps tired and frightened.

One study showed that women who were massaged during labour were less anxious and experienced less pain as well as having shorter labours and less postnatal depression than a control group of women who were not massaged.

Are massage oils a good idea?

Using oil makes massage easier to carry out and more pleasant to receive. However, you have to be careful which oil you choose for labour. Essential oils are extremely powerful substances and can interfere with contractions if used wrongly. Some (qualified and certified) aroma therapists prefer just to use base oil for labour. Base oils include sweet almond and grape seed. Don't use sweet almond if you have a nut allergy or are worried about nut allergies. Just as good is grape seed and even olive oil, which is particularly well absorbed by the skin.

Shoulder massage

It's important for labouring women to keep their shoulders relaxed. Relaxed shoulders assist rhythmic breathing and rhythmic breathing maximises the oxygen available to both you and your baby. Massage is very helpful for keeping the shoulders and breathing relaxed.

Your birth companion should place his hands on your shoulders and lean lightly on them. This will help you drop your shoulders if they are already hunched because you have become stressed. Next he can stroke down from your shoulders to your elbows, maintaining a rhythmical action and applying firm pressure. Tell him whether the massage is helping you and how he could make it better.

He could also try resting his hands on top of your shoulders and using his thumbs to massage in small firm circles behind your shoulder blades. Tell him if he is pressing too hard or not hard enough, or if he is massaging too quickly. It's important for him to avoid frantic massage as this serves only to speed up your breathing when the aim is to slow it down!

Back massage

Many women feel contractions strongly in their lower back, so back massage is very useful. In early labour, your husband can use the flat of his hand to stroke down the side of your spine, from shoulder to bottom. He then uses the other hand to stroke down the other side of your spine, maintaining a rhythmical movement, with one hand constantly in contact with you. These long, slow strokes are very soothing. Make sure that he is massaging you using the whole of his hand and not just the heel. His fingers need to be in contact with your body as he tries to respond to the tensions he finds there.

In advanced labour, very firm, even pressure at the sacrum or either sides of spine can be very helpful.

Foot massage

Many people who say that they can't tolerate having their feet touched nonetheless enjoy firm, rhythmical foot massage. The massage does need to be firm, however, or it will be unbearably ticklish. If you find yourself sitting down or in bed for long periods of your labour, foot massage is ideal. Your husband can simply stroke your feet firmly from ankle to toes, or make circles with his thumbs all over the soles of your feet. You may find that your feet become very cold in labour, and a foot massage will help to warm them up. This is different from reflexology, which focuses on pressure points - note that reflexology is not recommended in labour.

Hand massage

If you have had an epidural and are lying in bed, shoulder or back massage is difficult. And if you can't feel your feet, there's no point in your husband offering you a foot massage. In these circumstances, hand massage is very soothing. Your birth companion can simply stroke each hand in turn, first on the back, then on the palm, sweeping firmly down from your wrist to your fingertips. He can make small circles all over your palm, and gently pull each finger in turn to release the tension. This is a lovely way of being close to each other and making your labour special.

Not all women like massage

If your birth companion is keen to massage you in labour, he may be very disappointed if you don't like it. However, some women simply cannot bear to be touched when they are having contractions. The contractions are so strong that even the slightest extra stimulus is more than they can cope with. Other women find massage so helpful that they want their husbands to keep rubbing their backs for hours on end! Birth companions need to be aware of these different reactions and respond accordingly.

Relaxation

The benefits of relaxation in labour

In labour, relaxation performs many of the same functions as it does in everyday life:

• Relaxation prevents your muscles from becoming fatigued, especially the large muscle of the uterus (womb).

• It helps you cope better with the stresses of giving birth and manage the experience better.

• It helps conserve your energy, so you will have the strength to deliver your baby.

• It helps you communicate more effectively with your carers and understand what they are saying to you.

And equally importantly, relaxation helps your baby to cope with labour. If you are relaxed, you won't flood your baby's system with stress hormones that cause his heart rate to speed up. Staying relaxed also means that you breathe more deeply, so that your baby gets more oxygen.

Can you really relax in labour?

It's certainly not easy, but a few simple techniques can help, especially if you have the loving support of a birth companion. Being well supported in labour has repeatedly been shown to be the single most important factor in determining a positive birth experience for the woman and a positive outcome for her baby.

You might find it very hard to relax during contractions, but remember that most women are totally free of pain and discomfort in between contractions. This is the ideal time to check over your body, especially those parts that you know become tense, and relax them (see Know your body, below). Your companion can help you with massage, and with reassurance and encouragement. Focusing on your breathing both during and between contractions will help, too.

In some countries such as the UK, some women find labouring in water very relaxing. In Malaysia, this is currently available only in Pantai Medical Centre in Kuala Lumpur and Island Hospital Penang.

Create the right environment

The first step towards relaxation is to get the environment for your labour right. In the UK, women have the option of giving birth at home. Our public health delivery system and network are not set up for this, so homebirths are rare.

As such, you will most likely deliver your baby in a hospital room. You may wish to think about how to make your labour and delivery room as comfortable as possible. Consider bringing your own birth balls and pillows. Wear your own clothes for as long as possible (a loose top and elasticated jogging trousers are ideal). You may want to bring some little garments or toys for your baby and place them where you can see them.

Sheila Kitzinger, a leading UK expert on birth, says that women should deliver their babies in an environment similar to the one in which they conceived them - in other words, one that is dimly lit, cosy, comfortable and intimate. It's worth thinking about!

Know your body

During your pregnancy, whenever you become stressed, stop and think about which parts of your body are becoming tense. Do you frown when you are worried? Or grind your teeth? Or get tummy ache? Do your neck and shoulders feel tight and painful? These are all signs that your muscles are in a state of tension, causing them to become sore and tired.

Take a deep breath and, as you breathe out, let the muscles in question relax so that they feel loose and soft, rather than rigid. Practise this technique regularly - not only when you notice tension in your muscles, but before situations you know cause you stress. This way, by the time you go into labour you will automatically be able to identify areas of tension in your body and to relax them. It will also do wonders for your blood pressure.

In labour, take a deep breath at the beginning of every contraction and, as you sigh out, try to relax. Then focus on a word or phrase as a distraction technique. Hum 'ba-by' to yourself under your breath. Or repeat 're-lax' over and over again, or trying blowing out gently after taking a deep breath. Try visualising your baby as he moves down through your pelvis. Focus on the positive aspects - like the fact that you will see your baby soon!

Communicate clearly

You won't be able to relax during labour if:

• You don't know what's happening to you.

• You don't understand what the nurses and doctors are doing.

• You feel that there are conversations going on that you're not part of.

• If you are unsure about aspects of your labour.

• If you're frightened for your own or your baby's safety.

Ask to be informed about procedures and findings. Just knowing what is happening and what will happen next will be reassuring. Make sure that your birth companion understands that one of his most important roles is to keep you informed.

At one of your antenatal appointments, discuss a birth plan with your doctor, who will be able to tell you whether your wishes are realistic. Then show it to the nurses and midwives when you go into labour. Ask them to help you achieve the best possible labour for you. If they go off duty, make sure that you or your birth companion show the birth plan to the next team who cares for you. And seek their support, too.

Breathing

Breathing and over-breathing

When you are tense and frightened, your breathing becomes shallow and rapid. Your shoulders are pulled up towards your ears, and your neck and shoulder muscles feel tight and rigid. If you move into a state of panic, you start over-breathing, sucking the air into your lungs and breathing out in short, sharp gasps. You feel light-headed and out of control. Pins and needles start in your fingers and your mouth feels numb.

All these are common reactions to very stressful or frightening situations. They're normal, but the body can't continue in this state for long without becoming exhausted. In labour, your aim is to conserve your energy as much as possible. You also want to give your baby plenty of oxygen to help him cope with the stress of being born. Panic breathing cuts down on the amount of oxygen you take in for yourself and for your baby.

Breathing patterns for labour

Close your eyes for a moment now and focus on your breathing.

Notice how rhythmical it is. You breathe in, then there's a slight pause before you breathe out. Your out-breath matches you’re in-breath in length and depth. You pause slightly before your lungs draw the next breath in.

In labour, you want to keep your breathing rhythmical. Don't let the in-breath become longer than the out-breath. If anything, you’re out-breath should be longer than your in-breath. It's inevitable that when you are having very strong contractions, your breathing will become shallower. There's nothing wrong with this as long as your breathing doesn't start to get faster and faster and turn into panic-breathing.

Simple breathing techniques

• Think of the word "RELAX". It has two syllables, "RE" and "LAX". Now try this exercise. As you breathe in, think "RE" to yourself, and as you breathe out, think "LAX". Don't let your mind wander away from repeating the word "RELAX"' in tune with your breathing. When you breathe out, try to let go of any tensions in your body. Focus on the muscles which you know always becomes tense when you're stressed. Remember, every time you breathe out: "LAAAAAX". The out breath is the one to focus on: the in-breath takes care of itself!

• Or you can try counted breathing. As you breathe in, count slowly up to three or four (or whatever number seems comfortable for you) and as you breathe out, count to three or four again. You might find that it's more comfortable to breathe in to a count of three and out to a count of four.

• Try breathing in through your nose and out through your mouth. Keep your mouth very soft as you sigh the breath out. In through your nose, and out through your mouth. Many women also find it helpful to make a sound on the out-breath, such as "Oooooooh" or "Aaaaaah". In between contractions, have sips of water to prevent your mouth from becoming dry.

Support with breathing

It can be very hard to keep your breathing rhythmical and to relax every time you breathe out when you're having painful contractions, you're tired and labour seems to be endless. This is where the support of your birth companion is essential. He can help you keep your breathing steady by breathing with you. You need to be in eye-contact with him, and he should hold your hands or place his hands on your shoulders, leaning gently on them. Then you can follow his pattern of breathing as he breathes in through his nose and blows out softly into your face. Practise this during pregnancy. It feels strange to begin with and both of you may be rather self-conscious. However, co-breathing is wonderful when you're in labour and you think you just can't go on any more.

Breathing and pushing

During the second stage of labour, you will be pushing your baby out into the world. Many women want to hold their breath when they push. This is fine as long as you push down in between your legs, rather than into the back of your throat.

It may be better to take a deep breath when you feel your contraction starting, and then breathe or blow slowly out as you bear down. This will prevent you from damaging your throat, ensure that you maintain a healthy breathing pattern, and result in effective pushing. If you have had an epidural, and can't really feel where you are meant to be pushing, take a deep breath when your midwife or doctor tells you there is a contraction beginning, and as you blow out, let your mind travel down your body to your baby's head between your legs, and push.

Sometimes women are told to hold their breath and push for as long as possible. This is not a good idea. You will deprive yourself and your baby of oxygen, and you'll quickly exhaust yourself. Push as many times per contraction as feels right for you. Four or five pushes for every contraction is about right.

Breathing and not pushing

Sometimes women get the urge to push before their cervix is fully dilated. In this case, your doctor will ask you not to push to give your cervix more time to open. This can be extremely difficult! You can help by kneeling on all fours with your bottom in the air and your cheek resting on the ground. When a contraction arrives give four short pants, then a quick in-breath, followed by four more short pants and so on. You can also repeat the phrase "I must not push" in your head as you pant. Breathe normally between contractions.

Pregnancy week 28

Now I am in the home stretch. There's not long to go now. The third trimester typically starts at week 29 and lasts until week 40 and sometimes even beyond. (42 weeks is the maximum! After that, a woman usually induced to give birth. Prayers I’m not going to be that hard, Amin.) Most women gain an average of 11 pounds / 5 kilograms during this trimester yet I am more now. You may see your doctor more often from now on but you don't have to wait for an appointment if you want to discuss anything - just ring.

By this week, my baby should weigh nearly 2.3 pounds / a little over 1 kilogram and may measure 14.8 inches / 38 centimetres from top to toe. But he is already 1.108 kilos last week; hope he’ll not be too BIG!! At about this time, the doctor said that the baby can open his eyes and turn his head in uterus if he notices a continuous, bright light shining from the outside. His fat layers are forming as he gets ready for life outside the womb and his fingernails appear as well as budding. I like the thought of interacting with my baby while he's still in the womb, thus I always talking, singing and reading to the baby - but don't worry if you feel uncomfortable - it's not for everyone.

As me, you're probably vacillating between two feelings: "I've been pregnant forever" and "Help, I'm not ready for this"; and being nervous about labour and birth. Don't worry; you're not the only one. Swapping experiences with other women in your antenatal class can be reassuring. Try to arrange a tour of your hospital's labour and delivery ward so you know what to expect. Your antenatal class may organise one or the hospital may have an open evening, so ring to check. You could also read some of our birth stories to help you prepare for the big day. For me, checking off things on my to-do list helps a lot. Start selecting possible baby names and begin thinking about life after the birth as well.

If you're a dad-to-be, you may be beginning to worry about having to watch your wife go through childbirth and wondering how helpful you'll be. Knowing the different stages of labour is a good place to start, go and read it up. Make sure you know what to expect if things don't go straightforwardly. Your baby needs help to be born so find out about assisted deliveries and caesarean section.

Planning to breastfeed? Here something I would like to share from my reading.

why breast is best

Breast milk is the best food for your baby. Ask any health professional, and they will respond that the healthiest way to feed an infant is to breastfeed him. Studies show that breastfeeding exclusively for at least three months may help prevent gastroenteritis (an inflammation of the gastrointestinal tract, involving both the stomach and the small intestine and resulting in acute diarrhoea. It can be transferred by contact with contaminated food and water. The inflammation is caused most often by an infection from certain viruses or less often by bacteria, their toxins, parasites, or an adverse reaction to something in the diet or medication) in babies. If you do so for at least four months, you may be able to lower your baby's risk of respiratory illness and catching ear infections.

Breast milk starts from colostrums (a form of milk produced by the mammary glands of mammals in late pregnancy. Most species will generate colostrums just prior to giving birth; containing antibodies to protect the newborn against disease, as well as being lower in fat and higher in protein than ordinary milk) is a complete food source; it contains all the nutrients your baby needs - at least 400 of them - including hormones and disease-fighting compounds absent in infant milk formula. Remarkably, its nutritional make-up even adjusts to your baby's needs as she grows and develops. And apart from the brain-building, infection-fighting benefits of mother's milk, which no formula can duplicate, breastfeeding can help to build a special bond between you and your baby. When you breastfeed, your child thrives on the skin-to-skin contact, the cuddling and the holding. You will, too.

Preparing for breastfeeding

You can't really prepare your nipples for the experience of breastfeeding, but you can, and should, prepare your mind. It helps to learn as much about breastfeeding as you can before your baby is born. Dads should learn as much as possible, too, so they can support and encourage their breastfeeding wives.

From the class I’ve attended, first and foremost, you have to have your own intention and let your mind in peace on the trial giving the baby breastfeed. You can’t stressed out and being too pushy to yourself as this will stop / discourage the production of milk by mammary gland. It’s all controlled in your mind and never thinks it as simple as ABC!!!

How should I prepare for breastfeeding?

Learn as much as you can about breastfeeding before your baby is born. Talk to other breastfeeding mothers, read books to familiarise yourself and contact local breastfeeding support organisations. Try to attend a breastfeeding class or preparation for breastfeeding session (offered by many hospitals as part of their antenatal classes) sometime during your last few months.

Whether you think about it or not, your pregnant body is preparing itself for breastfeeding. That's one reason your breasts get so much bigger during pregnancy -- your milk ducts and milk-producing cells are developing, and more blood goes to your breasts than before. But breast size has nothing to do with the ability to breastfeed successfully -- even if you stay small-breasted, that will not reduce your chances of being able to feed your baby yourself.

How to breastfeed

Since feeds can take anything from seven to 40 minutes, pick a comfortable place for breastfeeding. Atmosphere is very important, especially in the early days of breastfeeding when you're still trying to get the hang of it. If you are easily distracted and disrupted by noise, find somewhere quiet. If you are easily bored, you may want to feed in front of the television, but only if breastfeeding is going well for you and your baby. Try different spots until you find what works for you.

Hold your baby in a position that won't leave your arms and back sore. Add support around you with plenty of cushions. Many women find the cradle position works well, although it really depends on what is most comfortable for you. Get yourself and your baby in a relaxed position before you start feeding. Pay attention to how your breasts feel when your baby latches on. She / He should take in a big mouthful of breast tissue. If latching on hurts, break the suction - by inserting your little finger between your babies’s gums and your nipple - and try again. Once your baby latches on properly, she will be able to do the rest.

Problems you may encounter

Although women have breastfed their babies for centuries, it isn't always easy. Many women face difficulties in the early days. In the first six weeks, as your milk supply adjusts and your baby learns how to breastfeed, you may suffer from:

• Engorgement: overfull breasts;

• Mastitis: an inflammation of the breast;

• Sore nipples.

What you may be feeling

Some women adjust to breastfeeding easily, encountering no major hurdles. But many new mothers find it hard to learn - so if you're feeling discouraged, remember that you're not the only one. If you feel like giving up (or just want professional advice), contact a breastfeeding counsellor (most hospitals have them). You could also contact Ibu Family Resource Group, a volunteer organisation which hosts breastfeeding support groups in their Klang Valley HQ. The organisation may also be able to recommend groups in other parts of the country. Also, talk to your doctor about any health concerns that may impede successful breastfeeding.

Breastfeeding takes practice. Give yourself as much time as you need to get it down to a fine art. Take it a day, a week or even just a feed at a time. If you're having a bad feeding day, tell yourself that tomorrow will be better. And keep in mind that any problems you are having are likely to be temporary. By the time of your six-week check, you'll probably be breastfeeding without giving it a second thought. If not, don't hesitate to ask for support.

Breastfeeding in public

Although you may feel shy about breastfeeding in front of other people, it is becoming an increasingly common sight in urban Malaysia. Besides, you can't be expected to run home every time your baby needs to eat. Some tops are designed to allow you to breastfeed discreetly. Avoid shirts that you have to unbutton as they will make you feel very exposed - stretchy tops you can pull up work well. Draping a scarf, selendang or thin cloth blanket over your shoulder and chest as your baby feeds also helps you feed more discreetly in public (make sure your child is still able to breathe easily).

Most of the larger shopping centres built or renovated within the last five years have mother and baby rooms where you can sit comfortably and feed alongside others. Even if you don't have access to such facilities, most establishments will accommodate a nursing mother and hungry baby. Go ahead and ask for a discreet room or corner when you want to feed your baby. Soon, when breastfeeding becomes more familiar, you won't think twice about feeding your baby in public.

On the other hand, you may want to consider the fact that the Malaysian lifestyle can present some unique challenges to breastfeeding in public. For instance, if you are out at the hawker squares or 24-hour mamak stalls (never mind facilities, where can I find a clean toilet?!), it may be better to give your hungry baby a quick feed in your car (doors locked and engine running so you can run the air-con). Complete the feed once you are home.

What you need to buy

You will need to buy at least two breastfeeding bras. These provide the extra support that your larger-than-usual breasts need. They come with hooks or zips that you can easily undo when you need to feed. Ensure that they are properly fitted and that any flaps open completely. If only a small part of the breast is exposed, the bra may push against you and cause blocked ducts. You may want to wait until after you give birth to make this purchase, to make sure you get a bra that fits perfectly. Note that good quality maternity, breastfeeding or nursing bras are not fitted with underwire as the hard wires can cause blocked ducts.

Some mothers find that their breasts have a tendency to leak when they're lactating. Another baby's cry or the sight of an infant can stimulate milk flow, sometimes at inopportune moments. Make sure you have a good supply of breast pads. You can stock up on washable pads, or buy disposable ones.

Can I breastfeed after I go back to work?

Going back to work doesn't have to mean the end of breastfeeding. In fact, mothers who work outside the home are often able to feed their babies for as long as they want. You may want to express milk at work or breastfeed only when you are with your baby. Both are possible.

Do I need to toughen my nipples or do anything else beforehand?

The hormonal changes pregnancy brings to the breasts are sufficient preparation for most women. You don't need to use creams to soften your skin beforehand or express colostrums either. In particular, don't rub or scrub your nipples - this will only hurt you and make breastfeeding difficult.

The best preparation for breastfeeding is getting your husband and family to support you in your decision to breastfeed, so that you and your baby can get off to a good start. Research shows that you are more likely to breastfeed for longer if your husband is well-informed.

The other thing you can do to help breastfeeding is make sure that your obstetrician as well as the midwives and nurses who attend you during your baby's birth know that you would like plenty of skin-to-skin contact with your baby when he or she is born. Skin-to-skin contact has been shown to increase the length of time that women breastfeed for. Even if you need a caesarean birth, you can still hold your baby against your skin soon after the birth with some help from a nurse. Your baby may crawl to the breast and may feed, or he or she may only smell the breast, lick it or nuzzle it. All these things will help establish and promote breastfeeding.

Things You'll Miss about Being Pregnant

Are you sick and tired (literally!) of being pregnant? The 40 weeks of pregnancy won't last forever, but while you're in the midst of gestation you may as well look on the bright side. There are plenty of fantastic reasons to celebrate the new life growing inside of you, and it's likely you really will miss some of these things someday!

Baby secrets: Even before it's apparent to everyone around you, you'll delight in the joy of your pregnancy—and can choose to keep this special time a secret between you, the baby's dad, and your baby until you're ready to share the good news. Once your growing belly becomes obvious, you'll still share secret moments with baby as he kicks you, rolls, and even hiccups with no one but you the wiser.

Comfy clothes: Goodbye restrictive waistbands, hello stretchy maternity pants! Buying a swimsuit during pregnancy can be fun when it's all about comfort with no worries about your terrific tummy.

Sleep soundly (and often): It is a hard work growing a baby, and mommies-to-be get tired. Take a nap, Mama, and rest with the guilt-free pleasure of snoozing in the middle of the day or whenever you can.

Beauty bonus: Those raging hormones offer great benefits for many moms-to-be, including thick, silky hair and stronger fingernails during pregnancy. Relish them while you can, ladies; most women's hair returns to its normal thickness after baby is born.

Extra endowment: Smaller-chested women, now is your time to enjoy the fuller figure that accompanies pregnancy. Your husbands will probably like this side effect of gestation, too.

Tea (and cookies) for two: Nobody's going to think you're overdoing it when you eat your entire steak dinner and still order the hot fudge sundae for dessert. (Just keep in mind it's no fun losing the baby weight if you go wild too often!)

It's good to be queen: Family and friends will no doubt treat you differently now that you're pregnant and carrying a new little life. Enjoy the pampering and attention while you can, as you're sure to be unseated as the attention-getter once your prince or princess is born.

Naming baby: Choosing your baby's name is a sure sign there truly is a child on the way! What fun to relax with a great naming book and make your lists, imagining each moniker for your little one-to-be.

Thump, thump: There is nothing quite as thrilling as hearing your baby's heartbeat for the first time ... and the second, and the third ...

Shopping: Baby's on the way, and what better excuse to shop! Expectant moms need plenty of things, from maternity clothes and nursing bras to tiny booties, crib sheets, and car seats. Whether you're buying new or hitting consignment shops and yard sales, it's fun to browse through the cutest little outfits while daydreaming about your baby.

Baby Showers: Speaking of new things for baby ... what mom-to-be doesn't love to be showered (with gifts!) to honor the pending arrival of her little one?

Smiles from strangers: If you're pregnant, you're sure to garner plenty of grins from people you don't even know. There is something endearing about a woman carrying a baby, so don't be surprised if people even give up their seat for you. You'll also start to recognize every other pregnant woman out there and possibly share knowing smiles with them, too.

Just for kicks: Movements that start as ticklish, gentle flutters can quickly become nudges, acrobatic rolls, kicks, and even hiccups! Feeling your own baby inside you is an unparalleled experience for humankind, and truly one of the most amazing and incredible happenings for a pregnant woman.

Ultrasounds: Our own moms couldn't have dreamed of seeing us so clearly on ultrasound the way we see our unborn babies now. From the regular two-dimensional sonograms to the latest in four-dimensional ultrasounds, expecting couples today get prodigious views of their little ones, and it's a thrill to see those little hands, feet, noses, and chins for the first time on the monitor.

Taking care of yourself: There is no better time than pregnancy for a woman to treat her body well. Pregnant women can enjoy adopting a healthy lifestyle for baby and themselves. Adhering to a nutritionally sound diet, getting plenty of rest, exercising sensibly, and abstaining from drugs and alcohol are all great habits for any woman to assume—and if you're in good health during your pregnancy, you'll be better equipped to take care of your little one once she's arrived, too.

A period-free period: If you're expecting, you have months of no birth control pills, no periods, and—oh yeah—no worries about getting pregnant during sex. Enjoy!

Revved-up romance: Couples may find themselves enjoying more intimate moments together now that baby is on the way, whether it's just spending more time together, cuddling, or being intimate. Some women may find their sex drives boost during pregnancy and that lovemaking is better than ever.

Miracle moments: Whether you're miserable with morning sickness or almost ready to deliver, there is no denying that what is happening to you is indeed miraculous. Growing another human being inside of your own body, sustaining a life, knowing that you and this child have a precious bond between you—these are all extraordinary emotions that women are blessed to experience. Enjoy your 40 weeks with your baby inside, Mama—it's a one-of-a-kind, life-changing time!

insomnia

Insomnia is never a good thing, but when a woman is in the early stages of pregnancy, insomnia can make for long nights and tired days.

In a poll conducted by the National Sleep Foundation (NSF), 78 percent of women reported more disturbed sleep during pregnancy than at other times. Sleep-related problems also became more prevalent as the women's pregnancies progressed.

Dr. Jill Powell, assistant professor in the Department of Obstetrics, Gynecology, and Women's Health at St. Louis University School of Medicine, says she finds most sleep disturbances follow the pattern found in the NSF's poll. In other words, sleep problems can develop early on but usually aren't too bad and abate as the pregnancy progresses. Later, other issues can cause insomnia to reoccur.

Insomnia in the First Trimester

In the first trimester, insomnia is relatively common and is caused by the hormonal changes of pregnancy. Dr. Powell says there are a couple of reasons for this. "Early in pregnancy women tend to feel very fatigued because of what I call the progesterone phenomenon," says Dr. Powell. "Progesterone is a natural sedative, and a woman may be so tired she has this sensation of not being able to keep her eyes open. She may react by napping during the day or falling asleep on the couch after work. This then gets her out of her normal sleep patterns."

The result is she may not be able to fall asleep that night, which then just sets in place a vicious cycle of exhaustion. To avoid this, Dr. Powell suggests trying to avoid long naps during the day. Try taking a walk or finding some other activity instead of sleeping. Go to bed at the same time every night, even if it's earlier than your "normal" pre-pregnancy schedule to get some extra sleep.

In addition to hormonal changes, Dr. Powell notes there is often a lot of anxiety in the first trimester. A woman may have concerns about her health or the baby's health and may worry about miscarriage. There may even be more specific reasons for anxiety, such as financial worries if the pregnancy was unplanned. For this type of emotion-related insomnia, Dr. Powell suggests trying to find someone to talk to who may help ease your worries, such as a friend, clergyman, or your doctor.

The other common reason for insomnia is sleep disturbances due to having to urinate frequently. At this point in the pregnancy, the uterus is still fairly small and has not yet pushed up out of the pelvis. As a result, it pushes against the bladder and can cause frequent urination. This will resolve itself in the second trimester as the uterus grows and pops up out of the pelvis.

Insomnia in the Third Trimester

Dr. Powell says women usually don't exhibit many sleep problems in the second trimester, what she calls "the honeymoon trimester," but insomnia often occurs in the third trimester. "As the third trimester progresses there's more pressure on your lungs and you fatigue more easily but start sleeping more poorly," says Dr. Powell. "The cause for virtually all of the sleep disturbances at this phase can be traced to the increase in size of the abdomen."

In the case of the third trimester, it's not so much inability to sleep or being out of rhythm with sleep cycles as it is sleep disturbances. For example, the bladder once again starts feeling the pressure of the enlarging uterus and the mother-to-be may find herself up and down several times a night.

Sleep disturbances are common for other reasons. Rolling over is not as easy as it once was, and for women who prop themselves with several pillows, it may involve enough readjusting to cause them to wake up. Heartburn can also be severe enough to awaken you from sleep.

Another common problem is trouble getting comfortable. Some people only get their best sleep in certain positions, so back sleepers or stomach sleepers have to adjust to sleeping on their sides. However, as Dr. Powell points out, this may actually be a good thing, as it's not good for the baby to sleep on your back.

At this point in the pregnancy, there's not a lot that can be done about some of the things causing insomnia. For heartburn, your doctor can recommend a safe antacid or other medication. Exercise may also help with insomnia.

7 Tips to Combat Insomnia

Dr. Ken Sassower, a staff neurologist at Massachusetts General Hospital working in the sleep disorders unit, says the most important thing for a pregnant woman to do to ensure good sleep throughout her pregnancy is to maintain good sleep habits. This includes the following:

Go to bed and wake up at about the same time every day.

Don't nap during the day.

Avoid alcohol and tobacco. Pregnant women should do this anyway.

Don't drink caffeinated beverages four to six hours before bedtime.

Avoid spicy foods.

Get regular exercise but not too close to bedtime.

Do not watch TV or read in bed. Go to bed only when you're sleepy, and use the bed only for sleep or sex.

Sleep Apnea and RLS

Insomnia is rarely a serious problem, but there are two issues that may start in pregnancy and continue after the baby's birth: sleep apnea and Restless Leg Syndrome (RLS).

Sleep apnea is often associated with excess weight but can be brought on by the edema of the nasal structures brought on by pregnancy. If insomnia due to sleep apnea becomes a serious problem during pregnancy or persists afterward, Dr. Sassower says it needs to be evaluated in a sleep study. RLS, the urge to move your legs when you're at rest, can manifest itself in pregnancy but often clears up afterward. If it doesn't, see your doctor.

In general, both Drs. Powell and Sassower agree that insomnia during pregnancy is transient and the conditions causing it quickly dissipate after the baby is born. It's then, says Dr. Powell, that you may be able to sleep, but the baby may have other ideas!

The advice for a pregnant woman today:

• Try to rest but not nap during the day.
• Drink chamomile tea before bed.
• Use the bed only for sleeping.
• Be sure to have comfortable bedding.
• Try to avoid reading or watching anything too stimulating before bedtime.
• Make sure to get daily exercise, ideally in the morning hours.
• Try drinking a warm glass of milk before you go to bed.
• Take a warm relaxing shower before you go to bed.
• Have your husband or partner give you a shoulder or back massage.
• Keep a notepad by your bed to write down any worries you have, or things you are trying to remember for tomorrow that you might be dwelling on—get them on paper and out of your mind.

Last but not least, if the above measures don't work, ask your doctor for a prescription sleep aid, like Ambien, to use every once in a while just to get a full night's sleep.

Pregnancy Week 28

All About You

Added baby weight is taking its toll on your body. Chances are you're feeling aches and pains all over! Your feet, ankles, and hands may be swollen. Cramps may cause intense pain in your legs, especially at night, and it may be hard to find a comfortable sleeping position. You may also be experiencing false contractions (called Braxton Hicks) where your abdomen tightens, then relaxes. Hang in there—you're getting closer to your due date!

Your uterus is around three inches above your navel. If you are Rh negative, you'll be getting a RhoGam injection right around now. And those tightening sensations? Braxton Hicks "practice" contractions.

Choosing Your Baby's Name

You are only a few weeks away from the big day. Have you been mulling over what you're going to name your new addition? No doubt friends and relatives have been offering subtle—and sometimes not so subtle—suggestions, but when it comes to choosing a name for your baby you should take your time. Enjoy the process! Here are a few ways to track down original, meaningful, and timeless names:

Look to the government: There's an easy way to figure out what the most popular baby names are—ask the government. The Social Security Administration (SSA) has been tracking baby names since the 1880s. The SSA's handy website allows you to search how popular your baby's potential name may be. For instance, in the 1880s the most commonly used names were John and Mary. Contrast that with the 2000s where Jacob prevailed for boys and Emily for girls. Use this site to search names nationally or within your state.

Search your family genealogy: Looking for something more personal then the top 20 name choices for a given year? Consider a family name. Nothing will endear your grandmother to your newborn more than using her name for your new little one. You don't need to stop with familiar relatives, either; explore your family history and you may dig up stories of pioneers, cowboys, generals, maybe even a gypsy or two. These names can give your child a connection to your family beyond his genes.

Consider favorite characters: Favorite books, television shows, rock bands, and movies can also be sources for names. You might want to pass on Han Solo, but Luke (minus the Skywalker) might be your way to pay tribute to your favorite film. Jane Austen fan? Consider using a character's name from one of Austen's books for your own baby.

Agreeing on a Name

It can be hard to decide on a name. You and your partner may struggle to come up with that perfect choice. Instead of settling on one name, try making a list of names instead. Many couples wait until their baby is born before they decide, while others are naming their baby-to-be in utero. Whether you select a name before or after your baby arrives, don't be surprised if friends and relatives don't agree with your choice (unless, of course, you name the baby after one of them!).

Making Your Baby's Name Permanent

After your baby's birth, the hospital will give you several documents to fill out that will declare, amongst other things, your child's name. You'll be asked to provide your baby's name for a birth certificate and to submit paperwork toward obtaining your newborn's Social Security card. While your baby isn't required to have a Social Security number, it's much easier to get one by filing the information at the hospital versus waiting—the process can take much longer if you apply at a local Social Security office. Your child's social security card won't cost you anything and will be mailed to your home address a few weeks after you turn in the paperwork.

Once you have your child's social security card, make sure to keep the number private. Thieves can steal your baby's identity if they get their hands on your child's number. Keep the card in a safe at home versus carrying it in your wallet.

All About Baby

Your unborn baby's survival rate outside the womb increases as each week passes. If he didn't open his eyes last week, chances are he'll take his first peek this week. Your baby-to-be's skeleton and muscles are maturing quickly. This week he can turn his head from side to side.

By your 28th week of pregnancy, most of Baby's lanugos have disappeared and he may have a full head of hair.

How Big Is Baby?

Your baby weighs in at around 2 pounds, 2 ounces and stretches to almost 15 inches (crown to heel).

Most Common Pregnancy Questions

I'm experiencing some strange leg cramps and my legs feel restless, too. What's going and what can I do?

Many women begin noticing leg cramps, or a restless feeling in their legs during the second and third trimesters of pregnancy. The muscles of your legs tightening or going into spasm cause these cramps. While no one is exactly sure what causes this to occur, there are some theories.

Leg cramps may be related to the increased pressure and weight being put on the muscles and nerves of your legs as your baby grows. Leg cramps may also be due to the increased blood flow that accompanies your pregnancy.

Sometimes your legs may feel this way if you are tired or have exerted yourself (and could also be due to a strain or injury). Even simply sitting in one place for too long can bring on leg cramps. Many women experience at least one episode of being awakened at night by cramping or spasms.

Some doctors theorize that a calcium deficiency might make you more prone to these cramps. However, studies now show that magnesium supplements can help with leg spasms or cramping.

A few tips to help you manage leg cramps:

• · Stay well hydrated
• · Maintain your exercise program
• · Stretch every day
• · Walk
• · Have your partner massage your legs with lotion
• · Use heat if the area is sore
• · Don't stay in one position too long (don't forget to get up and walk around!)
• · Make small circles with your feet and ankles if you are sitting for longer periods of time or while lying in bed.

For Your Partner

The Name Game

Have you and your partner begun discussing baby names? Chances are your partner has been playfully tossing about baby names since she was a little girl. Time for you to play catch up think about the names you like and your preferences. Some parents fret over finding the perfect name (but chances are once you start calling your new baby by name, dozens of times a day, it will sound perfect pretty quickly).

There are many creative ways to think about naming your baby. A name can be quite powerful in uniting disparate cultures, religions and/or ethnicities in your respective families. For instance, Latin-African American parents might name their child Raheem Santos or maybe Nordic-Chinese parents could try Eric Cheng.

In addition, naming your baby is an opportunity to show respect to family members, those who are alive or who have passed away. Giving your baby the same name as a relative you had a special relationship with can not only transfer positive feelings to your baby, but can also help give your child a connection to your family's history and ancestry.

Names are names, but sometimes names can have meaning and that meaning can help your baby begin to build its own identity.

What's the best position for my baby to be in?

Labour is nearly always shorter and easier if your baby is in a head-down position, with the back of his head slightly towards the front of your tummy. This is called an anterior position. Most babies get into this position by the end of a pregnancy.

In an anterior position, your baby fits snugly into the curve of your pelvis. During labour, your baby will curl his back over and tuck his chin into his chest. Your labour and birth should progress easily if your baby is in this position because:

• The top of your baby's head puts rounded, even pressure on the neck of your uterus (cervix) during contractions. This helps your cervix to widen and helps to produce the hormones you need for labour.

• At the pushing stage, your baby moves through your pelvis at an angle so that the smallest area of his head comes first. Try putting on a tight polo-neck top without tucking in your chin and you'll understand how this works!

• When your baby gets to the bottom of your pelvis, he turns his head slightly so that the widest part of his head is in the widest part of your pelvis. The back of his head can then slip underneath your pubic bone. As he is born, his face sweeps across the area between your vagina and back passage (the perineum).

What's a posterior position?

A posterior position is where your baby has his head down, but the back of his head is against your spine. By the time labour starts, about one baby in 10 is in this back-to-back or posterior position.

Most back-to-back babies are born vaginally, but this position can make labour more difficult for you, particularly if your baby's chin is pushed up rather than tucked in. As a result:

• You may have backache as your baby's skull is pushing against your spine.

• Your waters may break in early labour.

• Your labour may be long and slow.

• You may feel like pushing before your cervix is fully dilated.

When your baby gets to the bottom of your pelvis, he'll need to turn through almost 180 degrees to get into the best position to be born.

This can take quite a while, or your baby may decide he's not going to turn at all! In this case, he will be born with his face looking up at you as he emerges. He might need forceps or ventouse to help him out.

Why are some babies posterior?

Your baby may be posterior because of the type and shape of pelvis that you have. Some women have a pelvis which is narrow and oval (called an anthropoid pelvis) or wide and heart-shaped (called an android pelvis), rather than round-shaped.

If your pelvis is oval or heart-shaped rather than round, your baby is more likely to settle in a back-to-back position at the widest part of your pelvis. This is because he can rest his head more easily in this position.

Lifestyle may be another factor. It seems that Western (or urban) women are much more likely to have posterior babies than women in the developing world, who work manually in fields, or who squat to cook or eat. It's easy to understand why.

When you relax on a comfortable armchair watching TV, or work at a computer for hours, your pelvis is tipped backwards. This encourages the heaviest part of your baby (the back of his head and his spine) to swing round to the back. In this position, he'll end up lying against your spine.

If you do a lot of upright activities, your baby is more likely to go down into your pelvis in an anterior position, because your pelvis is always tipped forwards.

How can I help my baby into an anterior position?

You may have heard about a technique called optimal foetal positioning (OFP). This is a way of encouraging your baby into an anterior position by changing your posture, particularly when you're sitting down. Keep in mind that you're trying to tilt your pelvis forward rather than back, so, if you're sitting, check that your knees are always lower than your hips.

Try the following:

• Check that your favourite armchair doesn't make your bottom go down and your knees come up. If it does, try turning the chair round, kneel on the seat pad and lean forwards over the back of the chair.

• Scrub the floor! Our old granny used to say that washing the kitchen floor was a good way of preparing for labour. They were right - when you're on all fours, the back of your baby's head swings to the front of your belly.

• Take regular breaks and move around if your job involves a lot of sitting.

• Sit on a cushion in your car to lift up your bottom.

• Watch TV leaning forward over a birth ball.

Don't worry about getting your baby into the right position when you lie down to sleep. When you're lying down, your baby is not being pushed down into your pelvis. However, lying on your side rather than your back is the best position for sleep in late pregnancy.

Can I really make my baby get into the right position for birth?

There's nothing new about trying to get your baby into a good position. Reports of "maternal posturing" go back to at least the 19th century. It's known today as optimal fetal positioning (OFP) because of a midwife called Jean Sutton who publicised the technique in the 1990s. She advised pregnant women to get into upright and forward-leaning postures as often as possible in later pregnancy.

Some midwives and doctors have questioned whether it really works or just gives pregnant women something else to worry about. So far, studies into OFP show that adopting a hands and knees position for 10 minutes, twice a day, towards the end of pregnancy can help move your baby into an anterior position in late pregnancy.

Unfortunately, it doesn't seem to have an effect on how your baby lies at birth. Sutton recommends trying to stay in upright or forward postures regularly in every-day life, rather than for short bursts.

If you try OFP during pregnancy but your baby stays in a posterior position when labour starts, it may be because of the shape of your pelvis rather than your posture.

How can I improve my baby's position during labour?

If your baby is in a posterior position when labour starts you can still use upright or forward postures to try to help your baby to turn and to relieve your pain. It's common for babies to change position during labour and most babies get themselves into an anterior position by the pushing stage, no matter what position they were in at the start of labour.

Sometimes women have niggly pains for several days before labour really starts. This can be wearing, but the pain might be a sign that your baby is trying to turn into an anterior position. The best way to cope is to:

· try to get plenty of rest at night;

· during the day, remain upright and active;

· lean forwards during contractions;

· eat and drink regularly to keep up your strength;

· try to stay relaxed and positive.

You may find that the best posture to labour in is on all fours. In this position, your baby drops away from your spine, helping to relieve backache and hopefully helping him to turn, too.

When you're in actual labour, try to:

• Stay upright for as long as possible.

• Lean forwards during your contractions – use a birth ball, bean bag, your husband or the bed to lean on.

• Ask your birth partner to massage your back.

• Rock your pelvis during contractions to help your baby turn as he passes through the pelvis.

• Don't stay sitting in a chair or on a bed in a leaning-back position for too long.

• Try not to have an epidural if you can, as epidurals may increase the chance of your baby being in a posterior position at birth. Epidurals also make having an assisted birth more likely.

• If you get exhausted during labour, lie on your left side, as your pelvis can still expand to give your baby space to turn while you are resting.