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Prenatal Health
Are childbirth classes for me?

Childbirth classes teach how the body progresses through pregnancy, labor and birth. Topics typically addressed include nutrition, anatomy, exercise, emotional and physical aspects of pregnancy, breathing, relaxation and comfort, pain in childbirth, stages and phases of birth, medications and interventions, Caesarean birth, postpartum adjustment, breastfeeding and newborn care. It is important to take a class that fits your needs and lifestyle.

Childbirth classes are not just for those who want natural childbirth. Women need accurate information to make informed choices about medications; for example the appropriate time to take medications, possible side-effects of medications, and the options, benefits and trade-offs of medication.

Women attending childbirth classes often have the same concerns and questions. The classes usually include a tour of the labor floor and maternity unit. This helps give you a sense of what to expect in the hospital.

-- Ana M. Rivero

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Can I exercise while pregnant?

Exercising during pregnancy helps your body prepare for childbirth. The better shape you are in, the better your body can use your muscles for the rigorous event. It also improves circulation and reduces some discomforts.

Exercising can help you diminish pregnancy “blues.” Exercise keeps you occupied during the “waiting” process and relaxes you. It also can relieve stress and fight boredom. At night, the likelihood of better sleep increases because you already burned off that excess energy that can keep you tossing and turning. Your self-image will get a boost; exercise helps you feel more in control of your weight.

Most importantly, exercising during pregnancy will help you regain your pre-pregnancy figure more quickly since you have kept a routine of fitness that can be modified once the baby is born.

Some exercising can harm you and/or your baby. If you have a history of pregnancy-induced hypertension, a weak cervix, heart disease, pre-term labor or vaginal bleeding, you may want to hold off on the exercise until after you have given birth. Always check with your doctor before starting any exercise routine. If you begin exercising and encounter unusual pain, discomfort or dizziness, stop exercising until you are sure that you are not causing harm.

Exercising at a moderate intensity -- three times a week for 20 to 30 minutes -- has many health benefits for a pregnant woman. Before you start exercising, consult your health care provider to make sure your exercise program is right for you and your unborn child.

Here are several types of commonly recommended exercises during pregnancy:

  • Walking.
  • Swimming.
  • Yoga.
  • Stretching.
  • Light weight-lifting.
  • Dancing.
  • Low-impact aerobics such as classes offered for pregnant women.

Do’s for exercising

  • Exercise three times a week for 20 to 30 minutes at a moderate intensity unless advised otherwise by your doctor.
  • You will benefit most from swimming, water aerobics, walking and cycling on a stationary bike. These exercises don’t require your body to bear extra weight.
  • Warm up for five minutes before you start exercising and cool down for 10 to 15 minutes after.
  • Drink enough water to avoid dehydration.
  • Be careful of activities that increase your chances of falling.

Dont’s for exercising

  • If you haven’t exercised prior to your pregnancy, start slowly and avoid too much strain on your body.
  • Avoid sports such as horseback riding, scuba diving and skiing while pregnant.
  • Don’t continue with exercise if you feel fatigued.
  • After your first trimester, avoid exercises that require you to lie down on your back as they decrease blood flow to the womb.
  • Never exercise when it is very hot.
  • Listen to your body because it gives you signals when you are exercising too hard.

If you experience any of these symptoms, whether you are exercising or not, you should contact your doctor immediately:

  • Blood or fluid coming from your vagina.
  • Sudden or severe abdominal and/or vaginal pain.
  • Contractions that go on for 30 minutes after you have stopped exercising.
  • Chest pain.
  • Shortness of breath.
  • Dizziness.
  • A headache that is severe or won’t go away.
  • Dim or blurry vision.

-- Jeanine del Valle and Niki Martinez

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Could I be pregnant?

Many women think they might be pregnant even before a missed period. Although every woman is unique and every pregnancy is different, these are some universal symptoms a woman may experience early in her pregnancy:

  • Tender Breasts/Nipples: Breasts and nipples become tender around three weeks after conception. They may feel swollen, similarly to when you are expecting your period.
  • Slight spotting or cramping: Light spotting may occur when the embryo attaches to the lining of the uterus 8-10 days after conception. Cramping also can occur. Contractions can occur regularly, increasing with exercise, orgasm and even simple changes in position.
  • Darkening Areolas: The areola (the darker area around the nipple) begins to darken and increase in diameter. The veins in your breast may become more visible and the Montgomery's tubercles (the tiny "bumps" that are scattered around the areola) enlarge and increase in number.
  • Extreme Fatigue: During the first 8 to 10 weeks of pregnancy, a common symptom is exhaustion. Your body is adjusting to growing a baby.
  • Nausea and vomiting: As soon as a week after pregnancy, you may experience nausea, aversion to certain smells or increased sense of smell. These symptoms can occur anytime.
  • Frequent Urination/Constipation: You may urinate more frequently. The baby growing in your uterus puts pressure on your bladder. Bowel movements also may change because the intestines relax during pregnancy and, thus, become less efficient.

-- Raquel Ramos

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Does playing music to my unborn child matter?

The use of ultrasound has helped solve the mystery surrounding the womb. Research has made us aware of scientific evidence about the benefits of prenatal stimulation.

The ears appear in the third week of pregnancy. Around the 16th week the fetus begins to respond to a sound pulse; by the 24th week it is actively listening.

The inner ear of the fetus functions fully in the last trimester. Hearing is the most developed sense before birth. The sound of the mother's voice is very distinct, setting the stage for bonding with the unborn child. Prenatal sounds provide a foundation for later learning and behavior. Women from all over the world have sung lullabies to their babies even before birth. Elements used in a language also are elements in music. These elements include tonal pitch, timbre, intensity and rhythm. Music stimulates the baby’s hearing system and soothes the baby. It prepares the ear, body and brain to listen to, integrate and produce language sounds. There’s a documented connection between sound/music and prenatal memory/learning.

Several studies have been conducted on the effects of music in the womb. According to D.J. Shelter, infants who received prenatal music stimulation exhibit "remarkable attention behaviors, accurately imitate sounds made by adults and appear to structure vocalizations much earlier than infants who did not have prenatal musical stimulation.” The program, “Make Way for Baby,” encourages parents to learn the potential of unborn children. Formal testing at intervals from birth to age 6 shows that stimulated babies were superior in visual, auditory, language, memory and motor skills over the entire 6 years. The babies were stimulated using prenatal enrichment techniques such as singing, talking and playing music to the baby.

Another scientifically tested program, the FirStart Program, originated in Valencia, Spain. The first round of testing shows that babies who were provided enriched stimulation beginning at 28 weeks of gestation were significantly advanced in motor skills, linguistic development, sensory coordination and cognitive development.

-- Ana Rivero

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How can I sleep while pregnant?

Many changes occur in woman’s body during pregnancy. Her center of gravity has changed significantly; she may feel slightly off balance and even a bit clumsy. Sleep may no longer be a comfortable escape into dreamland; she may feel tired and stressed.

Tips for better sleep:

  • Try lying on one side, with one leg crossed over the other, and a pillow between them.
  • Place a pillow under your stomach.
  • Massage during pregnancy reduces tension and helps you to relax, making it easier to fall asleep. Let your partner do this for you. Please consult your doctor about what types of massage are most appropriate.
  • Muscle therapy can be relaxing for both mother and unborn baby. Slow, quiet classical music works best if you feel anxious.
  • Aromatherapy using lavender oil is a well-known remedy for insomnia. Try this before you go to bed.
  • Drink a glass of warm milk containing a teaspoon of honey before going to bed.
  • Don’t sleep on your back as the weight of the enlarged uterus reduces the blood supply to the baby.

-- Niki Martinez

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How do drugs affect pregnancy?

Many women fail to notice the early signs of pregnancy, and continue to use alcohol or illicit drugs throughout their first trimester.

Drug-dependent women may have unreliable indicators of pregnancy, since menstrual irregularities occur in 60-90% of women who use drugs. However, many are unaware of pregnancy until they detect movement of the fetus or notice their larger stomach. The awareness is further complicated by the confusion of pregnancy symptoms with signs of narcotic withdrawal. These include nausea, vomiting, pelvic cramps, fatigue and headaches.

Below are commonly abused drugs and how they affect the fetus:

  • Alcohol: Pregnant women who use alcohol increase the risk of their unborn infant developing physical and behavioral abnormalities. These abnormalities, including poor physical development and mental retardation, are called fetal alcohol syndrome (FAS).
  • Caffeine: In the second and third trimesters, the mother's body excretes caffeine up to three times slower than that of a non-pregnant woman. It is difficult to isolate the effects of caffeine from other drugs such as nicotine and alcohol. Existing research points to a relationship between caffeine consumption and lower birth weight, premature deliveries, spontaneous abortions in the first trimester and stillbirth.
  • Tobacco and Nicotine: Cigarette smoking has important health consequences in fetal and infant mortality, birth weight, lactation and breast feeding and childhood respiratory disease. Nicotine is dangerous because it crosses the placenta, increasing the blood pressure and respiratory rate of the developing fetus. Spontaneous abortions are two times more likely among smokers, and there is an increased risk of placental complications, stillbirths and low birth weight. Additionally, babies of smokers tend to be more irritable, have less ability to control their behavior and display a general lack of interest.
  • Marijuana: The effect of marijuana on the developing fetus has not been firmly established. There seems to be a trend toward increased irritability in these infants.
  • Cocaine: Cocaine decreases blood flow to the placenta and fetus, causing higher rates of spontaneous abortions and stillbirth. The increased levels of norepinephrine can lead to premature labor. Fetal effects include decreased birth weight, length and head circumference, as well as hyperactivity, poor feeding and sleeping patterns, irritability and an increased risk of sudden infant death syndrome (SIDS). Breast-feeding is not recommended for this population since it can easily compound and multiply risks.

-- Raquel Ramos

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How do I care for my circumcised son?

The procedure is usually performed after birth and before leaving the hospital. The penis should heal after 5-10 days. Once the redness has gone away, the area is healed. Until then follow three guidelines:

  1. Dab the penis with Vaseline each time you change a diaper. Be sure to completely remove the old Vaseline application before applying more. This will ensure bacteria and infection does not invade the area.
  2. Do not submerge the penis in water until completely healed. Instead, give your son a sponge bath.
  3. Call your child's doctor if you see redness more than 10 days, if there is swelling or there are sores. A yellow discharge from the penis is normal.

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How do I pick a good doctor?

Choose a doctor for your child before birth so that he/she will be accessible immediately following. When looking for a doctor, get recommendations from those you trust and respect. Consider the location of the office. You want to be sure it is as convenient as possible for regular visits. Interview, if you can, potential doctors. During this time, feel out the fit of your personality and needs with the personality and services the doctor provides. You want to feel comfortable with this person. Check the doctor's credentials and any discipline actions taken against him/her.

A good doctor for you and your child is someone with whom you feel comfortable enough to ask any question. Always ask what new things you can expect at your child's upcoming age; always ask what you can do to optimize your child's brain development at each age.

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How do I take care of my baby’s umbilical stump?

To prevent infection in your baby's umbilical stump and to speed up the healing of the navel area, take these steps:

  • Keep your baby's navel area as dry as possible.
  • Clean the navel area two to three times a day with clean cotton balls dipped in a little water. (Recent research shows cleaning your baby's navel with alcohol could actually kill the good bacteria that makes the navel heal faster.)
  • Don't bathe your baby in a tub with water. Use a sponge to clean your baby. Be careful not to get too much water on your baby's navel.
  • Avoid bathing your baby for another seven to ten days after the stump has fallen off. Continue to sponge bath the baby.
  • Don't pull the stump when cleaning the navel area; this could cause bleeding.
  • Fold down the front of the child’s diaper so that the stump can be exposed. This will avoid the stump chafing against the nappy and irritating the skin.
  • Keep your baby's navel area exposed for as long as possible. This will dry out the area and speed up healing.

If the area surrounding the naval turns red, or if you notice a pus-like discharge or blood coming out of the area, call the doctor.

-- Niurka Martinez

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How should I divide my attention between a new baby and my older child?

Your older child might need and demand attention after the baby arrives, especially in the first few weeks. Ask a friend, relative or neighbor for help to ensure the needs of both children are met. Spend at least 10 minutes a day with the older child. Try to make it the same time each day so the child can learn to anticipate and depend on that “together” time. Talk with your older child about things that do not involve the new baby. Remind visitors that the older child needs attention, too.

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Is this really labor?

When time comes for the arrival of your baby, your body will give you clues that labor is beginning or not far away. These are signs that your body is getting ready to bring your baby into this world. The signs are:

  • A sudden burst of energy.
  • The dropping of the baby in your belly.
  • An upset stomach.
  • Diarrhea.
  • The loss of mucous plug that has kept the cervix sealed until it’s time for delivery.
  • Your water breaking.
  • Contractions becoming stronger and closer together.
  • Contractions felt from the back moving forward.
  • Cervix opens and thins.

Pre-labor signs (called Braxton-Hicks) are:

  • Contractions that remain the same strength, distance apart and length.
  • Contractions that are irregular.
  • Contractions are felt in the front.

Everyone experiences labor differently. Walking or changing positions does not affect the contractions. What you may experience may not be what you read about. Trust your body. The final reward will be meeting your new baby.

-- Navia Mederos

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Nutritious lunches

When packing a nutritious lunch for your child, keep these things in mind:

  • Consider nutrition and convenience.
  • Keep food portions small.
  • Provide balanced choices.
  • Offer choices.
  • Invite the child to participate in making choices from each food group.

  • Include fruits and vegetables.
  • Choose whole grains, fruits and vegetables for adequate fiber.
  • Watch for excessive sugar, sodium and fat, especially in processed foods.
  • Offer everything in moderation.

Sample lunches:

#1) Chopped chicken and veggie taco, black beans and rice and plantains.

#2) Turkey sandwich on wheat bread, milk, tomato slices and banana.

#3) Cottage cheese, whole wheat crackers, carrots, milk and strawberries.

Snack suggestions:

  • Low-fat cheese sticks
  • Cheerios
  • Melon chunks
  • Cereal bars


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Postpartum depression. How does it affect the newborn baby?

Some mothers with PPD experience feelings of inadequacy and indifference toward their newborns. A person feeling sad or uncomfortable finds it difficult to meet an infant's needs. As a result, a child usually seeks out more attention; that, in turn, may increasingly upset a new mother. When a positive relationship between mother and child is not effectively formed, it will negatively impact a child’s long-term well being. Children who experience unstable patterns of nurturing from their mothers have a difficult time socializing with others and may be unable to achieve secure attachments or healthy relationships. They also tend to become easily agitated, aggressive or disruptive.

To overcome postpartum depression, talk with your doctor immediately and try these suggestions:

  • Establish a support system of friends, family members or other new mothers.
  • Talk about your feelings.
  • Take time to talk and connect with your partner.
  • Set a healthy exercise routine.
  • Start a journal to write feelings and concerns.
  • Keep a balanced diet rich in proteins, vegetables, grains and fruits.
  • Get enough rest.
  • Enlist friends or family members to help around the house.
  • Make time for yourself.

-- Jeanine del Valle

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Should I feed with the breast or the bottle?


  • Breast milk contains nutrients that match an infant’s needs.
  • Breast milk is easily digestible.
  • Breast milk is less likely to lead to weight problems later in life.
  • Nursed babies are almost never constipated.
  • Breast milk is safe.
  • Breast milk is economical. You don’t have to buy bottles, sterilizers or formula.
  • Breastfeeding reduces a woman’s risk of developing breast cancer.
  • Breastfeeding brings a mother and infant closer together.


  • Bottle-feeding allows a father to share feeding responsibilities.
  • Bottle-feeding doesn’t dictate your diet or your eating style.
  • Bottle-feeding doesn’t tie the mother down to her baby. She can more easily work outside the home, shop, go out in the evening and sleep through the night because someone else can feed the baby.
  • Bottle-feeding is an option for women who feel uncomfortable about nursing an infant in public.

Making the decision:

  • For all undecided women: Try to breastfeed first. If you don’t like it or feel uncomfortable, ask your doctor which bottle formula is best for your child.
  • The first few weeks of breastfeeding are difficult. At least a month or six weeks is needed to establish a successful feeding relationship. Although breastfeeding is generally thought to be the best option for the baby’s health, it doesn’t mean bottle-feeding is bad. Millions of happy and healthy babies have been raised on the bottle.
  • Love can be passed from the mother to child through the bottle as well as through the breast. Make every feeding a time to cuddle and give love to your baby.
  • If you decide to bottle-feed, you might want to offer the warmth and connection of skin-to-skin contact by sometimes letting your baby rest against your bare breast while feeding.

-- Barbara Alonso

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Should my baby be circumcised?

Every family must decide whether a baby boy should be circumcised. Circumcision is a procedure performed by a doctor after birth and before leaving the hospital. The procedure involves removing the foreskin covering the end of the penis. The decision of circumcision is really a personal choice based on parental preference. Consider the following when deciding:

Pros of the procedure Cons of the procedure

  1. During your child's first year, the occurrence of urinary tract infections is reduced.
  2. There is no chance for the surgical procedure between ages 3-5.
  3. No chance of cancer of the penis
  4. Prevents phimosis, a condition that keeps the foreskin from folding back.

  1. Chance of infection.
  2. Complications connected to foreskin infections.
  3. Pain the child will feel.

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To work or not to work after having a baby?

Many families struggle with this question. After being home with a child, feelings of sadness, guilt and nervousness are common and natural when it comes time to return to work.

Each family must consider the pros and cons of staying at home with the baby or going to work. What makes the biggest difference is your own attitude about being a working-outside-the-home mom. What you model for your child, spouse and other family members will help dictate how successful your returning to work will be.

Some thoughts and themes to consider.

  • Three of every five of women in the United States return to work outside the home within a year of having a baby.
  • Create a budget of your family’s income and expenses. Compare the financial impact of staying at home and returning to work.
  • Perhaps part-time work could be realistic for you.. Some companies offer flexible work arrangements known as “job sharing” where you and another share one full-time position. Ask your employer about options.
  • Perhaps you can find a job that allows you to be at home. There are internet resources for those who want to work at home. Access the web at your local library. Try searching by typing “stay-at-home jobs” or “work-at-home moms.”
  • Subscribe to or check out at the library such magazines as Working Mother that report on family-friendly companies.
  • Once home after work, spend quality time with your family.
  • Set aside part of the day that becomes “your” time.
  • Be organized. Every member of the house should have a specific responsibility to help with the everyday schedules of chores and activities.
  • Consistency is important for working families. Dinner and bedtime routines should be at the same time every day.

-- Vickie Burley

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What are prenatal tests?

All pregnant women should undergo a series of medical tests to monitor a baby’s health. These tests keep track of fetus movements, growth and heartbeat. Because these tests can detect problems early, it's important that all expectant mothers attend prenatal appointments, even if they are healthy. Visit the doctor as soon as you suspect you are pregnant. At each visit the doctor will examine your weight gain or loss, blood pressure, abdomen circumference, position of the fetus and fetal heartbeat. All this is to monitor the health of you and your baby. The earlier you start prenatal care, the earlier you and your provider can establish a healthy routine.

Women who start prenatal visits during the first three months of pregnancy have fewer problems with their pregnancy -- and healthier babies. Many mothers are not aware of the prenatal tests or may not have sufficient information about the purpose of the tests.

Here are explanations of the most common tests:

Amniocentesis: This is the most common procedure used to test for birth defects. Usually done at 15-18 weeks of pregnancy; it is performed in a hospital or in the health care provider's office. Testing should be offered to: (a) pregnant women who will be 35 or older on their due date (the risk of having an infant with a chromosomal problem such as Down syndrome increases with the woman's age); (b) couples who already have had a child with a birth defect or have a family history of certain birth defects, and (c) pregnant women with other abnormal genetic test results.

Fetal Heart Rate Monitoring: Fetal heart rate monitoring is a part of routine care. Electronic fetal monitoring is a good way to measure your baby's responses to labor and delivery. Electronic fetal monitoring uses equipment to record the heart rate on an ongoing basis. At the same time, the contractions of the uterus are measured. This can be done by feeling the abdomen or by using electronic equipment. Fetal heart monitoring will be done at different times depending on your stage of labor and if you are at risk for problems. You may be monitored as often as every five minutes or every 30 minutes. Or it may be done continuously. Ask your health care provider how fetal monitoring will be used during your labor.

Genetic Screening: Genetic screening is used to find out what diseases or birth defects children might inherit from parents. It is best to do genetic screening before you get pregnant, but it also can be done at your first prenatal visit and later in your pregnancy. Chorionic villus sampling (CVS) and amniocentesis are examples of genetic screening tests done during pregnancy.

Gestational Diabetes: Gestational diabetes can occur even when no risk factors or symptoms are present. Many health care providers test all pregnant women for diabetes. Gestational diabetes goes away after the baby is born. More than half of the women with gestational diabetes will develop diabetes, usually many years later. It's important to tell your health care provider if you have had gestational diabetes in previous pregnancies.

High Blood Pressure: Preclampsia is a condition of high blood pressure caused by pregnancy after the 20th week of pregnancy. Your blood pressure goes up; you retain water, and protein is found in your urine. Preclampsia also is called toxemia or pregnancy-induced hypertension.

Monitor Fetal Health: Four tests may be used to monitor the well-being of the fetus before birth: (1) Kick count: Note the number of times the fetus moves over a certain period. (2) Ultrasound: A test in which pictures (called sonograms) of the fetus are created from sound waves. (3) Non-stress test: Measures the fetus's heart rate in response to the movements of the fetus. (4) Biophysical profile: Examines the fetus's heart rate, fetal breathing, fetal body movement, fetal muscle tone and the amount of amniotic fluid.

Rh factor: The Rh factor is a type of protein on the red blood cells. Issues arise if Rh-negative blood (without Rh factors) comes in contact with Rh-positive blood (with Rh factor). The person with Rh-negative blood might become sensitized and produce antibodies to fight the Rh factor as if it were a harmful substance. This causes trouble during pregnancy if an Rh-negative woman becomes pregnant with an Rh-positive fetus; the woman’s body might produce antibodies to attack the Rh-positive cells in the fetus. The person with Rh-negative blood then may become sensitized. Thus, that person produces antibodies to fight the Rh factor as if it were a harmful substance. A simple blood test can tell a woman her blood type and Rh factor. Another blood test, called an antibody screen, can show if an Rh-negative woman has developed antibodies to Rh-positive blood. If an Rh-negative woman is given Rhogam, it is injected into a muscle of the arm or buttocks. She will be "passively immunized." This means that her body will not make antibodies that might otherwise attack the red blood cells of her Rh-positive fetus. Rhogam is safe for a pregnant woman to use. The only known side effects are a soreness where the drug was injected and a slight fever. And both are temporary. Monitoring helps you throughout your pregnancy by providing important information about the well-being of the fetus. A condition doesn't mean that there’s a problem but just that you need special care. The goal is for you and your baby to be as healthy as possible.

-- Niurka Martinez and Navia Mederos

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What can I do to nurture a new sibling relationship?

Involve the older child in pre-birth preparations. For example, if the child wants to help by reading, choose books from the child’s own collection he or she is willing to pass on to the baby and arrange a book space for the baby’s things. Talk with your child about expectations for the baby; children often expect an instant playmate and become disappointed when they realize that the baby cannot play the way the child might expect.

Your older child may regress in some areas -- bedwetting, whining, crying, baby talking and demanding the bottle or breast. That’s a child’s way of getting your attention. Be patient; remind your older child of all he or she can do that the baby cannot. This helps a child’s sense of independence.

Talk with your older child frequently about feelings. Anger and frustration often accompany the change that a new sibling brings. Respect the child’s feelings and help identify appropriate ways to act out. For example, it is all right to bite a chew toy when frustrated, but not all right, of course, to bite the baby.

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What can I do to promote a healthy pregnancy at work?
  • Wear comfortable shoes and clothes to ensure a comfortable work day.
  • Engage in tasks that do not require physical exertion.
  • Drink enough water to prevent swelling.
  • If you have a desk job, keep your feet up to improve circulation.
  • Prepare “to-do” lists and ask for help in getting things done.
  • Eat breakfast every day; don’t skip meals. Regular small meals will help you beat nausea associated with morning sickness
  • Keep stress levels under control. Take walks or practice yoga.
  • Get enough sleep at night. Take a quick nap at lunch time if possible.

-- Niki Martinez

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What does pregnancy mean for my body?

Expectant mothers should know what to expect when it comes to changes in their bodies during pregnancy. Pregnancy is divided into trimesters with different features and expectations in each.

First Trimester

The most common effects from hormonal changes include fatigue, nausea, breast changes and frequent urination. To decrease nausea and vomiting eat small amounts of nutritious food every 2-3 hours. Avoid greasy, fried or spicy foods. Eating crackers before getting out of bed is also helpful. Consume liquids between meals to avoid an upset stomach. To help with breast changes, undergarments should be comfortable and not tight. Rest with feet elevated as often as possible.

Second Trimester

At this stage, the mother’s blood volume increases, causing the blood pressure to decrease slightly and the heart rate to increase about 10 to 20 beats per minute. Meanwhile, the risk of urinary tract infection is more pronounced. Due to increased estrogen levels, gums tend to bleed easily. Nipples are larger and more pigmented. Due to hormonal changes, darkening of the skin over the forehead and cheeks may occur. Vaginal sensitivity increases.

Third Trimester

Fatigue, shortness of breath, and increased urinary frequency are typical. Increased urinary frequency is from the fetal pressing parts against your bladder.

Contractions become more regular and uncomfortable by 38 to 40 weeks. Blood pressure rises slightly. Heartburn is common due to the displacement of the gastrointestinal system. Avoid lying down after eating. Swelling, or edema, is also a common discomfort. One way to treat swelling is by drinking plenty of water. Expectants mothers also should wear comfortable shoes and put their feet up whenever possible.

Don’t lie flat on your back as the baby compresses vital large veins that supply you and baby with blood and oxygen. Lying down on either side is best. Avoid abrupt movements as this may precipitate sudden changes in blood pressure causing fainting-like symptoms. The expectant mother’s center of gravity shifts during this trimester. Be careful when walking or moving suddenly; you don’t want to fall.

-- Vanessa Tirado

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What if I don't have health insurance for my child?

Thousands of children in Miami-Dade County are uninsured unnecessarily. There is help out there.

Your child without health insurance may be eligible for KidCare. KidCare is a state-wide program offering insurance for children up to age 18. Four insurance options are available under KidCare:

  1. Medicaid, for all ages
  2. Healthy Kids, for children ages 5-18
  3. Medikids, for children ages 0-5
  4. Children Medical Services, for children with special health needs ages 0-18 Call 305-358-4357 or visit www.floridakidcare.org to find out for which program your child is eligible.

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What if I don't have insurance for myself?

The March of Dimes and the Florida Department of Health operate a service called the MomMobile. The MomMobile is a motorized clinic providing quality prenatal care and family planning to the community for free. The MomMobile is on an every weekday schedule visiting five sites in the southern half of Miami-Dade County. Please call 305-546-2986 to locate the site nearest to you.

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What is labor?

Labor is a series of continuous, progressive contractions of the uterus. These contractions allow the cervix to expand so the baby can move through the birth canal. Signs of labor are different for every woman, and it is almost impossible to pinpoint when it begins. Many physiological changes in a woman’s body work together during delivery.

Labor can be divided into three stages:

Stage One is made up of three phases:

  • First phase, the latent phase, is when contractions become more frequent (5 to 20 minutes apart) and stronger. The cervix dilates to about four centimeters and thins out. This is usually the longest and least intense phase of labor.
  • Then comes the active phase when the cervix dilates from 4 to 7 centimeters and the contractions become longer, stronger and more frequent.
  • Next, in the transitional stage, the cervix dilates from 7 to 10 centimeters, the contractions are longer, and the woman begins to feel an urge to push.

Stage Two is actual delivery of the baby.

Stage Three is the delivery of the placenta (the organ that has nourished the baby inside the uterus). This stage lasts a few minutes.

Labor experiences and the amount of time in each stage are different for each woman. Generally, labor in a first pregnancy lasts about 18-20 hours. Labor is usually shorter for subsequent pregnancies.

-- Ana M. Rivero

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What is morning sickness?

In your first trimester you may experience nausea and vomiting known as morning sickness. This is not solely a morning event; indeed, it is possible to have “all-day sickness.”

“Morning sickness” is the discomfort and fatigue that some women experience because of chemical changes during pregnancy. This is especially true for women in their first trimester of pregnancy. This is because pregnant women produce hormones such as progesterone and estrogen in excessive amounts. Hormone levels only increase until about the 12th week of pregnancy; these symptoms don’t last forever. Here are some recommendations:

  • Eat small portions at each sitting.
  • Avoid excessively greasy or fatty foods.
  • Stay away from spicy foods.
  • Sip water throughout the day.
  • Snack on Saltine crackers.
  • Give into cravings in moderation.
  • Keep a well-balanced diet.
  • Try to sleep at least eight hours each night.
  • Take prenatal vitamins in the afternoon instead of in the morning.
  • Get fresh air by opening windows or strolling outside.
  • Avoid the heat.
  • Keep away from nauseating odors that might be magnified during pregnancy.
  • Do not skip meals.
  • For severe morning sickness, ask your doctor about possible vitamin supplements or medications.

-- Jeanine del Valle

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What is postpartum depression?

Postpartum Depression, or PPD, affects one of every ten moms after delivery. Postpartum depression, even if treated, can last six months. Untreated, women can suffer for more than a year.

There are different forms of postpartum depression. Most women suffer from what is referred to as "baby blues." New mothers with these blues usually seem more irritable, sensitive and fatigued. The symptoms include slight mood fluctuations. “Baby blues” usually disappear within 10 days after giving birth.

The most severe type of PPD is called postpartum psychosis and affects 0.2% of all new mothers. These women often show signs of hallucinating and may have thoughts of hurting their babies. New mothers with this condition must seek medical attention immediately.

It is unclear why some women experience symptoms of PPD and others do not, but most experts agree that the rapid fluctuation of hormones such as estrogen and seratonin trigger chemical imbalances. Environmental elements seem to play a role in PPD, especially when the new mother lacks a support system from a spouse, friends or family members. She also may be more susceptible to PPD when the pregnancy has had complications such as premature labor or the baby must be separated from the mother due to a medical condition. A new mother's relationship with the father also is significant when analyzing the probable causes of PPD.

-- Jeanine del Valle

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What is the best way for siblings to share a room?

Talk with your older child about the situation and involve him or her in setting up the new space. If you involve the child in the design and decisions about the new space, that child has some control and ownership for a smooth transition.

Clearly distinguish the older child’s space from the new baby’s space and explain the idea of privacy for each.

Sharing a room is often a bonus for young children. When a young child awakens to see a brother or sister in the room at night, he or she is more likely to roll over and go back to sleep. Children also have someone to talk to before falling asleep and upon waking up.

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What kinds of childbirth classes are there?

The two leading methods of childbirth instruction are Bradley and Lamaze.

Dr. Robert Bradley developed the Bradley Method in the 1940s. This method encourages good diet and exercise during pregnancy. It teaches mothers-to-be how to deal with the stress and pain of labor through deep relaxation techniques and natural breathing. In this method a companion is educated to coach and support during labor. Obstetric interventions and pain-relieving medications are kept to a minimum.

Dr. Ferdinand Lamaze discovered the Lamaze Method, also called the psychoprophylaxis method, during a trip to Russia. This method teaches women to condition their responses to contractions through breathing, relaxation exercises and imagery in order to minimize pain. It encourages women to make informed choices about the use of pain relief medication during labor.

Some other methods of childbirth instruction:

  • Hypo Birthing or the Morgan Method: A deep relaxation method that eases fear, muscle tension and pain via natural childbirth education enhanced by hypnosis techniques.
  • Birthworks: A childbirth program that develops a woman’s self-confidence and trust in her ability to give birth. The classes provide physical and emotional preparation for birth.
  • The Alexander Technique: A pain management technique used by some midwives. Women are taught to cope with labor pain through “inhibition and direction” (Alexander Technique teaching terms) so that the usual reaction to pain eases.
  • Childbirth classes should take place in the last trimester of pregnancy. The classes should be completed by about three weeks prior to the expected due date. The courses, usually 12 hours of instruction, are taught by certified teachers.
  • Contact your health care provider or local birthing hospital for information about childbirth class offerings.

-- Ana M. Rivero

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What should I eat to have a healthy pregnancy?

1. Eat without regret. When you are about to eat a spoonful of food, ask yourself, “Is this the best bite I can give my baby?” If so, eat it; if not, put down the spoon or fork.

2. Choose carefully; choose quality over quantity. Have in mind that 150 calories from a chocolate chip cookie is not the same as 150 calories of a whole-grain muffin.

3. If you go hungry, your baby will, too. Even if you are not hungry, the baby is. Try not to skip meals. Eating six little meals each day will prevent bloating and heartburn.

4. Pick lean meats over fatty ones, low-fat milk and dairy goods over full-fat, broiled foods over fried, and spread butter lightly.

5. Simple carbohydrates such as white rice, white bread, refined cereals, cakes, cookies and pretzels are nutritionally weak. But complex carbohydrates such as whole grain breads and cereals, brown rice, vegetables, dried beans and peas and potatoes provide essential B vitamins, trace minerals, protein and important fiber. They are good for your baby and for you. They help diminish nausea and constipation, and they keep your weight in balance.

6. Substitute fruits and fruit juices for sweets and baked goods.

7. Choose fresh vegetables and fruits when in season or fresh-frozen when fresh are unavailable. If your broccoli has been boiled, processed, preserved and canned since harvesting, it probably doesn’t have much natural goodness left for you or your baby.

8. Involve the entire family with your healthy diet; it will benefit them, too.

9. Eliminate alcohol, tobacco and other unsafe drugs.

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When should I tell my child that we will have a new addition to the family?

Consider your child’s age and development when sharing information about the future event. A child under 5 years can be told when Mommy’s stomach gets big. An older child may be told earlier. Take your cues from your child, who will pick up on more than you might expect. Some children might become worried that something is not right if they overhear conversations or see Mommy experiencing morning sickness. Keep the explanation simple, and let your child take the lead with questions.

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