ON LI ! IL D M OL 19 S S ER PIE OV CO WHAT TO EXPECT® WHEN YOU’RE EXPECTING 5TH EDITION The #1 Bestselling Pregnancy Book What to expect WHEN YOU’RE EXPECTING T 5th EDITION he all-in-one guide that explains everything you need to know—and can’t wait to find out—about your amazing nine months, from conception to birth and beyond Featuring a week-by-week look at your baby, and information just for dads throughout ❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖ Completely New & Revised MURKOFF ❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖❖ Heidi Murkoff and Sharon Mazel Foreword by Charles J Lockwood, MD, Professor of Obstetrics and Gynecology and Public Health, Dean, Morsani College of Medicine, University of South Florida WHAT TO EXPECT ® WHEN YOU’RE EXPECTING 5TH EDITION Also Available from What to Expect® What to Expect ® the First Year What to Expect ® the Second Year Eating Well When You’re Expecting What to Expect ® Before You’re Expecting The What to Expect ® When You’re Expecting Pregnancy Journal & Organizer Qué puedes esperar ® cuando estás esperando (What to Expect ® When You’re Expecting—Spanish Edition) Qué puedes esperar ® en el primero año (What to Expect ® the First Year—Spanish Edition) The What to Expect ® Baby-Sitter’s Handbook WHAT TO EXPECT ® WHEN YOU’RE EXPECTING 5TH EDITION By Heidi Murkoff and Sharon Mazel Foreword by Charles J Lockwood, MD Professor of Obstetrics and Gynecology and Public Health Dean, Morsani College of Medicine, University of South Florida Wo rkm a n Pub l i s h i ng • Ne w York To Erik, my everything To Emma and Wyatt for making me a mom, and Lennox for making me a grandmom To Arlene, my first partner in What to Expect and my most important one Your legacy of caring, compassion, and integrity lives on forever; you’ll always be loved and always be remembered To moms, dads, and babies everywhere— and to all those who care for and about them Copyright © 1984, 1988, 1991, 1996, 2002, 2008, 2016 by What to Expect LLC Design copyright © Workman Publishing Co., Inc All rights reserved No portion of this book may be reproduced—mechanically, electronically, or by other means, including photocopying—without written permission of the publisher Published simultaneously in Canada by Thomas Allen & Son Limited Library of Congress Cataloging-in-Publication Data Names: Murkoff, Heidi Eisenberg, author | Mazel, Sharon, author Title: What to expect when you're expecting / by Heidi Murkoff and Sharon Mazel ; foreword by Charles J Lockwood, MD, Senior Vice President, USF Health, and Dean of the Morsani College of Medicine Description: Fifth edition | New York : Workman Publishing, [2016] Identifiers: LCCN 2015044527 | ISBN 978-0-7611-8748-6 (alk paper) Subjects: LCSH: Pregnancy | Childbirth | Postnatal care Classification: LCC RG525 M87 2016 | DDC 618.2 dc23 LC record available at http://lccn.loc.gov/2015044527 ISBN 978-0-7611-8748-6 (PB) ISBN 978-0-7611-8924-4 (HC) Book design: Lisa Hollander and Barbara Peragine Interior illustrations: Karen Kuchar Cover design: Vaughn Andrews Cover photographs: © mattbeard.com Cover quilt: Lynette Parmentier, Quilt Creations Cover quilt photography: Davies + Starr Workman books are available at special discounts when purchased in bulk for premiums and sales promotions as well as for fund-raising or educational use Special editions or book excerpts can also be created to specification For details, contact the Special Sales Director at the address below or send an email to specialmarkets@workman.com Workman Publishing Co., Inc 225 Varick Street New York, NY 10014-4381 workman.com WHAT TO EXPECT is a registered trademark of What to Expect LLC WORKMAN is a registered trademark of Workman Publishing Co., Inc Printed in the United States of America First printing April 2016 10 Thanks and More Thanks S o, it’s time for another delivery And if delivering a book is anything like delivering a baby—and it is, in many ways (you nurture, nurture, nurture, stress, stress, stress, try to breathe, breathe, breathe, and then you push, push, push)—I have a whole lot of birth attendants to thank: First, always and forever, the father of What to Expect, Erik—the man who made me a mom to Emma and Wyatt, a mom to What to Expect, and the happiest woman on the planet My 24/7 partner in life, love, work, parenting, and (best of all) grandparenting Suzanne Rafer, editor and friend, who has helped me birth more baby books than I can count, and has been there since What to Expect was first conceived (and who actually named our first baby): tirelessly coaching, cheering, and policing my puns (with limited success—that’s what erasers were made for) Peter Workman, who created the house I’ve delivered all my babies in, and whose legacy lives on in them Everyone else at Workman who contributed to this baby: Jenny Mandel, Emily Krasner, Suzie Bolotin, Dan Reynolds, Page Edmunds, Selina Meere, Jessica Wiener, and Sarah Brady Matt Beard, who had us covered, coverto-cover, bringing beautiful images of Lennox before and after Karen Kuchar for bringing moms and babies to life with her lovely illustrations Lisa Hollander and Vaughn Andrews for putting it altogether artfully in such a pretty package, Beth Levy, Claire McKean, Barbara Peragine, and Julie Primavera for masterfully producing and managing the seamless sausage-making Sharon Mazel, who has nurtured, stressed, breathed (and reminded me to breathe), and pushed alongside me for the last 15 years of birthing What to Expect babies—without ever asking for an epidural—while somehow managing to raise amazing daughters and staying happily married to the second most patient man on earth, Jay Dr Charles Lockwood (who appropriately played the role of ob in What to Expect When You’re Expecting, 4th and 5th editions!), our intrepid medical advisor—always ready to tackle any topic on the minds of moms (even those perhaps best left on the fringe), to bring his enormous reserves of knowledge, experience, wisdom, caring, and compassion to help deliver our latest baby safe and sound (as in sound advice) Dr Stephanie Romero for her incredibly insightful contributions Dr Howie Mandel, for delivering compassionate care— and Lennox ACOG, for being tireless advocates for moms and babies everywhere, and to all the doctors, midwives, nurses, childbirth educators, doulas, and lactation consultants around the world who literally nurture the nurturers among us, helping deliver the healthiest start in life for every baby and the healthiest future for all of us The experts and advocates at the CDC—an organization passionately devoted to the health and wellbeing of our global family, especially when it comes to our most vulnerable—for your shared mission and commitment, for being an invaluable partner in spreading important health messages (and preventing the spread of disease!) Our other partners in mom and baby health and #BumpDay: International Medical Corps (internationalmedicalcorps.org), humanitarians, first responders, and trainers of healthcare heroes (like my personal midwife hero from South Sudan, Tindilo Grace Losio, aka Amazing Grace) 1,000 Days™, for believing that a healthy future depends on a healthy (and well-fed) beginning The UN Foundation’s Universal Access Program, for their passionate support of women and girls and their reproductive rights, health, and wellbeing Our partners in Special Delivery, the USO, and the amazing military mamas around the world I’ve had the honor to hug and have yet to hug (more hugs coming!) Our incredible WhatToExpect.com team, fearlessly led by Michael Rose, Diane Otter, and Kyle Humphries, for their endless energy, enthusiasm, innovation, integrity, creativity, conviction, passion, and shared purpose (and for believing in the power of purple) For inspiration and love, our beautiful “children”: Wyatt, Emma, and Russell, and of course, Lennox Howard Eisenberg, Abby and Norm Murkoff, Victor Shargai, and Craig Pascal Contents Foreword to the Fifth Edition, by Charles J Lockwood, MD x Introduction to the Fifth Edition xi PART FIRS T 1: THIN GS FIR ST Chapter 1: Are You Pregnant? What You May Be Wondering About all about : Choosing and Working with Your Practitioner 10 Chapter 2: Your Pregnancy Profile 18 Your Gynecological History 18 Your Obstetrical History 24 Your Medical History 38 all about : Prenatal Diagnosis 53 Chapter 3: Your Pregnancy Lifestyle 62 What You May Be Wondering About 62 all about : Complementary and Alternative Medicine 78 Chapter 4: Nine Months of Eating Well 84 Nine Basic Principles for Nine Months of Healthy Eating 86 The Pregnancy Daily Dozen 90 What You May Be Wondering About 101 all about : Eating Safely for Two 117 PART 2: N I N E M O N T H S & C O U N T I N G F R O M C O N C E P T I O N T O D E L I V E RY Chapter 5: The First Month Aproximately to Weeks 122 Your Baby This Month 122 Your Body This Month 124 What You Can Expect at Your First Prenatal Visit 125 What You May Be Wondering About 128 all about : Your Pampered Pregnancy Chapter 6: The Second Month 149 Approximately to Weeks 156 Your Baby This Month 156 Your Body This Month 158 What You Can Expect at This Month’s Checkup 159 What You May Be Wondering About 159 all about : Weight Gain During Pregnancy 177 Chapter 7: The Third Month Approximately to 13 Weeks 182 Your Baby This Month 182 Your Body This Month 184 What You Can Expect at This Month’s Checkup 185 What You May Be Wondering About 185 all about : Pregnant on the Job 199 Chapter 8: The Fourth Month Approximately 14 to 17 Weeks 211 Your Baby This Month 211 Your Body This Month 213 What You Can Expect at This Month’s Checkup 214 What You May Be Wondering About 214 all about : Working Out When You’re Expecting 229 Chapter 9: The Fifth Month Approximately 18 to 22 Weeks 246 Your Baby This Month 246 Your Body This Month 248 What You Can Expect at This Month’s Checkup 249 What You May Be Wondering About 249 all about : Sex and the Pregnant Couple 273 Chapter 10: The Sixth Month Approximately 23 to 27 Weeks 281 Your Baby This Month 281 Your Body This Month 283 What You Can Expect at This Month’s Checkup 284 What You May Be Wondering About 284 all about : Childbirth Education 301 Chapter 11: The Seventh Month Approximately 28 to 31 Weeks 307 Your Baby This Month 307 Your Body This Month 309 What You Can Expect at This Month’s Checkup 310 What You May Be Wondering About 311 all about : Easing Labor Pain 330 Chapter 12: The Eighth Month Approximately 32 to 35 Weeks 337 Your Baby This Month 337 Your Body This Month 339 What You Can Expect at This Month’s Checkup 340 What You May Be Wondering About 340 all about :Breastfeeding 366 Chapter 13: The Ninth Month Approximately 36 to 40 Weeks 372 Your Baby This Month 372 Your Body This Month 374 What You Can Expect at This Month’s Checkup 376 What You May Be Wondering About 376 all about : Prelabor, False Labor, Real Labor 393 Chapter 14: Labor and Delivery 396 What You May Be Wondering About 396 Stage One: Labor 419 Stage Two: Pushing and Delivery 430 Stage Three: Delivery of the Placenta 436 Cesarean Delivery 438 Chapter 15: Expecting Multiples 441 What You May Be Wondering About 441 all about : Multiple Childbirth 454 PART AFTER THE 3: BABY IS BO RN Chapter 16: Postpartum: The First Week 460 What You May Be Feeling 460 What You May Be Wondering About 461 all about : Beginning Breastfeeding 478 Chapter 17: Postpartum: The First Weeks 488 What You May Be Feeling 488 What You Can Expect at Your Postpartum Checkup 490 What You May Be Wondering About 490 all about : Getting Back into Shape 518 PART S TAY I N G H E A LT H Y 4: WHEN YO U’RE EXPECTING Chapter 18: If You Get Sick 524 What You May Be Wondering About 524 all about : Medications During Pregnancy 538 PART T HE 5: COM P L ICATED PREG NANCY Chapter 19: Managing Complications 544 Pregnancy Complications 544 Uncommon Pregnancy Complications 563 Childbirth and Postpartum Complications 567 all about : If You’re Put on Bed Rest 573 Chapter 20: Pregnancy Loss 582 Types of Pregnancy Loss 582 all about : INDEX Coping with Pregnancy Loss 592 604 ... What to Expect ® Before You? ? ?re Expecting The What to Expect ® When You? ? ?re Expecting Pregnancy Journal & Organizer Qué puedes esperar ® cuando estás esperando (What to Expect ® When You? ? ?re Expecting? ??Spanish.. .WHAT TO EXPECT ® WHEN YOU? ? ?RE EXPECTING 5TH EDITION Also Available from What to Expect? ? What to Expect ® the First Year What to Expect ® the Second Year Eating Well When You? ? ?re Expecting What. .. but you? ??d like to become pregnant soon, start making the most of the preconception period by taking the steps outlined in What to Expect Before You? ? ?re Expecting Good preconception prep before you