Category: Healthy Pregnancy

When I was 41 weeks pregnant, I got a push notification on my Baby Center app that my little precious bundle had arrived. You’ve waited all this time and now she’s here! Congratulations! it cooed.
She was not here. In fact, my daughter was showing zero interest in exiting my body. I was so upset and frustrated—and so insanely hormonal and hot and just over it—that I deleted the app and threw my phone across the room. Oops.
There is a particular weirdness to waiting for a baby to be born. There is nothing quite like it, nothing that feels so utterly out of our control and so life-changing at once. Will it happen today? Tomorrow? Next week? Is it happening now? Now? Now?
I did all the things I’d been told to do: acupuncture, long walks, climbing stairs (two-by-two), lots of sex, nipple stimulation. Finally, on day 10, I rubbed castor oil on my belly, and on day 11, I went into labor. Twelve (very, very, very long) days after my due date, my daughter arrived. Via c-section. After 28 hours of labor.

When can I induce labor?

“Between 37 weeks and 40 weeks + 6 days are safe times to have baby,” says Jocelyn Brown, LM, CPM, a certified midwife at GraceFull Birthing in Los Angeles. She says babies and mothers have good outcomes during that time frame. Between 41 weeks and 41 weeks + 6 days, the baby is considered late-term. After 42 weeks, the baby is post-term.
After 41 weeks, the risks of stillbirth, c-section, and pelvic damage seems to become a little higher (although this is still statistically unclear). But at 42 weeks, the risk of stillbirth goes up enough that it is a true risk. One study shows that between 37 and 42 weeks, risk of stillbirth goes from 2.1 per 10,000 births to 10.8 per 10,000. Babies also tend to do worse in post-term labor and are sometimes badly positioned.
If you’re hoping for a vaginal birth—especially one outside the hospital—you might not have that option after 42 weeks. It all depends on your state, so be sure to check with your midwife before you get close to delivery. “In California, I’m only licensed to deliver women until 42 weeks outside the hospital,” explains Brown. “So I have the induction conversation before a woman gets to her due date. She can’t be in my care forever until she has the baby. But the last thing I want to do is put pressure on her to give birth.”

I’m 38 weeks, but I want this baby out of me! Can I be induced?

Although the baby is technically full term, unless you are at high risk, there is no reason to rush things along. But this doesn’t mean that you shouldn’t start preparing for labor.
“We talk about cervical ripening,” Brown explains, “not inducing.” This means working to soften the cervix before you’re 41 weeks along. In many midwife and OB-GYN practices, after 42 weeks, you have to go to the hospital (if you weren’t planning to already), where the likelihood of a medicalized induction is high. This is why cervical ripening can start earlier, between 35 and 37 weeks. Of when you’re ready to deliver, Brown says, “I want a nice, favorable cervix, so we are looking for a high Bishop score.”
Here are a few things that can get your cervix ready to go:

Acupuncture

First used over 3,000 years ago to induce labor, acupuncture is a very common part of the birth experience for many women, especially in China. But while it can increase your cervical ripening score (which helps lead to labor!), it might not shorten or induce labor. That said, it doesn’t seem to hurt, so you can start weekly or biweekly sessions around 35 or 36 weeks.
“I recommend it to patients,” explains Rachel Graves, MD, who practices in Portland. “The data is not great, but there is some that says it may help women to not go significantly past their due date.”
How does it work? “Acupuncture moves blood and qi [energy],” explains Kelly Smith, a licensed acupuncturist in the Twin Cities, “so I can bring blood to the uterus and move qi downward, using the right points on the right meridians. It also affects the sympathetic and parasympathetic nervous systems, which control hormone production.”
Starting at 39 weeks + 5 days, Smith encourages her patients to come in daily. That’s when she begins working on the “forbidden” points—the points that can possibly induce labor and have hitherto been avoided.

Nipple Stimulation and Breast Pumping

One recent study showed that women who performed nipple stimulation had shorter “phases of birth” than women who did uterine stimulation or nothing at all. (In this study, none of the women who did nipple or uterine stimulation had c-sections.) This can be started at 37 or 38 weeks. It might do nothing, but it could shorten the pregnancy by 3 days. “It doesn’t seem like a lot,” says Brown, “but 41 weeks + 5 is better than 42 + 1.” (Ain’t that the truth?) Plus, it can be the difference between a hospital birth and one at home, if that’s your goal.

I’m 41 weeks, and I want this baby out! How can I induce labor?

All the tips above are really meant to ripen the cervix before it’s go-time, but once it’s safe to actually start labor, you can take more advanced steps. “We don’t freak out at 41 weeks,” says Brown, but the approach becomes a little more intensive. But keep in mind that if nothing happens and you are almost at 42 weeks, your next stop is probably the hospital.
Here are some ways to move things along if you go past your due date:

Membrane Stripping

Membrane stripping (or sweeping) is often done at 41 weeks, sometimes earlier. One caveat to this less-than-pleasant process: The cervix needs to be dilated enough for your midwife or OB to get her finger in. “I put my finger in a curve hook shape and sweep around. I’m trying to separate the amniotic sac from the sides of the uterus and soften the cervix,” Brown explains.
Pros of Membrane Stripping:

• It could put you into labor.
• It could break your water (which can be a pro or a con). “If my messing with the amniotic sac easily breaks it, then probably that sac wasn’t long for this world,” says Brown. If your body is ready to go into labor, then that’s a pro, but if your little one isn’t quite ready to come out, membrane stripping could leave you and your baby at risk for infection.

Risks of Membrane Stripping:

• If you are Group B Strep positive, there is a small risk of infection, so Brown always waits until the last minute. In other words, she personally wouldn’t do it at 39 weeks, but at 41 weeks, when you’re looking at a hospital transport, it might be worth it to you.
• It’s painful. “It’s practice to labor—it’s intense, but labor is intense,” Brown says. “I always say the magic word is stop.”
• It could send you into labor—but with your baby in a bad position (i.e. if the baby isn’t really ready to come out yet).

Castor Oil Induction

Ah, the dreaded castor oil induction! We’ve all heard stories. Poop for days!
The idea behind castor oil is that it has prostaglandins, hormones that soften the cervix. “If you take it, you poop your brains out. The laxative effect activates the prostaglandins and makes the uterus contract,” Brown says. “It’s the most powerful thing outside the hospital.” One study does show that it can induce labor.
Brown advises women to begin at 41 + 3 days or 41 + 4 days. “Because we know we’ll need to go to hospital at 42 weeks, we back up the clock and induce before time is very pressing.” In other words, don’t start wait until 41 + 6 because nothing might happen for a day or two.
Note: Do not—we repeat, do not!—do this without consulting your midwife or OB.
Brown advises her patients to take up to 6 ounces of castor oil throughout the day. “There’s no evidence that it’s hard on babies, but if you want your baby monitored through early labor, then it’s best to go to the hospital.”
A less intense step would be to simply put castor oil on your belly and go to sleep. If nothing happens, begin the drinking protocol.
Brown suggests a castor oil smoothie: 2 ounces in a smoothie with an ice cream flavor that you like—but not your favorite “because it will ruin it forever.” Wait two hours, do it again, wait two hours, do it again. If you have heavy contractions, stop. But otherwise, you can take up to 6 ounces.
Brown encourages her patients to not get too depressed. “If you drink that much castor oil and it doesn’t work, then maybe the baby needs more monitoring. I’m a big believer in things being meant to be.”
Pros of Castor Oil Induction:

• You might actually go into labor!

Risks of Castor Oil Induction:

• Discomfort—you could have a lot of diarrhea for an extended period of time and experience nausea.
• A lot of pooping might lead to nothing—one study says castor oil is actually not all that effective in inducing labor.  
• Very few studies have been done on castor oil induction.

Nipple Stimulation and Breast Pumping

Nipple stimulation creates an oxytocin response, which creates uterine contraction. It also helps you stop hemorrhaging, deliver the placenta, and bleed less. It also works to ripen the cervix before you’re full term, but if you’re closing in on 42 weeks with no sign of baby coming, you can go at this a little more intensely.
Brown suggests trying 20 minutes on, 20 minutes off for two hours, then taking a break. Then try again. That said, don’t overdo it. Brown doesn’t want your nipples to be so sore by the time the baby is born that you can’t actually nurse!

Random Bonus Idea: Eating Dates

One study actually suggested that eating dates in the last four weeks of pregnancy can help induce labor, but the results were non-significant. Another study claimed that “date consumption reduced the need for labour augmentation with oxytocin but did not expedite the onset of labour.”

I’m desperate! What else can I try to start labor?

We’ve all heard myriad tales. Here are some common labor-inducing activities, and Brown’s thoughts on whether or not they work.
Sex: Some women are so desperate they will try anything! “It’s thought that semen will induce labor because it has prostaglandins that touch the cervix,” says Brown, “and also that orgasm increases uterine activity in healthy pregnant women.” But there’s little evidence that it actually works.
Walking: People sometimes think walking can make the baby “drop” or get contractions going, but this won’t help unless the cervix is already effaced, and contractions will likely stop once you stop walking. Or, as Brown puts it, “Walking is not going to make a baby come out.”
Spicy Foods: Many women are convinced this will do it—and will even name particular foods (e.g., tacos with TONS of super spicy habanero sauce). This thinking is based on the idea that spicy foods might give you diarrhea (obviously not true for everyone). “This doesn’t work unless it gives you diarrhea,” Brown says.
Evening Primrose Oil: There’s no evidence that this works, and studies have not shown that it is effective or safe during pregnancy, labor, or nursing. It might actually slow the labor or lead to a vacuum extraction of the baby, but again, there’s not enough evidence yet. Brown’s conclusion? “Doesn’t work and can make your water break prematurely.”

And if nothing works?

We know these last few weeks of pregnancy are impossibly hard. You feel huge and ready and scared. You have no idea when the baby will show up, and it’s incredibly anxiety provoking!
Brown’s recommendation? “Go to the movies. Have a good week,” she says. “I’m very businesslike about it—either let’s really get that baby out, or just enjoy your last few days of pregnancy.”
In the end, I tried to just lay low those last few weeks. I watched a lot of terrible movies and TV shows I would not have otherwise allowed myself (how many episodes of The Voice can one person watch?!). I read and napped and spent time with my husband. This time is also an opportunity—as crazy as it sounds—to just be in these last few moments of coupledom (or single kid-dom). This time won’t come again, so try as hard as you can to just take a deep breath and know all will change soon enough.

There are so many aches and pains during pregnancy, it’s sometimes hard to tell what’s what: Will it affect the baby? Is this just run-of-the-mill pain, or is it something serious? Am I in labor?!
Almost all hip pain and back pain during pregnancy is simply a symptom of your changing body, not something that will stick around once the baby is out. (You might have hip and/or back pain then, too, but that will have more to do with the birth and/or carrying around an infant than pregnancy.)
That said, there comes a point when enough is enough. “It is always important to check in with a doctor or midwife if you are experiencing intensified pain that stops you in your tracks and/or becomes worse or doesn’t let up,” says former dancer and veteran prenatal massage therapist, Ellen Giglio, who is based in New York City. “Typical pregnancy symptoms tend to come and go with the hormonal and structural changes, but severe pain or discomfort that doesn’t let up could be a red flag.”

Why do I have hip pain during pregnancy anyway?

You’re growing a baby! This is all, unfortunately, totally normal. In fact, about 60 percent of women report lumbopelvic pain (that is, low back and hip pain) during pregnancy, so you’re in good—though pained—company.
The combination of surging hormones and growing a person inside you can be really challenging on the body, especially the lumbopelvic region, causing that dreaded hip pain during pregnancy. “The influx of pregnancy hormones naturally loosens soft tissue structures, especially ligaments and tendons,” explains Giglio. The connective tissue has to soften in order to make room for the baby to grow and then exit, but it also changes your own structural alignment—in other words, your bones and vertebrae need to shift around, which can be really uncomfortable.  “This has a huge effect on the structural alignment, and can weaken the muscles,” Giglio says.
There’s also the simple fact of gaining weight in a relatively short span of time. This alone can put a lot of pressure on your joints. Combining all of these factors results in hip pain in pregnancy, plus a few more aches and pains you likely hadn’t anticipated, like…

Round Ligament Pain: What are these sharp pains? Am I in labor?

Probably not, so don’t panic. Don’t confuse sharp, jabbing pains in your lower abdomen with normal hip pain: These are most likely round ligament pain.
According to the Mayo Clinic, “The round ligaments are a pair of cord-like structures in the pelvis that help support the uterus by connecting the front of the uterus to the groin region.”  As the baby grows in utero and the uterus expands, these ligaments also get stretched out and pulled on, causing some strain. The pain often occurs when the ligaments are in spasm or the nearby nerve feels irritated.  
“Pregnant women say they feel it when they are on their feet for too long, or when they are getting up from sitting, or when sneezing or coughing,” says Giglio. “Sometimes women feel it when they are exercising or making a sudden movement; others say they feel it any time of the day, mostly when they’re in motion, not typically while lying still.”

How can I alleviate round ligament pain?

Pay attention to when you are feeling round ligament pain the most, Giglio advises. Is it when you get up from sitting? When exercising? When sneezing? Figuring out when you tend to get the pain—becoming aware of the patterns—can help keep it from happening too often.
Here is some concrete advice to avoid round ligament pain during pregnancy:

• Stand up slowly. Wait for the muscles and ligaments to settle into a standing position before moving or walking.
• Sit down or flex the hips just before sneezing or coughing.
• Use warm compresses and take warm baths.
• Prioritize strength and flexibility. Keeping your core strong and both legs strong and flexible can help to ease the pain.
• Get a massage.
• Tylenol might help, but always consult your doctor before taking any medication.

Here’s the thing with round ligament pain, though: As long as the baby keeps growing, those sharp pains are likely to come and go as the stretching of the uterus, surrounding muscles, tendons, and the round ligament continue to stretch.  
If this pain becomes severe and does not let up, always get it checked for those rare cases of appendicitis or preterm labor.

Sciatic Pain: I’m feeling pain in my back and pain down my leg. What’s happening?

That hot nerve pain you feel down your leg when you sit, bend, or stand around for a while? That’s the dreaded sciatic pain.
Although sciatica can be caused by several things—most commonly a herniated disk, spondylolisthesis, or stenosis—in pregnant women, it’s likely because of the spinal alignment shifting around and added pressure on the pelvis, Giglio explains. Sciatica usually shows up somewhere in the second and/or third trimester when the soft tissue structures become more affected and the spinal alignment continues to shift around.
“What I typically see in pregnant women is the change in their stature and alignment as the baby grows in the uterus,” she says. “As the weight of the baby/uterus/placenta continues to stretch the uterus, abdominal muscles, and ligaments, the low back tends to arch more and more, causing a sway back. This puts the vertebrae in a completely different position, constricting lumbar muscles.”
This can also put more pressure on the sacroiliac joint, also known as the SI joint. This joint connects the sacrum to the ilium and allows for movement in the low back and hips. Trying to locate the spot? You can palpate it right where there’s a little divet on either side of your bony sacrum, right above your butt—probably right where it hurts! Pregnancy can pull on the SI joint, hamstrings, gluteal muscles, deep lateral rotators, and hip stabilizers, causing a world of hurt.  

How can I alleviate sciatica during pregnancy?

Try to remind yourself, first of all, that your sciatica won’t last. Unless you have a serious medical condition, like a herniated disc, once the baby is out of you, sciatic pain will go away. So as uncomfortable as you are, it will soon shift.
In the meantime:

• Exercise. Swimming is especially good for back and sciatic pain because you are weightless.
• Invest in regular massage therapy to help to release tightening muscles.
• Take warm baths to help circulation to the muscles and with sciatica (but don’t make them too hot!).
• Use ice.
• Find the right position while at rest. This gives all the bony and soft tissue structures a chance to be in a neutral and relaxed position.
• Use a lumbar support or regular pillows against the low back when sitting. This can calm aches in the low back, thus causing less strain on the sacrum, hip joints, and muscular structures.  
• Wear comfortable, supportive shoes with some cushion. This lessens the compression of the joints due to the extra weight on the body and the shifting alignment issues.

How else can I avoid pain during pregnancy?

• Don’t get stuck in any one position for too long, especially sitting or standing still. (This is true whether you’re pregnant or not!) “As my wise acupuncturist used to say, ‘too much of anything is no good!’” says Giglio. So moderation is important.  
• Stay hydrated—more than usual. This is key for muscles, joint structures, blood volume, circulation, the production of amniotic fluid, and even the production of breast milk. “When you’re pregnant, your body makes about an extra quart of blood for the baby,” explains Giglio, “and that’s extra fluid that the body has to work to pump around.”
• Exercise. Seriously. Look, we know all you want to do is nap sometimes. But it’s very important to keep your legs and core strong during pregnancy—those can also help during labor and delivery. Prenatal yoga, daily walking, gentle Pilates, swimming, or dancing can keep you moving, strengthen your cores and legs, and can help alleviate some of the aches and pains from many of these musculoskeletal changes and symptoms.

We know it’s no fun to be in pain, and hearing It’s all worth it! rarely helps. But most of your back and hip pain during pregnancy is just that: during pregnancy. So follow our advice (and moan to your partner and girlfriends all you like!), and know that soon you’ll have a gorgeous babe in your arms—and not in your body!

Pregnancy can feel eternally long—40 weeks (which is actually 10 months, not nine!). But sometimes something goes awry, and the baby decides they want to come out early. Dangerously early.
Although many women fear going into labor and giving birth early, it’s actually not all that common: In 2016, 9.6 percent of births were preterm, and 75 percent of those happened between 32 and 36 weeks.

What is premature labor?

A pregnancy is considered preterm before 37 weeks’ gestation. “Technically, premature labor is defined as uterine contractions, which cause cervical change,” explains Sara Twogood, MD, OB-GYN, and assistant professor at the Keck School of Medicine of the University of Southern California.
In other words, if your contractions are causing your cervix to change—meaning dilation or effacement are taking place—and you are not yet 37 weeks along, then this is considered preterm.  

What premature labor signs should I be looking out for?

As your pregnancy progresses, you should be looking out for uterine contractions with cervical change. There’s a difference between having Braxton Hicks, or false, contractions (which won’t lead to labor) and having contractions that are actually leading to labor.
How can you tell the difference? “This varies from woman to woman, but I usually describe Braxton Hicks contractions as only being in the uterus. In fact, sometimes you actually feel a tightening of the uterus. You may see your abdomen change shape, and it might be uncomfortable. If you palpate your abdomen, the uterus feels firm. But a few minutes later, it feels soft.” Braxton Hicks are irregular and unpredictable. They go away with rest and hydration.
As anyone who has given birth will tell you, labor contractions are painful—and they become more painful with time, as well as (usually) more predictable. In other words, you know when the next one is coming, since they are approximately 5–6 minutes apart (and grow more frequent). “Labor may start in the back or low pelvis and travel forward,” explains Twogood. “They feel like severe menstrual cramps. They are more painful, and won’t go away with hydration and rest.” Women often have terrible back pain, especially if they’re having back labor.
The key is to differentiate between the two. “If we catch preterm labor early, it’s easier to stop,” says Twogood. “So it’s easier to stop dilation that is 1 cm than 8 cm. We don’t want women ignoring contractions thinking they’re Braxton Hicks, but we don’t need them coming in for them.”
As for cervical change, this, too, can be hard to know and will usually require an evaluation. “Your mucus plug can pass anywhere from 6 weeks to 6 minutes before delivery,” says Twogood, “so it’s not a good gauge.” It can also pass multiple times during pregnancy, so losing it at 35 weeks does not necessarily indicate that labor is imminent.
In the hospital, your OB will check your cervix, if it’s safe. More specifically, she will check the Bishop score: effacement, dilation, consistency of the cervix, position of the cervix, and fetal station (how far up the birth canal the baby is stationed). She’ll also check your cervical length—how long the cervix is. This gives her (and you) a sense of how far off labor might be. If you score below a 5, you’re not close yet.
Always call your doctor if you feel that something is off, but remember that Braxton Hicks are quite common, especially in the late stages of pregnancy.

Can bed rest prevent preterm labor?

“Hydration and rest can help ease Braxton Hicks contractions,” Twogood explains. “Hydrating with IV fluids can also help decrease or minimize labor contraction, but it won’t stop preterm labor.” Bed rest is a management strategy that might bring more blood to the placenta, but it unfortunately does not change outcomes.
Twogood explains that doctors and patients use it because it makes sense intuitively—rest, decreased stress, and diminished pressure on the cervix doesn’t hurt. But bed rest does have its own risks: muscle and bone weakness, increased risk for deep vein thrombosis (or blood clot), increased anxiety or depression, and musculoskeletal and cardiovascular deconditioning.
It’s becoming more popular to instead move to modified activity, or activity restriction, rather than complete bed rest. If a patient is admitted to the hospital for preterm labor, she is monitored continuously, which also limits activity.
These restrictions depend on both patients and physicians, but in general, if you are at home and not in the hospital, and you are at risk of going into preterm labor, you can abide by the one-thing-a-day rule:

• One trip to the grocery store or one outside activity but no more.
• No heavy lifting.
• Not being on your feet for more than a few hours per day.
• Limited work (depending on the type of work).
• Minimized stress.

I think I might be in preterm labor. When should I go to the hospital?

One thing is certain: If your water breaks, go straight to the hospital, because there are different treatment and management guidelines when that happens.
Additionally, if you’re experiencing any bleeding or consistent, heavy contractions, contact your doctor, who can help you decide if you should head to the hospital.

What causes preterm labor?

There are a few ways to tell whether you might be at risk for preterm labor:

• A history of preterm labor. “This is by far the biggest risk factor,” explains Twogood. “The earlier the preterm labor (say 24 weeks vs. 36½ weeks) puts a woman at higher risk for having another episode of preterm labor.” It’s important to distinguish between preterm labor and preterm birth—the former does not always lead to the latter. Preterm labor leading to preterm birth will put you in the highest risk group.
• Smoking and/or drug use. “Almost every bad outcome is linked to those two factors,” says Twogood.
• An infection. Kidney infections or appendicitis during pregnancy can increase your risk for preterm labor. You can also develop an infection in the uterus or amniotic cavity. This is treated slightly differently because in those cases, the baby can be infected as well.
• Stress. This one is complicated because women often assume stress is the culprit for preterm labor, but stress itself is not necessarily a risk factor. It all depends on your physiological response to stress: If it increases cortisol levels, causes changes in your diet (food and drink), or creates lifestyle alterations—these can predispose you to preterm labor. “That said, different women respond differently to stress,” says Dr. Twogood. “Some life event in one woman might not cause any physiological changes in another woman. It’s so variable from one woman to the next. I don’t want them to think they can’t work! Work has actually been shown to be healthy for pregnancy. Stress can’t cause preterm labor. It does cause physiological changes, but it is not a source of preterm labor.”

What happens if I go into preterm labor?

If you go into preterm labor, your doctor may try to stop it with medications called tocolytics that can only be administered in the hospital. If your baby is not yet 34 weeks, you’re identified as higher risk, so in addition to medications to stop contractions, doctors also administer antenatal corticosteroids to the mom to help the baby’s lungs mature. In case the baby is born, the baby will do better than without the steroids.

How can preterm labor (and premature birth) affect mom and baby?

This depends almost entirely on how early a baby is delivered. A preemie born at 36 weeks and 6 days will do better than a baby born at 28 weeks.
“Before 34 weeks, you can expect the baby to be hospitalized,” says Twogood. “There is also potential for all sorts of complications. The baby will need to stay in the hospital for monitoring weight gain/loss, bowel function, and brain development, among other things.”
Preterm birth can also, of course, impact nursing. “If the baby is hospitalized with tubes and not feeding well, this can really affect how mom is connecting to baby,” she says. “This can predispose her to postpartum depression, especially if she’s neglecting to care for herself. Women who’ve had babies in NICU have a different experience than having baby in the room with you and going home a few days later.”
An early birth is often accompanied by a slew of complications, which are exacerbated the earlier the baby is born. Other than being quite small, the baby might have difficulty breathing and regulating temperature and a lack of reflexes to suck or nurse. The baby may have heart problems (low blood pressure or heart complications), brain problems (because of possible brain bleeds), blood problems (anemia and/or jaundice), and gastrointestinal problems (because the system is underdeveloped). The immune system is also compromised.
Preemies often develop into healthy kids, but some can suffer long-term effects, such as cerebral palsy, hearing or vision problems, impaired learning ability, and compromised immune systems.

When it comes to preterm labor, trust your body.

Pregnancy is a trip, but it’s a chance to get to know your own body: Does this contraction feel like it did last week? Yesterday? Does drinking water and sitting down help? Or do I really feel like my body is going into labor? If you feel like something is off, then reach out to your provider. You know your body best. Trust your gut.

When she was seven weeks pregnant, Uma (who’s asked that we use a pseudonym) started spotting. She was prescribed bed rest, but the spotting soon became real bleeding. It felt like she was having menstrual cramps, but she soon miscarried in the middle of the night, over the toilet. “I remember trying desperately to keep it in,” she says.
The first doctor she saw after the loss was “unspeakably cruel.” He refused to confirm that she’d miscarried, insisting she go to another facility although he clearly had the equipment to examine her. “It was winter, with lots of snow on the ground,” she says, “and I remember walking past heaps of it on the pavement and crying.”
When she returned two weeks later for a follow-up, she lost it on the tram going to work. “My colleague held me for a long time at the tram stop without asking me what had happened. And then I went to a shopping mall stairwell and cried for another couple of hours. It did make me realize one thing, though: I actually really wanted a baby.”
Two months later, she got pregnant with her son—her so-called rainbow baby—who is now 8.
For some, however, a subsequent pregnancy doesn’t come so quickly (or at all): Keely Mitchell lost a pregnancy at eight weeks and another two years later at between six and eight weeks.  “When I discovered I was pregnant, everything in my world stopped and shifted. Suddenly I was planning for a whole new future,” she says. “Once I learned I had miscarried, it was all over. In a moment, my future just went back to where it had been. It was a strange and complicated mental shift. I felt lost.”
Although she didn’t really grieve for the first loss, the second hit her hard. “We had been hoping to get pregnant again for two years, so I was excited and ready. I felt attached to this potential child, and I was devastated to lose them. The physical pain and visual proof of all the blood were so upsetting. And I knew I wanted to try again, but I was scared of losing another pregnancy. I just couldn’t fathom how much more of this grief I could take.”
Five months later, however, she got pregnant with a girl, who is now 3.

What’s a rainbow baby?

“Rainbow baby” is a relatively new term coined for a baby born soon after a pregnancy loss: either a miscarriage or stillbirth. The term comes from the nature of rainbows—that they appear after a scary, dark storm and bring renewal and beauty back to the world. Without erasing the tumult that has come before, they bring new life and light to the world.
Many women have found great comfort in the term—it feels truly miraculous.
Although pregnancy loss is all too common—10 to 25 percent of clinically recognized pregnancies result in a loss—not every mom loves the term “rainbow baby.”
“I associate rainbows with unicorns and light and fluffy things,” says Uma. “And what’s come before isn’t light and fluffy.” Mitchell agrees: “It feels too saccharine for me.”

What’s it like to be pregnant after a loss?

“During the second pregnancy, we were on tenterhooks,” says Uma. She had the same bleeding at eight weeks, but this time she went to a gynecologist who prescribed progesterone suppositories (progesterone supplements have been shown to decrease miscarriages).
Although this pregnancy did not end in loss, it was not without struggle. “I did feel the loss of innocence. When I got the Down syndrome test back, it was quite a high percentage, and the doctor said I could do an amnio, but we didn’t because of the chance of miscarriage.” (Her son was not born with Down syndrome.)
She also learned that you can hold two difficult truths at the same time: “That you lost something that would’ve turned into a person of endless possibilities and imaginings (for me, I think about if it was a girl). And that if that she had been allowed to develop fully, that your present child—with the real possibilities and imaginings—wouldn’t exist. Both hold equal weight.”
For her part, Mitchell says, “I was not able to feel much emotionally about my third pregnancy until I had made it through the first trimester. I was reluctant to get attached or have any hopes or dreams about the future until I felt I was through that window of likely miscarriage. I really didn’t get excited or think of the fetus as my child until I had my 20-week anatomy scan and saw my beautiful daughter moving on the ultrasound screen. When I saw her spine, I suddenly saw her future.”
But you may not see that future until you are holding the baby in your arms, and that’s okay, too. “You may need to protect yourself emotionally,” says Mitchell. “If you can help it, don’t worry constantly about miscarriage again, though. I know that’s difficult, but it doesn’t really help. It can be tempting to read into things that are the same or different from the lost pregnancy—like you don’t feel morning sickness this time—but since every pregnancy can be so different, these things mean very little, and it is not terribly helpful for your state of mind.”
Many women feel like they don’t have a right to be sad about a loss at six or eight weeks, but it’s important to grieve the loss, no matter how early it came. “It’s also okay to still grieve the loss even as you have your new child in your arms,” says Mitchell. “It can be a very confusing feeling to feel grief and excitement simultaneously.”
She adds, however, that it’s okay to not grieve those past losses and just be excited about this new pregnancy. “If you are struggling with your feelings,” she says, “find someone you can talk to.”

How can I help a friend who is dealing with loss?

The most important thing you can do for a friend who is dealing with loss—and possibly a subsequent pregnancy or “rainbow baby”—is to follow her lead. She might want to talk and talk and talk. If so, let her. (Read: Do not advise or tell her how she should feel. Simply listen.) “I felt much closer to women I’d known for ages but never known they’d had miscarriages,” says Uma. “When I opened up to them, they opened up to me.”
Or she may not want to talk at all. “A woman who is pregnant after a loss might not want to hear your excitement because she isn’t excited yet, and it makes her nervous about the pregnancy,” Mitchell says. She may not want to talk about the pregnancy at all. In fact, I had a friend who suffered a miscarriage and then a late-term loss whose subsequent pregnancy went completely unmentioned until she was almost 30 weeks along (and unmistakably pregnant).
On the other hand, a friend might need your vocal support and excitement. “Ask her, if you need to!” advises Mitchell. “If the pregnant person in your life has a partner, they might have completely different feelings about the past loss and current pregnancy. Ask them what they need, too.”

What do I do if I want to keep my pregnancy after loss a secret?

Many women save sharing news of a pregnancy until the end of the first trimester, when the risk of loss is lower. You may be someone who needs more support—telling your mother, sister, and friends as soon as you pee on a stick—but you may also want to keep the news between you and your partner for as long as you possibly can. That doesn’t mean you need to be alone in your worry and excitement. “An anonymous online pregnancy forum can be really helpful,” says Mitchell. “I found a lot of support in those groups, people I could talk to about how I was feeling or what I was worried about, or even just read their stories and not feel alone.”
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Because she’d experienced pregnancy loss herself, Crystal Henry, a writer who blogged about her surrogacy experience, had no reservations when she decided to carry a child for a friend whose chances of natural conception were slim at best. When her friend decided to try IVF treatments, though, Henry knew she still wanted to be a surrogate.
“I remember thinking I’d love to help another woman become a mother. I loved being pregnant, and after my natural delivery with my second daughter, I knew I wanted to do that again. I also knew our family was complete, so surrogacy was the next natural step to chase that birth high.”
Though Henry knew right away she wanted to be a surrogate, the decision to become a surrogate or gestational carrier is a huge decision.
If you’re considering becoming a surrogate, here’s what you need to know, from fertility doctors, surrogacy lawyers, intended parents, and surrogates who’ve been there.

Surrogate, Gestational Surrogate, Egg Donor: What’s the Difference?

There are a couple of different ways to become a surrogate, and each one has its own pros and cons for all parties involved. Traditional surrogacy is when the surrogate’s own egg is fertilized with either the intended father or a donor’s sperm, meaning that the surrogate is biologically tied to the child. A gestational surrogate, on the other hand, carries a fertilized egg from the intended parents and/or egg and sperm donors, so they have no genetic ties to the child. An egg donor is just that: a woman who only donates her eggs to be fertilized.
Now that we’ve got the basics down, here’s what you need to know if you’re considering becoming a surrogate.

Surrogacy won’t make you rich.

Kim Kardashian West, who famously became a surrogacy advocate when her daughter Chicago was born via surrogate earlier this year, reportedly paid the surrogate around $45,000 (the average cost to hire a surrogate) over a 10-month period. If you’re dreaming of ways to pay down your student debt or make a down payment on your dream home, a $30,000 to $50,000 check can sound ultra-tempting. But when you break down the actual cost-to-work ratio of incubating a little human for almost 10 months, your earnings may surprise you.
“I did get pre-birth child support. If you think about it, there aren’t a lot of babysitters who would do the job 24 hours a day for nine months for free,” says Henry. “It took us two years, months of IVF injections, countless [reproductive endocrinologist] and OB doctor’s visits as well as the risks and pain of labor and childbirth—I delivered without so much as a Tylenol. I think when we totaled it up I got paid just over $1 per hour. So I can assure you that no surrogate does this for the money.”

I just want to help people have kids. How do I become a surrogate?

Becoming a surrogate is a lengthy process. First, you’ll need to meet a few standards that almost all surrogacy agencies require.
“Ideally, surrogates to have a healthy BMI, have delivered at least one healthy baby vaginally, and pass any psychological testing required,” explains Shahin Ghadir, MD, of the Southern California Fertility Center. “In California, a surrogate must also be between the ages of 21 and 39 years old, have had no more than three cesareans, and no more than five vaginal deliveries.”
While the agency won’t require it, Stephanie Caballero, a surrogacy lawyer who practices at the Surrogacy Law Center in California, recommends surrogates also have a stellar support team.
“She’s [a surrogate], been pregnant before, and she gets it,” Caballero says of the ideal surrogate, “but a surrogacy really does take a village and that village includes agency personnel, if any, intended parents, OB-GYN, IVF physician, nurse coordinators, attorney, and a mental health professional.”
After her friend decided to pursue IVF, Henry decided to work with an agency to become a surrogate, but it took a couple of tries to find a good fit.
“During the initial interview process they asked how I felt about termination. …While I’d never begrudge another woman’s decision, I couldn’t be in a position to terminate,” says Henry.
So, she reached out to other agencies until she found a surrogacy agency that did not require termination as part of the surrogate’s contract. If you feel strongly about a particular issue, as Henry did, make sure that you find a reputable surrogacy agency that’s right for you. It may take a little longer to make a match with intended parents, but it’s in everyone’s best interest to be on the same page.

What are a surrogate’s legal rights?

A surrogate will enter into a contract with the intended parents before becoming pregnant. Every single detail will be outlined in that contract, but actual surrogacy law differs from state to state.
“In the United States every state handles surrogacy differently so the potential gestational carrier—the most common form of surrogacy, where the woman carrying the child is not genetically related—needs to check the laws in her state to see if surrogacy is practiced,” says Caballero.
“For instance, surrogacy is very limited in the state of New York where only compassionate surrogacy is allowed. No fees are involved, so typically surrogacy is between family or friends,” Caballero explains. “Contrast that with the state of California, where my firm is located. California has very solid case law and a surrogacy statute that defines the roles of both the gestational carrier and the intended parents and protects them.”
Surrogacy contracts are very detailed. A surrogacy contract will cover everything from the rights and responsibilities of both the parents-to-be and the gestational carrier, medical and life insurance, parental rights, intent of the parties, escrow and trust holder information and details, medical procedures, delivery and birth, and conduct of the surrogate, as well as payment to the surrogate, if that’s applicable.
While extreme surrogacy cases (like a surrogate keeping a child) make for great Lifetime movies, they hardly ever happen in real life, says Caballero.
“These situations are extremely rare and usually happen when corners have been cut and the surrogate has not received psychological screening and testing and she did not have an attorney represent her,” Caballero explains.

Who uses surrogates—and is it weird for a surrogate to be friends with the intended parents?

The demographics of intended parents vary: Of course there are heterosexual couples who cannot or choose not to conceive and opt to use a surrogate, as in Henry’s experience, which involved an intended mother and an intended father. That said, gay couples are increasingly using surrogacy to build their families, too.
The Chicago Tribune reports that at Fertility Centers of Illinois, gay men rarely pursued surrogacy just five years ago. Since then, the number has been increasing. A 2018 report showed that overall, gay male couples are content with the level of contact they have with their surrogate; the only men in the study who were discontent wanted more contact with their surrogate, not less. Also heartening if you’re considering becoming a surrogate: The findings of a 2016 report showed that children conceived by surrogacy and raised by gay men tend to have positive relationships with their surrogates.
But before anyone can build a positive relationship with their surrogate, they have to find one! So how do couples feel about finding (and nurturing a relationship with) the right surrogate?
“It takes a long time to meet the right surrogate, but when you do, you just know,” Dustin Lance Black, an Academy Award-winning screenwriter, tells HealthyWay. He and his husband, Olympic diver Tom Daley, are expecting their first child via surrogate later this year. “I knew the first time we met our surrogate that we’d made a match. It was partly how she was with her own kids and husband, loving and hilarious, and how she was with Tom and I. …She reminded me so much of our own families that I hoped and prayed she’d say yes to carrying our firstborn. Because at the end of the day, she’s going to be in our family’s heart and lives for a good long time, and we adore her and her family.”
The relationship between a surrogate and the intended parents is very intimate for obvious reasons, but it will mostly be defined by the contract both parties agreed upon. For example, the intended parents will probably want to attend the surrogate’s OB appointments and be present for the birth of the child. Still, each surrogacy relationship is totally unique.
“An open line of communication is key in these relationships,” says Ghadir. “It is very important that both parties—potential surrogates and intended parent(s)—feel a good connection.”
When Henry was matched with her first intended parents, she felt an immediate connection.
“They asked questions like Would I feel comfortable with them being in the room during delivery?” Henry remembers. “I joked that not only would they be in the room, but [the intended father] would deliver the baby. They laughed, but two years later he sat at the edge of my hospital bed and caught his daughter as she came into the world. Baby mama was laying next to me in the bed ready to be the first one to hold her daughter skin-to-skin. It was absolutely the most incredible thing I’ve ever done.”

Surrogacy is a challenging (and totally rewarding) experience.

Being a surrogate is a life-changing experience for the surrogate, intended parents, and most importantly, the child who’s being born.
Most of the people I spoke to about surrogacy said they’d do it again without hesitation. For Henry, helping a family have a child fulfilled her own desire to make a difference in the world.
“If this little surro baby grows up to be president, I get to say I played a role in her existence,” explains Henry. “People always say I’m some kind of angel or some selfless person, and they couldn’t be more wrong. I was just trying to fulfill my own dream, and it happened to fulfill the dreams of another couple. The family who allowed me to carry their only hope of a child were the brave and inspiring ones. They were the ones that had to wait for two years, and to trust someone they hardly knew to care for their child.”
For Black and Daley, surrogacy has been a lesson in gratitude.
“I lost my mother many years ago now. Tom lost his father as well. When Tom and I first met, we shared our dream of having children of our own one day, to pass on our parents’ love and lessons to our own. Surrogacy has given us this chance. There’s nothing I’ve ever been more grateful for.”

Being pregnant really is great: You get to eat all the soft pretzels and ice cream you want, because at a certain point, you just stop looking at the scale when they weigh you during OB appointments. But trust me, there will come a time when you’re 100 percent over being pregnant.
For me, that time came at around 37 weeks, when, on our nightly walk, my husband literally had to call an Uber five blocks from our house because I just could not waddle any farther. Fast forward three weeks later, and I was STILL pregnant.
At my 40-week appointment, my doctor suggested that we start thinking about induction, because it was obvious that my nugget liked the womb a little too much. She suggested a procedure called membrane stripping, which sounded totally gross and a little scary, so I immediately said no. Instead, I was scheduled for a c-section when I hit 41 weeks. Three days later and still pregnant, I was rethinking my hasty decision when contractions started.
I didn’t have to have my membranes stripped to induce labor, but if I had been pregnant just one minute longer, I was definitely would’ve been considering my options. If your pregnancy is near or at full term, your doctor may also have suggested membrane stripping (also called membrane sweeping) as a way to induce labor. Stripping membranes is a relatively common procedure, but is it really worth it?
To find out, I spoke to mamas, doctors, doulas, and other pregnancy experts to get the real scoop on membrane stripping.

Stripping membranes sounds kind of icky.

So you’re not wrong—membrane stripping isn’t exactly a day at the spa.
But what really happens when they strip your membranes?
“Membrane stripping is a mechanical method of induction used between 38 and 40 weeks gestational age to prevent post-term pregnancies (after 41 weeks gestation),” says Tami Prince, MD, the founder of the Women’s Health and Wellness Center of Georgia. “An OB-GYN will insert a finger into the cervix and sweep between the membranes of the amniotic sac in an effort to separate the sac. This action increases endogenous production of prostaglandins, oxytocin, and phospholipase A which help to soften and dilate the cervix.”
Say what, now?
Okay, let me break this down with a little anatomy lesson: You know how your OB provider typically does weekly cervix checks toward the end of your pregnancy to check dilation and effacement? Well, stripping membranes is kind of like that.
Remember the female anatomy poster in your OB-GYN’s office? The cervix is essentially the gateway to the uterus. There’s the external orifice, which is where the doctor will insert their finger. Things get uncomfortable when the doctor has to reach for the internal orifice, where the membranes of the amniotic sack, also known as the bag of waters, is attached to the uterine wall.
Your doctor will then gently sweep their fingers back and forth (FYI: It does not feel gentle) to try to separate the membranes from the uterine wall, which tells your body it’s go time.
The idea is that stripping membranes kick-starts labor, so unlike a medicated induction, your labor will still start semi-spontaneously after a membrane sweep.

Does stripping membranes actually work to induce labor?

“The jury is still out on the effectiveness of membrane stripping alone,” Prince tells HealthyWay.
“Efficacy depends on gestational age, with it being low at an earlier gestational age and increasing after 38 weeks.”
So what does the research really tell us about the efficacy of membrane sweeping?
According to one 2010 study involving 30,00 women in 22 trials, “routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinically important benefits.” In laywoman’s terms, results showed that membrane sweeping didn’t induce labor in enough cases to warrant its recommendation as a regular induction method.
The 2010 study focused on women who were at full-term pregnancies, between 38 and 40 weeks. That said, another study found that membrane sweeping actually was successful in late-term pregnancies, or those lasting longer than 41 weeks, and significantly reduced the need for other induction interventions.

How is an expecting mama supposed to know what to do?

The information presented in different reports can be confusing, but basically, if your body is poised for labor, stripping membranes will be more likely to induce labor. If you have it done too early, though, it may not work—and it may increase the need for other interventions later.
Prince says despite the conflicting data, research does show that stripping membranes is safe and comes with minimal risks. Since stripping membranes is a low-risk procedure, it is often touted as a “natural” alternative to induction with oxytocin or vaginal prostaglandins and can usually be done in your provider’s office, unlike other pregnancy interventions, like versions, which must be done at the hospital.
Still, while they’re rare, there are some risks associated with stripping membranes.
“During the stripping process … the physician could inadvertently place a finger through the amniotic sac as opposed to between the membranes, causing a rupture of membranes,” explains Prince. “Once membranes rupture at term, labor must be augmented if a woman is not already in active labor. Also, stripping may involve mechanical dilation of an unfavorable cervix. The cervix is highly vascular and bleeds easily during pregnancy so women may experience light spotting afterwards.”
What does Prince mean by “augmented”?
Basically, if the doctor accidentally ruptures the amniotic sac while stripping membranes, it means you may end up having an emergency c-section.
This is a worst-case scenario, however. More often, doctors worry about introducing bacteria into your cervix while stripping membranes, resulting in an infection that could complicate labor and delivery.
To avoid infection, your doctor will check to see if you are GBS positive. Group B streptococcus is a type of bacterial infection that about 25 percent of all healthy women carry, and while it’s rare, it can pose serious risks as it can be passed to your baby during delivery. Doctors routinely screen for GBS after the 35th week of pregnancy. If you test GBS-positive, talk to your doctor about what’s right for you. According to a 2015 study, stripping membranes of GBS-positive women posed no threat to the baby or mother, so your doctor may go ahead with the procedure, but it’s a decision you should make together.

What do real women say about stripping membranes?

“I was 41 weeks pregnant—first pregnancy—by the time I had my membranes stripped,” says Kayla Hanks, a first-time mom in Virginia Beach, Virginia.
“I remember my mother coming into town and [being] ready for my son to be here. …Honestly, I feel like the pain [of membrane sweeping] was akin to labor itself! It took my breath away. I remember having some spotting after but [my OB] warned that it can happen. Stripping my membranes sent that early labor into overdrive (at least in my mind)! I stayed home until around 2 a.m. when my water finally broke. When we got to the hospital, they said I was only 3 centimeters along! Would I do it again? Only if it were necessary. I understand I was 41 weeks and in my first pregnancy, but it HURT!”
Ashley Phillips, a veteran mom of two, had a membrane sweeping procedure during her first pregnancy, and explains that her doctor didn’t exactly give her a choice:
“At my 39 week appointment, the doctor just told me he would be stripping membranes to try and induce labor, and because it was my first pregnancy, I didn’t know I could say no. It was a really painful experience, and I bled a lot after, almost like a light period. And I still didn’t go into labor!”
“I had my membranes stripped with my daughter, Cameron, twice,” says Jessica Stafford, who delivered each of her three children vaginally. “Each time it did nothing but cause pain and cramping. I didn’t do it with Clayton and don’t regret it, but I did do it with my third, Cohen and he was born the same day. In my experiences, it will only work if your body is ready for labor.”
Tracy Jarrell, mom to 1-year-old Naomi, says, “My labor started about 12 hours after having membranes stripped. Not the most comfortable procedure…but it did get my labor started.”

Looking for a natural alternative to stripping membranes? Try some sexy time.

If your pregnancy is at full term and you’re ready to meet your baby, there are less invasive ways to get labor started.
So let’s start with my personal favorite: getting it on to get your labor on. I personally swear this works. You may not feel like having sex at 39-, 40-, or heaven forbid, 41-weeks pregnant, but coitus (especially if you orgasm) can actually stimulate labor by triggering uterine contractions, according to a 2014 study. Plus, it’s likely the last time you and your partner can be intimate for the next six weeks, so make sure to really enjoy your sexy time.
Another proven method of labor induction is through prolonged nipple stimulation. I first read about this method of labor induction in Ina May Gaskin’s Ina May’s Guide to Natural Childbirth. According to Gaskin, “Nipple stimulation causes the release of oxytocin into the maternal bloodstream, and this oxytocin the stimulates contractions of the uterine muscles. Both manual and oral stimulation are effective at stimulation … Breast stimulation is especially effective in starting labor at term when it is combined with sexual intercourse.”
Autumn Vaughn, a licensed acupuncture physician who specializes in prenatal and postnatal care, says that holistic providers really prefer not to use the term “induction” and choose instead to focus on the long-term health of the mother and baby. “Weekly acupuncture sessions can shorten the length of labor and reduce the need for pain-management interventions because it naturally helps prepare the body for labor by ripening the cervix, relaxing ligaments and tendons, and helps baby get into the right position for labor,” says Vaughn.
And while there isn’t a lot of scientific data to support efficacy of Eastern medical techniques, like acupuncture, to stimulate labor, one study did show that women who received acupuncture had shorter overall delivery times than those who did not. Another study published in 2015 showed that acupuncture during pregnancy was found to be completely safe, so there’s no harm in trying acupuncture as a holistic alternative to stripping membranes.

What’s the bottom line on stripping membranes?

Stripping membranes is most likely to be effective later in pregnancy, with the highest rates of efficacy after 38 weeks. Believe me, I get it. Pregnancy is hard. And when 37 weeks is technically considered full term, it’s ultra-tempting to schedule a membrane stripping procedure to help get that baby outta there as soon as possible.
Still, an astonishing amount of prenatal growth occurs in the final weeks of pregnancy, so unless there’s a true medical need for baby to be born sooner, it’s probably best for baby to bake until at least 39 weeks.
Still, there are times when a scheduled birth is easiest for everyone. We’re a military family, and I know several women who have chosen a scheduled induction so that their partners could be present for the birth because of impending deployments. Or a medical condition could prompt an early delivery that is in the best interest of both mother and baby’s health.
Ultimately, whether to have your membranes stripped should be a decision you and your doctor make together. If you feel at all pressured to have a membrane sweep done (or any procedure you don’t have a good feeling about during pregnancy) you should definitely seek a second opinion, because there are induction alternatives that may be just as efficient as stripping membranes at inducing labor.
After all, the most important thing is making sure your little nugget is happy and healthy when they decide to make their debut.
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These days, women have more information than ever when it comes to their reproductive health.
Women’s health is (finally!) being taken seriously by the medical community and thanks to technological advancements that allow us to better understand our bodies, modern women have more understanding about their reproductive health systems than women of any other generation. All that knowledge is empowering, but it also means that more women are finding out that they have anatomical differences, like a tilted or reverted uterus.
When it comes to reproductive health, emotions run high, so hearing that you have a tilted uterus can be scary. Is something wrong with you? Could this affect your chances of getting pregnant and delivering a healthy baby? Although most of us probably don’t give too much thought to our uteruses in day-to-day life, it’s still important to know that your reproductive system is healthy, and that it will be ready if you decide you want to have children.
Luckily, having a tilted uterus is usually just another variable when it comes to the ways our bodies are all made a little differently. Usually it’s nothing to be alarmed about.
However, there are some instances in which having a tilted uterus can indicate an underlying health concern, or can lead to trouble getting pregnant.
HealthyWay talked to women’s health and fertility specialists to answer all of the most common questions about having a tilted uterus. Here’s what you should know about having a tilted uterus, and how this condition affects conception, pregnancy, and delivery.

What is a tilted uterus?

Most people, including medical professionals, use the term “tilted uterus” to mean a uterus that points toward a woman’s back. This is also known as a retroverted uterus.
Many women are born with a uterus that is straight up and down within the abdomen, which is considered standard positioning. However, many woman have a uterus that tilts after the cervix, the opening to the uterus. The most common type of tilt is a uterus that leans slightly to the front, known as an anteverted uterus. A retroverted uterus—usually referred to simply as a tilted uterus—is the opposite of that.
Bat-Sheva L. Maslow, MD, a reproductive endocrinologist at Extend Fertility in New York City, says that having a tilted uterus is just another variation of normal, similar to being left-handed.
“While less common, having a retroverted uterus is not abnormal,” she says. In fact, about one in five women around the world have a tilted uterus.

Why do I have a tilted uterus?

If you’ve been told that you have a tilted uterus, you’re probably wondering how a tilted uterus develops. In most cases, this is just the way you were born.
“This condition can be the way some women are built; it is perfectly natural,” says Joshua M. Hurwitz, an OB-GYN and board-certified reproductive endocrinologist and infertility specialist at Reproductive Medicine Associates of Connecticut.
However, in some cases there are physical changes within the body that cause a tilted uterus. The most common is from scar tissue caused by endometriosis or fibroids. This scar tissue can weigh the uterus down, or pull in toward the back, resulting in a retroverted uterus. These conditions can also create scar tissue in the abdomen, which can then push the uterus backward. Women who have a tilted uterus accompanied by pain should talk to their doctors about whether they have any other signs of endometriosis, a condition in which the lining of the uterus grows outside the womb.
Other women might develop a tilted uterus after pregnancy. That’s because the ligaments that hold the uterus in place stretch and loosen during pregnancy, so after delivery the uterus can settle in a new position, resulting in a retroverted uterus. Menopause can cause this as well since the ligaments holding the uterus relax as estrogen drops, allowing the uterus to slip into a tilted position.
Because these conditions are all beyond your control, there is no way for a woman to prevent developing a tilted uterus.

What are the signs I might have a tilted uterus?

A woman with a tilted uterus will most often not have any signs or symptoms according to Phil Chenette, MD, a board-certified specialist in reproductive endocrinology and infertility with Pacific Fertility Center in San Francisco.
“Most women with a tilted uterus never know until it is found on pelvic exam or a pelvic ultrasound exam,” he says. Although it’s easy for a doctor to diagnose the condition during a routine exam or ultrasound, the women who have the condition usually have no signs, so a retroverted uterus usually goes unnoticed.
However, some women who have a tilted uterus will experience symptoms. A woman with a tilted uterus might experience menstrual cramps as pain that is located more toward her back than her abdomen, Maslow says. Additionally, some women who have a tilted uterus will experience more severe pain with menstruation—although that’s usually because of another underlying health issue like endometriosis (more on that in a moment).
A woman who has a tilted uterus might also experience pain during intercourse or while using tampons if her tilt is severe, Maslow explains. That’s because in some cases the uterus can tilt so severely that it puts pressure on the vagina. However, Maslow underscores that these symptoms are rare.
“The vast majority of women with retroverted uteri will experience no symptoms and not know they even have one unless a doctor has told them,” she says.

Is is harder to get pregnant with a tilted uterus?

Many women who hear that they have a retroverted uterus worry that having a tilted uterus will affect conception. The good news is that most of the time a woman with a tilted uterus will not have have a more difficult time getting pregnant that anyone else.
“As a fertility specialist, I do not believe there is any connection at all between a tilted uterus and infertility,” says Hurwitz. “Only in those exceptional cases where scar tissue from endometriosis or surgeries has caused this uterus to be mechanically displaced is there a tie-in to fertility problems.”
Chenette says that when a uterus is severely tilted it can lead to trouble conceiving. Some women have an acute retroversion, where the cervix has a tilt that is between 90 and 180 degrees, he says. Women with a more severe tilt and a sharper curve in their uterus are more likely to have trouble conceiving.
“Some women have a sharp hockey stick kind of curve and some have a slow gradual rounded curve,” Chenette says.
Having a significant tilt can prevent sperm from reaching the egg in women with a tilted uterus, thus making it more difficult to get pregnant.
“Since traversing those angles as a sperm cell can be challenging, women with a significant tilt can experience longer times to conception,” Chenette says.
If a woman with a tilted uterus is having trouble getting pregnant and all other infertility causes have been ruled out, a doctor might recommend intrauterine insemination or in vitro fertilization. During intrauterine insemination, a doctor places sperm in the main body of the uterus using a catheter. This way, sperm do not need to navigate the bend of a tilted uterus, and more of them are likely to reach the egg, increasing the chances of conception. During in vitro fertilization, an embryo (a fertilized egg) is placed in the uterus above the tilted portion. If this embryo successfully implants, the patient will become pregnant.
Although both procedures are highly effective even when a patient has a tilted uterus, Chenette says that assisted reproduction is a bit more complicated for a woman who has a tilted uterus.
“It takes an experienced doctor to perform insemination or embryo transfer in these patients,” he says. “The same cervical curve that produces the original problem can make insemination or embryo transfer challenging.”
However, usually a woman with a tilted uterus can become pregnant, even if she requires assistance.
“Careful ultrasound guidance and an experienced hand almost always solves this problem,” Chenette says.

How does a tilted uterus affect pregnancy and birth?

Although a tilted uterus can make conception tricky in some cases, it should not affect pregnancy at all.
“Once a woman conceives, which most do, the pregnancy proceeds normally,” Chenette says.
During pregnancy, the uterus expands rapidly. It starts off at about the size of an orange, and grows to the size of a grapefruit by the 12th week according to the American Pregnancy Association. By week 20 (halfway through pregnancy) the uterus usually reaches a woman’s belly button, and by full term the uterus is the size of a watermelon, stretching to the bottom of a woman’s rib cage. All of that growth works to correct the position of a tilted uterus.
“As the uterus grows with a pregnancy, it comes out of the pelvis and ‘unfolds,’” Maslow says. “By the time the baby is large enough for the mom to feel its movements, the uterus is typically out of the pelvis and you really no longer see much of a difference between those that are folded forwards or backwards.”
Whether or not the mother-to-be had a tilted uterus before pregnancy will not affect her during delivery, Maslow says.
“By the time the baby is term, there is no distinction between the way the uterus had been folded and as far as I know there isn’t any data to support that having a retroverted uterus has any impact on delivery outcomes,” she says.

How can a tilted uterus affect your sex life?

Sometimes a woman with a tilted uterus will experience pain during penetrative sex, if her tilt is severe enough that it is putting pressure on her vagina. Pain during sex is most commonly experienced by women who have endometriosis in addition to tilted uteri, so if you experience this, be sure to mention it to your doctor so you can discuss any other signs of symptoms you have that might be associated with endometriosis, Chenette says.
Most often there is a simple solution to pain experienced during intercourse, he adds.
“Sometimes a change in position is enough to relieve the discomfort,” he says.

What are the treatments for a tilted uterus?

Because a woman with a tilted uterus usually has no symptoms, there is often no need to correct the condition.
“The condition is not worrisome or dangerous at all and there is nothing to do about it or treat,” Hurwitz says.
However, if your tilted uterus is causing you pain either during sexual activity or during your period, your doctor will likely be able to recommend some treatments. One correction that you can try at home is doing a knee-to-chest exercise, according to Hurwitz. To try to reposition your tilted uterus using this exercise, lie on your back on the floor. Raise your right knee to your chest, holding for 15 to 30 seconds. Then, return that foot to the foot and draw your left knee up toward your chest. Do ten repetitions per side, three times each day. Even when knee-to-chest exercises aren’t enough to correct a tilted uterus, they can help with back pain that women with a severely tilted uterus can experience, Hurwitz says.
For women who have lots of pain that is caused by or made worse by a tilted uterus, doctors may recommend surgery to reposition the uterus. This is very rare, and usually only done when a woman has a tilted uterus that is associated with endometriosis, Hurwitz says.
Living a healthy lifestyle can help reduce pelvic pain, including the pain associated with a tilted uterus, Chenette says.
“Stress reduction and mindfulness techniques, as well as reducing alcohol and [improving] nutrition, can reduce some of the symptoms of pelvic pain,” he says.

So should you be worried about having a tilted uterus?

Unless you are having severe associated symptoms, having a tilted uterus isn’t anything to stress over.
“It is important to remember that a uterus can point in any direction: up, down, to either side, and even be rotated,” Hurwitz says. “This does not mean there is a medical, fertility, or pregnancy problem at all.”
In fact, the toughest part about having a tilted uterus is often finding out that you have the condition.
“I think the worst part for a woman hearing that she has a ‘tilted uterus’ is the anxiety and worry that the label places on her anatomy, which really does not have any negative effect anyway,” Hurwitz says.
Today it’s totally normal to hop online and research any new medical condition, but going down that rabbit hole can be scary. The experts who spoke with HealthyWay all emphasized that for most women having a tilted uterus is nothing to worry about.