Category: Mom x Body

Pregnancy comes with a lot of worrying, much of it unwarranted but natural and—dare I say?—unavoidable. But a few things are actually worth knowing about, if not actively worrying about. One of those things is preeclampsia.
Preeclampsia is a pregnancy complication that causes high blood pressure and protein in the urine, and it needs immediate attention. Why? Left untreated, it can lead to kidney and liver failure, stroke, seizures, and maternal death and/or stillbirth.
It is therefore important to be aware of the symptoms so you can spring into action quickly if you sense that something is off.

What is preeclampsia?

“Honestly, most of us are still trying to figure this out!” says Kerry Price, MD, an OB-GYN at Orange Coast Women’s Medical Group in Orange County, California. “It is the number one thing … that [OB-GYNs] still need a definite cause for, and discovering its cause is one of the most researched topics in our field.”  
Here’s what doctors believe: Preeclampsia is a disorder of the vessels in the placenta that causes increased resistance. This increases pressure gradients, which causes maternal blood pressure to rise and puts greater demands on the vital organs. In short, the problem is in the placenta—which is why delivery is the cure.
[pullquote align=”center”]Never doubt that you know your body best and continue to seek out the best medical attention you can find.[/pullquote]
High blood pressure caused by preeclampsia can come on slowly over time or very suddenly, which is why your OB checks your urine and blood pressure at every single visit and why it’s important for pregnant women to be aware of all the symptoms.
That said: The condition can be treated and managed—how effectively is really a question of how early it is diagnosed and how close the mother is to delivery.

How common is preeclampsia?

Preeclampsia affects between 3 and 10 percent of pregnancies. In fact, it’s one of the most common complications of pregnancy. Price says she’s seeing a rise in cases in the U.S. due to two main factors:

1. The average age of mothers is on the rise. In other words, more women are having babies at age 35 and older.
2. More women are overweight and obese—and these are both risk factors for preeclampsia.

Signs and Symptoms of Preeclampsia

You know how your urine is tested at every single doctor’s visit? Preeclampsia is one of the things she’s testing for. (We know it’s annoying, but so, so necessary!)
At your 20-week appointment—and then at every other subsequent visit—your OB will likely go over the signs and symptoms of preeclampsia with you, but it’s good to keep them in mind for yourself, too. Here’s what to look out for:

• A headache that is not responsive to rest, Tylenol, or fluids
• Blurred vision
• Epigastric and right upper quadrant abdominal pain
• Swelling of the hands and face
• General malaise
• Fluid in the lungs
• Signs of kidney trouble
• A seizure, which is a very late-onset symptom that would actually mean a woman has moved from preeclampsia to eclampsia

Risk Factors for Preeclampsia

There are a few risk factors associated with preeclampsia:

• History of preeclampsia in a previous pregnancy
• Chronic hypertension (or elevated blood pressure)
• Advanced maternal age (over 35 but especially over 40)
• Young maternal age (under 25)
• Obesity
• Type 2 diabetes
• Kidney disease/dysfunction
• Smoking/tobacco use
• Systemic lupus
• Connective tissue diseases
• Multiples (twins or higher)
• Women who develop gestational hypertension or gestational diabetes during their pregnancies are also at increased risk for developing preeclampsia
• Women who got pregnant via in vitro fertilization (IVF), donor insemination, or egg donation

One very important point: Women of color—especially African American women—are more likely to develop preeclampsia. According to a recent feature story in The New York Times Magazine, their symptoms are often ignored by medical professionals, causing a range of medical complications, including stillbirth.
Never doubt that you know your body best and continue to seek out the best medical attention you can find.

Diagnosing Preeclampsia

In order to be diagnosed with preeclampsia, a woman needs to show signs of two things:

1. Elevated blood pressure: This means 140 or higher systolic, and 90 or higher diastolic, so 140/90 or higher. Ideal blood pressure is less than 120/80.
2. Proteinuria, or protein in the urine

You can have elevated blood pressure and not have preeclampsia, and you can spill protein in your urine and not have it. You need both to be diagnosed.
Price explains that there are varying stages of preeclampsia: mild preeclampsia and preeclampsia with severe features. These are indicative of a more serious disease state. “The gold standard for any evaluation is a 24-hour urine protein collection, which can be done as an outpatient or inpatient depending on the severity of the patient’s condition,” Price explains.
That said, high blood pressure at one appointment does not mean you have preeclampsia! This is why your doctor will probably test your blood pressure again four hours later and monitor you closely for at least 24 hours and for the remainder of the pregnancy.

Treating Preeclampsia

If you are experiencing any of the signs or symptoms above, you should contact your doctor’s office immediately and ask for an evaluation. If your OB’s office is closed, Price advises going to labor and delivery for an evaluation or speaking to your doctor’s on-call physician to see if an evaluation is warranted.  
“A patient should never wait hours or days to contact her physician about this,” Price says, “because if preeclampsia is truly there, time is of the essence.”
Treating preeclampsia depends entirely on the severity of the symptoms and the gestational age of the fetus. Milder cases and those closer to term might not necessitate hospitalization or a super-early delivery. These are most often treated with frequent outpatient visits, blood pressure medication, and non-stress testing with amniotic fluid checks. Bed rest doesn’t help with preeclampsia.
[pullquote align=”center”]“A patient should never wait hours or days to contact her physician about this because if preeclampsia is truly there, time is of the essence.”
—Kerry Price, MD[/pullquote]
More severe cases require IV antihypertensive medications, inpatient hospital admission, and more continuous monitoring of the baby. Your doctor is trying to prevent the condition from causing a stroke, fetal abruption, seizures, or severe bleeding. The baby will undergo more monitoring as well: non-stress tests and frequent ultrasounds.
That said, if you are diagnosed with preeclampsia, you will not deliver your baby any later than 37 weeks—it’s simply not safe for you or the baby. More severe cases require preterm delivery to save both mom and baby from the worse outcomes, which can include brain damage or death.
This is what makes preeclampsia so tricky: The only “cure” is delivering the baby.
An OB’s goal is to keep the mother and baby safe for as long as possible—and not push it a moment longer.

Preventing Preeclampsia

There is no way to definitively prevent preeclampsia, but there are ways of improving your odds of staying healthy throughout your pregnancy. Though you should always consult your own physician, here are Price’s recommendations:

For Women at High Risk

As soon as you find out you’re pregnant, take a daily 81 mg dose of aspirin. This has been shown to significantly reduce the risk of developing preeclampsia.

For Women Planning to Get Pregnant (Who Have Risk Factors)

Work on getting to a healthy weight and have any chronic medical conditions (elevated blood pressure, diabetes, kidney disease, lupus, etc.) under control.

For Women Without Risk Factors

Make sure you exercise regularly, eat a healthy diet, and avoid excess weight gain during pregnancy. Excess weight gain is linked to gestational hypertension and gestational diabetes, both of which are risk factors for preeclampsia.

Can preeclampsia come on suddenly?

“Yes it can, which is very scary and why your OB is constantly on the lookout!” Price says.

Can preeclampsia occur before 20 weeks?

In short, no. The longer answer is a little more complex.
“While there are case reports out there of an earlier diagnosis, there is almost always a very significant underlying medical condition, so it is not a true diagnosis of preeclampsia,” Price explains.
If your blood pressure is high before 20 weeks, it probably indicates chronic hypertension (usually diagnosed if your blood pressure is significantly elevated in the first trimester) or another underlying medical condition

How does preeclampsia affect mom?

If the case is mild and managed well, preeclampsia is mostly just uncomfortable and annoying—there are the symptoms (headaches, etc.) and all the trips to the hospital for frequent checkups.
If the case is severe, you can develop HELLP syndrome, which is dysfunction and/or a shutting down of the kidneys and liver. This can lead to uncontrolled bleeding, stroke, and death.
Preeclampsia can also evolve into eclampsia, which involves seizures. These can cause brain damage because of lack of oxygen and aspiration pneumonia if vomit winds up in the lungs.
Again, this is in very severe and unmonitored cases. The long and short of it is: If you suspect something is wrong, contact your doctor immediately.

Does preeclampsia affect my baby?

Yes. The baby is affected because preeclampsia is a placental issue. “The main fetal effects we see are growth restriction and low amniotic fluid volumes,” Price explains. “This can lead to significant developmental issues, especially if this happens earlier in gestation.”
If preeclampsia develops at term and is diagnosed in a timely manner, the baby is usually unaffected and does very well—which is what makes accurate and timely diagnosis very important. “This is why we dip people’s urine at every visit!” Price says.

Is preeclampsia hereditary?

Nope. So just because your mom or grandmother had it doesn’t mean you will.

As a new mama to your little peanut, you want to give the very best to their growing body. But it’s not that simple when your baby is gassy and fussy and you feel like you’ve tried everything to make them happier. Your pediatrician or even well-meaning friends may ask you if you’ve tried cutting out every food under the sun to see if that helps.
Not sure which foods might be having some adverse effects on your little one?
Luckily, most foods are still on the table while you’re breastfeeding. But there are some that should be avoided, because your diet should be about keeping your baby safe while still giving them all of the nutrients they need.
But maybe your little one is doing just fine, and you’re not so concerned about which foods to steer away from. Instead, you may be wondering, “What foods are good to eat while breastfeeding?” Whether you want to increase your milk supply or just ensure you’re being as healthy as possible, we talked to experts to get the deets on those foods too.
We asked a lactation counselor and two registered dietitians about the foods to avoid while breastfeeding—and the ones to pack into your diet.

Which Foods to Avoid While Breastfeeding

Determining which foods to avoid can be tricky, especially since searching the topic online can produce a variety of conflicting results.
“Make sure your information is coming from a valid source. Look at the credentials and licensure of anything you read or hear,” says certified lactation counselor Katie Halloran of Grand Rapids, Michigan. If you can’t find a clear answer online, Halloran recommends talking with your healthcare provider or a lactation consultant.

Avoid: High-Mercury Seafood

“It’s important to avoid all high-mercury fish, such as shark, swordfish, king mackerel, and tilefish, because mercury can be harmful to a developing baby,” explains Amy Gorin, registered dietitian nutritionist and owner of Amy Gorin Nutrition in the New York City area.
She says that “You can safely eat up to 12 ounces a week of lower-mercury fish, such as salmon, sardines, and anchovies, or 6 ounces of moderate-mercury fish, such as halibut and albacore tuna.”

Avoid: Certain Herbs and Herbal Supplements

Just because something is “all-natural” doesn’t mean it’s good for you and your precious little human.
[pullquote align=”center”]“Before you take any herbs, even if you hear it increases milk supply, talk first with your physician and your baby’s pediatrician.”
—Katie Halloran, APR, CLC
[/pullquote]
“Herbs can have pharmacological side effects. So before you take any herbs, even if you hear it increases milk supply, talk first with your physician and your baby’s pediatrician. You want to ensure it doesn’t counteract with your medications or your health or your baby’s,” Halloran says.

Avoid: Too Much Caffeine

As a general rule, you shouldn’t give your baby what you shouldn’t be giving yourself anyway, like too much caffeine, says Halloran. But she does say that “If you drink some caffeine, that shouldn’t deter you from breastfeeding.”
The U.S. Department of Health and Human Services Office on Women’s Health states that “Drinking a moderate amount (one or two cups a day) of coffee or other caffeinated beverages does not cause a problem for most breastfeeding babies. Too much caffeine can cause the baby to be fussy or not sleep well.”
So, no need to fret: Your morning latte can still be your energy lifesaver! Just think twice about having a cup every hour.

Avoid: Too Much Alcohol

Can’t breastfeeding mamas treat themselves to a glass of wine? The answer is yes. (And thank goodness for that!)
An Australian study showed that “low level drinking during breastfeeding is not linked with shorter breastfeeding duration or adverse outcomes in infants up to 12 months of age.”
“If you decide to drink, wait to breastfeed until the alcohol has cleared from your breast milk,” Gorin says. “This usually takes two to three hours for one alcoholic beverage (one 5-ounce glass of wine, one 12-ounce beer, or 1.5 ounces of liquor).”
Halloran agrees, saying that alcohol isn’t trapped in the breast milk, so pumping and dumping won’t remove the alcohol: “It simply takes time to get out of your system, just like it does your blood alcohol levels.”

Sushi and Breastfeeding: Is It Safe?

Time to celebrate another “yes”!
“Breastfeeding moms can eat any type of sushi, except poisonous blowfish, which probably no one should be eating,” says Kathy Kimbrough, registered dietitian at iLiveWell Nutrition in Austin, Texas.
Kimbrough says the challenge is that we never know when we will get food poisoning or what may cause it. “The best way is to be mindful of safe food-handling practices including hand-washing and ensuring proper temperatures for food storage. Eating fully cooked meats is one way to minimize risk. That said, I myself enjoy eating sushi and raw oysters occasionally, and I’m breastfeeding,” she explains.

Foods to Avoid While Breastfeeding to Prevent Colic

Why some babies are colicky sadly remains a mystery to doctors (and parents)—and it appears that the best cure is time. “Colic will likely improve or disappear by 3 or 4 months from birth,” says the Office on Women’s Health.
While changing your diet can sometimes help your colicky baby, holding or soothing your baby might also be the answer. “Eating regularly is the best ammunition for dealing with colic. Burp them consistently. Educate yourself on tummy massages and bicycling the legs to help their little belly pass gas,” encourages Kimbrough.

Common Causes of Fussy, Gassy Babies

As a dietitian and breastfeeding mom, Kimbrough finds that many women cut out certain foods, like spicy foods or dairy, if their baby is fussy or gassy. “In reality, there are very few things that actually cross over to the breast milk from the mother’s diet that makes them gassy,” she says.
But a protein or dairy allergy is different. “An allergy can manifest in many ways, and usually it’s pretty extreme. The stool will be green or contain mucus or blood, so it’s obvious something is wrong.”
[pullquote align=”center”]“Remember to take care of yourself by eating well and eating regularly so you can take care of your baby.”
—Kathy Kimbrough, RD[/pullquote]
Most babies, though, (unfortunately) will be gassy from time to time. This is normal: They have brand new bodies and digestive systems.
And it’s natural for moms to want to fix our baby’s irritability, but changing and limiting your diet can just be more challenging and stressful for everyone.
An elimination diet is not often the answer. “Remember to take care of yourself by eating well and eating regularly so you can take care of your baby,” says Kimbrough.

What to Eat While Breastfeeding

Thank goodness the menu is large when you’re breastfeeding!
Here are the key points to know.

Focus on a well-rounded diet.

“In order to nourish your baby, you have to nourish yourself. Aim for eating every 2 to 3 hours (just like baby!),” says Kimbrough. “Try to include carbohydrates, protein, and fat with a vegetable or a piece of fruit at each meal. And pair carbohydrates with protein for snacks. This balance will help your blood sugar remain within healthy fluctuations and keep your energy levels up.”
But Kimbrough reminds new moms to give themselves grace. “There were many times I wanted to stop breastfeeding because I was so tired. It can be really isolating when all you feel like you’re doing is pumping and breastfeeding.”
So go easy on yourself. Make simple meals, and don’t beat yourself up if you buy pre-chopped vegetables or packets of oatmeal instead of making it yourself on the stovetop.

Include fatty fish (in moderation).

Give your baby all of the powerful nutrients you can!
“Fatty fish such as salmon provides beneficial omega-3s to your baby,” says Gorin. So get cooking some tasty salmon recipes (or better yet, have your partner help).

Drink plenty of water.

“Hydration is very important for breastfeeding moms. You need extra water because your body uses water to produce breast milk,” shares Gorin. “It’s a good idea to drink a glass of water each time you nurse.”
In addition to having your water bottle nearly joined to your hip, hydrate your body more by eating water-rich foods such as fruits, vegetables, and soup, says Gorin.

Galactagogues: Foods That Increase Milk Supply

While many clinicians recommend continued use of prenatal vitamins during breastfeeding, there’s less consensus on the foods and herbs that increase milk supply.
“There are some foods that [are often said to increase] your milk supply, like milk thistle, oatmeal, fenugreek, and brewer’s yeast,” says Kimbrough. These supplements and herbs are commonly called galactagogues.
“Research indicates there are no long-term effects of increased milk supply for galactagogues,” explains Halloran. Unfortunately, there’s not much evidence of any food or herb being a magic bullet for increasing milk supply.
The best ways to maintain your milk supply are eating enough calories and drinking enough water, says Kimbrough. The American College of Obstetricians and Gynecologists states that your body needs about 450 to 500 extra calories per day to make breast milk, meaning you really need to get those nutrients in to keep your supply up.
But even if you’re eating well and drinking enough water, you can still struggle with having enough breast milk or getting your baby to breastfeed often enough. And that’s where additional resources come in.
If you’re having trouble breastfeeding or feel your supply isn’t where it needs to be, seek assistance sooner rather than later, says Halloran.
Many hospitals employ lactation consultants who can offer you techniques and personalized guidance. And many communities host breastfeeding support groups. “A breastfeeding group allows you to talk about successes and challenges with other breastfeeding moms and get that extra support,” shares Kimbrough.
Don’t live close enough to a support group or a lactation consultant? Call The Office on Women’s Health Helpline from anywhere in the U.S., Monday through Friday, 9 a.m–6 p.m. ET at 800-994-9662.

Miscarriage can be a deeply traumatizing event, and the subject itself is often considered taboo. It’s a heartbreaking topic, and it’s so difficult that many people don’t learn about miscarriage in high school biology or sex ed lessons. Because of this stigma and silence, many of us aren’t well educated about miscarriage, what it looks like, or why it happens.
Ten to 25 percent of all clinically recognized pregnancies—pregnancies in which a woman and her doctor know she is pregnant—end in miscarriage. That’s why it’s so important to educate ourselves about miscarriage. In the unfortunate event that we, or a loved one, lose a pregnancy, that education can help us navigate the difficult experience and find help and support.
Something few of us realize is that there are many different types of miscarriages. Miscarriage can occur for many different reasons, most of which are completely out of our hands, at different times throughout a pregnancy. To find out more, we spoke to OB-GYNs about miscarriage.

Chemical Pregnancy

Miscarriages in the first trimester of pregnancy are unfortunately very common. The American College of Obstetrics and Gynecology reports that around 10 percent of recognized pregnancies end in first-trimester miscarriages. About 50 to 75 percent of these first-trimester pregnancy losses are chemical pregnancies, says Beth Davis, an OB-GYN at Baylor Obstetrics and Gynecology at Texas Children’s Pavilion for Women.
“A chemical pregnancy is a miscarriage that occurs very shortly after implantation or around the fifth week of gestation,” Davis says. “The majority of the patients do not experience [linkbuilder id=”6467″ text=”pregnancy symptoms”] during a chemical pregnancy because the pregnancy hormone hCG [human chorionic gonadotropin] is in very low levels,” she says.
Others might have a [linkbuilder id=”6470″ text=”positive pregnancy test”] but experience heavy bleeding and a negative pregnancy test soon after.

Blighted Ovum

According to the American Pregnancy Association, a blighted ovum could account for about half of all miscarriages in the first trimester, making it another common form of early pregnancy loss.
“Blighted ovum, also known as an anembryonic pregnancy, refers to a pregnancy with an empty gestational sac,” says Nichole Mahnert, an OB-GYN at Banner – University Medical Center Phoenix. “At some point, very early in the pregnancy, the embryo stopped developing,” she explains. Mahnert says that it’s believed that a blighted ovum is caused by a chromosomal abnormality, which prohibits the development of the embryo.
Since one’s hCG levels will be high when they have a blighted ovum, they’ll probably receive a positive result on a pregnancy test. An ultrasound is thus necessary to confirm a blighted ovum.

Ectopic Pregnancy

When a pregnancy implants outside the uterus, it’s called an ectopic pregnancy. Most ectopic pregnancies occur in the fallopian tube, but it might also implant in or near the cervix, ovary, or at a prior cesarean section scar, says Davis.
Symptoms of an ectopic pregnancy often include vaginal bleeding with or without abdominal pain. “[The] vaginal bleeding may be light spotting or [a] heavier flow like a menstrual cycle,” she says. “Abdominal pain is usually localized to one side of the pelvis but may be diffuse and severe if the ectopic pregnancy ruptures.”
In the case of an ectopic pregnancy, treatment might include surgery or a medication called methotrexate, says Davis. If untreated, an ectopic pregnancy can be dangerous for the pregnant person, as the fallopian tube does not have enough space to accommodate a growing embryo.

Complete Miscarriage

“A complete miscarriage is when the miscarriage is confirmed and no products of conception are in the uterus any longer,” says Mahnert. In other words, all the tissues have been expelled from the uterus. Complete miscarriages are often accompanied by noticeable symptoms like cramping and bleeding.

Incomplete Miscarriage

Mahnert says that sometimes someone might experience miscarriage symptoms, like cramps or heavy bleeding, while some fetal tissue is still in the uterus. This is referred to as an incomplete miscarriage.

Missed Miscarriage

It’s possible to miscarry without experiencing any symptoms. A missed miscarriage occurs when there are no symptoms of miscarriage—such as cramps or bleeding—but a scan reveals that the fetus has no heartbeat, says Mahnert.

Stillbirth

According to the National Institute of Child Health and Human Development, the term miscarriage technically refers to any pregnancy ending on its own before 20 weeks of gestation.
After 20 weeks of gestation, a pregnancy loss is generally referred to as a stillbirth, although some people might refer to this as a miscarriage, too.
The American Pregnancy Association notes that there are numerous causes for stillbirths and not all of these causes are understood. Possible causes could include problems with the placenta, infections, birth defects, or growth restriction.

Aborting a Desired Pregnancy for Medical Reasons

Many people view abortion and miscarriage as two totally separate issues, with abortion being totally voluntary and miscarriage being totally involuntary.
However, in some circumstances, people might choose to abort a fetus for medical reasons, even when they actually want to have a child. In the second and third trimester of pregnancy, a doctor might perform tests to find out whether the fetus has any chromosomal conditions. An example could be anencephaly, which is a condition in which a fetus is missing parts of the brain and skull. Most fetuses with anencephaly don’t survive birth, or the infant dies soon after birth. In circumstances like this—where the prognosis is bleak—one might decide to have an abortion to spare the baby and the mother pain.
Technically, an abortion in a case like this is elective because the pregnant person could decide to keep the pregnancy. Elective abortions, even under these conditions, are controversial, as some might believe it’s best to let nature take its course. Others believe it’s more humane to have the abortion to reduce the suffering of everyone involved.

How can Rhesus factor complications cause a miscarriage?

Sometimes, miscarriages—complete, incomplete, or missed—can be caused by Rhesus factor complications. The Rhesus, or Rh, factor is what determines whether you have a negative blood type or a positive blood type. For example, B+ blood is Rhesus positive, whereas A– blood is Rhesus negative.
If someone with a Rhesus negative blood type is pregnant with a Rhesus positive fetus, this could cause complications. This isn’t usually an issue during the first pregnancy, but after that point, one’s body might develop antibodies that turn against the fetus, Davis says. “If unrecognized, the fetus may go on to develop in-utero anemia,” she adds.
Fortunately, this can be prevented with an injection of anti-D immune globulin or Rhogram, says Davis. This prevents your body from developing antibodies that attack the fetus. “It is important to [linkbuilder id=”6468″ text=”know your blood type”] if you experience a miscarriage to avoid your risk to subsequent pregnancies,” Davis says. “If you have a miscarriage and your blood type is negative, you should see your doctor.”

Do I need to see a doctor if I have an early miscarriage?

If you miscarry a pregnancy early in the first trimester (or you suspect you have), Mahnert advises you to check in with your doctor. While treatment isn’t always necessary after very early pregnancy losses, it can never hurt to have that confirmed by your OB-GYN. “If a woman has unexpected heavy bleeding and cramping after a confirmed pregnancy test it is always a good idea to check in with your OB-GYN,” Mahnert says. “If you experience heavy bleeding and other symptoms such as dizziness or faintness, you should be evaluated urgently.”
“If you have a confirmed intrauterine pregnancy based on ultrasound and then suspect a miscarriage, you should be re-evaluated by your physician,” Davis adds. “While spotting can be common in the first trimester, particularly around the time of uterine implantation, any bleeding like a menstrual flow or severe abdominal pain warrants an examination.”
If you miscarry 13 weeks or more into your pregnancy, you might need a dilation and curettage (often known as a D&C), which is a surgical procedure that removes all pregnancy tissue from the uterus.  
Davis notes, “No clinical evaluation is typically required afterwards unless you experience more than three recurrent losses.” But if you’re trying to conceive and you’ve had even one miscarriage, Davis suggests making an appointment with your doctor to discuss your and your partner’s health.

Rebecca was a trained wilderness first responder. She knew about ectopic pregnancies. Still, when an embryo implanted in her Fallopian tube, Rebecca (who’s asked that we not use her last name) missed the signs of an ectopic pregnancy completely.
“I didn’t even know I was pregnant,” Rebecca recalls. “I had suspicions, but a test came out negative, then I traveled to Hawaii for several weeks.”
It was while she was in Hawaii that the bleeding started, along with painful cramps, two classic signs of ectopic pregnancy. But since her [linkbuilder id=”6463″ text=”pregnancy test”] was negative, Rebecca shook them off for days, then a week. Finally, nine days after it all started, she mentioned she’d been bleeding to a friend who happened to be a nurse. Suddenly, two and two came together to make four.
“She sent me straight to the hospital, where I found out I was pregnant, miscarrying, and ectopic all at once,” Rebecca recalls.
Rebecca’s life was saved by that trip to the hospital. An estimated 2 percent of pregnancies are ectopic pregnancies, and for women living in North America, this condition is the leading cause of death in the first trimester of pregnancy and accounts for anywhere from 10 to 15 percent of all maternity-related deaths.
But what is an ectopic pregnancy? And are the signs really that easy to ignore? We talked to the experts about how ectopic pregnancy is defined, what they do to treat the condition, and how you can stay safe.

What is an ectopic pregnancy, anyway?

When someone gets pregnant, the embryo that’s created when sperm meets ovum is supposed to travel up the Fallopian tube and find its way to the uterus where it will hang out until birth, developing, growing, and turning into a human being.
But when a pregnancy is ectopic, the embryo gets lost on its way to the uterus. Technically, an ectopic pregnancy is “any pregnancy that implants outside the uterine cavity,” says G. Thomas Ruiz, an OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California.
In almost every case of an ectopic pregnancy—about 95 percent of the time—the embryo will implant itself in the Fallopian tube. In about 2.5 percent of ectopic pregnancies, the fertilized ovum can settle in at the cornua of the uterus (essentially the spot where the uterus and Fallopian tube meet). The other 2.5 percent are found in the ovary, cervix, or abdominal cavity.

What’s the problem here?

So the embryo didn’t go where it was supposed to. Why is that a problem? Well, every part of the female reproductive system has its own job. The uterus, of course, has the job of providing a growing fetus a safe place for development.
The Fallopian tube, cornua of the uterus, ovary, cervix, and abdominal cavity, on the other hand, are not suited for a developing fetus. There simply isn’t room in those structures for what has to happen to get a baby from conception to birth.
According to Cindy Basinski, an OB-GYN from Newburgh, Indiana, “Pregnancies that develop outside the uterus are dangerous because as the pregnancy grows it can rupture and cause life-threatening bleeding inside the abdomen.”
Sometimes the body will figure out something is wrong, and essentially “fix” an ectopic pregnancy, stimulating a miscarriage early on. Sometimes a woman won’t even know she was pregnant, let alone that her body was dealing with an ectopic pregnancy.
It’s when an ectopic pregnancy continues to grow, however, that the condition becomes something serious, Basinski says. Until the condition is treated—or if it ruptures—you might notice signs and symptoms like Rebecca’s.

Signs of an Ectopic Pregnancy

Notice Basinski said might.
“Unfortunately, for some women, ectopic pregnancy may have very little to no symptoms until it ruptures, causing bleeding in the abdominal cavity—leading a woman to seek emergency care,” Basinski says. “It is unpredictable during growth of an ectopic pregnancy—[whether it’s] weeks or months—when this event may happen.”
On the other hand, for many women, there are noticeable symptoms of experiencing ectopic pregnancy.
Some women report bloating, nausea, or vomiting, although these symptoms are common in [linkbuilder id=”6462″ text=”early pregnancy”] and can easily be confused for garden-variety morning sickness. Pelvic pain that can’t be explained by period cramps or another source or vaginal bleeding in the early stages of a pregnancy, on the other hand, are reasons to call your OB-GYN immediately. Once you’re in their office, you may well be diagnosed with an ectopic pregnancy.

“Pain may be related to stretching of the Fallopian tube as the ectopic grows within it or small amounts of bleeding leaking into the abdominal cavity from the growing pregnancy,” Basinski explains. “Vaginal bleeding may occur as pregnancy hormones are often not produced normally, causing bleeding.”

How is an ectopic pregnancy diagnosed?

Even after you tell your doctor that you’re feeling any of the signs of ectopic pregnancy, diagnosis can be tricky. In fact, according to a 2002 study published in the journal Obstetrics and Gynecology, almost 40 percent of ectopic pregnancy diagnoses are incorrect and are later revealed to be normal, intrauterine pregnancies.
Avoiding this confusion comes down to talking to your doctor about what tests they’re performing.
“If a person is truly diagnosed with an ectopic pregnancy by a physician, this is generally a very accurate diagnosis,” Basinski says. “Physicians are very careful to proceed to treatment of ectopic until they are certain because they do not want to harm a pregnancy if it is a normal one.”
That’s why they require a number of tests before diagnosis or treatment.
“If a physician is concerned that a patient may have an ectopic pregnancy, they will often follow a patient’s levels of beta-human chorionic gonadotropin (BHCG, a pregnancy hormone) to see if it is rising normally,” Basinski says. “If it is not rising normally, this can indicate either an impending miscarriage or ectopic pregnancy.”
An ultrasound is the next step, allowing doctors to take a look inside to see if the embryo is located inside the uterus (where it belongs) or outside of the uterine cavity (making it ectopic). This is where things can get tricky.
“It is difficult to see any pregnancy in any location until the pregnancy has grown enough to be seen—about four to five weeks,” Basinski notes. “If pregnancy levels reach a certain level but no pregnancy is seen in the uterus, this may be an indication of an ectopic pregnancy. If a pregnancy is seen outside the uterus, a definitive diagnosis of ectopic is made.”

Treating an Ectopic Pregnancy

After a definitive diagnosis of ectopic pregnancy, the first treatment most doctors reach for is methotrexate, Ruiz says. The medicine is used in other medical settings to treat everything from rheumatoid arthritis to certain cancers, and it’s contraindicated for most pregnant women because of potential harm to the fetus.
However, in cases of an ectopic pregnancy, there is no saving the fetus, Ruiz says.
“If the embryo is an ectopic, it will not survive,” he notes. “The risk to the mother can be loss of life, loss of the uterus, loss of the tube, or impairment to future fertility.”
Prescribing methotrexate in cases of pregnancy (whether ectopic or intrauterine) stops the growth of the cells in the embryo, and the body will typically miscarry the pregnancy.
“Methotrexate is used in early diagnosed ectopic pregnancies and basically prevents DNA replication in rapidly dividing tissue,” Ruiz explains.
There’s a strict criterion before it’s prescribed, he adds, including a BHCG level that’s less than 5,000 milli-international units per milliliter and no fetal cardiac activity, to ensure the fetus is not viable.
For some women, however, methotrexate doesn’t work. Rebecca’s ectopic pregnancy remained in her Fallopian tube even after she was treated with the drug, and her doctor had to go in surgically to remove the embryo and save her Fallopian tube, enabling her to get pregnant again in the future.
Other women may have to have the affected tube removed completely, Ruiz says, if the methotrexate doesn’t work or if the diagnosis is not made soon enough. Typically this can be done laparoscopically, but if the tube has already ruptured, an ectopic pregnancy becomes a surgical emergency, requiring an abdominal incision.
Although a D&C, short for dilation and curettage, may have once been a means to treat ectopic pregnancy, the procedure is rarely used today, Ruiz says.
“Twenty-five years ago, if we were really stumped, we would do a D&C and send it for rapid frozen section,” Ruiz says. “If the rapid frozen section returned negative for chorionic villi we would proceed to laparotomy [a surgery where the surgeon cuts through the abdominal wall] for a presumed ectopic.”
These days, Ruiz says, highly sensitive ultrasounds and blood testing have rendered the D&C essentially obsolete.

How does this all happen?

Ectopic pregnancies are not a woman’s fault. There’s nothing you do that makes the embryo implant in the wrong part of the body.
But that doesn’t mean there aren’t risk factors at play, Basinski says.
Those with a higher risk of ectopic pregnancy include women with a history of:

• Pelvic inflammatory disease due to a sexually transmitted disease
• Endometriosis causing damage to fallopian tubes
• Previous pelvic surgery for any reason, including appendectomy, tubal ligation, or tubal ligation reversal surgery.

A previous ectopic pregnancy can also increase your chances of having another one, as can smoking and the use of an IUD as a form of contraception.

Ectopic pregnancy prevention is possible (sort of).

There’s no way to tell whether or not a pregnancy will turn out to be ectopic. You can’t tell the embryo where to go, nor can you will it into the uterus.
But if you aren’t specifically trying to have a baby anyway, condom usage can go a long way toward preventing ectopic pregnancy, Basinski says. After all, it’s one of the most effective means of preventing any pregnancy!
If you do want to get pregnant and you have any of the aforementioned risk factors, hope is not lost.
“Women with risk factors should let their physicians know so that together they can closely monitor future pregnancies to enable an early diagnosis and treatment,” Basinski says.
In Rebecca’s case, ectopic pregnancy was not the end of her fertility journey. After two ectopic pregnancies, both of which ended in surgery, she tells HealthyWay, “I’m the mom of two beautiful boys, both conceived with IVF.”

Danna Lorch had never heard of diastasis recti when she was pregnant, but even if she had, the new mom didn’t have time to think about her stomach muscles after she gave birth. Back and forth she went from her hospital room—where she was recovering from an emergency c-section—to the neonatal intensive care unit, where her newborn son needed her to hold him and feed him.
No one told her then that the muscles at the core of her body might have been stretched apart during her pregnancy. In fact, it wasn’t Lorch’s physician who diagnosed her with diastasis recti. And it wasn’t the first physical therapist she saw about the agonizing pain in her hip—or the second. It took three physical therapists before the problem with Lorch’s abdominal muscles finally had a name and she could get some help.
The number of people who experience diastasis recti after [linkbuilder id=”6506″ text=”pregnancy is hard”] for researchers to quantify. Diastasis recti—a separation of the rectus abdominis muscles in your abdomen that leaves a gap that allows your belly to pooch out—isn’t always diagnosed.
Some people with diastasis recti simply assume they’re having a hard time losing weight after giving birth or having back pain because they’ve been hunched over a baby while breastfeeding or feeling the strain of carting a bulky infant carrier. They may not be wrong, but then again, there may be another underlying condition that’s exacerbating that sore back and unrecognizable tummy.
In one study of 300 first-time pregnant women who were followed from pregnancy till 12 months postpartum, the prevalence of diastasis recti was 33.1 percent, 60 percent, 45.4 percent, and 32.6 percent at gestation week 21, 6 weeks, 6 months, and 12 months postpartum, respectively. In other words, a whole lot of pregnant people. In the study, which was published in the British Journal of Sports Medicine, the researchers found no difference in risk factors between those who had diastasis recti and those who didn’t. No one did anything “wrong” to create this painful condition. It simply happened.
So how can you tell if you might end up with diastasis recti after giving birth? And what exactly is it?

Deciphering Diastasis Recti

Diastasis recti is the separation of the rectus abdominal muscles. But does that mean the muscles in the abdomen suddenly decide to go walkabout? And if yes, why?
According to Mary Fleming, MD, an OB-GYN and attending physician at Einstein Medical Center Montgomery in East Norriton, Pennsylvania, pregnancy is often to blame. As the uterus expands to accommodate a growing fetus, it puts pressure on the abdominal wall and stretches these muscles. In part, that’s a necessity of pregnancy. Our hormones ebb and flow, softening and stretching the muscles of the abdomen to accommodate the baby as it develops.
For most, that stretching is simply a way for the abdomen to round out as the uterus grows. But for others, that stretching will push the muscles apart, and the muscles won’t quite spring back into place. That’s diastasis recti.
This can happen to anyone who is pregnant, but if you have a c-section, the risk increases because the muscles have to be surgically separated during the procedure to allow doctors access to the uterus to deliver the baby.
“For most women, these muscles will return to the normal place after delivery (of either type),” Fleming says, “However, for some women they do not, leaving a separation or gap, which can be seen as a midline bulge below the umbilicus (belly button). Diastasis recti is the clinical term for this condition.”

Do I have diastasis recti?

Let’s face it: The state of the abdominal area after giving birth can really vary. Some women seem to have magical powers that pop everything back from whence they came just minutes after birth. (Or so it feels anyway…we’re looking at you, Duchess Catherine!) For others, nothing in the abdominal region will ever look quite the same as it did before they earned their tiger stripes.
[pullquote align=”center”]According to one study, diastasis was present among all women at 36 weeks of pregnancy and decreased to 39 percent at 6 months postpartum.[/pullquote]
How it looks doesn’t (or shouldn’t) matter. But how it feels does, and the pain and discomfort that can come with diastasis recti shouldn’t be ignored.
Of course, it’s hard to say just how many women find that their abdominal region is affected by diastasis recti. There is limited research on the condition. But according to one study, diastasis was present among all women at 36 weeks of pregnancy and decreased to 39 percent at 6 months postpartum, says Nichole Mahnert, an OB-GYN at Banner – University Medical Center Phoenix in Arizona.
What makes it hard to judge just how often the condition crops up is that for some people, diastasis recti will resolve on its own without medical intervention. This can happen in as little as six months, Fleming says, leaving a new mother largely unaware that her abdominal muscles decided to start wandering away from one another.
What’s more, the stigma of dealing with post-pregnancy weight can keep some parents from talking to their doctors and finding out they have diastasis recti. Even reporting on the topic of diastasis recti has been met with debate over society’s health and beauty standards and the damaging effect they can have on a new parent’s psyche. But again, it’s important to note that diastasis recti treatment isn’t about creating a “perfect mom bod.” It’s about healing the muscles of the abdomen and helping you regain core strength, which connects to overall body health.  
As Lorch says, “[Diastasis recti] kept me from feeling strong for a long time and also made me wonder why I wasn’t conforming to the pervasive ‘bounce back baby body’ nonsense that celebrity gossip magazines pump out at us.”
When someone is grappling with angst over why their body just isn’t “bouncing back” the way the tabloids tell us it should, an actual medical condition that’s split their abdominal muscles is often the last thing that comes to mind.

Diagnosis: Recti

While some folks never get help (or put it off), for others, diastasis recti can be debilitating enough to send them running to their doctor, begging for help.
That’s what happened to Grace Everett. The mom of two sons, ages 5 years and 20 months, felt what she calls “pretty acute back pain” after her second child was born, and it became untenable somewhere around the six- to eight-week mark.
“At that point, the rest of my body had recovered from the c-section, but I realized my back was not doing well at all; in fact, it seemed to be getting worse,” Everett recalls. “I wasn’t able to do normal things, like pick up my preschooler or clean (without pain) and had trouble sleeping.”
When she mentioned the pain to her doctor, they referred her to a physical therapist, where she was officially diagnosed with diastasis recti.
“[It] was essentially making my back work way too hard, because my core was totally out of commission,” Everett says. “‘My physical therapist was amazing from the start. She used an ultrasound machine so we could actually see what my muscles were doing. And then we started off small, with very specific exercises that were invisible to watch, where I was laying down prone just trying to get my abs to wake up. I had to retrain my core to engage and convince my back it wasn’t needed.”
Aside from back pain, another sign that you might have diastasis recti is a bulge right in the center of your abdominal area. This bulge will be vertical and is most apparent when sitting up from a lying-flat position, Mahnert says.
This can happen just days after giving birth, and it’s typically not an emergency situation. But it’s not normal for significant or severe pain to be associated with the separation, so that would warrant an immediate call to your doctor, Mahnert cautions.
Whether it’s pain, a bulge, or things just don’t feel right, it’s worth mentioning to your OB-GYN how your abdomen is feeling after birth. After all, this is why follow-up obstetrical care is recommended post birth—so the OB-GYN can catch conditions that relate to pregnancy or birth.
A diagnosis of diastasis recti will usually be made by measuring the length between the two muscles at rest and again when the muscles are contracted. From there, treatment will begin.

Rectifying the Recti: Healing Diastasis Recti

The good news? Surgery is very rarely needed to heal diastasis recti. Although an abdominoplasty can bring the walls of the abdomen together, this operation is considered elective, Mahnert says, meaning it’s often not covered by insurance. What’s more, it’s not recommended until after someone is finished with childbearing.
Instead, physical therapy—like the course that helped Everett get back on track—is the most common path for treatment because it’s both less invasive and more likely to be covered by insurance.
A physical therapist will examine you and begin developing an exercise routine that will target the abdominal muscles without exacerbating your symptoms.
For example, Megan Eggleton, a physical therapist at Grover M. Hermann Hospital in Callicoon, New York, says you’ll want to avoid exercises that increase that bulge, like full sit-ups.
“So very gentle abdominal activation to start, like pelvic tilts, very small crunches, pulling in your stomach like you’re sucking it in and holding for 10 seconds 10 times, and also on hands in knees doing alternating arms and legs,” she says.
Another popular diastasis recti treatment is sitting on an exercise ball and marching in place, Eggleton says, as it will help tighten the core abdominal muscles without worsening the diastasis recti.
Slow and steady can feel frustrating when you just want to feel better, but Lorch found that her physical therapist helped her feel strong and in control of her body again.
“My teacher, Hened, tailored exercises just for my diastasis and even taught me how to check my own stomach as I exercised to make sure I wasn’t straining the gap but strengthening it,” she says. “I saw results in about three months, and in about six the gap had nearly closed. It’s still not perfect by any means, but it’s no longer something that makes me feel weak or self-conscious. I used to love running before the baby and that’s something that I’m finally slowly getting back into.”
[pullquote align=”center”]”Life won’t get less crazy. So take care of yourself now, so you can keep up once they’re zooming all over the house!”[/pullquote]
The process was similar for Everett, who advises other parents in her situation make the call to their doctor as soon as possible, so treatment can begin right away.
“Don’t wait until life gets less crazy,” she says. “We moms have a way of putting off self-care, but honestly, taking an infant to my appointments, where he would just snooze in his car seat, was a heck of a lot easier than when he became mobile and I had to line up a sitter every time. Life won’t get less crazy. So take care of yourself now, so you can keep up once they’re zooming all over the house!”

Why Diastasis Recti Happens

Everett and Lorch both underwent c-sections, which can increase a risk of diastasis recti because of the work a doctor has to do to pull apart the abdominal wall to access the uterus.
But it isn’t only c-section deliveries that can result in the condition, Eggleton says. In fact, pregnancy isn’t the only cause, and it can happen to anyone—women, men, non-binary folks … whoever.
“The most common cause of diastasis recti is pregnancy in women. However, less commonly, it can also be caused by obesity (carrying a lot of weight in the abdominal area), lifting heavy weights incorrectly, and performing excessive and often incorrect abdominal exercises,” Eggleton says.
Few other risk factors for the condition have been identified, which makes it harder for a parent-to-be to prevent diastasis recti. Instead, doctors suggest patients simply follow the same healthy measures they’re recommended to follow anyway: Eat a healthy diet and exercise regularly.
And if diastasis recti does happen, find someone who is qualified to help get you on the path to treatment. The better acquainted they are with diastasis recti, the better chances they have of helping you!

Pregnancy can be such an intense time, both for your mind and your body. So many changes at once! Such discomfort! Such flexibility! Exercise that once felt good doesn’t always work, and where you were once tight you are now a limber lady. How should a pregnant lady deal?
To figure out which pregnancy stretches are best (and which ones to avoid), we spoke with Bec Conant, an experienced registered yoga teacher (500 hours), registered prenatal yoga teacher, and owner and founder of OM Births in Watertown, Massachusetts. Conant has been teaching prenatal yoga for over 15 years and is also a doula and mom to little Sawyer, which means she has extensive professional and personal experience helping women get ready for labor.
There are plenty of pregnancy stretches that can help ease pain, reduce stress, and even help you prepare for the big event: labor. However, it’s key to make sure you’re stretching the right way so you can keep yourself and your baby safe through all three trimesters.

HealthyWay: Is stretching safe during pregnancy?

Conant: Absolutely! It’s vital. With the change in your center of gravity, your postural muscles can get tight, especially if you spend much of the day sitting. Being able to release tension and re-balance the load on your body makes for much greater comfort.

How can pregnancy stretches help get my body ready for labor?

Balance! Our bodies are already primed for labor; we just have to maintain good muscle tone for the big day. We want to be both strong and supple as we embark on the journey of labor. That’s where pregnancy stretches come in: Stretching the hips, low back, and sides can help balance tension so that one set of muscles isn’t tasked with the whole load all the time.
Certain postures, such as squatting, can mimic the way the pelvis may need to open during the birth process, and thus are helpful to practice as long as you aren’t already super flexible in this area! [More on that to come.]
Exercises that bring awareness to the pelvic floor are super important for this opening. We all know about practicing our Kegels, but we should also focus on the full range of lift and release available from the pelvic floor muscles.
Good postures to practice are squatting, child’s pose, tadasana, and baddha konasana.
Don’t just practice lifting the pelvic floor but releasing it, too—this is the action that helps birth the baby.

What are good stretches in the first, second, and third trimesters? Are they different?

Many pregnancy stretches stay the same throughout each trimester, but the focus of each posture will change as your pregnancy progresses.

First Trimester

This time is about finding your current flexibility and nurturing your body as it begins to grow this new human being. Gentle lunges, hamstring stretches, and upper back releases are helpful.

Second Trimester

The focus becomes about making room for baby and developing strength for later on. Goddess squat and Warrior II can be helpful as long as you practice proper alignment. This is a good time to start working on on hip openers, incorporating fire logs, pigeon, and malasana.

Third Trimester

This last phase is about opening (within appropriate range) and finding that balance and suppleness. Try baddha konasana, malasana (assuming baby is in a head-down/spine-to-mom’s-belly position), and chest and shoulder openers, which can help balance the extra weight on the front of the body.

How is prenatal yoga good beyond preparing my muscles?

Yoga isn’t just about the body; it’s also about the mind. Practicing mindful awareness during movements—and especially during intense sensations—is directly applicable to both labor and motherhood. In yoga, we are learning not just how to stretch, but how to listen to the body and learn from its signals. It’s that same inward listening that guides moms through the intensity of labor. If you’ve spent time getting comfortable with how your mind responds to intense feelings, then you can harness this same skill during labor. This skill is useful after birth, too, when parenting gets challenging!

Should I worry about overstretching? Why?

Yes, especially during the third trimester, and especially if you are a naturally flexible person. During pregnancy, the body starts getting ready to open for birth before the actual labor begins. It does this in part through hormonal changes, which soften the connective tissue in your body, making the pelvic joints more flexible.
This is great for labor, but can be slightly dangerous before because it affects all the connective tissue in the body. In the third trimester, the body produces more of the hormone relaxin than usual. Ligaments are meant to stop you from going too far while stretching, but with an onslaught of relaxin in the body, especially during the third trimester, this doesn’t always occur. The trouble is that you often won’t know when you’ve overstretched until after it’s been done, and by then the damage has already occurred. This is why it’s key to get a sense of your flexibility early in pregnancy so you are more aware of where your limits are before the third trimester.
The basic rule of thumb is to start by stretching to 50 percent of what you think you can do, and to then to gradually and mindfully see where you begin to encounter resistance. While we do want to stretch, this is not the time to increase range of motion.
Postures to be especially mindful of include lunges, pigeon, warrior, and any pose that involves moving one leg forward and one back. Twists or binds which cannot be done with ease should not be attempted for the moment. Gentle, open twists are okay, but there should be no pushing.

I’m having trouble with…

Round Ligament Pain

Cat–cow can sometimes help. Since round ligament pain is often caused by a twisting motion that stretches the ligament on one side more than the other, gentle pelvic rocking in a symmetrical position can sometimes relieve the discomfort and rebalance the uterus in the pelvis.

Sciatica

The best approach to stretching to relieve sciatica during pregnancy depends on whether it’s being caused by overly tight muscles or overly loose joints. If the former, then postures that stretch the glutes and piriformis are often the way to go. Baddha konasana or agnistambhasana (fire log) can bring great relief to tight hip muscles. If your sciatica is due to excessive laxity, however, then the focus is more on stabilizing.  Baddha konasana is still a great option, but instead of working to drop the knees, focus on pressing the feet together and drawing the lower abdominals inward. Another option is to practice table pose, focusing on actively drawing the abdominals inward to support the weight of the belly.

Back Pain (Other Than Sciatica)

Continue everything you’re doing for sciatica, but add windmills (aka prasarita padottanasana while lifting one arm and lowering it again). If you’re still comfortable lying on your back, lie down over a rolled blanket (the blanket should go under your shoulder blades, perpendicular to your spine), and allow the spine to melt into the backbend. This one can be fairly intense while doing it, but brings wonderful relief when you are done. Be sure to roll to the side before getting up.

Gas

My two favorites for this are actually the same movement, just one is upside down. If you’re still comfortable on your back, then lie down and draw the knees into the chest (allowing room for the baby). Pushing them out and drawing them back in again can relieve gas. Another option is  rocking between child’s pose (again, leaving room for baby) and table.

Heartburn

Kneel facing the wall, extend the arms overhead against the wall and lean in to rest the forehead against the wall. The aim is to create a passive backbend in the upper back. Also, stay more horizontal than fully inverted in postures like uttanasana by placing blocks under the hands. This is helpful because lifting the rib cage in a passive backbend helps things run downward instead of being pushed up. You get a small version of the same thing if you lift the arms into urdhva hastasana. Interlace the palms to press upwards and then exhale strongly while continuing to reach upwards. I’ve found that the additional upper body backbend the wall stretch provides increases this effect.
[related article_ids=18882,1001537]

The day Bobbi Daniels learned she’d had a miscarriage, she felt like she’d failed. “After seeing my baby’s heartbeat three days before, I laid on a table as the tech searched and searched for a viable baby,” the mom from Camden County, New Jersey tells HealthyWay. “I had lost my baby, had failed another [IVF] cycle, and was $35,000 deep into the process.”
Daniels was seven weeks pregnant at the time, carrying a little boy she’d conceived thanks to in vitro fertilization (IVF) after doctors said she had just a 10 percent chance of ever getting pregnant without intervention. Noah is the name she’d given the boy.
Miscarriage is difficult. It’s confusing. It’s heartbreaking.
It’s not, however, a failure on the part of a mom-to-be. In fact, doctors say the signs of miscarriage can be so similar to your period that some women who miscarry in the very early stages of pregnancy never even know they were pregnant—let alone that they’ve miscarried.
Daniels, on the other hand, had a confirmed pregnancy. She knew she had been pregnant, and she knew she had lost the baby she and her husband were so excited to welcome into their family.  
“I knew in my heart I had lost Noah,” she recalls. “The morning I was going for my scan and found out I had lost Noah, I was going through the list of podcasts to listen to. It sounds ridiculous, but for a quick second I had the thought ‘I don’t want to start a new podcast because I’ll never be able to listen to it if I lost this baby.’ After I had the scan, the doctor recommended a D&C to make sure everything was cleaned out and to speed the process up of bleeding.” (A D&C, or dilation and curettage, is the surgical procedure of clearing out the contents of the uterus.)
“There are no words to explain the pain of walking into a hospital still carrying your child [and] to leave hours later with no baby,” Daniels says. “The nurse had me take a pregnancy test because she didn’t realize what procedure I was there to have done. The torture of watching that stick have two lines, knowing my baby was gone, literally made my chest hurt.”
It’s an experience Daniels will always carry with her, even now that she has a little girl who she calls her rainbow baby, a term used by moms who give birth after a pregnancy loss. And she’s far from alone.
A miscarriage is defined as a pregnancy loss before the 20th week of pregnancy, and miscarriage rates are hard for experts to accurately estimate. Doctors can only judge miscarriage rates by pregnancies that have been confirmed, and those figures are high. According to the American College of Obstetricians and Gynecologists, early pregnancy loss occurs in as much as 10 percent of all clinically recognized pregnancies. Some 80 percent of those cases occur, as Daniels’ did, in the first trimester.  
In fact, the majority of miscarriages will occur right between six and eight weeks, says Sherry Ross, MD, an OB-GYN and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California.

Signs of Miscarriage

Although the result of a miscarriage—the end of a pregnancy—is the same in all cases, the signs can vary widely from woman to woman.

• Late Period

  Women who don’t know they’re pregnant often miss the symptoms of miscarriage, says G. Thomas Ruiz, MD, an OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California. These women, who have what’s termed a “chemical pregnancy,” will typically endure a miscarriage within a week of the embryo’s implantation in the uterus. If they’d undergone blood tests, Ruiz says, doctors would be able to see a spike in the hormone hCG, but after a miscarriage, that “rapidly goes to zero.” Then the body starts to bleed, expelling the fertilized egg from the uterus, which most women assume is their period showing up just a week or two behind schedule.

• Bright Red Bleeding and Uterine Cramping

  If you have had your pregnancy confirmed, bleeding and cramps will be more likely to serve as a warning sign of miscarriage, Ruiz says. After all, a woman who is pregnant knows she should not be expecting her period, as the menstrual cycle goes into hibernation during pregnancy.
  “If a woman is having heavy bleeding that is not stopping and/or if she is experiencing severe abdominal pain, she should go to an emergency room immediately,” Ruiz says.
  Even if the bleeding is not heavy and the pain not intense, it’s still important for a woman to call her doctor. They can determine whether it’s time to run to the ER, head to their office, or go to a medical facility for testing.
  Bleeding could indicate miscarriage, but it could also indicate an ectopic (or tubal) pregnancy, Ruiz explains. That means the fertilized egg has attached itself someplace other than inside the uterus, typically in the fallopian tube.
  “As a tubal pregnancy progresses, the [fallopian] tube can dilate and rupture, which will cause severe abdominal pain and a surgical abdomen, which is a medical emergency,” he notes, so the tests are necessary to prevent further complications.
  For women whose pregnancies have entered the second trimester, testing may also determine if bleeding is being caused by a cervical insufficiency, says Renée Volny Darko, DO, an OB-GYN and founder and CEO of Pre-med Strategies, Inc. Although it sounds like a bit of a slam at a woman’s body, a diagnosis of cervical insufficiency is not a judgment from your doctor. Instead it means that the cervix has dilated too early, which is endangering the pregnancy.
  In that case, “interventions like a cerclage, which essentially ties the cervix closed, can be used to help keep the pregnancy,” Darko says, although she’s quick to add that cerclages are not always successful.

• No Signs at All

  Some miscarriages may simply occur without a sign. A mom may walk into her doctor’s office as Daniels did, ready for standard testing, only to find out that the baby has no heartbeat.
  “The process of conception and human development is intricate and often imperfect,” Darko says. “But miscarriages might have no symptoms at all. A miscarriage can be diagnosed on a routine ultrasound where the pregnancy is found not to have developed beyond a sac or the fetus has no heartbeat.”
  For moms like Daniels, that can be the most devastating of all.
  “I sat there holding the prayer card to my belly, which was the St. Anthony prayer of miracles,” Daniels recalls of the 15-minute scan when she got the news. “As she asked me to hold my breath, and I watched her face, I knew my baby had died. I cried so hard that no sound could even escape my body. Tears soaked the bed. The nurse whispered ‘I’m sorry hon, I don’t see a heartbeat, get dressed and meet me outside.’”
  Daniels recalls her life flashing before her eyes in those moments. “I didn’t just lose a 7-week baby. I lost the first day of kindergarten, my baby reaching for my hand calling me Mommy, a round belly everyone was going to rub and fuss over, a tired baby I rock to sleep who was comforted by my voice, birthday parties, late night feedings, a lifetime of memories,” she says.
  Her doctors were able to tell her that she could try again, and her little girl, born in April 2018, is the result of her second pregnancy.
  Trying again is not on every woman’s mind. Grief and recovery can take all forms, but Darko says moms who do want to try again are typically given the all clear very soon after a miscarriage, depending on the cause of the pregnancy loss and when it happened.
  “After most first trimester miscarriages, there is really no need to wait to conceive again,” Darko notes. “After a second trimester miscarriage, a woman should be evaluated to see if the reason for the miscarriage can be corrected before conceiving again.”
  So what are the reasons a woman might have a miscarriage?

Why Miscarriage Happens

Because so many women miscarry before they even know they are pregnant, experts don’t know what causes all miscarriages. They term pregnancies in two camps: normal and abnormal. Again, it’s important to note that these terms are medical in nature. “Abnormal” does not refer to a mom herself.
“Normal” pregnancies last beyond 10 weeks, Ruiz says, while abnormal pregnancies make up the bulk of miscarriages.
So what causes miscarriage? Here are some of the most common causes, according to the experts:

• Genetic Abnormalities

  No parent wants to hear that their baby is abnormal, but again, this is a medical term rather than a judgment from the doctor. In some 60 percent of miscarriages, pregnancy loss will occur seemingly randomly, but it’s due to a genetic abnormality, Ross says. The fertilized egg is unable to continue development, causing the process of pregnancy to end.
  Turner syndrome, also known as 45,X or 45,X0, is one of the leading genetic abnormalities linked to miscarriage, Ruiz explains. The condition, in which a female embryo is partly or completely missing an X chromosome, has been tied to about 15 percent of miscarriages.
  Women in their late thirties and early forties are more likely than others to have miscarriages due to genetic abnormalities, Ross notes, and it can be tied to a mom’s eggs. Because we’re born with all the eggs we will ever have, the older a woman is, the older her eggs are too. “What is well known in the medical world is fertility declines progressively with age,” Ross says. “The aging of eggs is a well-known biological phenomenon referred to as our ‘biological clock.’ If you are 45 years old and trying to conceive, you will have a greater than 80 percent chance of having a miscarriage, compared to a woman under 30 years old who will have a less than 20 percent chance of having one.”

• Infection

  Simply getting sick during a pregnancy is not a guarantee that a woman will miscarry (although it’s always important to contact your doctor if you are coming down with something). But certain common infections—from the flu to sexually transmitted infections such as syphilis and herpes—have been linked to a higher incidence of miscarriage. To stay ahead of these conditions, your OB-GYN may screen for STIs at one of your early appointments, and the Centers for Disease Control and Prevention recommends pregnant women receive a flu vaccine for their own protection as well as their baby’s.

• Abnormal Uterine Cavity

  The uterus is where an embryo implants and then resides, developing until birth. But for some women, problems with the uterus can lead to miscarriage, Ruiz says. Dubbed an “abnormal uterine cavity,” one of the most common is a uterine septum, an upside down, triangular piece of tissue that can divide the uterus in half. “if the embryo implants on the septum, there is high risk for a miscarriage,” Ruiz says.

• Asherman Syndrome

  Scarring of the uterine cavity is another issue that can cause miscarriage. Called Asherman syndrome, the condition is rare and typically occurs after an infection or a woman undergoes a D&C, Ruiz explains. Because the condition affects the endometrium, or the wall of the uterus, it can make even getting pregnant difficult to begin with. “The embryo needs a nice endometrium to implant well,” Ruiz adds.

• Medications

  If your pharmacist asks you whether you’re pregnant when you’re filling your prescription, they’re not just being nosy. Studies have linked miscarriage risks to everything from certain antibiotics to anti-inflammatory pharmaceuticals.

• Cervical Incompetence/Cervical Insufficiency

  The cervix is a narrow passage that separates the uterus—where an embryo develops—and the vagina. When it’s time for a baby to be born, the cervix will begin to dilate, allowing a baby the space to move out of the uterus and into the birth canal to come into the world. But in some instances the cervix begins to dilate too soon—sometimes as much as three to four months before the fetus is ready for birth.
  More commonly linked to miscarriage in the second trimester, an “insufficient” or “incompetent” cervix is one that begins to dilate too early in the pregnancy. This condition is associated with weakness in the cervical muscles, and Ruiz says it can be related to a previous D&C or biopsy of the cervix (such as one done by an OB-GYN when abnormal tissue is found that might indicate a cancer or pre-cancer). It can also happen to women who’ve had multiple previous births. And although there are several risk factors connected to the condition, it can also happen out of nowhere with no foreseeable cause.

Minimizing Miscarriage Risk

There is never a guarantee, Darko says, as pregnancy loss is a part of life, albeit a difficult one for parents-to-be.
The best defense, however, is a good offense. If you’re planning to try to conceive, Darko says to meet with your doctor. Discuss your risk factors and any medications you might need to change or conditions you might need treated.
“Seeing a doctor to optimize your health before getting pregnant can be the difference between a good and bad outcome,” she notes.
And while one or several miscarriages can be heartbreaking and discouraging, the majority of women do get the all-clear to try again from their doctors, and for many of them, it can be successful.
For Daniels, another cycle of IVF and another pregnancy helped bring her little girl into the world. “The road that led me to her was the most difficult, trying time in my life,” she says. But, she adds, “Noah will always be a part of me, he is me, and because of him I continue so he continues. His sister will grow to always know the love I have for her and her brother.”

Prenatal yoga can feel sooooo good to a mama-to-be—all that stretching and relaxing and preparing for the birth. And it’s also safe, right? Well, yes and no.
Prenatal yoga can be a wonderful way to strengthen your body and work with your mind before giving birth. But there are some poses—or ways of approaching poses—that should be avoided during pregnancy, just to be on the safe side.
I spoke with the wise and wonderful Bec Conant, owner and founder of Om Births in Watertown, Massachusetts. She’s also a birth doula and mom to little Sawyer. Below she answers all your most pressing questions about practicing yoga safely while pregnant.

HealthyWay: What are the basics of practicing prenatal yoga safely?

Conant: The first rule is true for all yoga practice: Don’t do anything that feels like it might injure your body, and don’t ever strain for a pose! If you start with the first yogic principle of ahimsa (not harming), things will fall into place from there. That said, here are some basics that are specific to pregnancy to bear in mind:

• Avoid anything that squeezes or compresses the belly (ouch!), or anything that demands intense abdominal control. Even in the first trimester it’s smart to be cautious around arm balances and deep twists—everything is shifting inside you and the body is trying to protect this tiny growing being.
• When you get into your second and third trimesters—as the baby grows—widen the feet in standing postures like uttanasana where the belly would hit the thighs.
• Always make sure that all your joints are slightly soft. In other words, don’t lock at in the elbows or the knees. The soft joints help keep things supported as the hormones shift to soften connective tissue, especially in the third trimester.
• Avoid any pranayama (breath practice) where your breath is doing crazy or unusual things. (Think breath of fire or anything that places unusual strain on the nervous system.)

What prenatal yoga poses are definitely safe for me to do?

In the first trimester, everything is okay, with the exception of anything that would put pressure into the abdomen. So a belly bolster is out right away, and deep twists like parivritta parsvakonasana are best to avoid. You can go into the shape (twisting your body), but don’t push yourself further into the twist.
And don’t start learning new things like arm balances and inversions! If you are already practicing these, it’s fine to keep doing them, but this isn’t the moment to finally learn to go upside down!

What prenatal yoga poses should I avoid by trimester and why?

Second Trimester

Avoid anything that compresses the belly, so stay away from poses like paschimottanasana (seated forward bend) with legs together and ardha matseyandrasana (half lord of the fishes pose). Start exercising caution in the deep backbends, like wheel, where the expanding abdominal wall could be affected. In lunges and deep squats, the focus should be on support rather than releasing and opening. You need to do this to support the pelvis, which is preparing to open for the birth.

Third Trimester

Avoid the obvious stuff like lying on your belly and possibly lying on your back if it doesn’t feel comfy (if it makes you feel dizzy, nauseated, or faint). Good postures to practice are those that help open and align the pelvic connective tissues: baddhakonasana, bridge (to stretch the psoas muscle, which runs from the spine to the top of the thigh), gentle spinal twists, as well as postures that help during labor such as all fours (table), table with elbows on the floor, and deep relaxation.
Deep relaxation is key during the third trimester because it helps the body stay free of stress before the birth process.

When should I start practicing prenatal yoga, and when should I stop practicing?

Start as soon as you like! I have students who are only six weeks pregnant in class. End when your water breaks—seriously, you can practice right until the baby is in your arms. Of course one could say that’s when the real yoga begins.

How can I find a prenatal yoga teacher I can trust?

Ask around your area, or start by looking on Yoga Alliance to see who’s in your region with a prenatal designation (RPYT), but also check out various classes. The designation by itself doesn’t guarantee you will feel comfortable with the person, so check it out for yourself. Look for a teacher who doesn’t just teach prenatal yoga, but who has experience in the birth field as a doula or childbirth instructor. They’ll know more than just the postures and will probably be really passionate about the prenatal experience.

Quick Prenatal Yoga True or False with Bec

• Twists are okay: True. They are better if you just twist to open up. Save room for the baby!
• Lying on your back in poses is okay until it’s personally uncomfortable (this varies person by person): True.
• Don’t do core work because it causes diastasis recti: True—and false. Don’t do surface core work, but exercises that work the transverse abdominals, like plank, can be done with caution and might even help maintain a strong center. Pelvic floor work will also contribute to an integrated core.
• You can go upside down (and it can be great for turning a breech baby!): True, but it’s best to have a spotter or previous knowledge of inversions. (But poses like downward dog and bridge can also help turn a breech baby.)
• It is bad to put firm direct pressure on the belly: True.
• It is bad to jump in the first trimester: True.
• Binding is bad because of the hormone relaxin and softer connective tissue which could cause instability: True. [Many prenatal yoga instructors stress that relaxin can alter ligaments; some studies have shown that higher relaxin levels during pregnancy correlate with pelvic and hip joint instability.]
• Expelling breath out and holding it is not safe: True.
• It is recommended to start yoga in the second trimester because the first is always riskier: False. People may feel more comfortable starting prenatal yoga in the second trimester because they will have cleared the challenges of the first trimester, but the risks of miscarriage during the first trimester are not going to be increased by a gentle yoga practice.