Pregnancy is broken into three time periods, called trimesters. Most women feel differently, both physically and mentally, during each trimester. In addition to weight and body shape, other alterations in your body chemistry and function also take place during pregnancy. Your heart works harder, your temperature registers slightly higher, body secretions increase, joints and ligaments are more flexible and hormones are altered.
Mood changes also are common, resulting from a combination of hormonal changes and greater fatigue, as well as normal anxiety over body image, sexuality, finances, partner roles and impending parenthood.
For the vast majority of women, pregnancy follows a fairly routine course. Some women, however, have complications or challenges related to their health or the health of their baby. These women experience what is called a high-risk pregnancy.
Signs to Watch For
Although there are many symptoms that are a normal part of pregnancy, there are certain danger signs that may indicate problems. You should notify your doctor immediately if you experience any of the following:
- Persistent vomiting
- Chills or fever
- Continuous pain
- Burning with urination
- Blurred vision
- Continuous headache
- Sudden swelling of the hands or face
- Five or more uterine contractions per hour
- Decreased fetal movements
- Leaking of fluid from the vagina (blood or water). If you have vaginal bleeding at any time during your pregnancy, have someone call your doctor immediately.
Our Approach to Pregnancy
UCSF provides world-class care for women who are pregnant or considering becoming pregnant. Each pregnancy is unique. That's why collaboration with individuals is the core of our approach. We listen to your needs, provide information and support, and guide you through the process of having a child, from the early stages of family planning through pregnancy, delivery, postpartum recovery and beginning life as a new parent.
Our team of obstetricians, perinatologists (specialists in maternal-fetal care) and nurse-midwives has the expertise and compassion to care for all pregnancies and deliveries, from the routine to the highest risk. UCSF has a family-oriented, state-of-the-art birth center, where birthing suites are equipped with a spa-style bathtub, a dedicated family area and a media wall for education and entertainment. Should you or your baby need special care, we provide a seamless transition to renowned specialists and one of the nation's finest intensive care nurseries.
In addition to patient care in the clinic, we offer a variety of other resources, such as classes and support groups, to help you navigate pregnancy, childbirth and parenting.
Awards & recognition
Among the top hospitals in the nation
One of the nation’s best in obstetrics & gynecology
Rated high-performing hospital for maternity care (uncomplicated pregnancy)
Excellence in supporting breastfeeding
The Three Trimesters
Pregnancy has three trimesters, each of which is marked by specific fetal developments. A pregnancy is considered full-term at 40 weeks; infants delivered before the end of week 37 are considered premature. Premature infants may have problems with their growth and development, as well as difficulties in breathing and digesting.
First Trimester (0 to 13 Weeks)
The first trimester is the most crucial to your baby's development. During this period, your baby's body structure and organ systems develop. Most miscarriages and birth defects occur during this period.
Your body also undergoes major changes during the first trimester. These changes often cause a variety of symptoms, including nausea, fatigue, breast tenderness and frequent urination. Although these are common pregnancy symptoms, every woman has a different experience. For example, while some may experience an increased energy level during this period, others may feel very tired and emotional.
Second Trimester (14 to 26 Weeks)
The second trimester of pregnancy is often called the "golden period" because many of the unpleasant effects of early pregnancy disappear. During the second trimester, you're likely to experience decreased nausea, better sleep patterns and an increased energy level. However, you may experience a whole new set of symptoms, such as back pain, abdominal pain, leg cramps, constipation and heartburn.
Somewhere between 16 weeks and 20 weeks, you may feel your baby's first fluttering movements.
Third Trimester (27 to 40 Weeks)
You have now reached your final stretch of pregnancy and are probably very excited and anxious for the birth of your baby. Some of the physical symptoms you may experience during this period include shortness of breath, hemorrhoids, urinary incontinence, varicose veins and sleeping problems. Many of these symptoms arise from the increase in the size of your uterus, which expands from approximately 2 ounces before pregnancy to 2.5 pounds at the time of birth.
Expert prenatal care ensures that both you and your baby are as healthy as possible throughout your pregnancy. If you think you are pregnant, contact your doctor to make an appointment and establish your prenatal care schedule. During prenatal visits, tests are performed on you and your baby to assess any potential risks, treat any complications, and to monitor the growth and development of your baby.
Many factors affect the number of prenatal visits you have, including your personal health and your doctor's preference. Additional prenatal care may be necessary if you have preexisting medical conditions, such as diabetes, or if complications arise during your pregnancy. If your pregnancy is going well, visits are planned around key pregnancy developments and certain tests that need to be performed.
In addition, visits are a time for your doctor to give you important information as your pregnancy progresses and help you prepare for birth.
Common tests performed during pregnancy include the following:
- Genetic carrier screening. Many genetic conditions, such as cystic fibrosis, sickle cell anemia and hemophilia A, can be diagnosed before birth. Your doctor may recommend genetic testing during your pregnancy if you are over 35, if you have a family history of genetic disorders (or the other biological parent does), or if you have had a fetus or baby with a genetic abnormality.
- California prenatal screening (CA-PNS). This blood test is performed during your visit at 15 to 20 weeks. It measures the levels of alpha-fetoprotein (AFP), a protein released by the baby's liver and found in your blood, as well as certain hormones. Abnormal results on the expanded AFP test may indicate fetal brain or spinal cord defects, multiple fetuses, a miscalculated due date or Down syndrome. Typically, the patient's obstetrician performs AFP screening. If your test result indicates a potential risk, you may be referred to the UCSF Prenatal Diagnostic Center for follow-up care.
- Nuchal translucency (NT) screening. UCSF Health is one of the few centers nationwide to offer NT screening, a new noninvasive test performed early in pregnancy to identify an increased risk for Down syndrome and certain other birth defects. Offered to pregnant people of all ages, NT screening is performed when you are between 11 and 14 weeks of pregnancy. A high-resolution ultrasound exam is done on the nuchal region – an area at the back of the fetus' neck. The results are combined with the pregnant individual's age to determine an adjusted risk for Down syndrome. The detection rate for Down syndrome is about 80%. Based on the results, people have the option of undergoing chorionic villus sampling or amniocentesis for more information.
- Chorionic villus sampling (CVS). This prenatal test is usually performed between week 10 and week 14. Like amniocentesis, CVS can often detect genetic abnormalities and chromosomal disorders. However, an advantage of CVS is that it can be performed much earlier in pregnancy than amniocentesis.
- Amniocentesis. This test is performed between weeks 15 and 20. Although not all pregnant people choose to have amniocentesis, it is routinely performed on those who are over 35 or at risk for genetic disorders. During the procedure, a small sample of the amniotic fluid surrounding the fetus is obtained. The fluid is analyzed to help identify chromosomal and genetic disorders and certain birth defects. When done during the third trimester, this procedure also can assess the maturity of your baby's lungs.
- Ultrasound. This machine uses sound waves to generate pictures of the fetus, which allow doctors to determine the fetus' age and whether there are twins. A detailed ultrasound can detect certain birth defects.
- Glucose tolerance test. This test is usually performed during the fifth month of pregnancy. It measures the levels of sugar (glucose) in your blood. Abnormal glucose levels may indicate gestational diabetes, a form of diabetes that sometimes develops during pregnancy and requires monitoring.
- Fetal monitoring. Your doctor may want to monitor fetal heart rate and uterine activity during your pregnancy. This involves using an ultrasound transducer to measure the fetal heart rate and a toco transducer to identify uterine activity.
- Group B strep culture. Group B streptococcus is an infection in pregnant people that can lead to complications and sometimes death in newborns if transmitted during delivery. Group B strep has become more prevalent in the last two decades. Doctors now routinely perform cultures on the vagina and rectum of pregnant individuals to diagnose the infection. Group B strep is easily treated with antibiotics.
Labor and Delivery
Labor is a series of progressive and continuous contractions of the uterus that help the cervix to open and thin, allowing the baby to travel through the birth canal. Labor usually starts within two weeks before or after your estimated delivery date. However, this can vary widely.
Labor and delivery are hard work and involve some discomfort. The level of discomfort experienced during childbirth varies from woman to woman and from pregnancy to pregnancy. Each woman chooses a different way to experience her birth — some prefer to go through it without medication, while others choose to have medication or anesthesia. Many decide to "see how it goes" and make choices as their labor unfolds.
We offer a spectrum of options for managing your pain during labor and delivery. You will be assigned to your own nurse during your stay in the birthing suite. He or she will help keep you comfortable and guide you through non-drug approaches to pain management, such as whirlpool soaks and position changes.
Non-Medical Approaches for Labor and Vaginal Birth
The Birth Center rooms provide a number of options for comfort during labor including space to move around, tubs for soaking, rocking chairs and beds that convert into different positions.
Relaxation and breathing techniques ease the discomfort for many, as does the presence of family and friends and the support of health care providers. Comfort measures can be learned from classes, books or videos available through UCSF's Great Expectations Pregnancy Program.
Medical Approaches for Labor and Vaginal Birth
- Narcotic Injections of a narcotic can be given intravenously (through an IV) during labor. The narcotic works quickly and can be given every hour during labor. However, it is not given immediately before delivery to ensure that the effects will have worn off before the baby is born. For some women, this medication takes the edge off and allows them to rest and relax between contractions.
- Nitrous oxide gas This is the same gas that is used at the dentist, and can be inhaled during contractions through a mask you hold. The gas can lessen but not eliminate the pain of labor. The effect occurs only while the gas is being inhaled and disappears rapidly when the mask is removed. It can be used through delivery.
- Epidural anesthesia An epidural offers the most complete pain relief during labor and birth. A tiny tube or catheter is placed through a needle into a space (the "epidural space") outside the spinal cord sac in the lower back. The needle is removed and the tubing is taped in place. Similar to an IV, medication is given continuously through the tube during labor and birth. The medication blocks the pain of contractions. Because of the numbness produced by the epidural, a woman with an epidural cannot get out of bed. Most women take the opportunity to get some rest. A "walking epidural" — also called a "combined spinal-epidural" — is a technique that allows a woman to continue to move around while receiving a lighter form of medication.
Our anesthesiologists are available to the Birth Center 24 hours a day. The anesthesiologist on-call meets every woman who is admitted in labor regardless of whether she is planning anesthesia for her birth. The purpose of this visit is two-fold: To learn of any medical problems you may have in the unlikely event of an emergency, and to answer any questions you may have about the pros and cons of medical approaches to pain relief during labor.
When a Caesarean is Needed
While most women will have a vaginal delivery, some may need abdominal surgery referred to as Caesarean section. Most often women have a Caesarean birth when labor does not progress — the cervix does not completely dilate or the baby cannot be pushed out — over a long period of time. It is a decision made by the woman and her doctor when both feel everything else has been tried and this is the only alternative.
Sometimes a Caesarean birth is planned. Situations that might require a scheduled Caesarean include:
- Breech position
- Previous Caesarean section
- Placenta previa, when the placenta is covering the cervix
Rarely, Caesarean birth is due to an emergency situation that endangers the woman's or her baby's health. In these situations, there is no time to wait for the regular process of labor and the decision to perform a Caesarean section must be made very quickly. Indications for an emergency Caesarean may include:
- Maternal bleeding
- The baby being in distress
Anesthesia for Caesarean Section
For a planned or non-emergency Caesarean, an epidural or spinal anesthesia is the anesthesia of choice. This allows the woman to be awake and able to see her baby immediately after birth. In an emergency situation, the woman would be put to sleep using general anesthesia. This is the fastest anesthesia to administer when time is of the essence.
If the woman is awake, a support person can be with her for the birth. If general anesthesia is used and the woman is asleep, support people need to wait in the labor room or waiting room until the surgery is completed.
Caesarean Procedure and Recovery
Most often, the doctor will make a low transverse incision — a "bikini cut" — both on the skin, just above the pubic hair, and on the uterus itself. This is a preferable cut for both comfort and recovery. Occasionally an "up and down" or vertical incision is made on the skin, uterus, or both. This is a faster cut and may be used in an emergency. The size and position of your baby also may determine the need for this kind of incision.
Recovery from surgery takes longer than recovery from a vaginal birth. Usually it requires an extra night or two in the hospital, for a total of three to four nights, and more help at home in the first few weeks.
Many women choose to attempt a vaginal birth after Caesarean, called VBAC, and many will succeed. Every woman who has had a Caesarean will need to discuss the subject of VBAC with her provider. Many factors — including the reason for the Caesarean, the type of incision and the number of prior Caesareans — will influence the safety of VBAC.
You will be provided with a Birth Plan, a form asking about your preferences for delivery. This promotes communication with your health care provider and helps them meet your individual needs. You will complete your Birth Plan and discuss it with your health care provider at your 34 to 36 week visit.
Make photocopies of your Birth Plan. Give one to your health care provider to put in your medical record, and bring one with you when you come to the hospital in labor.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.