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Pregnancy
An illustrated DAY BY DAY
daily countdown
to motherhood,
from conception
to childbirth
and beyond

Consultant Editor Paula Amato, MD

Adjunct Associate Professor
Department of Obstetrics & Gynecology
Oregon Health & Science University
Editor-In-Chief Maggie Blott, MB BS
Pregnancy
DAY BY DAY
An illustrated daily countdown to motherhood,
from conception to childbirth and beyond
Pregnancy DAY BY DAY

Consultant Editor Paula Amato, MD

Adjunct Associate Professor, Department of Obstetrics & Gynecology,
Oregon Health & Science University

Editor-In-Chief Maggie Blott, MB BS

LONDON, NEW YORK, MUNICH, MELBOURNE, DELHI

Project Editors Dawn Bates, Claire Cross

Project Designers Emma Forge, Tom Forge, Peggy Sadler
Senior Editors Andrea Bagg, Anne Yelland, Emma Woolf
US Editors Shannon Beatty, Jane Perlmutter
US Consultant Editors Lisa Fields, Patricia Bontekoe
Senior Art Editors Sarah Ponder, Nicola Rodway, Liz Sephton
Production Editor Ben Marcus
Production Controller Alice Holloway
Creative Technical Support Sonia Charbonnier
Illustrators Debbie Maizels, Medi-Mation
New Photography Ruth Jenkinson
Art Direction for Photography Emma Forge
Picture Researcher Sarah Smithies
Managing Editors Esther Ripley, Penny Warren
Managing Art Editors Glenda Fisher, Marianne Markham
Publisher Peggy Vance

Every effort has been made to ensure that the information in this
book is complete and accurate. However, neither the publisher nor
the author is engaged in rendering professional advice or services
to the individual reader. The ideas, procedures, and suggestions
contained in this book are not intended as a substitute for
consultng with your health-care provider. All matters regarding
the health of you and your baby require medical supervision.
Neither the publishers nor the author shall be liable or responsible
for any loss or damage allegedly arising from any information or
suggestion in this book.

First American Edition, 2009

Published in the United States by
DK Publishing
375 Hudson Street
New York, New York 10014

09 10 11 10 9 8 7 6 5 4 3 2 1

Copyright © 2009 Dorling Kindersley Limited

All rights reserved

Without limiting the rights under copyright reserved above, no

part of this publication may be reproduced, stored in or introduced
into a retrieval system, or transmitted, in any form, or by any
means (electronic, mechanical, photocopying, recording, or
otherwise), without the prior written permission of both the
copyright owner and the above publisher of this book.

Published in Great Britain by Dorling Kindersley Limited

A catalog record for this book is available from the

Library of Congress.

ISBN: 978-0-7566-5041-4

DK books are available at special discounts when purchased in

bulk for sales promotions, premiums, fund-raising, or educational
use. For details, contact: DK Publishing Special Markets, 375
Hudson Street, New York, New York 10014 or [email protected].

Color reproduction by MDP, Bath, UK

Printed and bound by Star Standard, Singapore

Discover more at www.dk.com

US consultant editor
Dr. Paula Amato is a fertility consultant and an adjunct associate
professor at the Oregon Health and Science University in Portland,
Oregon. She received her medical degree from the University of Toronto
in 1989, where she also completed her residency in obstetrics and
gynecology. She subsequently completed a fellowship in reproductive
endocrinology and infertility at the University of California, San Diego.
Dr. Amato was awarded an American Obstetricians and Gynecologists
Foundation Fellowship (1997–2000) and was a recipient of the Berlex
Scholar Award in Basic Science Research in 2001. She is board certified
in both obstetrics and gynecology and reproductive endocrinology and
infertility. As an academician, she has held faculty appointments at the
University of California, San Diego, and at Baylor College of Medicine.
Dr. Amato is a former associate editor of Sexuality, Reproduction,
& Menopause, a vice chair of the American Society of Reproductive
Medicine (ASRM) Sexuality Special Interest Group, and a member of
the ASRM Ethics Committee. She was the US medical consultant for
DK’s bestselling title, I’m Pregnant!

Editor-in-chief
Dr. Maggie Blott MB BS, FRCOG is Consultant Obstetrician at University
College Hospital, London, where she jointly manages a multidisciplinary
high-risk prenatal clinic and runs the labor ward. She is also spokesperson
for The Royal College of Obstetricians and Gynaecologists, London. Dr.
Blott is a regular columnist for Top Santé magazine and writes for a
number of other pregnancy-related publications.

Contributors
Dr. Carol Cooper MA, MB, BChir (Cantab), MRCP General Practitioner, London;
Tutor at Imperial College School of Medicine, London O Ms. Friedericke Eben
FRCOG Consultant Obstetrician and Gynaecologist, Whittington NHS Trust
and Portland Hospitals, London O Dr. Katrina Erskine MD, MRCP, MRCOG
Consultant Obstetrician and Gynaecologist, The Homerton Hospital, London
O Dr. Laura Goetzl MD, MPH Associate Professor, Department of Obstetrics
and Gynecology, Division of Maternal Fetal Medicine, Medical University
of South Carolina, Charleston, South Carolina O Dr. Belinda Green PhD
Midwife, University College London Hospitals, NHS Foundation Trust, London
O Dr. Deirdre Guerin MB BCh, BAO, LRCP and SI, FFA, or CSI Medical Director
of Resident Obstetric Services and Consultant Anesthetist, The Portland
Hospital for Women and Children, London O Amanda Hutcherson DipHeMid,
RM, PGCert Ed, MA Midwife Practitioner, London O Dr. Philippa Kaye MD, MB
BS Hons, MA Hons (Cantab), DCH, DRCOG, DFSRH Works in general practice
O Dr. Su Laurent MRCP, FRCPCH Consultant Paediatrician, Barnet Hospital,
London O Mr. Andrew Loughney PhD, MRCOG Consultant Obstetrician,
Royal Victoria Infirmary, Newcastle upon Tyne O Dr. Paul Moran MD, MRCOG
Consultant Obstetrician, Head of Fetal Medicine, Royal Victoria Infirmary,
Newcastle upon Tyne O Melinda Nicci BA (Psych), HDipEd Fitness and
lifestyle coach and founder of baby2body: pregnancy and post pregnancy
health and fitness O Catharine Parker-Littler SRN, RSCN, SCM, DPSM (Advanced
midwifery), BScMid (Hons) Practicing midwife; founder and midwifery director
of midwivesonline.com, a website for midwives, health-care professionals,
and parents-to-be O Dr. Hope Ricciotti MD Associate Professor of Obstetrics,
Gynecology, and Reproductive Biology, Harvard Medical School, Beth Israel
Deaconess Medical Center, Boston, Massachussetts O Dr. Vincent M. Reid
PhD Lecturer in Developmental Psychology, Durham University O Dr. Mary
Steen RGN, RM, BHSc PGCRM, PGDipHE, MCGI, PhD Reader in Midwifery and
Reproductive Health, University of Chester O Karen Sullivan ASET, VTCT, BSc
Developmental Psychology; Child-care expert and author O Sally Watkin
Pregnancy and parenting author
Contents
Introduction 8 Labor and birth
Pain relief options 396 Coping with pain 397 Natural
A healthy pregnancy pain relief 398 Drugs for pain relief 402 1st stage of
Your pregnancy diet 14 Exercising safely 18 Sex and labor 408 Approaching labor 409 How labor progresses
relationships 19 Illnesses and medications 20 Lifestyle 412 Monitoring during labor 418 Positions for 1st stage
hazards 24 Skin, hair, and teeth 26 Traveling in of labor 420 2nd and 3rd stages 422 Delivering your
pregnancy 28 baby 423 After your baby is born 428 Special cases 430
Premature birth 431 Induction of labor 432 Breech
baby 433 Multiple births 434 Assisted birth 436
Pregnancy day by day Cesarean section 438
Welcome to your first trimester
Your 1st week 34 Your 2nd week 42 Conception 50 Life with your new baby
Your 3rd week 52 Genes and inheritance 54 Your
4th week 62 Your 5th week 70 Your 6th week 78 The first 12 hours 442 Day 1: Getting acquainted 444
A changing world 82 Your 7th week 88 Strengthening Day 2: Settling in 445 Day 3: Going home 446
and toning exercises 90 Miscarriage 94 Your 8th Day 4: First outing 447 Feeding your baby 448
week 98 Prenatal care options 102 Your 9th Day 5: Baby blues 450 Day 6: Finding your
week 108 Your baby’s life support system 112 Your way 451 Neonatal intensive care babies 452 Day 7:
10th week 118 Your first prenatal visit 122 Your Tuning in 454 Day 8: Healthy living 455 Day 9: Focus
11th week 128 Your 12th week 136 First ultrasound on you 456 Day 10: Getting checked 457 Day 11:
138 Screening tests 142 Taking stock 458 Day 12: Looking back 459 Day
13: Feeling close 460 Day 14: New beginnings 461
Welcome to your second trimester Your six-week checkup 462
Your 13th week 150 Diagnostic tests 152 Your 14th
week 160 Your 15th week 168 Your 16th week 176
Your 17th week 184 Your 18th week 192 A safe Concerns and complications
workout 196 Your 19th week 202 Your 20th week 210 Common concerns in pregnancy 466 General
Your 20-week ultrasound 214 Your 21st week 220 Your
symptoms 466 Skin changes 467 Breast problems 467
22nd week 228 Your 23rd week 236 Your 24th week 244 Digestive problems 467 Heart and circulation
Abdominal exercises 250 Your 25th week 254 problems 468 Aches and pains 469 Urinary and
Welcome to your third trimester vaginal problems 471 Complications of pregnancy
Your 26th week 264 Your 27th week 272 Your 28th and labor 472 Complications in pregnancy 472 Labor
week 280 Assessing fetal growth and well-being 284 complications 474 Concerns after the birth 475
Your 29th week 290 Your 30th week 298 Planning Maternal problems 475 Congenital problems in the
for your birth 302 Your 31st week 308 Twins 312 baby 476 Problems in the baby from birth 477
Your 32nd week 318 Your 33rd week 326 Your
34th week 334 Your 35th week 342 Your rights and Glossary 478
benefits 348 Your 36th week 352 Your 37th week 360 Resources 480
Your 38th week 368 Your 39th week 376 Your 40th Index 482
week 384 Overdue baby 393 Acknowledgments 494
Introduction
Pregnancy is an exceptional time when you enter one of your most
significant life stages and need to quickly assimilate knowledge and
understanding of the process of pregnancy and birth. In the past,
when women traditionally gave birth at home, cared for by midwives
and female relatives, pregnancy and birth was a familiar event.
Today, it’s unusual to have such firsthand experience and a woman’s
knowledge of pregnancy and birth is often nonexistent or limited to
that which she gained in her first pregnancy. As a result, many, if not
all, women contemplate pregnancy with a mixture of trepidation and
curiosity. These feelings are often compounded by the recognition that
their own lifestyle choices can have an enormous influence on their
own and their baby’s health. For all these reasons, there is a great
need for women to be able to access information about pregnancy
that is accurate, balanced, and accessible.
In Pregnancy Day by Day, information is gathered from a wide
body of professionals, each with his or her own area of expertise.
The midwives, doctors, obstetricians, and pediatricians who have
contributed the core information in this book have between them
cared for thousands of women at each stage of pregnancy and labor,
delivered thousands of babies, and provided care and support for
women and their babies after the birth. The exhaustive record of
pregnancy, birth, and the postpartum period provided by their
combined expertise is complemented by specialized knowledge on
diet and exercise from a nutritionist and a lifestyle and exercise coach.
The information presented—at once practical, detailed, and full of
simple explanations and advice—will provide the vital tools women
need to help them plan for pregnancy, negotiate the many changes
they will experience, and develop a safe and appropriate birth plan.
Most pregnancy books are written for women. Today many men
also want to follow closely the development of their unborn child, but
have little information and often feel excluded. Within the book, there
are reassuring explanations for partners about the changes that occur
during pregnancy as well as advice for women on how to include
partners during pregnancy and the early days of parenthood.

Dr. Maggie Blott

How this book is organized
This book starts with guidance on how to enjoy a healthy three trimesters, each of which comprises around a
and safe pregnancy, with lifestyle advice that often applies third of the pregnancy. Beyond being a simple measure
to the preconceptual period too. The core section of the of time, each trimester represents a distinct phase in the
book gives a day-by-day account of pregnancy with detailed development of the baby and in the pregnancy.
explanations of the physical and emotional changes that
take place in your body along with fascinating insights The first trimester The definition of the first trimester
into how your baby develops within the uterus. A labor is given here as weeks 1–12, though you may also see
and birth chapter takes you through the delivery of your weeks 13 and 14 included elsewhere. This trimester covers
baby, followed by a summary of the first two weeks with the time from the beginning of the menstrual period to
your new baby. A final chapter deals with concerns and the moment of conception, which is usually around two
complications in the mother and baby in pregnancy, labor, weeks. Because the exact moment of conception is
and the postpartum period. unknown, pregnancy is counted from the one definite
date, the beginning of the menstrual cycle. Although
A healthy pregnancy technically your pregnancy may not begin until two
This chapter provides the information you need to weeks into your menstrual cycle, these two weeks are
make lifestyle choices that will maximize your own very important in helping your body achieve a healthy
health throughout pregnancy and give your baby the best pregnancy. Here, we explain day by day the changes that
possible start in life. It includes guidelines for exercising take place in your uterus to prepare it for conception and
safely, eating healthily, avoiding hazards, and dealing with implantation of the early embryo, and offer dietary advice
illnesses. It also addresses concerns you may have about and recommendations from fertility experts to boost your
how the emotional and physical changes of pregnancy chances of conceiving.
may impact your relationships. The first trimester is a period of extraordinary
development, when all your baby’s major organs form,
Pregnancy day by day and he or she will grow faster than at any other period in
Here, the book takes you day by day through the life. A day-by-day account is given of the changes that you
extraordinary story of conception and pregnancy, and your baby undergo, and advice offered on how to cope
counting down each of the 280 days until the onset with the exhausting changes that occur in early pregnancy.
of labor. Each day reveals how your baby is developing There’s also an honest appraisal of the emotional feelings
and the changes that are occurring in your body. The you’re likely to experience, reassuring you that negative as
280 days, or 40 weeks, of pregnancy are divided into well as positive emotions are normal. Practical information
on accessing prenatal care and detailed explanations of that having sex won’t harm the growing baby, helps you
the choices that are available help you begin to plan your navigate your way through the final weeks of pregnancy.
pregnancy and think about your options for the birth.
Labor and birth
The second trimester In the second trimester, One of the best ways to cope with labor is to understand its
which is designated as weeks 13–25, your baby’s organs stages. In the labor and birth chapter, a team of professionals
mature further and growth continues. This is an exciting covers in detail the progress of labor, each providing their
time as your body starts to change shape to accommodate own expert insight. A doctor writes about normal births
your growing baby and you feel your baby move for the and discusses natural pain relief. An anesthesiologist gives
first time. However, it is also a time when women can the options available for medical pain relief, including
experience symptoms that are often due to quite normal detailed descriptions of how epidurals are given and their
pregnancy changes but that can occasionally indicate pros and cons. While most women have a normal birth
a problem. For example, abdominal pain can be due to without complications, 30 percent have a cesarean section,
ligaments being stretched or to constipation; however, and around 5 percent have an assisted delivery, with either
it could also indicate a problem with the placenta. forceps or vacuum extraction. An obstetrician writes about
Symptoms such as these are discussed at the relevant difficult births, describing complications and the medical
point in pregnancy, with detailed explanations that will interventions that may be required.
provide reassurance or alert you to the possibility of
something more serious that should be brought to the The first two weeks
attention of your doctor. Here, the early days as you adjust to life with your new
baby are charted in the day-by-day format. A pediatrician
The third trimester In the third trimester, addresses the practical issues of baby care. Also discussed
designated as weeks 26–40, your baby continues to are the emotional and physical renewal you undergo as
grow and mature and, if born early, could survive life your body recovers from the birth and you begin the new
outside the uterus. During this time, your body starts tasks of nurturing and feeding your baby.
to prepare itself for labor. We describe the changes taking
place and explain why they occur, as well as providing Concerns and complications
pointers to what is normal and which symptoms need This reference section is a concise guide to conditions in
to be reported to your doctor. Women recount their pregnancy and labor, and postpartum concerns in the mother
experiences, and questions that are presented daily and baby. Clear explanations enable you to digest medical
to doctors are reproduced to provide a bank of vital information, understand which symptoms are not of concern,
knowledge. Practical guidance on all matters, from and feel reassured about how more serious conditions are
maternity leave entitlement information to reassurance managed in pregnancy, labor, and the postpartum period.
In pregnancy, feelings of awe and excitement are often
mingled with concerns about your own and your baby’s
well-being. With an ever-growing body of knowledge
on how a mother’s behavior in pregnancy impacts her
baby’s short- and long-term health, women today have
the opportunity to ensure that their lifestyle choices
positively benefit their babies. Eating healthily, exercising
regularly, and avoiding hazards will all help give your
baby the best possible start in life.
A healthy
pregnancy
 Your pregnancy diet
You can optimize your own health and your baby’s future health
by eating a nutritious, balanced diet throughout pregnancy.
general, white is bad when it comes
to carbohydrates, since refined foods
such as white rice and white breads
are rapidly broken down and enter the
bloodstream in the form of a spike of
glucose. It is thought that this spike
may have health risks for mother and
baby, producing larger babies with a
subsequent risk of obesity later in life.
Unrefined carbohydrates are less
processed, so they break down more
slowly in the bloodstream and release
glucose steadily. They are also a good
source of fiber, which helps prevent
constipation. These are a healthier
choice, and at least half, if not all, of
your carbohydrates should come from
unrefined (whole grain) sources. such as
Eating regular nutritious meals and snacks throughout the day is vital during pregnancy to whole-wheat or multigrain bread; brown
keep your energy levels up, and to provide your growing baby with all he needs to develop well. rice, whole-wheat pasta, and cereals.

In recent years, much has been learned percent of your calories should come Protein
about what constitutes a healthy diet in from carbohydrates; 20–35 percent from Protein is essential for the growth of the
pregnancy. In addition to the importance fats; and 10–35 percent from protein. The baby and the placenta, as well as for your
of nutrients such as folic acid (see p.16), components of these nutrients don’t need health. Pregnant women need around
A healthy pregnancy

there is mounting evidence that a person’s to be in this exact ratio for each meal, or 6-6½ oz each day. Aim for two to three
health may be influenced by the mother’s even every day, but you should aim to servings of protein-rich foods a day, a
diet in pregnancy, including whether achieve this balance over the course of typical serving being 3 oz (85 g) red meat,
particular nutrients were received at a week. A diet that includes plenty of or 5 oz (150 g) fish. Since most adults get
certain times. Current thinking is that vegetables, fruits, whole grains, and good about 3½ oz (100 g) of protein daily, there
good nutrition in pregnancy may reduce proteins and fats will automatically is usually no need to increase your intake,
a baby’s future risk of diseases such as contain the proper mix of nutrients. especially if you have protein at each meal.
obesity, diabetes, and heart disease. If you’re vegetarian, in addition to protein
In addition to influencing your baby’s Carbohydrates at each meal, you should have a protein-
health, good nutrition in pregnancy also Carbohydrates are an important source containing snack. If you’re having twins
optimizes your health, helping you to of fuel for you and for your baby since or more, ask your doctor how much
deal with the demands of pregnancy. they are broken down into glucose, protein to consume and when breast-
which passes easily across the placenta. feeding, 6½ oz (185 g) daily.
A healthy diet Try to get six servings a day, a serving Choose protein sources that contain
Getting the right balance of protein, being equivalent to a slice of bread, 2 oz less saturated fat, such as skinless
carbohydrates, and fats in pregnancy (60 g) of cereal, or five crackers. chicken, lean beef and pork, tofu, low-
is simple, since the ratios are the same Carbohydrates are divided into two fat cheese and yogurt, and skim milk.
in pregnancy as at other times: 45–65 subgroups: refined and unrefined. In Fish, nuts, and seeds contain healthier

14
unsaturated fats (see below), although
YOUR RECOMMENDED DAILY INTAKE
your intake of some fish should be limited
since they contain mercury, which could Eating a healthy, balanced diet is of paramount importance during pregnancy
be harmful to your baby (see p.17). to help you deal with the additional demands on your body and to provide your
developing baby with essential nutrients. By eating a wide variety of healthy
Fats foods, you will be ensuring that you and your baby are receiving the correct
Fats contain vitamins and contribute to balance of nutrients. Try to include a range of foods each day from each of the
the healthy development of cells. However, major food groups (see opposite) and eat plenty of fresh fruit and vegetables.
although fats make a useful contribution
to overall nutrition, their intake needs to
be limited. Choose healthier unsaturated
fats, found in foods such as fish and some
types of oil, over unhealthy saturated fats
found in whole milk dairy products, meat,
or trans fats found in processed foods.

Omega 3 fatty acids Studies suggest

that the development of the baby’s
nervous system may be boosted by
Include 2–3 portions each day of protein- Try to include 3 servings of dairy
omega 3 fatty acids, the richest source rich foods, such as fish, lean meat, chicken, products each day. Ideally, these should
of which is found in fatty fish. Avoid fish legumes, cheese, and nuts to ensure the be low-fat products, such as low-fat milk
that are high in mercury (see p.17) and healthy growth of body structures. and low-fat cheese and yogurts.
opt instead for salmon and anchovies,
which are good, safe sources of omega 3
fatty acids. Wild salmon is very rich in
omega 3, but farm-raised salmon is also
a good source. Other sources include
omega 3-enriched eggs, flaxseed, flaxseed
oil, walnuts, canola oil, and omega 3
supplements and prenatal vitamins
containing omega 3 fatty acids.

Dairy products Have 3 servings of whole grain 4–5 servings of vegetables each day will
These are an important component of

Your pregnancy diet

carbohydrates, such as brown rice and ensure a good supply of essential vitamins
the diet since they provide a good supply whole-wheat breads and and pasta, to keep and minerals. Try to eat different colored
of proteins and fats, as well as calcium up energy levels and ensure a supply of fiber. produce and don’t overcook vegetables.
and some vitamins. Calcium is essential
for the healthy development of bones and
teeth. Opt for low-fat dairy products and
low-fat or skim milk. Aim for 2–3 servings
each day, a typical serving being 1 oz (30 g)
of hard cheese, or 1 cup (200 ml) milk.

Vitamins and minerals

In pregnancy, you need to ensure a rich
supply of vitamins and minerals, since
these are important for your own health
3–4 portions of fresh fruit daily will 1–2 servings daily of iron-rich foods such
and for your developing baby. They also provide a wide range of vitamins and as eggs or dark leafy green vegetables will
support the healthy functioning of body minerals, many of which contain important help maintain healthy iron levels during
systems and contain antioxidants, which protective antioxidants. pregnancy when demands are increased.
protect the body against the effects of

15
 Asia, the Middle East, or the Caribbean
Eating plenty of fresh should take a 10 mg vitamin D
fruit and vegetables will supplement daily.
help optimize your health
during pregnancy because
Vitamin E This vitamin contains
your body will be equipped
with all the essential antioxidants and keeps skin, hair, and
vitamins and minerals. muscles healthy. Good sources of vitamin
E include nuts and seeds.

Folate and folic acid Studies have

shown that sufficient amounts of the B
vitamin folic acid, or its natural form
folate, can help reduce the risk of neural
tube defects, such as spina bifida, by
up to 50 percent. In these defects, the
embryonic neural tube fails to close
properly during the first four weeks
of pregnancy, leading to incomplete
development of the brain and spinal
cord. Folate helps the neural tube close
and pregnant women are advised to eat
a folate-rich diet. Foods high in folate
include green leafy vegetables, legumes;
and fortified cereals. It may not be
possible to get sufficient folate through
diet alone, so women are also advised
to take a folic acid supplement of 400
micrograms before conception and
during the first trimester.

Iron This is needed for hemoglobin

production in red blood cells. Sources
include meat, fish, chicken, eggs, dried
A healthy pregnancy

harmful chemicals called free radicals. Vitamin B This contributes to the apricots, spinach, and broccoli.
Good sources of the most important healthy functioning of body systems,
vitamins and minerals are given below. As and helps the body fight infection. Good Calcium This is essential for healthy
long as you eat a varied diet that includes sources include bananas, milk, whole bones and teeth. Sources include dairy
plenty of fruits and vegetables, you should grains, cheese, and cabbage. products, eggs, fortified cereals, and
be getting all you need, with a couple of leafy green vegetables.
exceptions. It can be hard to get enough Vitamin C This aids the absorption
iron in your diet to meet the demands of of iron and helps fight infection. Rich Zinc This helps maintain a healthy
pregnancy. Your iron levels will be checked sources include citrus fruits, kiwis, immune system. Sources include
during pregnancy and supplements may peppers, broccoli, and spinach. seafood and nuts.
be recommended. You’ll also need a folic
acid supplement before conceiving and Vitamin D This helps the absorption A vegetarian diet
in early pregnancy (see right). of calcium. Food sources include eggs A vegetarian diet, and vegan diets where
and dark leafy green vegetables, and it dairy products are excluded, can be safe
Vitamin A This is important for healthy is also obtained from sunlight. Women and healthy during pregnancy as long as
eyes, skin, and hair; it’s found in orange with limited exposure to sunlight, who you ensure a good balance of nutrients
fruit and vegetables, such as apricots, are housebound, predominantly covered and sufficient protein (see p.126). Babies
peppers, carrots, and tomatoes. when outdoors, or from Africa, South born to vegetarians are in a healthy

16
weight range, although vegans do need end of a baby’s growth chart, see p.284).
WHAT TO AVOID
to be vigilant about obtaining adequate There are health risks later in life linked
protein, as well as reliable sources of to a high birth weight, such as obesity,
B12 and zinc. Vegans can discuss with diabetes, and heart disease. One study
Dietary precautions
their doctors whether they'll be able to found that women who consumed a low Certain foods should be avoided or
meet their vitamin B12 needs through GI diet had infants that were a normal their intake limited since they may
diet alone. Since vitamin B12 is found size, but had less body fat than those from pose a risk to your unborn baby.
primarily in animal sources, a supplement women who consumed a high GI diet. Simple cooking and hygiene measures
may be required. Non-animal sources A low GI diet can also help control are also important to limit the risks.
of B12 may be unreliable. glucose levels in mothers with gestational
Listeria is a food-borne bacteria
diabetes (see p.473), in turn reducing
to which pregnant women are
A low GI diet complications of labor and birth
more susceptible. It is found in
Glucose, the product of carbohydrates, associated with this condition.
unpasteurized dairy products, as
serves as the primary fuel for your
well as refrigerated, ready-to-eat
growing baby. A new concept in nutrition Your calorie intake foods like meat, poultry, and seafood.
is the glycemic index (GI), which looks During pregnancy, most women need to
To avoid it, thoroughly reheat hot
at how much a food will raise the level increase their calorie intake by 100–300
dogs, lunch meats, or prepared deli
of glucose in the bloodstream. Foods calories a day for proper nutrition and
foods and avoid unpasteurized dairy
that release glucose gradually, such weight gain. Your energy needs may
products and check soft cheeses
as unrefined carbohydrates (see p.14), vary depending on your pre-pregnancy
labels to be sure they’re made with
and thus have a low GI, appear to weight and your activity levels.
pasteurized milk.
be healthier. Gaining the correct amount of
weight in pregnancy has benefits for Nearly all seafood contains at least
Benefits of a low GI diet Evidence both mother and baby. You’re more trace amounts of mercury which can
suggests that a low GI diet has health likely to return to your pre-pregnancy affect the development of the fetal
benefits for both the mother and baby. weight if you gain weight within the nervous system. Pregnant women
Maternal carbohydrate intake can affect recommended guidelines (see p.99). should avoid swordfish, shark, king
glucose levels in the bloodstream, which Gaining too much weight is linked mackerel, and tilefish. To stay within
in turn can affect the baby’s growth. with bigger babies, which carries future safe limits, eat up to 12 ounces per
Higher glucose levels, even those in the risks to the baby’s health (see above). week of lower-mercury seafood like
normal range, can make for a bigger Conversely, gaining too little weight is shrimp, salmon, pollock, catfish, and
baby—above the 90th percentile (the top also not ideal for a baby’s future health. canned light tuna

Toxoplasmosis is a parasite spread

Your pregnancy diet

YOUR BODY MASS INDEX through cat feces or undercooked
beef, pork, or lamb that can harm the
At the start of pregnancy, your considered overweight; 30–39.9 is
fetus. Avoid changing cat litter and
doctor may tell you your body mass classified as obese; and over 39 is very
practice careful hygiene in the kitchen
index, or BMI. This is an estimate of obese. If you have A BMI of below 18.5,
when preparing raw meat, being careful
your body fat based on your weight you are thought to be underweight.
not to contaminate other foods such
and height. By calculating your BMI, Being underweight in pregnancy
as lettuce or vegetables. Beef, pork,
your doctor can establish whether can make you more likely to give
and lamb all need to be well cooked.
you are a healthy weight for your birth prematurely, or have a “small-
height or whether your weight could for-dates” baby. Being overweight Salmonella bacteria are found in
cause problems during pregnancy. means that you are at a higher risk chicken and eggs. Infection with
Your BMI is calculated by multiplying of problems such as high blood salmonella can cause severe vomiting,
your weight in pounds by 703, dividing pressure, preeclampsia (see p.474), but doesn’t directly affect the baby.
the answer by your height in inches, and gestational diabetes (see p.473), Avoid any products containing raw or
then dividing the answer by your height and are more likely to have a larger undercooked eggs, and make sure all
in inches again. A BMI of 18.5–24.9 is baby. These factors increase the risk of poultry is thoroughly cooked through,
considered normal; 25–29.9 is complications at the time of delivery. since cooking kills the bacteria.

17
 Exercising safely
Staying fit in pregnancy has many benefits for you and
your baby and increases your stamina for labor and birth.
If you had an exercise program before positive outlook and feel confident
you became pregnant, you can continue about your changing body image. Exercise
with this in the first trimester as long as can also ease common pregnancy
you have the all clear from your doctor. discomforts such as nausea, leg cramps,
As your pregnancy goes on, you may swollen feet, varicose veins, constipation,
need to adapt your program. insomnia, and back pain. By keeping
If you didn’t have a regular exercise muscles strong and toned, exercise
program before, now is the ideal time makes it easier for your body to deal with
to adopt a new, healthier way of life from changes in posture during pregnancy.
which you will reap the rewards for There is also evidence that increased
years to come. If you do start exercising fitness helps shorten labor and your
now, build up gently; listen to your body postpartum recovery time and lessens
and do only what feels comfortable. your overall anxiety about the birth.
Regular gentle exercise is much better
than intense irregular bouts of exercise Food for fuel
(which aren’t advisable in pregnancy), A nutritious, balanced diet is vital in
since your body responds more postively pregnancy. If you’re exercising too, eating
to consistent, moderate exercise. well to keep energy levels balanced is
doubly important. Eat regular, nutritious
How exercise helps meals, ensuring that your calories come
Stay well hydrated by drinking plenty of In addition to increasing your energy from wholesome, fresh foods, and avoid
water before, during, and after your workout. levels, exercise helps you maintain a high-calorie sugary snacks.

DO’S AND DON’TS

A healthy pregnancy

Exercise is safe in pregnancy O Build your strength, but do this to maintain energy and avoid having
as long as you follow the simple gradually. Focus on your back, your blood sugar levels fall.
guidelines listed below. As your shoulders, chest, and lower body.
pregnancy progresses, you will O Practice Kegel exercises (see p.69) daily Don’t:
probably need to adapt and moderate to maintain the pelvic floor tone. O Exercise in a hot or humid
your exercise program. O Breathe properly while exercising, environment.
especially when lifting weights. O Do jerky or bouncy moves or twist
Do: O Protect your back when getting up or rotate your abdomen.
O Warm up and cool down properly. from a lying position: roll onto your O Lift weights that are too heavy.
O Drink enough water before, during, left side and sit up using your legs. O Do sports where you risk falling, such
and after exercising. O Avoid exercises that feel awkward as skiing or horseback riding.
O Wear comfortable clothes that don’t or uncomfortable. O Overstretch: the pregnancy hormone
restrict your rib cage. O Focus on posture and alignment. relaxin can make you feel more
O Exercise regularly and consistently. O Stop immediately and seek advice if supple than you are.
O Adjust your expectations; you feel severe localized pain, vaginal O Exercise to exhaustion. If you’re tired,
pregnancy is not a time to go for bleeding, or general unwellness. decrease the intensity or duration. Get
personal bests. O Eat frequent small meals and snacks an hour’s rest for each hour of exercise.

18
Sex and relationships
You may find that you and your partner need to adapt to the
emotional and physical changes that accompany pregnancy.

In a low-risk pregnancy, sex is perfectly

WHAT TO DO
safe, although your levels of desire may
fluctuate throughout pregnancy. Most
women report that their interest in sex
An intimate
is the same or slightly reduced in the pregnancy
first trimester. In the second trimester, During pregnancy, fatigue, feelings
it varies from woman to woman, and in of insecurity about your new shape,
the third trimester libido often falls. and concerns about the safety of
sex can all take their toll on your
Sex during pregnancy relationship. Allowing yourself time
During the first trimester, the hormonal to adjust and keeping the channels
changes that cause nausea, vomiting, of communication open will help
and fatigue can naturally result in a you and your partner enjoy this
reduced interest in sex. However, other new stage in your relationship.
pregnancy changes may increase your Spending time touching and caressing can
desire, such as an increased blood flow, help you and your partner maintain feelings O Talk to each other about your

which produces swelling in the clitoris of closeness and intimacy. feelings and be aware that, for both of
and labia and extra vaginal secretions. you, levels of interest may fluctuate.
In the second trimester especially, When to seek advice O
If your belly makes some positions
vaginal lubrication and intensity of Some women experience vaginal uncomfortable, experiment with
orgasm can increase, which may be bleeding after sex in pregnancy. This is alternative ones that accommodate
accompanied by gentle contractions; most likely to be harmless and is often your size, such as side-by-side, rear
these are normal and are nothing to caused by the increased blood flow to entry, or woman-on-top positions.
worry about. Many women find that the cervix in pregnancy, which can cause
their libido falls toward the end of it to bleed on contact with your partner’s O
Enjoy other ways to maintain

Sex and relationships

pregnancy since a bigger belly makes penis. If this is the cause, the bleeding intimacy besides intercourse, such
sex more awkward and uncomfortable, should resolve after the birth. However, as touching and massage.
and they may also feel increasingly since there are other possible causes,
anxious about the birth. report any bleeding to your doctor.
In addition to the size of your belly previous premature labor or risk factors
How your partner feels As with causing discomfort during sex, some for premature labor, such as a weak
women, men display a range of feelings women experience pain during sex cervix, or if you have placenta previa
toward sex in pregnancy. While some toward the end of pregnancy as the (see p.473), or leakage of amniotic fluid,
may find their partner’s new, fuller baby moves farther into the pelvis; or which can mean your water has broken.
shape particularly sensuous, others may they may find that the contractions If you have any concerns, don’t be
feel apprehensive about sex, fearing that can accompany orgasm become afraid to ask your doctor for advice.
that they may harm the baby. Some increasingly uncomfortable. These Being able to enjoy sex in pregnancy
men may feel a combination of these symptoms are unlikely to be a cause will help you and your partner feel
emotions. Unless there are concerns for concern, but it’s worth mentioning close during this time of transition.
about your pregnancy (see right), it’s them to your doctor for reassurance. Indeed, psychologists have found that
generally thought that sex won’t cause There are some circumstances in late couples who enjoy sex in pregnancy
harm, since your baby is well protected pregnancy when intercourse may not be are more tender toward each other and
by the amniotic fluid and your uterus. safe. This can be the case if you’ve had a communicate better after the birth.

19
 Illnesses and medication
Knowing how to manage illness and what medications are safe
to take is important to protect your own and your baby’s health.
Whether you have a preexisting born to diabetic women also have a p.474) and premature labor (see p.431),
medical condition, or acquire an illness greater risk of other problems, such as you may be advised to have an induction
or infection during pregnancy, always having a large birth weight, respiratory of labor a week or so before your due
consult your doctor before taking problems at birth, jaundice, and low date (see p.432).
medication or before stopping any blood sugar at birth. Once in labor, your blood sugar levels
prescribed medication. As soon as you’re pregnant, you will be closely monitored, and you will
should be referred to an obstetrician probably be given an insulin IV. After
Preexisting conditions who specializes in pregnancy and the birth, your baby’s blood sugar levels
If you have a condition such as high diabetes where you’ll receive extra care. will be closely monitored too for around
blood pressure or diabetes prior to You will have more frequent prenatal 24 hours. If you’re planning to breast-
pregnancy, your pregnancy will be visits, additional scans, and extra blood feed, which is recommended, your
classified as high risk and you’ll need to tests to monitor your blood sugars. You insulin dose may need to be changed
be monitored carefully. If you become may need diabetes medication and/or after the birth.
pregnant while taking medication insulin injections each day; the dose
for a condition, don’t stop taking the usually changes throughout pregnancy Epilepsy If you have epilepsy, it’s very
medication, but consult your doctor and needs to be monitored. The better important to discuss pregnancy with
as soon as possible. You may find that your blood sugar control, the less likely your doctor before you become pregnant,
your existing medication is safe, or you you or your baby is to experience since certain drugs carry a small risk of
may need to change to another type problems during pregnancy. causing harm to the developing baby.
of medication. The most important Since diabetic women have an Nonetheless, it’s also important that
thing is to control your condition during increased risk of late pregnancy your epilepsy is controlled, so your
pregnancy to minimize the risks to you problems such as preeclampsia (see doctor will try to ensure that you’re on
and your baby, which will usually mean
continuing with medication.
A healthy pregnancy

Diabetes If you have diabetes and

are planning to conceive, you need
to get advice on how to manage your
condition. Meet with your doctor while
you're thinking about conceiving to
discuss the best way to control your
blood sugar levels and talk about how
diabetes will be managed in pregnancy.
Women with diabetes are advised
to take a prenatal vitamin with folic
acid before trying to conceive and for
the first three months of pregnancy.
Diabetic women who are overweight
may be advised to lose weight before
getting pregnant, and they’ll likely be
told to monitor their blood sugar more Diabetes is controlled with daily insulin injections in pregnancy. As the skin on your abdomen
frequently and take their medications becomes taut, you may find it easier to inject into the fatty tissue of the thigh (left). Continuing
on time during their pregnancy. Babies with asthma medication is important to keep symptoms under control in pregnancy (right).

20
the lowest possible dose of medication
COMMON WORRIES
before you get pregnant. When you are
pregnant, the anomaly scan at around I’m asthmatic. Can I use my inhalers efficacy of homeopathy and the scientific
20 weeks (see p.214) will check for during pregnancy? opinion is that there is insufficient
problems such as cleft palate, which It’s essential that you keep asthma evidence to show that homeopathy
are slightly more common with certain under control in pregnancy, which has any effect beyond that of a placebo.
medications. If your condition worsens means continuing to use your inhalers, But talk to your doctor before using
in pregnancy, contact your doctor. since the risks from uncontrolled asthma any homeopathic products or remedies
are greater than any risk from taking during pregnancy, since homeopathy
Systemic lupus erythematosus asthma medication. If asthma is is an area of complementary and
This is an autoimmune disorder that uncontrolled, it can mean that not alternative medicine that's associated
can affect many parts of the body, enough oxygen gets to the baby, leading with much debate and scientific
including the kidneys, joints, skin, to a low birth weight or other problems. controversy. If your doctor gives you
nervous system, heart, and lungs. One of the best ways to control asthma, the okay, a certified homeopath may
The condition is more common in in addition to taking medication, is to be able to provide treatment.
women, and particularly in those of avoid asthma triggers such as pet fur
childbearing age. Some women find and dust mites. Use air filters, vacuum What’s the verdict on taking herbal
that the symptoms for this condition often, and damp dust, and use duvet, remedies and teas during pregnancy?
ease during pregnancy, however for mattress, and pillow protectors. The US Food and Drug Administration
some they can worsen. It’s important to Sometimes, pregnancy reduces the does not regulate herbs and other
control the condition during pregnancy severity of asthma, but if you feel dietary supplements, and there's
since it can affect the developing baby, wheezier than usual, talk to your doctor not much research about the health
with an increased risk of miscarriage, about reviewing your medication. effects of many herbs on pregnant
poor growth, premature labor, and women, so it's best to avoid them while
stillbirth. Most medications for lupus Homeopathy seems to be a popular you're pregnant, including herbal teas.
are safe to use during pregnancy, but form of therapy. How effective is it Decaffeinated black teas are your best
some aren’t, so you need to check with and is it safe? bet, but if you want a fruit or ginger tea,
your doctor about whether you need to Homeopathy works on the principle read the ingredient label on the package
change your current medication. From of treating like with like to stimulate carefully to be sure that no herbs are
around 32 weeks, your baby will be the body’s natural healing mechanisms. present. If you want to use an herbal
closely monitored and his growth and There has been debate about the remedy, talk to your doctor first.

Illnesses and medication

well-being will be checked. If there are
concerns about you or your baby, labor
may be induced early, or you may have Your doctor may also recommend function will be monitored to check
a planned cesarean. additional scans to check that your that your medication doesn’t need
baby is growing well. to change.
High blood pressure If you have
high blood pressure that requires Thyroid problems If you have an Bowel disease Women with
medication, check with your doctor underactive thyroid gland for which inflammatory bowel conditions, such
that the medication you are on is safe you are taking thyroxine, you’ll need as ulcerative colitis or Crohn’s disease,
to use during pregnancy. It’s important to have a blood test to ensure that your usually find that their condition
to continue your medication so that thyroid is functioning well and that improves during pregnancy, although
your blood pressure is controlled, you’re taking the correct dose, since you may relapse after the baby is
because high blood pressure can be sometimes the thyroxine requirement born. Although it’s unusual for bowel
dangerous both for you and your baby. increases in pregnancy. It’s important conditions to cause major problems
Your doctor will frequently check your that you are not lacking in thyroxine, during pregnancy, it is important to
blood pressure, and will test your urine because this may affect the baby. If check that you are not anemic, which
to check for the presence of protein, you are being treated for an overactive can be a side effect of some bowel
because high blood pressure and protein thyroid gland, check with your doctor conditions, and your doctor may
in the urine are symptoms of the that you’re taking a thyroid medication recommend extra scans to check
condition preeclampsia (see p.474). that is safe in pregnancy. Your thyroid that the baby is growing well.

21
 Infections during pregnancy can include dehydration and
WHAT TO DO
When you’re pregnant, your immune pneumonia, and complications are
system is slightly suppressed. This is more common in pregnant women.
Exposure to necessary to stop you from rejecting The US Centers for Disease Control
chickenpox or rubella the baby, who is genetically half the and Prevention recommend that
Chickenpox in pregnancy can cause father’s! This means that you may be all pregnant women should get flu
problems for the baby and can be slightly more susceptible to common vaccinations. However, the CDC says
severe in a pregnant woman, possibly problems such as colds, coughs, a sore they should not get the nasal-spray
leading to pneumonia. If you contract throat, or food poisoning, and that the flu vaccine, which is not approved
rubella for the first time in early illness may last longer. for pregnant women.
pregnancy, it can cause miscarriage
or severe problems in the fetus. Colds and coughs Most women get a Food poisoning and stomach upsets
cough or cold at some stage during their A severe episode of food poisoning can
If you encounter chickenpox, contact pregnancy. However, you should avoid cause problems for you and your baby
your doctor who can check your taking cold medications since these can and could trigger an early miscarriage,
immunity. If you aren’t immune, your contain ingredients that are not safe in so it’s vital to practice good kitchen
doctor may advise an injection to pregnancy, especially during the first hygiene (see p.17). If you do develop
protect you from severe chickenpox. three months (see opposite). Steam food poisoning or a stomach upset, try
Your rubella status is checked at the inhalations can ease congestion and to drink plenty of fluids, and if it continues
start of pregnancy. If you aren’t immune, hot honey drinks help to soothe a sore for more than 24 hours, see your doctor
you can be vaccinated after the birth. throat. Saline nasal sprays can also help (see also Gastroenteritis, p.468)
Meanwhile you need to be extra careful. relieve congestion.
Yeast If you have an abnormal
If you develop chickenpox or suspect Flu If you get the flu during pregnancy, discharge, talk to your doctor since this
rubella because of a rash, contact your call your doctor to get advice or make may be yeast (candidiasis), which is
doctor immediately, but don’t go to the an appointment. Drink plenty of liquids common in pregnancy. A swab may be
doctor's office, where you may spread and get plenty of rest. Don't take any taken to confirm the diagnosis, and an
the infection to other pregnant women. flu or cold medications without talking appropriate local antifungal treatment
to your doctor first. Flu complications prescribed (see opposite). Eating natural
yogurt may help restore the bacterial
balance in your vagina. Wearing cotton
underwear and avoiding tight clothing
is also recommended.
A healthy pregnancy

If you’re laid low with an illness Urinary infections Many pregnant

during pregnancy, take time to rest women get urinary infections because
and recuperate since pregnancy can the hormone progesterone relaxes all
exacerbate everyday symptoms.
of the smooth muscle, allowing the
bacteria that normally live in your
vagina to travel up the urethra (the tube
that leads to the bladder) where they
may cause an infection. The symptoms
of an urinary infection may be slightly
different in pregnancy. You may have
the classic symptoms of burning when
urinating and frequent passing of urine,
or you may have different symptoms
such as back pain, lower abdominal
pain, nausea, or vomiting. These are
usually easily treated with antibiotics,
most of which are safe in pregnancy.

22
WHAT’S SAFE AND WHAT’S NOT

Taking medications during pregnancy

During the first three months of antiemetic medication that is safe to Analgesics The general advice is to
pregnancy, it's best to avoid all over- use during pregnancy. avoid all analgesics during pregnancy,
the-counter medications. Once you especially during the first trimester.
are past the first trimester, some Antifungal remedies You should avoid Before using pain medication for a
other medications are considered over-the-counter antifungal remedies, common problem, such as a headache
safe, but always consult your doctor including oral and local remedies, for or backache, first try natural remedies;
if you are in any doubt. The following treating yeast. Consult your doctor, massage or a warm bath are often
provides guidance on medications who can recommend an antifungal effective in relieving aches and pains.
used for treating common pregnancy medication that is appropriate for use If these aren’t sufficient, call your
complaints and minor illnesses. in pregnancy. doctor for advice. Aspirin and anti-
inflammatories such as ibuprofen
Antacids Heartburn and indigestion Cold remedies Remedies for should be avoided throughout
are common problems in pregnancy, coughs and colds often contain pregnancy. The pain medicine codeine
particularly during the third trimester a range of ingredients, such as can sometimes be used for a short
when the increased size of the baby caffeine, antihistamines, and other period to treat specific pain, but
puts pressure on your stomach. decongestants, many of which aren’t should only be taken on the advice
Some antacids are safe to use during safe in pregnancy. Ideally, avoid all of a doctor.
pregnancy, although you should avoid cold remedies and instead have
sodium bicarbonate because it may steam inhalations and hot caffeine- Rehydration solutions If you have
increase fluid retention. Consult your free drinks. If you need relief, talk a stomach upset resulting in a severe
doctor or pharmacist about which to your doctor before using any over- bout of diarrhea that lasts for an
ones are recommended. the-counter treatments. extended period, your doctor may
recommend a rehydration solution
Antibiotics Many antibiotics used to Diuretics It’s normal to experience that is safe to use in pregnancy.
treat infection are safe for use during some swelling in the hands and feet
pregnancy. This includes antibiotics during pregnancy, and you shouldn’t Steroids If you have eczema, or
containing penicillin, although there attempt to deal with this by taking find that this condition develops

Illnesses and medication

are safe alternatives if you’re allergic diuretics, including herbal diuretics. or worsens during pregnancy, talk
to penicillin. The following antibiotics If you have sudden swelling in the to your doctor about appropriate
should be avoided during pregnancy: face, hands, or feet, you should consult medications. Corticosteroids, which
O
Streptomycin. This can damage the your doctor immediately because are used to treat eczema, aren't
ears of the fetus as it develops and this can be a sign of preeclampsia associated with birth defects,
may result in hearing loss in the baby. (see p.474) but they are known to cross the
O
Sulphonamides. These can cause placenta, so both topical and oral
jaundice in the newborn baby. Laxatives The first step in dealing corticosteroids aren't recommended
O
Tetracyclines. These drugs shouldn’t with constipation is to take dietary during pregnancy.
be taken because they can affect the measures by increasing your intake Steroid inhalers used to treat
development of the baby’s bone and of fiber and drinking plenty of fluids. If asthma are safe in pregnancy, and
teeth and can cause discoloration in this isn’t enough to ease constipation, it’s important to control your asthma
the teeth. then some over-the-counter laxatives while your’re pregnant.
may be safe to take during pregnancy, Oral steroids may also be prescribed
Antiemetics If you have severe including laxatives that contain bulking for certain other conditions, and these
nausea and vomiting and natural agents. Those containing castor oil may be safe to continue with under
remedies such as gingersnaps or may cause uterine contractions. the guidance of your doctor. Anabolic
ginger tea don’t relieve the problem, Check with your doctor before taking steroids should not be taken during
your doctor may recommend an any laxatives. pregnancy.

23
 Lifestyle hazards
Pregnancy can be beset with anxiety about potential hazards.
Being aware of exactly what to avoid will help to allay fears.
Whether you’re pregnant or are planning
to conceive, now is the time to do a safety
check on your social habits and home
and work environment. Anything that
could affect your well-being could affect
your baby too, especially in the first
trimester. However, don’t become overly
anxious. Instead, arm yourself with the
facts so that you can avoid hazards, but
also relax and enjoy your pregnancy.

Your social habits

The decision to have a baby may inspire
you to review your social habits and, if
necessary, make changes.
Wearing rubber gloves when using household cleaning products will reduce your exposure to
Alcohol consumption You should chemicals (left). Opt for “greener” paints and keep rooms ventilated while decorating (right).
stop drinking alcohol while trying to
get pregnant and once you're pregnant with the supply of oxygen to the baby, clear, but smoking the drug involves
according to the US Surgeon General. which can lead to a low birthweight the same risks as tobacco smoking.
There is no known safe consumption and increases the risk of stillbirth or the
level for pregnant women, so abstaining death of a baby in the first month of life. Hazards at home
from drinking is the safest option. What Many of us use chemicals daily in and
isn’t in doubt is the damage caused to Recreational drug use In addition to around the home. In addition to personal
the fetus by excessive alcohol intake. damaging your own health, recreational products, such as bath oils, deodorants,
A healthy pregnancy

Continuous heavy drinking in pregnancy drugs are not advised in pregnancy since and hairsprays, we also keep dozens
can lead to a condition known as fetal some pose dangers for the fetus and of other substances around the home,
alcohol syndrome. The effects of this others carry a range of possible hazards. including cleaning fluids, detergents,
include retarded growth, facial and joint Heroin and cocaine are damaging both bleach, and air fresheners.
abnormalities, and heart problems. to a pregnant woman and her unborn When products are used in accordance
If you drank in the weeks before you baby. These drugs stunt fetal growth, with the manufacturers’ instructions,
knew you were pregnant, try not to worry, affect the placenta, and can cause there is little chance of them causing
but stop now. Many women also decide miscarriage or premature birth, as well as harm in pregnancy. However, minute
to give up alcohol while they’re trying health problems in the newborn. Babies traces of chemicals can enter the
to conceive to optimize fertility. born to women who use heroin often bloodstream, either through the skin
show drug withdrawal symptoms. A or by inhalation, and cross the placenta.
Smoking Ideally, you should stop report on ecstasy linked the use of this in While there is no hard evidence to show
smoking before you get pregnant. If pregnancy to a rise in birth defects, such that this has an ill effect, it makes sense
you’re still smoking once you conceive, as limb abnormalities. The specific effects to minimize the chances of chemicals
try to stop right away. If your partner or on the fetus of amphetamines and LSD from reaching a developing baby.
friends smoke, ask them not to smoke are unclear, but it’s safest to avoid them. When using products, wear rubber
in your home or anywhere near you. The direct effects on the fetus of the gloves to prevent skin contact and
Inhaled cigarette smoke interferes active chemicals in marijuana are not ventilate rooms. To avoid inhaling mists

24
or vapors, choose nonaerosol products. In pregnancy, being aware of your rights
COMMON WORRIES
Also, choose products recommended for can help protect you and your baby.
their low environmental impact, which In recent decades, women worried Is it safe to use a cell phone during
contain fewer chemicals. Where possible, about whether working at a computer pregnancy? I’ve read that phones
use natural alternatives to chemicals. screen put their babies at risk. It’s emit radiation.
now clear that using a VDT (as well as The radiation emitted by cell phones
Painting and decorating It’s important photocopiers and printers) is safe. Some is “non-ionizing.” This is not the same
to stay safe while doing home projects. environments do pose possible dangers. as the radiation received from X-rays,
Don’t climb up ladders or stand on If you work in a health-care setting with which can be harmful in large doses.
tables to reach high places since your ionizing radiation or cancer-treatment There is no evidence to show that
belly alters your center of balance. Also drugs, inform your department that using a cell phone is a health risk
avoid skin contact or inhalation if you you’re pregnant, so that if necessary, to either you or your baby.
use oil-based paints; spray paints; paint you’re given alternative duties.
strippers; floor varnishes; and sealant Women employed in places such I go swimming twice a week and
adhesives. Make sure rooms are well as hairdressers, manicure salons, labs, love the feeling of having the weight
ventilated while decorating, and, ideally, and craft workshops may be exposed to taken off my belly! But is the chlorine
get someone else to do the decorating. toxic chemicals. Working around some in the pool bad for my baby?
dry cleaning solvents has been linked In the past there has been some
Pets and infections Certain infections to miscarriage. It’s up to employers to debate about whether it’s safe to swim
that could harm the fetus can be picked ensure protection from hazards. If you’re in chlorinated pools during pregnancy.
up from pets. The parasitic infection unhappy about conditions, talk to your However, now most experts believe
toxoplasmosis is spread through contact boss or HR manager. that swimming in chlorinated water
with cat feces. It may produce flulike Standing on your feet all day and does not pose any health risks for
symptoms, or no symptoms at all, and physical work that involves heavy lifting pregnant women and their developing
many unknowingly acquire immunity can be exhausting in pregnancy. If your babies. You may find that the smell
through previous exposure. However, work involves either of these, ask if it’s of chlorine might add to your nausea
although it rarely happens, contracting possible to switch to less tiring tasks. if you are suffering from morning
toxoplasmosis for the first time in sickness, although this is less of a
pregnancy can cause serious problems, problem in an outdoor pool. Try not to
such as miscarriage or birth defects. Other swallow the water, and shower when
pets, such as dogs, caged birds, and turtles you come out of the pool. Swimming
can carry salmonella bacteria. Salmonella has great benefits during pregnancy. It
infection doesn’t directly harm the baby, has a low risk of injury while providing
but can make a pregnant woman ill. a good cardiovascular workout and
Being scrupulous about hygiene helps improving muscle tone, so don’t be

Lifestyle hazards
you avoid such infections. Wear rubber put off by unnecessary worries.
gloves when handling a cat litter box,
cleaning cages where animals are kept, Is it OK to use nicotine patches
or disposing of dog feces, then wash your or gum while I’m pregnant?
hands (and the gloves) afterward. Wear Nicotine is known to decrease the
gloves also for digging or weeding in case blood supply to the fetus. This could
animals have defecated in the garden. affect the baby’s growth, especially
Or get someone else to do these tasks. in early pregnancy. Although tobacco
Toxoplasmosis and salmonella can also substitutes such as patches, gum,
be contracted from eating undercooked and lozenges deliver less nicotine to
or raw meat or eggs, so be careful with your body than smoking, you should
kitchen hygiene and cooking (see p.17). never use them without a doctor’s
advice. Ask your doctor for information
Workplace hazards If your job involves handling chemicals, on safer ways to beat cigarette and
It’s the legal responsibility of your ensure that a risk assessment is done and nicotine cravings.
employer to provide a safe environment. that you are able to avoid harmful substances.

25
 Skin, hair, and teeth
In addition to affecting what happens to you internally, hormonal
changes in pregnancy can also affect your external appearance.
Many women look and feel better Many creams, lotions, and oils have photosensitizing skin-care products
than ever during pregnany, while those been marketed for the prevention or may reduce chloasma. A recent study
less fortunate report that there is a treatment of stretch marks but none found that using a highly protective
downturn in their appearance. However has been proven to work. Studies have sunscreen (SPF 50 and UVA-PF 28)
pregnancy affects you, the changes will shown that some creams containing prevented most pregnant women
be temporary and you’ll be back to your ingredients such as vitamin E, elastin, from developing chloasma.
normal self soon after the birth. collagen-elastin hydrolysates, and
menthol can reduce the development Hair and nails
Skin of stretch marks; but other trials have Hair stays longer in the growth phase
You may find that your skin looks better shown that creams containing vitamin during pregnancy, meaning that your
in pregnancy due to hormonal changes, E had no effect. If you want to use a scalp hair is likely to grow and thicken.
mild fluid retention, and increased blood commercially recommended cream, Not so welcome is the fact that facial
flow. These can all result in smoother lotion, or oil, they are safe to use and and body hair may also increase. After
skin and are responsible for the famous may help prevent stretch marks, but the birth, many women find that they
“pregnancy glow." On the other hand, unfortunately there is no guarantee. suddenly lose a lot of hair as the growth
you may find that your skin gets drier phase stops. You should find that your
and more pimply and you may need to Chloasma This describes the increased hair is back to normal within six months.
take extra care of it during pregnancy. pigmentation of the cheeks, nose, and Fingernails may also change, often
Skin also tends to darken during chin that affects around 50–70 percent becoming stronger, although some find
pregnancy, although the cause for this of pregnant women. Using a protective that they become softer and brittle.
is unknown. One possible explanation sunscreen and avoiding the use of any Nails may develop white spots or
is the increased levels of estrogen and
melanocyte-stimulating hormone,
which stimulate skin pigmentation.
A healthy pregnancy

Stretch marks (striae gravidarum)

Many women develop stretch marks
during pregnancy, which can occur
on bellies, breasts, hips, or legs. These
initially appear as pink or purple lines
and may be quite itchy. After pregnancy
they fade into pale wrinkles. Nobody
knows for sure why these occur, but
they probably result from a combination
of pregnancy hormones and your skin
stretching. You’re more likely to get
stretch marks if you’re very young, if
you gain a lot of weight in pregnancy,
or if you have a very big baby. There is
less agreement about the role of other
factors such as a family history, being Applying moisturizing creams to relieve dry, itchy skin, or ones recommended to reduce
very overweight before pregnancy or stretch marks, is safe during pregnancy (left). Taking good care of your teeth and gums is
belonging to a particular ethnic group. important during pregnancy, when you’re more susceptible to dental problems (right).

26
 COMMON WORRIES WHAT’S SAFE AND WHAT’S NOT

I am 18 weeks’ pregnant and due to Another similar medication, isotretinoin,

go on a beach vacation. My facial and which is taken orally, may increase the
Beauty treatments
body hair has grown and become very risk of birth defects and is therefore and cosmetics
unsightly. How can I safely remove it? contraindicated in pregnancy. The following advises which products
You can safely tweeze, wax, and shave and treatments are safe in pregnancy.
new stray hair. Skin bleaching and hair I’m in the first trimester and will be
removal creams are probably safe during going to my sister’s wedding. Can Hair and nail products Shampoos,
pregnancy, but there has been insufficient I have highlights put in my hair? conditioners, manicures, and pedicures
research to clear them since they can be Although the research into the safety of are safe. Minute amounts of hair dye
absorbed through the skin and their effects hair dyes if used in the first trimester may may be absorbed through the skin, but
on the baby are unknown. Permanent seem conflicting, the amount of chemicals there’s no evidence that this affects the
hair-removal techniques, such as laser used is small and it’s unlikely that hair baby. Chemical hair straighteners and
and electrolysis, are thought to be safe in dyes cause harm. Also, if your hairdresser curlers are also thought to be safe.
pregnancy. Both techniques penetrate the uses foil, the dye is kept off your skin. Piercing Facial piercing or piercing the
skin no deeper than a few millimeters. belly button, nipples, or genitalia isn’t
Consult your doctor to see if this is okay. I’ve heard that nail polish needs to advised since you’re at a higher risk of
be removed if you have a cesarean. infection. If you have a navel piercing
I’ve been using topical cream to treat Why is this? already, you can change a metallic ring
acne and I’ve just found out that I’m Previously, women were encouraged for a flexible plastic retainer made from
pregnant. Will it harm my baby? to remove nail polish before surgery. PTFE (polytetrafluoroethylene). Nipple
Tretinoin belongs to a group of medications One of the reasons was that the “pulse rings can affect breast-feeding, so
called retinoids that contain vitamin A oximeter,” a device attached to your finger remove a ring before birth so the skin
and may be associated with birth defects. to measure the oxygen in your blood can heal. Vaginal or vulval piercings are
Studies have looked at the effects of this during surgery, may give lower readings best removed to avoid damage at birth.
cream in pregnancy and have found that if placed over nail polish. However the
babies whose mothers used it, even in device works as intended with nail polish Tanning Tanning beds aren’t advised
the first trimester, had no increase in birth or long nails if it’s mounted sideways on because of harmful UV rays. Tanning
defects. However doctors recommend a finger. Therefore there’s no need to beds can cause your body to overheat,
avoiding tretinoin cream in pregnancy. remove your polish. which can harm your baby, and UV rays
may break down folic acid. Tanning
lotions are safe.
transverse grooves, but these are rarely teeth during pregnancy and visit your

Skin, hair, and teeth

Body wraps/ Hot tubs These raise
anything to worry about and don’t dentist and dental hygienist regularly. body temperature, which is unsafe
mean that you’re lacking in vitamins. To keep your mouth healthy during for you and your baby. Heat exposure
pregnancy, brush twice a day with from a hot tub in the first three
Teeth fluoride toothpaste and floss every day. months can increase the risk of a
Pregnant women are more prone to Routine dental treatment and some baby developing spina bifida.
tooth decay (dental caries), bleeding local anesthetics are safe in pregnancy,
gums, and chronic gum infection although it's better to postpone elective Facials The cosmetics used for
(periodontal disease). Poor dental health dental treatments until after pregnancy facials are thought to be safe.
not only affects you, but can also have or take care of them before pregnancy. Botox The Food and Drug Administration
an impact on your baby. Studies have Many women worry about having their recommends that women who are
linked infection of the gums in pregnant teeth x-rayed in pregnancy. The pregnant or breast-feeding should
women to premature birth, and if a radiation exposure from dental X-rays not use Botox. Although it's used for
woman has ongoing tooth decay after is minimal and the risk to your baby cosmetic reasons, it is a drug and should
the birth, her baby may acquire bacteria probably negligible. However,dentists be considered as such. Doctors also
directly from her saliva, leading to tooth will take every precaution to minimize advise avoiding Botox during pregnancy.
decay in the child later on. It’s therefore your radiation exposure, covering you
important that you take care of your with a leaded apron before the X-rays.

27
 Traveling in pregnancy
Your growing belly shouldn't put a stop to travel plans. Just a bit
of extra planning is required to help your vacation run smoothly.
Provided your pregnancy is normal, Making plans
CHECKLIST
going to faraway places is perfectly A little extra planning is the key to
possible. However, discomforts such successful travel in pregnancy. However
Trimester-by- as extreme heat, high altitude, and tempting brochures look, think carefully
trimester travel guide makeshift accommodations may be before you book. How will you get there
Think about the implications of less tolerable, and in some cases may and how long will it take? Pregnancy
traveling at different times in your compromise the safety of your baby. adds to the stress of a long-haul trip.
pregnancy when planning a trip. If you want to fly, check with the airline
The best time to travel about its policy. Some require a current
1st trimester (weeks 1–12) In the first trimester, you may find that letter from your doctor confirming your
O Period of highest risk for miscarriage morning sickness and fatigue lessen due date and your fitness to fly after
and development problems in the your enthusiasm for travel. Most women 36 weeks. This is largely because of the
baby. Be extra careful to avoid feel at their best in the second trimester possibility of going into labor mid-flight.
extremes of temperature and overly and this is also seen as the safest time
vigorous activities. to travel since your risk of miscarriage Taking precautions Unless you
O Motion sickness could make is low, energy levels are increased, and have no choice, avoid visiting countries
morning sickness worse. your due date is still some way off. After where disease is a high risk factor. Many
O Flying is allowed, provided you have 28 weeks, the size of your belly, fatigue, doctors agree that protective drugs, such
no pregnancy complications. and the looming birth date are likely to as certain vaccines and antimalarial
O Insurance is unlikely to be a make home seem the best place to be. pills, are not advisable in pregnancy
problem.

2nd trimester (weeks 13–25) ADVANCE PLANNING

O You are likely to be feeling your
best, and the chances of miscarriage You’ve found your passport
or fetal development problems are and put the tickets in your bag.
A healthy pregnancy

greatly reduced. However, when you’re pregnant

O Flying is allowed, but check to see
you may also need to take the
whether you need to carry a doctor’s following items:
O A note from your doctor stating
letter stating your due date.
O Check with individual travel your due date and giving you the
insurance companies to see if you all-clear to travel (helpful if you’re
can get coverage—policies vary. over 28 weeks).
O Any special medical records
3rd trimester (weeks 26–40) regarding your pregnancy or
O Your belly is huge and travel may general health.
be very uncomfortable now. O A list of numbers for health-
O Some airlines may not allow you care facilities at your destination.
to fly after 36 weeks without a letter O Remedies for heartburn or
from your doctor written within 72 other minor pregnancy problems,
hours of your flight that includes such as hemorrhoids. You may
your due date and confirms your not be able to buy your usual The best time to travel is often during the
fitness to fly. products abroad. second trimester when nausea has abated
and your belly size is not yet uncomfortable.

28
or when trying to conceive. Check the
COMMON WORRIES
internet for information about an area’s
health hazards and local hospitals. If I am five months pregnant and about to
you have a condition such as diabetes go on a beach vacation. I know that too
that could cause complications, make much sunbathing causes skin damage,
sure you can get treatment while away. but can hot sun also harm my baby?
Before you leave, try to get travel Experts are investigating a link between
insurance. Some companies consider prolonged exposure to the sun and
pregnancy a preexisting condition and damage to the fetus. There is a possibility
won't provide coverage for your trip. that ultraviolet rays could cause a
deficiency of folic acid—a vitamin that
Avoiding bugs helps prevent defects in the baby’s
Pregnancy reduces the efficiency of your nervous system leading to spina bifida.
immune system, increasing your risk Nothing is yet proven, but it’s not worth
of an infection. When you’re traveling, taking the risk. Enjoy the sun in moderation
“stomach bugs” caused by contaminated but don’t bake yourself or use tanning
food and water are more likely to strike. beds before you go on vacation.
If you’re unsure about local tap water,
buy bottled water (make sure the seal I’m worried about flying, because
is unbroken) and use it when brushing someone told me there is a high risk The position of your seatbelt may need
your teeth as well as for drinking. Avoid of DVT in pregnancy. Is this true? adjusting to accommodate your belly.
drinks with ice and don’t eat salads or Deep vein thrombosis (DVT), the formation
fruit you can’t peel since they may have of a blood clot in a vein (often in a leg), Are car seatbelts and airbags safe
been washed in contaminated water. is sometimes caused by long periods of to use in pregnancy?
A less obvious danger is fruit such as immobility, such as sitting on a plane In the event of an accident, these appliances
melon, which may have been injected (see p.186). Although the risk factor may are far more likely to prevent injury than
with water to increase its weight. be slightly increased in pregnant women, cause it—never travel without fastening
Avoid outdoor stalls or cafés where because their blood tends to clot more your seatbelt. For comfort, position the
food might have been prepared hours in easily, the chance of your developing DVT straps above and below your belly rather
advance. Try to find restaurants where is still very low. To minimize the risk even than across it. Being hit by an inflated
food is freshly cooked and standards further, you could purchase some special airbag will not hurt you or the baby, but
seem high. Be scrupulous about hygiene, support socks, which are designed to to lessen the impact you should position

Traveling in pregnancy
and carry moist wipes in case hand- improve blood flow in the legs. your seat as far back as possible.
washing facilities are inadequate.

On the trip Vacation activities affect fetal development. You might also
Sitting in a cramped seat for hours can There are some activities to forego become dehydrated, which later on can
cause your ankles and feet to swell. If in pregnancy, such as water skiing or increase the risk of premature labor.
you’re traveling by car, stop every hour horse riding, where a fall could harm Be cautious also about less energetic
to stretch your legs, have a snack, or your baby. Scuba diving is particularly activities. Hot tubs and saunas are best
find a bathroom. On a train or airplane, dangerous because of the risk of air avoided since the heat could make you
keep your circulation moving with bubbles forming in the bloodstream. feel faint and may be harmful to your
foot and ankle exercises, and get up If you have children, ignore pleas to baby. An aromatherapy massage sounds
regularly to walk down the aisle when join them on amusement park rides. like a treat, but some oils may be toxic to
it's safe to do so. Stay hydrated by If you’re used to exercising, there the baby, especially in the early months.
drinking lots of water or juice, even is no reason not to go swimming or If you want pampering, look for spas
if you do need to empty your bladder walking, just don’t overdo it—hiking with treatments for pregnant moms.
frequently. A few comforts, such as a up hills under a blazing sun could In pregnancy, your skin becomes
cushion to tuck behind your back or a send your temperature soaring, which more sensitive to the sun, so whatever
cooling water spritzer, can make a trip is a bad thing in pregnancy. In the first you’re doing be careful to protect against
more bearable. trimester especially, extreme heat can overexposure to the sun.

29
The 40 weeks, or 280 days, of pregnancy are a time
of constant change as your body continually adapts
to accommodate the new life growing inside you. This
extensive chapter guides you through the physical
and emotional changes you’ll experience and offers
reassurance, advice, and practical tips. Your baby’s
progress is charted in fascinating detail with scans
and day-by-day insights into how your baby grows
and develops within your uterus.
Pregnancy
day by day
 Welcome to
your first trimester
WEEK 1 2 3 4 5

It’s official! By the time you

discover you’re pregnant,
your baby has reached the
embryonic period and the
brain, heart, and other
organs are starting to form.

Pre-conception care A daily Avoid alcohol Drinking

prental vitamin supplement soft drinks rather than
before and during early alcohol may help you The release of an egg At
pregnancy helps protect your to conceive; add fruit to ovulation, an enlarged follicle
baby from spinal cord defects. drinks for extra benefit. in the ovary ruptures to release
the mature egg, ready to be
fertilized in a fallopian tube
by your partner’s sperm.
At first, only you are aware of
subtle body changes. By three Early growth In the crucial first
months, changes may be visible. weeks, the baby’s vital organs
begin to develop and the neural
tube, which becomes the brain
and spinal cord, is forming.

The path to conception Sexual

intercourse timed to coincide with
ovulation is most likely to lead to
First trimester Your baby is developing rapidly a successful pregnancy.
and you may have a whole host of symptoms,
but outwardly there’s little sign that you’re
pregnant. Starting to show By the end of this Facts and figures You have a 3.5 in
trimester, your waistline may start to expand. 1000 chance of having identical twins.
You’re at the beginning of an incredible stage of life
that will see your body undergo dramatic changes.
6 7 8 9 10 11 12

Feeling exhausted A classic symptom of early

pregnancy is a feeling of complete exhaustion,
thought to be due to rising hormone levels and
the dramatic physiological changes your body
undergoes as your baby grows rapidly.

At 6 weeks, budlike By 8 weeks, the head At 9 weeks, the fetus

structures can be seen has grown rapidly, is starting to have a
on the embryo that giving an unbalanced recognizable form,
will develop into your appearance, and the with facial features
baby’s limbs. limbs are lengthening. beginning to develop.

Facts and figures At 7 weeks, your baby

measures just 1⁄3 in (8 mm) crown to rump.

Dating the pregnancy Between 10 and 14 weeks,

your first ultrasound will confirm the gestational
age of your baby. Your original due date may be
revised as a result of this scan and the timing of
future tests will be based on its findings.

Soothing foods Early

pregnancy can often
be marred by nausea
and vomiting, especially
Parents-to-be As the realization sinks in that in the mornings; eating
you’re facing parenthood, you may discover a new crackers or sipping a
dimension to your relationship and an enhanced decaf tea can help
sense of togetherness. quell the symptoms.
 Your 1st week
THE 280-DAY COUNTDOWN BEGINS HERE—EVEN THOUGH YOU HAVEN’T YET CONCEIVED

It’s business as usual for your body this week. You’re having a period,
so you know you’re not pregnant. But if you conceive during this
menstrual cycle, the first day of your period will count as the first day
of pregnancy. It’s a good idea to review your lifestyle and to make sure
that you understand how everything works “inside.” Knowing the facts
may help to raise your chances of conceiving.
The thick lining of the uterus

Muscular wall (endometrium) that built up

The fallopian tube is of uterus during your last menstrual cycle
the passageway down is shed as you have your period.
which a newly released
egg travels on its way
to the uterus.

Each ovary contains

eggs at various stages of
development. By the end
of next week, at the
mid-point of your cycle,
ovulation may occur. This
Your first trimester

is when a mature egg is

released from its follicle.

The ovarian ligament

stabilizes the ovary
within the abdomen.

Fallopian tube Cervix

Ovary YOUR REPRODUCTIVE

ORGANS Vagina

The pre-pregnant uterus is

about the size of a plum. Bladder

34
 THIS IS DAY 1 OF YOUR MENSTRUAL CYCLE

279 days to go...

WHAT’S HAPPENING INSIDE
The lining of the uterus builds up in the first two weeks of the menstrual cycle to
prepare for pregnancy. The yellow and blue areas seen here are cells and the pink area,
secretions. If no pregnancy occurs, the lining breaks down and menstruation occurs.

This is day one of your period. If you are trying to conceive during
this menstrual cycle, keep a note of this highly significant date.
Although this is officially the more likely to remember when your
TIME TO THINK ABOUT
first day of your pregnancy, last period started, especially if you’re
you won’t conceive until around two hoping to get pregnant and are keeping
Having a baby
weeks from now. This is classified as a record of your menstrual cycle.
“day one” because once you conceive While dating a pregnancy in this There’s no perfect time to become
your pregnancy will be dated from the way is a handy, if slightly baffling, parents, but you might want to bear
first day of your menstrual period. It convention, it does mean that your in mind the following:
would be more logical to date a pregnancy body is getting geared up for pregnancy
O While practical matters such as
from the day of ovulation or conception, from today. In around 280 days, or nine
the state of your finances and the
but, like most women, you’re unlikely to months’ time, you could be holding your
size of your house are considerations,
know the day on which you ovulate, let newborn baby in your arms. Good luck
remember that being parents is about
alone conceive. You are, however, far and enjoy the journey!
more than what you are able to offer
your baby materially.
FOCUS ON... NUTRITION O This is a decision only you and your
partner can make. Don’t act on the
Take folic acid advice of family members and friends.
O You might conceive immediately or
Start taking this vital supplement
it could take several months, so relax
now, from day one, if you haven’t
and don’t have a set date in mind.
already. You should take folic acid as

Your 1st week

soon as you begin trying to conceive
because it will be essential to your
baby’s development in the first few AS A MATTER OF FACT
weeks of pregnancy (see p.16).
Just 20 percent of couples
The amount of folic acid that has
actively trying to conceive
been shown to be effective is a daily
become pregnant in the first
supplement of 400 mcg. A diet of
monthly cycle.
foods rich in folate is also advisable
so eat plenty of green vegetables, such For 75 percent of couples it takes six
as green beans, spinach, and broccoli; months. So be patient and try not to
legumes, such as peas, beans, and get too stressed if you don’t manage
chickpeas; fortified cereals; and wheat to conceive immediately.
germ and other fortified grains.

35
 THIS IS DAY 2 OF YOUR MENSTRUAL CYCLE

278 days to go...

WHAT’S HAPPENING INSIDE
Your eggs are already developing, as can be seen in this color-enhanced ovary.
The small white structures are the immature follicles that contain the eggs at different
stages of development. Once one of the follicles matures, the egg will burst out.

By tracking your menstrual cycle and understanding how

it works, you may increase your chances of conceiving.
This is day two of your period the blood vessels in the uterus constrict,
AS A MATTER OF FACT
and day two of your complete which can cause cramplike period pains.
menstrual cycle, which starts on the As soon as your period has finished, an Periods can synchronize in
first day of your period and ends on egg begins to mature within its follicle in women who live or work together.
the first day of your next period. A full one of your ovaries, ready to be released
Scientists claim that pheromones
cycle is, on average, 28 days, but many around mid-cycle. This is called
(chemicals that trigger a biological
women have a shorter or longer cycle. ovulation (see p.49).
response in someone) waft from one
This may be the time when your Meanwhile, the lining of the uterus
woman to another. Receptors in the
period is at its heaviest, since the tissue starts to build up again under the
nose detect these pheromones and
and blood that make up the lining of the influence of the hormones progesterone
a biological process takes place
uterus (the endometrium) is shed. The and estrogen, ready to receive a
whereby one woman naturally
average blood loss during menstruation fertilized egg. If the egg is not fertilized,
adjusts her menstrual cycle.
is around two tablespoons (30 ml). hormone levels fall, the lining sheds,
While the lining is being sloughed off, and the cycle begins again.

CHANGES DURING THE MENSTRUAL CYCLE

Your first trimester

Menstrual Relatively The monthly cycle of an egg as it

period infertile phase Fertile phase Infertile phase
grows to maturity inside an ovary is
shown at the top of the chart. It is
Inside the ovary

released from its follicle around day

14. The bottom of the chart shows the
corresponding development of the
Maturing follicle Ovulation Corpus luteum lining of the uterus—shedding at the
start of a period, then rebuilding in
preparation for the fertilized egg.
The empty egg follicle (called the
corpus luteum) secretes progesterone,
Endometrium

which is a hormone that helps the

endometrium reach a thickness
of about 0.2 in (6 mm) over the 28
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
days of the menstrual cycle, ready
Days of cycle to receive a fertilized egg.

36
 THIS IS DAY 3 OF YOUR MENSTRUAL CYCLE

277 days to go...

WHAT’S HAPPENING INSIDE
The lining of the uterus, known as the endometrium, can be seen here (pink structure)
shedding during menstruation. This happens if a fertilized egg does not implant. The
red dots are red blood cells, released when the blood vessels break down.

When you’re trying to get pregnant, it helps to be aware of

lifestyle and medical factors that can affect your menstrual cycle.
You may notice the timing and conditions such as fibroids (see p.218),
ASK A... DOCTOR
volume of your period differs. Your which can affect fertility. A higher than
menstrual cycle can be affected by stress average level of blood loss can also Should I monitor my menstrual
as well as by medical conditions, such make you anemic, which is not the best cycle? Yes, monitoring your cycle
as an overactive thyroid. In both these start for pregnancy for you or your baby, is an important part of planning
cases, periods can become lighter or less so you may want to look at boosting for pregnancy because it can help
frequent. If your periods are erratic, it your iron intake (see p.154). you figure out roughly which day
can be difficult to predict when you Painful periods can impact fertility. you’re ovulating (see p.49) and
might ovulate. Unpredictable or missed Endometriosis is a common disorder thereby improve your chances
periods may mean that ovulation isn’t that can make periods painful and of conceiving. It means you can
occurring at all. If you know this to be cause discomfort during sex. If you have ensure you have sexual intercourse
the case because you’re monitoring the these symptoms, see your doctor who at roughly the right time.
signs of ovulation (see p.43), or using might arrange a scan or refer you to It’s also helpful to note the
ovulation predictor tests (see p.43), seek a specialist. In endometriosis, cells length of your cycle, which may
medical advice about your fertility. resembling those that line the uterus vary. The most important thing to
You may be able to become pregnant come to lie outside the uterus on note is that from ovulation to the
naturally and easily despite problems structures such as the ovaries, the start of your next period is always
related to your period, but some fallopian tubes, and walls of the pelvis. around 14 days so when you get
conditions that cause long, irregular, There are treatments for endometriosis, your next period, you can figure
or heavy periods are linked to lower including laser surgery, that can boost out roughly when you ovulated.

Your 1st week

fertility. Heavy periods can be caused by a woman’s chances of conceiving.

FOCUS ON... IVF

Stimulating egg follicles

IVF (in vitro fertilization) may be an option if a woman is having trouble
conceiving. The first stage with this procedure is to stimulate the ovaries to
produce many follicles, so that multiple eggs can be fertilized outside the body.
Starting on around day three of your cycle, you will be given drugs to stimulate
your ovaries. You will need to inject yourself (see right) or use a nasal spray to
suppress the normal cycle, followed by injections of a follicle-stimulating-like
hormone. Egg retrieval will then take place (see p.57).

37
 THIS IS DAY 4 OF YOUR MENSTRUAL CYCLE

276 days to go...

WHAT’S HAPPENING INSIDE
In this color 3-D scan of the human brain, the green central structure is the
hypothalamus. This controls emotions and body temperature, and releases chemicals
that regulate the release of hormones from the pituitary gland (green circle at bottom).

Like many women, you may sometimes feel ruled by your

hormones, and it helps to understand why they fluctuate.
The hormone build-up to second part of the cycle. Under the
THE LOWDOWN
ovulation starts right now in week influence of progesterone, the muscles
one of your menstrual cycle. Your in the cervix relax, easing open the
Fertility rites
pituitary gland, which lies in the base of cervical canal. Changes also affect the
your brain, produces follicle-stimulating mucus, which becomes more fluid, so Rooted in folklore, these fertility
hormone (FSH). During your period, the sperm find it easier to swim through. tips require a leap of faith and a
level of FSH rises steadily, triggering the It is progesterone that enables the lining good sense of humor!
development of the follicles (around 15– of the uterus to thicken in preparation
O Use the moon. Exponents of
20 each month) in each ovary. As well as for implantation of the fertilized egg.
“lunaception” believe that women
containing each egg, the follicles
whose menstrual cycle aligns with
produce estrogen.
AS A MATTER OF FACT the lunar cycle—so they menstruate
The hormone estrogen circulates,
during the new moon and ovulate
affecting the pituitary gland and Men get PMS too!
when the moon is full—have more
causing it to produce luteinizing
Scientists have confirmed there’s a chance of conceiving. It’s based on
hormone (LH)—this triggers ovulation
male version of PMS—Irritable Male the theory that women’s cycles are
(see p.49). This week your estrogen
Syndrome. Mood swings, temper influenced by natural light.
levels are low and steady, but will rise
tantrums, and loss of libido in men
Your first trimester

dramatically later in your cycle. O Dance around the Maypole.

were found to be caused by falling
Progesterone levels are low during Maypoles are thought to herald the
levels of testosterone due to stress.
your period, but start to rise several arrival of spring and celebrate fertility.
days afterward and stay high for the

CHANGES DURING THE MENSTRUAL CYCLE

Menstrual Relatively There are four hormones at work

period infertile phase Fertile phase Infertile phase
during the menstrual cycle: FSH
(follicle-stimulating hormone) causes
FSH Estrogen LH Progesterone
the egg follicles to start developing in
the ovary; estrogen is produced by the
Hormones

developing egg and peaks just before

ovulation; LH (luteinizing hormone)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
triggers ovulation; progesterone
Days of cycle thickens the lining of the uterus.

38
 THIS IS DAY 5 OF YOUR MENSTRUAL CYCLE

275 days to go...

WHAT’S HAPPENING INSIDE
This cross section through the ovary shows several ovarian follicles. Between each
follicle, the connective tissue can be seen. Each month about 15–20 follicles mature,
but it is usually only one that will fully mature and release an egg.

Making some lifestyle changes is essential when you’re trying

to get pregnant and cutting down on alcohol is a good start.
Even though it’s still the week of TIME TO THINK ABOUT
your period, and some time before you
ovulate, try to ensure you’re in the best
Medical checkups
possible health to maximize fertility. One
way is to cut down your alcohol intake. Before you try to conceive, speak to
Heavy drinking can reduce the chances your doctor about the following tests:
of conceiving and, if you do get pregnant,
O
Rubella: have a blood test to
it can also harm your unborn baby’s
check that you have antibodies
development. There is plenty of evidence
against rubella (German measles).
that drinking beyond the recommended
Being infected by the rubella virus
amounts is harmful. What’s lacking is
for the first time in early pregnancy
evidence of the effects on conception and
is associated with an increased
pregnancy of the occasional alcoholic
risk of the baby developing an
drink. There is no known safe level of
abnormality, and increasing the
alcohol consumption for pregnant
risk of miscarriage. If you were
women. However, many women decide
vaccinated against rubella as a child,
to err on the side of caution and stop Opt for nonalcoholic drinks if you’re trying
your antibody level may be high
drinking alcohol entirely while trying to to get pregnant. A high intake of alcohol can
adversely affect your chances of conceiving.
enough to protect your baby. If it
conceive and in early pregnancy. Some
isn’t high enough, you’ll be offered
find that morning sickness (see p.81)

Your 1st week

a MMR (measles, mumps, rubella)
naturally reduces desire for alcohol.
AS A MATTER OF FACT vaccine and advised not to conceive
Alcohol also affects male fertility. It
for three months.
has adverse effects on the quantity and Illicit or “street” drugs can O Sexually transmitted infections:
quality of sperm produced, and drinking harm your unborn baby.
go to your doctor for tests to rule out
large amounts can cause impotence.
You should try to stop using drugs infections such as chlamydia, genital
You may find a drink helps you and
before you conceive. However if you warts, and herpes. You may also want
your partner relax and puts you in the
regularly use drugs, or find it hard to to consider having an HIV test at your
mood for sex, thereby increasing your
manage without them, it is essential as well. Women with HIV can still
chances of conception, but you may want
to get medical support. Ask your bear children, but may be prescribed
to rethink having the occasional glass
doctor for advice. He or she will be a medicine to reduce the chances of
of your favorite tipple. The US Surgeon
able to help and put you in touch passing the infection to their child.
General recommends that women trying
with a support group. A cesarean may be recommended.
to get pregnant abstain from alcohol to
eliminate potential problems.

39
 THIS IS DAY 6 OF YOUR MENSTRUAL CYCLE

274 days to go...

WHAT’S HAPPENING INSIDE
In this artwork of the uterus, the green central structure is the pear-shaped uterus
itself; the red part is the cavity of the uterus. The blue structures to either side
are the fallopian tubes, which each have an ovary, seen in pink here, at the end.

Eating well is an essential part of conception and pregnancy

so you and your partner should get into good habits now.

FOCUS ON... NUTRITION

Take the time in this first two that stimulate ovulation. Once you’re
weeks of your cycle, before you pregnant, being overweight can
ovulate, to look at what you eat on a also cause an increased risk of
Vital B vitamins
daily basis—if you and your partner complications, decreasing the chance
Your diet should include foods (see p.44) make some simple changes of carrying the pregnancy to full term.
containing B vitamins (see p.16). Take to your diet, it might just improve your Weighing too little when you’re trying
a pregnancy multivitamin if needed. chances of conception. to conceive isn’t healthy either.
O B1 deficiency has been linked to Use this opportunity to check your Pregnancy takes its toll on a woman’s
failed ovulation and implantation. weight ie. your Body Mass Index (BMI) reserves, so a little stored fat is a good
O B2 deficiency has been linked (see p.17) since a BMI of under 19 or thing for mother and baby. Being
to infertility and miscarriage. over 24 could adversely affect fertility. seriously underweight can affect
O B5 is important for conception If you’re overweight, excess fat ovulation and make periods irregular
and fetal development. tissue may affect your metabolism and or absent, and conception unlikely.
O B6 is essential for the formation hormones and you may not ovulate as Your BMI when you conceive is
and functioning of sex hormones. regularly, or at all. If you need fertility also a good indication of how much
O B12, with folate (see p.16), is treatment, the chances of success are weight you should gain once you’re
essential to fetal development. also lower if you’re overweight, because pregnant (see p.99) so it’s worth getting
Your first trimester

you may respond less well to the drugs it checked at this point.

GET FIT AND FERTILE!

Regular exercise can increase your chances of conceiving by allowing your

body to work at optimum levels. If you’re fit and have a healthy lifestyle, you will
reduce the level of toxins in your body and be less stressed, which makes it easier
to conceive. Exercise will also regulate your energy and your blood-sugar levels,
which assists the body in regulating the hormonal cycle—a key player in the
reproductive process. Conversely, overexercising can adversely affect the ovulation
process and make conception more difficult.
The guidelines for exercising at this crucial time of conception are to continue
weight-bearing exercise, such as walking, running, or aerobics, for 30 minutes
five times a week at a moderate intensity. It is important to listen to your body—
moderate means exercising within a comfortable range, where the exercise isn’t
too hard but is pushing your body enough to feel the benefits.

40
 THIS IS DAY 7 OF YOUR MENSTRUAL CYCLE

273 days to go...

WHAT’S HAPPENING INSIDE
Here an egg can be seen, in orange, developing in the ovary. The cells of the
follicle, in which it is contained, can be seen surrounding the egg. At birth, baby
girls have millions of follicles present in their ovaries.

When you’re trying to get pregnant, you need to take your age
into account because your fertility will change as you get older.
In about a week’s time you THE MALE BIOLOGICAL CLOCK?
are likely to ovulate. At the start
of puberty, you had no more than about A man can continue to make
400 eggs in your ovaries, and will have sperm more or less throughout his
made no new eggs. Your lifetime of eggs life, so you might not expect male
were there when you were born. Given fertility to fall significantly. There
these facts, it’s hardly a surprise that are plenty of older fathers around
your fertility falls as you age. that seemingly prove this.
Women 20–24 are generally Recent research from France,
at their most fertile and although, for however, found that men over 35
most women, periods continue until took a lot longer to get their partner
their early fifties, the rate of fertility pregnant. For those who conceived,
gradually lowers in the 30s, 40s, and The follicle lies below the surface of there was a slightly higher risk of
50s and the rate of chromosomal the ovarian wall and protrudes just prior to miscarrying. This is because sperm
abnormalities and miscarriage ovulation. The follicle is most likely to rupture from older men is more likely to
and release an egg mid-cycle, around days
increases. Nonetheless, every year contain damaged DNA. So although
13 and 14 of a 28-day cycle.
thousands of babies are born to women older couples do conceive, it’s a fact
in their late thirties and forties. Women that men, like women, pass their
can conceive beyond that age, which is If you’re concerned about your fertility, peak fertility.
why doctors advise menopausal women it is possible to have a blood test that

Your 1st week

to use contraception for two years after can give an indication of your remaining
their last period. ovary function so that you know how
AS A MATTER OF FACT
If, however, you’re hoping to start a much reproductive time you have left.
family, it’s safe to assume that fertility While some tests are based on levels of Sperm have a long and
begins to fall off sharply after age 35. FSH (see p.38) and estrogen, newer tests perilous journey of 12–16 in
Your age also affects the quality of your use other markers found in the blood, (30–40 cm) to reach the egg.
eggs. In women in their early 20s, such as anti-Mullerian hormone (AMH)
This is why nature is bountiful when
around 17 percent of eggs have a and inhibin B.
it comes to sperm, producing many
chromosomal abnormality, but the But making a baby depends on more
millions with each ejaculation. On
figure rises to over 75 percent in women than releasing an egg; it must travel
average each ejaculation produces
in their 40s. Chromosomal problems down the fallopian tube, be fertilized,
2–8 ml of semen, with over 40 million
increase the chances of having a child implant, and the pregnancy be
sperm in each milliliter.
with a disorder such as Down syndrome maintained. There’s also the father’s
(see p.476). contribution to consider (see box, right).

41
 Your 2nd week
YOUR “FERTILE WINDOW” IS APPROACHING AND THIS COULD BE THE TIME YOU CONCEIVE

Toward the end of this week, one of the eggs in your ovaries is likely
to have reached full maturity. Ovulation occurs as the egg, under the
influence of hormones, bursts out of its follicle. If it meets a sperm, you
may become pregnant. Now is the time to enjoy lots of sex with your
partner, so go for it—as often as you like. If you have any anxieties
about fertility, try to put them aside and relax.
Cilia (small hairs) lining the
fimbriae produce currents that help
move the egg into the fallopian tube.

The wall of the

fallopian tube contracts
and relaxes to draw the
egg into the tube for its
journey to the uterus.

The mature egg is released

Your first trimester

from its follicle and breaks

through the surface of the
ovary. To meet a sperm, and
be fertilized, it must enter
the fallopian tube.

Fluid from the egg

follicle is released with
the mature egg.

Fimbriae, the fingerlike projections

at the end of the fallopian tube, OVULATION Inside the ovary, the empty
reach for the egg and sweep it egg follicle produces the
gently into the tube. hormone progesterone,
which stimulates the lining
of the uterus to thicken.

42
 THIS IS DAY 8 OF YOUR MENSTRUAL CYCLE

272 days to go...

WHAT’S HAPPENING INSIDE
Here, three developing ovarian follicles can be seen in white. The inner circle of
each is the egg. Of the follicles shown, it is likely that only one will fully mature
at ovulation (see p.49) and release an egg.

By the end of this week you’re likely to have ovulated. It’s a good
idea to know the signs that indicate you’re at your most fertile.
This is week two of your cycle. and less enjoyable. They work by testing
ARE YOU OVULATING?
You will probably ovulateby the end of the urine to detect a surge in LH, the
this week and will therefore be fertile. hormone that triggers egg release. This week, look out for:
However, the fertile window can be from Always follow the instructions given. O Lower abdominal pain at
5 days before ovulation to 12–24 hours Testing between 10 am and 8 pm should ovulation, called mittelschmerz (the
after as sperm can survive for 5 days be fine, but try to aim for roughly the German for “pain in the middle”).
inside you. If your periods are regular, same time every day. After a positive O Basal body temperature (your
ovulation can be easier to track, but you test, you should ovulate 12–36 hours temperature when you first wake
may want to use other methods, such as later. Results are about 99 percent in the morning) rising slightly.
looking out for natural signs (see box, accurate but occasionally the result is a O Cervical mucus—the cervix
right) or using an ovulation kit. false positive. Results can occasionally produces secretions, which become
Remember, however, the best way to give a false negative, especially if you’ve wetter, clearer in color, and stretchy,
conceive is to have sex regularly. drunk a lot of water. If your test was resembling raw egg white, just
While they are useful, testing kits are negative, do another one the next day. before ovulation. This indicates
expensive and can be counterproductive Once you have a positive result, you can the start of your fertile phase.
because they make sex more clinical stop testing for that month.

CHANGES DURING THE MENSTRUAL CYCLE

Your 2nd week

Body temperature can be seen at the Menstrual Relatively
top of the chart, rising sharply right period infertile phase Fertile phase Infertile phase

after ovulation. The bottom section

Temperature

shows cervical secretions. These begin

in the days leading up to ovulation, Temperature rises
starting off moist and sticky, then after ovulation
becoming wetter and stretchy at your
Moist, sticky, cloudy
Cervical secretions

most fertile time. Period

(usually no Dry (no
If you feel some of the secretions) secretions) Wet, slippery, stretchy Dry (few secretions)
cervical mucus with your
fingers, you will find you
can stretch it out. This
is a sign that you are 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
about to ovulate. Days of cycle

43
 THIS IS DAY 9 OF YOUR MENSTRUAL CYCLE

271 days to go...

WHAT’S HAPPENING INSIDE
In your partner’s body, sperm is constantly being produced. Here the sperm cells
can be seen: they consist of a head (green), which contains the genetic material,
and fertilizes the egg, and a tail (blue), which propels the sperm along.

While you wait to ovulate, fascinating changes are occurring

in your ovaries as your follicles mature to release an egg.
In the time leading up to inside the follicle. Some women release
SPECIALIZED MEDICAL ADVICE
ovulation, which will happen later more than one egg some months (see
this week, the most advanced follicle p.49) and if both are fertilized, it will
moves to the surface of the ovary, ready mean nonidentical twins are conceived.
to release its precious cargo. While you By the time of ovulation, the follicle
were having your period, around 15–20 will be about 1 in (2 cm) in diameter,
follicles were developing in your ovaries. while the egg is just about visible
Both of your ovaries contribute to without a microscope.
follicle growth, but usually only one To mature, follicles need FSH (follicle-
ovary brings a follicle to ovulation. stimulating hormone) produced by the
Which ovary it is seems to depend on brain’s pituitary gland (see p.38), but
chance since ovaries are not on a strict their early growth doesn’t appear to rely
rotation. As the follicles grow, they on it. It may, however, depend on other
enlarge greatly, filling with fluid secreted hormones and chemicals.

FOCUS ON... DADS

If you have any ongoing medical
Your first trimester

problems, go to see your doctor

Dads: your diet counts too before you start trying to conceive.
It’s never too late to start eating Eat tuna, wheatgerm, whole grains, Conditions such as diabetes,
well if you want to become a dad. But and sesame seeds. asthma, high blood pressure, heart
because sperm take some weeks to O Zinc is present in large amounts trouble, a previous bout of deep
mature, ideally start eating a healthy in semen. Eat fish, lean meat, vein thrombosis (DVT) (see p.186),
diet at least three months before shellfish, turkey, chicken, eggs, whole thyroid conditions, sickle-cell
conception. There are supplements, grains, rye, and oats. disease, and epilepsy can all impact
but most vitamins and minerals work O Manganese is another element that a pregnancy.
better in the form of real food. could help male fertility. Eat leafy The effect will depend on the
O Antioxidants A diet rich in anti- vegetables (including broccoli) carrots, individual condition and a specialist’s
oxidants, including vitamins A, C, and eggs, whole grains, and ginger. advice and care will be needed. If
E, selenium, and zinc, helps prevent O Essential fatty acids may improve you’re in any doubt about how your
damage to sperm DNA. sperm motility. Eat oily fish, such as own medical history may affect a
O Selenium may also help sperm mackerel, salmon, and sardines, pregnancy, check with your doctor
penetrate the outer layer of the egg. flaxseed and linseed, and kiwi fruit. before you start trying to conceive.

44
 THIS IS DAY 10 OF YOUR MENSTRUAL CYCLE

270 days to go...

WHAT’S HAPPENING INSIDE
As ovulation approaches, more cervical mucus is produced. Here it has crystallized
to form a “fern leaf” pattern. Around the time of ovulation the mucus becomes clear,
slippery, and stretchy, which makes it easier for sperm to swim through.

You may not care whether you have a boy or a girl, but
according to some theories you can influence gender.
Conceiving is all about having AS A MATTER OF FACT
sex at the right time this week,
but if you’re hoping to have a child of a If you already have two same-
specific gender, the timing could be even sex children, you’re 75 percent
more important. Some experts claim more likely to conceive a child
there is a link between when you have of that sex again.
sex and the baby’s gender (see below).
Although the sex of the baby
Recent research suggests that women
conceived is random, conceiving
who have a high calorie intake (especially
children of the same sex could be
if they eat that most phallic of fruit, the
due to the fact that some men
banana) are marginally more likely to
produce better quality X sperm,
bear a boy. Those who skip breakfast or
which makes baby girls, or Y sperm,
have a low calorie intake are more likely
which makes baby boys.
to have a girl. One reason for this is
Statistically, couples who have two
thought to be that the extra calories
Research has found that women with children of different sexes are less
consumed affect vaginal secretions and high glucose levels, achieved by eating likely to try for a third child.
help to give the Y sperm that makes baby normally and not skipping breakfast, were
boys a vital boost. more likely to conceive a boy.

Your 2nd week

MAKING BABIES... BOYS AND GIRLS

The Shettles method, devised by Dr. Landrum Shettles, is The Whelan method, devised by Dr. Elizabeth Whelan,
based on the fact that Y sperm (for boys) are smaller, faster, suggests that having sex earlier on in the cycle, some four
and less resilient than X sperm (for girls), and are less able to six days before ovulation, is more likely to result in a boy.
to withstand an acidic environment in the vagina. Sex nearer the time of ovulation is more likely to result in a
girl. Curiously, the Whelan way is more or less the opposite
To conceive a boy, the Shettles method advises: of the advice given by Shettles.
O Timing sex as close to ovulation as possible and adopting
positions such as rear-entry that promote deep penetration. But what works? The mainstream medical view, supported
O The woman should orgasm, ideally at the same time as by reports in journals such as the New England Journal of
the man to make the vagina less acidic and favor Y sperm. Medicine, is that the timing of sex has little or no bearing on
O Drinking a cup or two or strong coffee just before sex to gender. The possible exception is that having sex two days
give Y-sperm an added kick. before ovulation may be slightly more likely to favor a girl.

45
 THIS IS DAY 11 OF YOUR MENSTRUAL CYCLE

269 days to go...

WHAT’S HAPPENING INSIDE
The lining of the fallopian tube, seen here, has a moist mucous membrane.
This contains cells (brown) that protect the tube’s surface. The hairlike cilia (blue)
move the eggs along the tubes following ovulation.

If this isn’t the first month you’ve been trying to conceive,

don’t be too disappointed. It’s normal for it to take some time.
Have you been trying for a time frame, say 12 months, unless
ASK A... NUTRITIONIST
baby for some time? It’s hard you have any specific reasons to be
to face the fact that we don’t always concerned about your fertility or your I’ve heard that green tea will help
conceive when we want to. This lack health in general. me conceive. Is this true? So far,
of success may be difficult to handle, The main exception is if you are over studies on green tea and fertility
especially if you’re someone who has 30. In this case, see your doctor after aren’t conclusive one way or the
achieved in other areas of your life. trying for about six months. The first other. Overall, it’s likely to benefit
With reproduction, there’s a large step is likely to be a blood test for you, your health without affecting your
element of chance. Even for young and a semen analysis for your partner. fertility. However, although green tea
women at their peak of fertility, the However, be reassured that if you are has a host of health benefits, it
odds of conceiving in any one cycle are over 30, you may still get pregnant in contains small amounts of caffeine
50–50. It’s not unusual to try for six the old-fashioned way. The average time and tannic acid, both of which have
months, or even 12 months, without taken for a 39-year-old woman to (at least in large quantities) been
success. Around 16 percent of couples conceive is 15 months. But the snag is linked to fertility problems and an
take over a year to achieve a pregnancy. that if you do end up needing assisted increased risk of miscarriage.
So plan for conception over a longer fertility techniques, it all takes time.
Your first trimester

STOPPING CONTRACEPTION

You can get pregnant as soon as of the hormone are still lingering, but
you stop using some contraception. you may still conceive.
O IUD (coil): you can get pregnant if O Injections: irregular bleeding can
you have sex in the week before it’s continue for months, and you may
removed since sperm can live 3–5 days. not be able to conceive for several
O Pill: assume you’re fertile months either. However, as with
immediately. Some women seem to be implants, it’s possible to get pregnant
extra fertile after stopping the Pill. before your periods return properly.
O Implants: fertility can return O IUD or IUS: you could get pregnant
immediately after removal of the if you have sex in the week before
implant, but some women find it removal of the IUS system, but
takes longer. Occasionally periods can because the system contains When you come off the pill, you
might become pregnant in the first
take three to nine months to become progesterone, conception is less likely
month. If you’re not ready yet, use
regular. This suggests that the effects than with a regular coil (see left).
condoms for a month or two.

46
 THIS IS DAY 12 OF YOUR MENSTRUAL CYCLE

268 days to go...

WHAT’S HAPPENING INSIDE
This mature ovarian follicle contains a fluid-filled cavity (pale pink) known as the
follicular antrum. At this stage, just prior to ovulation, one follicle has become much
larger than the others, and it is this follicle that will rupture to release an egg.

As your hormone level rises around this stage of your cycle,

so might your libido—it seems nature takes care of everything!
Estrogen levels are rising and rising later this week. Progesterone
AS A MATTER OF FACT
reach their peak today, based levels are low. There’s no call for this
on a 28-day menstrual cycle. The rise hormone until the uterus lining needs Being stressed can affect your
in estrogen from the follicles is what to thicken. In fact, high levels would ability to conceive.
stimulates the release of the LH make the cervix hostile to sperm, so
Perhaps it’s no surprise that nature
hormone (see p.38), which surges they would have trouble getting through
makes it more difficult to conceive in
about 24 hours before ovulation. FSH to the uterus and the fallopian tubes
stressful circumstances. One reason
(see p.38) from the pituitary gland starts to fertilize the egg.
might be that it reduces the ovary’s
Women also produce the male
response to the hormone surge at
hormone testosterone and this reaches
ASK A... DOCTOR mid-cycle (see left). There is also a
a peak around ovulation. This hormone
link between stress and the failure
I had a miscarriage four weeks is responsible for libido in both sexes
of fertility treatments, although the
ago. Is it safe to try for another so, hopefully, you and your partner
exact reason for this isn’t known.
baby right away? There is no exact should find you’re both in the mood
advice on when you should try for making babies at this time.
again following a miscarriage. As
a general guide, wait until you’ve
had one menstrual period. This will
help to date the pregnancy should

Your 2nd week

you conceive quickly. However,
your doctor may advise otherwise,
especially if your miscarriage was
linked with an infection. If you
are waiting for tests because you
miscarried, it makes sense to
have these first.
You and your partner may
need time to grieve for the lost
pregnancy, so it is unwise to rush
into trying to conceive again. Be
reassured that the vast majority
of women who had a single
miscarriage go on to have a baby. It’s a good idea to talk about and work through your grief together before trying to get
pregnant again. Miscarrying can be extremely tough and may put a strain on your relationship.

47
 THIS IS DAY 13 OF YOUR MENSTRUAL CYCLE

267 days to go...

WHAT’S HAPPENING INSIDE
The sperm cell can be seen here inside the fallopian tube. Since sperm can stay
active and alive inside you for up to 72 hours, it’s possible to get pregnant even
if you don’t ovulate for two to three days from now.

This is an optimum time to conceive, but try not to think too

much about when you might be ovulating and just enjoy sex!

AS A MATTER OF FACT
Use the time around ovulation Try to have sex every 24–48 hours. If
to put some excitement and spontaneity your partner ejaculates regularly, it will
Having an orgasm could boost back into your sex life. With all the encourage the production of quality
your chances of conception. recommendations and restrictions, sperm. The benefits of abstaining have
not to mention old wives’ tales, that been greatly overstated in the past. It is
One theory is that the female orgasm
supposedly maximize conception true that not having sex for up to seven
is an evolutionary device designed
rates, it’s easy to forget that sex is days can boost the number of sperm,
to convey semen into the cervix as
meant to be enjoyable. If you’re hell but research now shows that abstinence
the uterus contracts. If the woman
bent on conceiving, then the fun can can impair the motility (swimming
climaxes up to a minute before her
get forgotten. You might want to try ability) of sperm, especially if the sperm
partner, or she doesn’t orgasm, she
different positions, times, or places were already borderline. The longer the
will retain less semen than if she
for sex. If you and your partner aren’t period of abstinence, the more marked
comes at the same time or after him.
usually that adventurous, this is a good the effect will be. So have fun and if you
opportunity to try varying things a little. conceive that’s a bonus!

It may improve your chances SEXUAL POSITIONS

of conception if you lie down for
Your first trimester

15–20 minutes after having sex. It seems that how you have sex
Lying with your legs in the air can help conception. Positions
will aid gravity further. that maximize penetration, such
as rear entry, may work best since
sperm is then deposited as close to
the cervix as possible—languishing
too long in vaginal secretions can
lead to a sperm’s early death. If
the man is on top, the woman
could try placing a pillow under
her buttocks to raise her pelvis and
aid the movement of sperm toward
the cervix. Woman-on-top positions
may lead to leakage of sperm. Avoid
using lubricants because they can
adversely affect sperm.

48
Exploring the Variety of Random
Documents with Different Content
 LYTHAM AND ST. ANNE’S
The seventh tee

As compared with Hoylake, St. Anne’s is very smooth and trim, and
just a little artificial. If the day is calm and we are hitting fairly
straight, the golf seems rather easy than otherwise; and yet we
must never allow ourselves to think so too pronouncedly, or we shall
straightway find it becoming unpleasantly difficult. If there is a
strong wind blowing we shall not even be tempted to think it easy,
for there is plenty of rough grass on either side, and the hitting of a
good straight tee-shot, which seemed so simple and made the holes
seem simple, will be a cause of considerable anxiety. Whatever the
weather and the wind, there is one thing that we ought always to do
well at St. Anne’s, and that is putt, for the greens are as good and
true as any in the world, and can even challenge comparison with
those in the Old Deer Park. Given an opponent who is a really fine
putter—Mr. Lassen or some other inhuman fiend—and till he has
played two more while our ball lies stone dead we can never feel
quite happy; the truly-struck putt comes on and on over that
wonderfully smooth turf and flops into the hole with a sickening little
thud, and there are we left gasping and robbed of our prey. There is
no kind of excuse for bad putting at St. Anne’s, and in fine weather
there is indeed little excuse for any form of error, for the lies are
uniformly good and the stances uniformly smooth, save perhaps at
two holes, where the land lies in ridges and furrows, and we may
need a measure of skill to persuade the ball to fly from the hanging
sides of a ridge. The trouble, besides rough grass and pot-bunkers,
consists of sandhills, both natural and artificial. To build an artificial
sandhill is not a light task, and it is characteristic of the whole-
hearted enthusiasm of the golfers of St. Anne’s that they have raised
several of these terrifying monuments of industry. They are still in
their infancy, and look just a little new and raw, but they will destroy
the golfer’s card and temper just as effectively as those that have
stood from time immemorial. They are, moreover, covered with bent
grass, which will no doubt increase and multiply to the greater glory
of the hills and ruination of the golfer.
The course begins with a short hole of no particularly coruscating
virtues, but the second and third are both good, and the railway on
the right scares us into a hook: and the hook takes us into a bunker,
and the bunker loses us the hole. The fourth has a very pretty
green, well and naturally guarded by hummocks; and Nature has
been very kind again at the sixth, where there is a deep crater, to be
comfortably reached in two good shots. Indeed these natural craters
are rather a feature of the course, for there is something of the
same kind to be found at the seventh, and a very perfect example at
the fourteenth. The worst that is to be said against them is that they
give some encouragement to a second shot off the back-wall, but
the attendant risks are very great, and the back-wall shot that just
misses the mark brings with it a peck of troubles.
The ninth has a fine tee-shot and a long, difficult, and blind second
shot, in which the stranger always finds that he has aimed at the
wrong chimney pot in a row of houses at Ansdell. The tenth has a
hut for drinks and a tee-shot that fully justifies such an indulgence;
while at the eleventh we must go on driving and driving till we reach
the green, which, contrary to our expectations, we shall ultimately
do. The thirteenth is of an unattractive and inlandish appearance,
but is as good a hole as is to be found on the course, and needs the
very straightest of play to avoid a network of bunkers. Out of a
puddle in the bottom of one of these bunkers I once holed a pitch,
and have never played the hole so well either before or since. Then
comes the crater hole, the fourteenth before mentioned; and after
that we may hope to get home with a three and three fours, but the
four at the seventeenth is not a particularly easy one, and there is
always a chance of too strong an approach being bunkered in a
flower bed beyond the home green, to the great amusement of the
spectators in the smoking-room window.
There is nowhere in the golfing world where keener opponents and
more friendly hosts are to be found than in the counties of
Lancashire and Cheshire, and I cannot help saying that I, along with
my brothers of the Oxford and Cambridge Golfing Society, owe them
a very deep debt of gratitude.

TRAFFORD PARK
The club-house from the eighteenth tee
Before finally quitting Lancashire, we must look at one inland course,
namely, Trafford Park, which may be accepted as the foremost
among the purely Manchester courses. I was interested and
surprised to find, in reading a little history of the Manchester Golf
Club, that golf was played in Manchester at a date so utterly
prehistoric as 1818. However, a few enthusiasts really did play upon
Kersal Moor at that remote period, and they called themselves the
Manchester Golf Club. They had no imitators till sixty-four years
later, when Mr. Macalister founded the Manchester St. Andrews Golf
Club that played in Manley Park. The birth of this second club
happened almost simultaneously with the death of the first. Kersal
Moor, for all its solitary and savage name, fell a prey to the builder,
and in 1883 the original Manchester Golf Club ceased to exist, and
its name was assumed by the Manley Park Club. Since then, it
should be added, it has, happily, come to life again under the title of
the Old Manchester Golf Club.
Meanwhile, Manley Park came to share the fate of Kersal Moor, and a
move was made to Trafford Park, which has now been the home of
the Manchester Golf Club from 1893 to the present time. It has
flourished ever since, and has played a prominent part in the golfing
life of Manchester.
Trafford Park is a good course in spite of the most unpromising
surroundings. All round the fine old park, formerly the home of the
de Traffords, manufactories now raise their hideous heads, while
along one side runs the Manchester Ship Canal, and the man who
desires an excuse for a bad shot may allege that an ocean liner
insisted on coming behind him just as he was playing. These are
certainly not recommendations, but there are compensating
advantages in good turf, good greens, good length holes, and the
old mansion-house, which has been converted into one of the most
comfortable and palatial of club-houses.
The turf is excellent. It is certainly not muddy, nor is it precisely
sandy. One who has played much golf at Trafford describes it as
‘peaty,’ and I will leave it at that. The hazards are of the usual park
description: trees, artificial bunkers, and at one hole a pond, while
the ground is pleasantly undulating for the first nine holes, and
rather too flat for the second.
We begin by driving downhill, which is always a comforting thing to
do, although we ought to have warmed to our work a little in order
to get full value out of a downhill drive. This takes us into the lower
ground, and after a moderate first we have a really good two-shot
hole for the second; well over four hundred yards long, and with a
thoroughly interesting second shot on to a raised green. The third,
which is a one-shot hole—there are four of these in all—takes us up
a hill again, and of the holes that follow the fourth and the seventh
are especially good, the former demanding a long, straight, iron shot
on to a particularly well bunkered green.
Coming home the course suffers a little, as I said, from being too
flat, and, so as with many of these park courses, it is rather hard to
pick out any one hole from among its fellows. Good sound golf will
be repaid, and so will the golf that is unsound and bad, but neither
the rewards nor the punishments are of a thrilling or heroic order.
There is one hole, however, that calls for special mention, the
sixteenth, where two really fine shots are needed to reach the
green, and the only thing to be said against the hole is that it would
be better still if it were number seventeen instead; not that the
present seventeenth is bad, but that the sixteenth is so eminently
well adapted to occupy that critical and important position. Gaudin
has been round the course in 65, but the intending visitor will be
disappointed if he imagines that he himself will necessarily do a
particularly low score on that account. In these days of expanded
courses—against which one begins to see some signs of a revolt—
Trafford Park is not vastly long, but it calls for good, honest golf for
all that.
 CHAPTER VII.
YORKSHIRE AND THE MIDLANDS.

With an open mind and a golfing friend I started in the month of

March on a short pilgrimage to the courses of Yorkshire and the
Midlands. Two rounds a day on a new course, to be followed by
some hours of travelling, constitute a strenuous life for the ordinary
golfer, although no doubt it is mere child’s play to the great
‘showmen’ of golf, as Mr. Croome has christened them. On my
remarking on this point to my companion that we now knew what it
must feel like to be Braid or Taylor, he replied that personally he did
not feel in the very least like them, and that he did not think my play
was any justification for my doing so either.

GANTON
The carry at the eighteenth tee
In spite of this slight unpleasantness, we had a most agreeable
pilgrimage, which was begun by taking a train to Scarborough, in
order to play at Ganton. Ganton sprang into fame as being the
home course of Harry Vardon. It was there that he played the
second half of his great match with Willy Park, and having gained a
small but serviceable lead at North Berwick, played one of his most
overpowering games on his own course, and never gave his
adversary even the faintest of chances. Some of the glamour of
Harry Vardon still hangs round Ganton, although he has left it now
for some years, and has a worthy successor in Edward Ray, the
hitter of mighty drives and smoker of many pipes. The course has
been a good deal altered since Vardon’s days, for with the advent of
the Haskell, it suffered the common lot and became rather too short.
Now it has been stretched and rearranged and pretty severely
bunkered; most noteworthy of all, the hole of which the visitor to
Ganton formerly carried away the most vivid impression, has been
altered out of recognition. This is the present twelfth hole, where in
old days the tee-shot consisted of a mashie pitch, played mountains
high into the air in order to clear the tops of a row of tall trees. Now
the trees have been ruthlessly cut down, and we have a one-shot
hole, demanding not a mashie but a brassey shot, very good and
very orthodox. No doubt the old hole was a bad one, and the new
one is good; nevertheless there must have been some bitter regrets
over the felling of the trees. Unless we are utterly consumed with a
fire of reforming zeal, we can well afford to drop a tear over the
disappearance of these holes—once the pride and joy of their
creators, now destroyed or altered beyond recognition. The once-
famous short holes are meeting with the same fate all over the
country. The ‘Maiden,’ long since shorn of much of its glory, is
undergoing yet another metamorphosis, and it is even rumoured
that some day it will be a blind hole no longer. The ‘Sandy Parlour’
has even been threatened, and indeed it may be laid down that if
the golfers of a dozen years ago praised a hole as being ‘sporting,’
that hole will be the first marked down for the reformer’s attack. It is
all very splendid no doubt, but it is also just a little bit sad.
So much for the twelfth hole of blessed memory; and now we must
get back to the course in general. To begin with, Ganton is a course
of sand and fir trees and gorse bushes. It is a little like Woking, a
little like Worplesdon; and, generally speaking, it is the type of
course that one would expect to find in Surrey rather than in
Yorkshire. Needless to say, however, it has plenty of character of its
own, and in particular it possesses by far the vastest and generally
most gorgeous bunker that is to be found, as far as I know, on any
inland course. It is a huge pit of sand, with just the depths and
shallows, the bays and promontories of the genuine seaside article.
It is so large that, by its unaided efforts, it provides highly effective
bunkering for the tee-shots to the two last holes; and as regards its
dimensions, I shall not be flattering it very grossly if I compare it to
the bunker in front of the fifth tee at Westward Ho! It is the more
striking because it lies on the other side of a road away from the
main body of the course; and after a series of trim little pot-bunkers,
one comes quite suddenly upon it, rugged, natural, and magnificent.
Nature has done nearly all the bunkering work for these last two
holes; at the others she has had to be assisted by man, and man
has been very busy cutting pot-bunkers, and mostly towards the
sides of the fairway and the edges of the green. The bunkering
seems to me, if I may say so, to be exceedingly well done, and for
the most part one has to keep reasonably straight—sometimes very
straight indeed—from the tee. The sixth, seventh, and eighth I
remember particularly as all demanding scrupulously accurate tee
shots, and of these perhaps the eighth is the most difficult, with
serious bunkers on opposite sides of the course at just the distance
of a moderately good drive; it is not unlike the tee-shot to the sixth
at Woking, or the eighth at Walton Heath; and to say that is not to
call the shot an easy one.
There are whins in fair profusion, and they play an important part at
both the second and third holes. The approach to the second is a
really difficult one, for the green lies in an angle made by two lines
of whins, which are partially protected from the infuriated niblick
player by formidable bunkers, so that any perceptible error is likely
to bring with it a disaster either sandy or prickly. At the third, again
—a very full one-shot hole—the whins guard the entire left-hand side
of the course. It is, to be sure, possible to hit over them, but the
feat entails a carry of some two hundred yards, and even Ray admits
that a long shot is wanted to get clear to the left.
The criticism I feel disposed to make, very tentatively, of the first
nine holes at Ganton is that they are a little too much of the same
length. There is the third hole aforementioned, and there is the fifth,
demanding an extremely pretty little pitch from the tee; nor must I
forget the ninth, a really fine two-shot hole that winds its way along
the bottom of a little valley. At the other six one seems to be playing
the second shot with the same straight-faced iron club. They are
individually very good, but the least little bit in the world
monotonous, and there is a more attractive variety about the home-
coming nine.
Of these last nine nearly all are good; but the last three are, I think,
the most attractive, being all interesting and all different. The
sixteenth is a fine straight-hitting two-shot hole over undulating
country. The seventeenth brings us face to face with the big bunker,
and if the wind be favourable we may hope to reach the green with
a really good hit, but the green is curly, tricky, and difficult of access.
Finally, we have another drive over the big bunker for the last,
taking care to avoid being stymied by a clump of firs, and then we
may pitch comfortably home across the road with a four well in
sight.

HUDDERSFIELD
The club-house
We had two rounds of Ganton on the first day of our pilgrimage—a
warm, delightful, sunny day—and then took train to Huddersfield to
play at Fixby. Fixby is as different from Ganton as chalk is from
cheese, or as a watering-place is from a manufacturing town.
Ganton is charmingly pretty in a way that is comparatively ordinary
to anyone who has seen Surrey and Berkshire. Fixby has for the
southerner’s eye a kind of grim and murky romance. For some two
miles we have to wend our way up a long slope through
Huddersfield and its outskirts, looking rather drab and ugly and
intensely prosperous. Then suddenly the romance begins. We climb
up a steep hill through a pretty wood, albeit the trees are black with
the smoke of many chimneys, finally to emerge rather breathless in
a new land. Now we are perched on the top of a hill, in wild, solitary,
moorish country. A long way down below us are Huddersfield and its
mills, and all around is a great stretch of view, rather bleak and
sombre, but possessed of a very distinct beauty of its own. We are
not really on the moors, but we feel as if we were, and all the
colouring is moorland colouring. Everything is a subdued grey or
green, and even the stone walls, which abound on the course, have
a gloomy tint of their own—a kind of purplish black that I have never
seen anywhere else. It strikes us at once that this course could only
be in the north; there is nothing southern about it, and by this
strangeness and strong character it casts something of a spell over
the southern visitor. This is how I saw Fixby, with a grey leaden sky
and a mighty wind blowing the misty rain that is called ‘moor-grime’
strongly in my face. In summer it must possess quite a different sort
of beauty when the great clumps of rhododendrons are all in bloom,
as the artist has depicted them, and the club-house in the centre of
a blaze of gorgeous colour.
To turn from the scenery to the golf, there is a very clearly-marked
distinction between the two rounds of nine holes, each of which
begins and ends near Fixby Hall, which is used as the club-house.
The first nine holes might be described as park golf; and yet this
would be perhaps to give a false impression, for the trees do not
play an important part, and the turf is harder and dryer than the
normal park turf. It is plain-sailing, straightforward golf, in which we
can see where we are going, and the trouble consists mainly of
artificial bunkers of the ordinary type.
The second half is much more sui generis. We emerge from the park
land into country which is more open and much more undulating.
We have to play a great many more blind shots—in fact, we have
rather too many of them; and there are one or two holes—
exceedingly difficult holes they are—which would be, I venture to
think, much better if only we could get a good view of the flag.
Another feature of the second half is the ubiquitous stone wall.
Sometimes it is an ordinary wall; sometimes it partakes of the nature
of a sunk fence, and we only realize its presence by seeing our ball
suddenly plunge, like another Curtius, into the bowels of the earth. I
should not like to pledge myself as to the exact number of walls, but
we shall be lucky if we do not make acquaintance with more than
one of them upon a windy day; and, in parenthesis, the wind can
blow at Fixby with an energy worthy of the strongest seaside gale.
The two halves may fairly be summed up by saying that the first half
provides the sounder golf, and the second the more exciting; and
that both need a man to play them.
On the way out the holes that I personally think the more attractive
are the fourth—a nice single shot, 170 yards long, on to a plateau
green—and a group of three that come together, the sixth, seventh,
and eighth. Of these the eighth is a pretty enough little short hole
with a very well-guarded green, but the seventh is the best of the
three and also the most interesting, from the fact that it owes its
merits almost entirely to ingenuity in construction rather than to
natural advantages.
The green has certainly a good natural protection to the right in the
shape of a ditch, to which has been added a bunker on the left; but
still, if we were allowed to make a direct frontal attack upon the
hole, we should have no great difficulty to contend with. A frontal
attack, however, has been forbidden us by Mr. Herbert Fowler’s
ingenuity. In the straight line between the tee and the green have
been erected a series of formidable fortifications, wherefore we must
drive out to the right and then approach the hole from the side. The
further we go to the right the more difficult the approach will be, but
if we can play with a judicious hook, and so ‘pinch’ the fortifications
as close as we dare, we shall obtain a reasonably open and easy
approach. This device of compelling people to play the hole as a
‘dog legged’ hole has made all the difference between a good and
an ordinary hole. Of some of the longer holes on the way out I have
said nothing, not because they are not sufficiently testing in
character, but because they are for the most part straightforward
holes that do not lend themselves to distinctive description.
After the turn comes, as I have said, the region of blind shots and
stone walls. The twelfth is a curious hole, because of the
extraordinary difficulty of judging the direction of the second shot
over a high grassy mound. Even those who are steeped to the eyes
in local knowledge are never quite certain if their ball will be lying
close to the flag or thirty yards away, and race feverishly to the top
of the mound to see what has befallen them. The thirteenth, again,
has a puzzling, blind uphill approach, after a really good tee-shot
across a wall. There is a good long, punishing finish, all the last
three holes being over, and two of them well over, four hundred
yards in length. At the last there is a chance, if the breeze be
favourable, of a really fine second shot from the crest of a hill that
shall send the ball soaring away for an apparently immeasurable
distance, avoiding stone walls and trees, and ultimately reaching the
green.
There is plenty of hard work to be done in reaching the greens at
Fixby, and still more when we have reached them, for they are fast
and curly to a degree, although very true when at their best, and
there is much allowance to be made for borrow and much gentle
trickling of the downhill putt. That Fixby is a difficult course is proved
by the fact that the redoubtable Sandy Herd has never accomplished
the full round of this his home course under 70. If 70 is Herd’s best,
anything under 80 is not to be despised by the ordinary mortal.

HOLLINWELL
Looking across the second green
Continuing our journey of discovery in a southerly direction, we next
took the train to Nottingham, and thence some few miles out to
Hollinwell, passing on the way Bulwell Forest, formerly the home
of the Notts Golf Club, but now converted into a very popular
municipal course. Though Hollinwell is some miles out of
Nottingham, the factory chimneys are not so far away, but that the
ball, which starts its career on the first tee a snowy white soon
passes through a series of varying greys till it is coal black, unless its
complexion is renewed by the use of the sponge. The southern
caddie’s simple and natural method of cleaning a ball is not here to
be recommended.
Hollinwell is a wonderfully sandy course, and when there is a strong
wind one may see great clouds of sand blowing down the course
after the most approved seaside fashion. The course is rather
curiously shaped, since nearly all the holes lie in a long, wide valley.
Sometimes we play down the valley, and sometimes we play across
it, tacking this way and that, so that we are never hitting
monotonously either with or against the wind. Sometimes also we
scale the side of the valley and play along the top of the slope, and
herein lies a certain weakness of the course, for these upland holes
are not quite worthy of the rest. They are of the downland order,
with blind shots, big perplexing slopes, and greens cut out of the
sides of hills. Luckily there are but few of them, for they are but poor
golf, whereas most of the holes in the valley are very good indeed.
I never saw a course that began with fairer promise, for the first
hole looks and is delightful—a good long hole of well over 400 yards
in length. To the right stretches a line of bracken, while on the left is
a small clump of firs, just near enough to the line to induce a slice
into the ferns. This first hole is so good that the other holes have a
high standard to live up to, and in one important respect they
perhaps do not quite succeed. That wilderness of bracken to the
right holds out a promise which is not quite fulfilled, because that
which Hollinwell lacks is rough ground severe enough to punish the
erratic driver. I have no doubt that I was lucky, but I remember
several of the most perfect lies for a brassey which were meted out
to me, when in common justice I should have been plying my
niblick. The rough’s bark is much worse than its bite, and one may
often hit very crooked and not be one penny the worse. More
bunkers—many more bunkers—at the sides of the course, and
perhaps not quite so many in the middle would be no bad
prescription for Hollinwell.
If, however, the course has some faults, it also has many merits, and
the most attractive, because the most characteristic holes, are those
in which the peculiar character of the ground comes into play. Thus
at both the seventh and ninth we play across the breadth of the
valley into little gullies that run some way in between the spurs of
the hill. If we are perfectly straight, the gully receives us with open
arms, but to be at all seriously crooked is to be perched on a hillside
among thick grass and red sandstone. These are both holes of a fine
length, and though with hitting an arrow-like straightness we may
hope for fours, we need not make undue lamentations over fives.
The eleventh, again, is a charming hole, where the way to the hole
follows the contour of a subsidiary valley that wanders away from
the main valley on some little expedition of its own; nor, to retrace
our steps, must the second be left out, with its pretty background of
trees and water.
After the eleventh the golf degenerates for a while, when we leave
the lowlands for the highlands; but, just as we are feeling a little
sad, comes a marked improvement at the fifteenth, and we end with
two really good holes, one short and one long. To justify its
existence as a seventeenth hole, a short hole must needs be a very
good short hole, and this is an excellent one, save that the
inordinately long approach with the wooden putter should be
prevented by a bunker on the left. The eighteenth, except that it is a
good deal longer, is almost the converse of the first, and the clump
of firs that made us slice at the first tee will certainly trap us if we
pull our second shot. This last hole lives in my memory from the fact
that it gave to my companion a temporarily undeserved reputation
among the golfers of Nottingham. Having played a round of almost
unbroken sixes, he placed the ball close to the hole with a long iron
shot for his third, and holed the putt before an awestruck assembly
in the club-house window with an air and manner suggesting that
four was the highest rather than the lowest score that he had
accomplished during the round. What is more, he only just failed to
do the same thing in the afternoon, although the hole is 555 yards
long. Such is the inveterate habit that some people have of playing
to the gallery.
From Nottingham our way lay to Birmingham, where we were to
play at Sandwell Park. A train journey to a melancholy and
mysterious place called Spon Lane, followed by “a penny to the left
and a penny to the right” (as we were advised) in a tramcar brought
us to West Bromwich. West Bromwich is a name calculated to thrill
the football devotee with glorious memories of West Bromwich
Albion, but it is not in itself a particularly attractive spot. Yet
Sandwell Park must once have been a beautiful place before the
houses began to crowd round its gates and the colliery chimneys to
pour black volumes of smoke across it. It is a fine park still, if one
can only blind oneself to the houses and the chimneys; but that,
save in one or two secluded corners, is a difficult task—Birmingham
is too all-pervading to permit of many illusions.
We did not see Sandwell under very favourable conditions as regards
weather. There was every now and again a flurry of snow, and a
most piercingly cold wind blew across the course, rendering useless
any number of waistcoats and mittens, and robbing the fingers of all
power of gripping the club. It is very difficult under such
circumstances to judge of the length of any particular hole, for the
wind laughs at yard measures, and reduces a good length hole to a
drive and a pitch, and converts a drive and a pitch into a three-shot
hole.
Perhaps it was the effect of first going out to face the icy blast, but I
thought the first few holes at Sandwell rather poor, being of a hybrid
length and not particularly exciting. The golf improves wonderfully,
however, as it goes on, and from the seventh onward is infinitely
more interesting. The eighth needs a very straight drive, followed by
a very delicate second shot—a tricky shot in whatever way we start
to play it. If we pitch up the hill, we must pitch just up and no
further; while if we run the shot, the hill is just steep enough to
induce a lively fear that the ball will refuse to climb it. Moreover,
when I played it, the hole was cut with fiendish cunning very close
to the top of the hill, so that the very nicest judgment was necessary
in order to avoid a long, sloping and curly putt. The ninth consists of
an absolutely blind pitch with a small crater, reminding one of a very
old but not very highly esteemed friend, the ‘Crater’ hole at
Aberdovey. Then comes a hole that is really good, and it seemed to
me the best on the course—two honest shots along a narrow neck
of turf, which tapers perceptibly as it nears the green.
 SANDWELL PARK
Mr. Woolley driving from the ‘Pulpit’ tee

By this time we have reached the highest point of the links, and now
descend into the lowlands again, driving from the ‘Pulpit’ tee to a
green which lies in front of the big, white, gloomy house, whence
the owner has long since retired, smoked out by the colliery
chimneys. A good two-shot hole follows, and next comes one of the
most amusing of short holes, which, whether intrinsically good or
bad, deserves to escape the zeal of the iconoclast because of its
singular character. One hundred and thirty are all the yards it can
boast, but between tee and green a terrible monster rears its head
in the form of some ancient rifle butts. They tower so high above
and so close to us that even with a mashie and a teed ball we are all
too likely to err. Moreover, it is not merely a matter of getting over at
any price. The hole is quite close to the butts on the far side, and
only the ball that shall just drop over and no more should satisfy us.
Circumstances alter cases, of course, and with his opponent having
the honour and failing to get over, a man may well play his shot with
a brassey if he have a mind to it. Then, indeed, it is a case of over at
any price, for the ground short of the butts is terribly rough, and a
brilliant recovery is not in the least probable. It is the hole that must
have been the grave of many hopes, perhaps even of some
foursome friendships; and yet, if we were out practising with half a
dozen old balls and no one to look at us, we could do as many twos
and threes as ever we wanted.
There are some other good holes to follow, but they appear
comparatively orthodox and ordinary after that quaint little
thirteenth. One of the best things about the course is the turf, which
is very springy and pleasant to walk upon. This old park turf very
often proves sadly disappointing when it comes to making putting
greens out of it, but the Sandwell greens are excellent, and in more
propitious weather must be delightful to putt upon.

HANDSWORTH
The first tee
Not far from Sandwell Park is another very well-known Birmingham
course, Handsworth. This is the home green of that keenest and
most persevering of golfers, Mr. C.A. Palmer; he has tried as hard
over his own course as he did over his own game, and the system of
bunkers, for which he has chiefly been responsible, is marked by a
great deal of skill and ingenuity. The course is undoubtedly a good
sound test of golf, and there is one type of golfer who will be tested
out of his seven senses, and that is the victim of a chronic slice. All
along the right-hand side of the course there runs an out-of-bounds
area, so that the poor slicer is for ever dropping another ball over his
shoulder.
Another hazard that plays an important part, especially in those
holes that come in the middle of the round, is a stream. Full and
ingenious use has been made of this stream, and there is a good
deal of rather cunning pitching to be done in order to circumvent it;
anything in the nature of a running shot is, naturally enough, at a
discount.
The course begins quite excellently, and the first two holes are two
of the best on the way out. At the first there is a big pool on the
right and a generous supply of bunkers on the left, so that the very
first tee-shot of the day has to be hit quite unpleasantly straight. If it
is so hit, an iron shot of moderate length should see us safely on the
green with the orthodox two putts for a four; if it is not, it would be
rash to dogmatize as to what our precise score may be. The second
hole, again, has one of those interesting carries from the tee that
the player can make just as short or as long as he likes, according as
his tactics are those of Fabius or some more dashing hero. The
green lies on a hill-top some 380 yards away from the tee, and a
bold tee-shot, followed by a really well-struck second, may make a
four hole of it, but it is a good four.
The sixth is another good hole, although there is rather an
aggravating cart track at just such a distance from the tee as to be
likely to trap a respectable shot. The green, moreover, is very well
guarded by a brook on the left and some pot-bunkers on the right.
At the eighth we come to the first of the regular short holes, of
which there are three in all, though there are two more which may
on occasion be reached with a particularly shrewd blow, and it may
be said in parenthesis that it is something of a weakness in the
course that none of the three can be called passionately interesting.
It is to be hoped that we get a three at this eighth, for we shall need
a little cheering before facing the prospect of real, honest hitting at
the next three holes. The ninth is well over four hundred yards long,
and we begin the homeward round with a five-hundred-yarder, or
something very little short of it. It is not a very thrilling hole,
however, and the fourteenth and seventeenth, both good two-shot
holes, are certainly more interesting, and perhaps the best in the
homeward nine.
The whole course is in good order, and the greens thoroughly well
kept, although they are perhaps rather lacking in variety and err on
the side of flatness. The soil is good and light, and that is no small
thing to be thankful for in the very centre of England, when the
nearest seaside golf is as far off as the coast of Wales.
 CHAPTER VIII.
OXFORD AND CAMBRIDGE.

The Universities of Oxford and Cambridge are rich in many things,

but are very decidedly poor in the matter of golf courses. I should be
more precise if I said poor in their own courses, for in Frilford Heath
and Worlington (or as it is often called, Mildenhall) they are lucky to
possess hospitable neighbours, who provide them with very
delightful golf indeed.
The courses of Cambridge I know very well indeed, having played
over them at intervals during the greater part of my life. With those
of Oxford I have only, comparatively speaking, a bowing
acquaintance, founded on the annual match between the University
and the Oxford and Cambridge Golfing Society. Before turning to
Frilford there is a word to be said of Cowley, Radley, and Hinksey,
the latter of which has now ceased to exist. Cowley, so I have heard
my friend Mr. Croome declare, is now rather a good course, and as I
have never seen it, I most certainly will not venture to contradict
him; but I can take my oath as to both Hinksey and Radley that they
call for some other epithet. Hinksey was certainly amusing, and I
have spent some not wholly unpleasant afternoons there squelching
through the mud and trying vainly to hole putts by cannoning off
alternate wormcasts. There was a short hole—the fourth, I think—
where one played a pitching shot into the heart of a wood which
was distinctly entertaining, but on the whole it was not a good test
of golf, or, if it was, then I would rather have my golf tested in some
other way.
When Hinksey ceased to exist Radley came into being, and it is
most decidedly a longer and more difficult course, but I am not
certain that it is such good fun. It is a good deal longer; indeed a
great many of the holes are of a very good length. There is a really
good seventeenth, where one skirts a wood on the right, and
granted a good lie—a thing which rests upon the knees of the gods
—one may hit two really fine shots and get a fine four. I imagine,
however, that no one will be prepared to deny that it is muddy—I
will go so far as to say extremely muddy—and in these days we are
so pampered with beautiful sandy inland courses that we no longer
suffer mud at all gladly. So if we are at Oxford I think we had better
throw economy to the winds and charter a ‘taxi,’ which shall take us
up Cumnor Hill to Frilford Heath.

FRILFORD HEATH
Approaching the ninth green
Frilford is only seven miles from Oxford, but it might be a hundred
miles from anywhere. It lies on a little unfrequented by-road, and is
as utterly rural and peaceful a spot as could be found anywhere.
Here is sand enough and to spare—a wonderful oasis in the desert
of mud. The sand is so near the turf that out of pure exuberance it
breaks out here and there in little eruptions on the surface or flies
up in a miniature sand-storm as the ball alights. The ground is for
the most part very flat, and there are fir trees and whins scattered
here and there. There is also a pretty wood of firs and birches, over
which we have to drive at the third hole, of which more anon. The
greens are a little rough as yet, and some of the bunkers have still
to be made, or at least had not been made when I last played there;
but time alone is wanted to make Frilford a very fine course indeed.
It is already a wonderfully charming one.
The first two holes remind one a little of Muirfield, since there is a
stone wall over which a pulled ball will inevitably vanish. The second
is a fine long two-shot hole, and at the first, which is somewhat
shorter, a highly ingenious use has been made of a solitary tree,
which forces the player to drive close to the stone wall if he is to
have an open approach. Then comes the third before mentioned,
which is a one-shot hole. The wood rises pretty steeply in front of
the tee, and the shot is made the more difficult because a cleek is
hardly long enough, and so we have to take a wooden club. Many a
shot that would under ordinary circumstances fill us with a mild
degree of conceit will only send the ball crashing into the forest. It is
no hole for the ‘low raker’ which we regard with complacency at
Hoylake and St. Andrews. We must hit a fine high towering shot,
and then we may hope to find our ball on the green—a pretty little
green which nestles close under the lee of the wood on the far side.
After this come some long open holes in a country of scattered whin
bushes. Exactly how long they are I am not prepared to say. I played
them in the company of Mr. A.J. Evans, and he appeared to regard
them justifiably enough as two-shot holes, but personally I found
myself taking by no means the most lofted of my iron clubs for my
third shot. There is a pretty little pitching hole over a stone wall—the
seventh—which has a flavour of Harlech about it; and the ninth,
which brings us close to the club-house again, is surely one of the
most alarming holes in existence. The drive is simple enough, but
my goodness, what a second! In front of the green is a mountain,
and on either side of the green are deep pits, towards which the
ground ‘draws’ most unmistakably. Then the green itself is quite
small, and has in its centre a copy of the aforesaid mountain in
miniature. The approach shot, moreover, is by no means a short
one, but is for the ordinary driver a good firm iron shot, so that a
four is really an epoch-making score for the hole.
After the turn it seems to me that the golf shows a distinct falling
off. The holes are still long enough and difficult enough, and Mr.
Evans still seemed to require one stroke less to reach the green than
I did, but for the most part they lack the indefinable charm of the
first nine. There is, however, certainly one exception to this general
criticism, and that is the really fascinating seventeenth, which is
emphatically the right hole in the right place. There is a wood and a
stone wall to carry, and the angle at which we play is such that there
is a very real reward for the long ball which is judiciously hooked. A
good as opposed to an ordinary drive may make all the difference
between a four and a five, for the green is full of undulations, and
the nearer we are to it when we take our iron in hand the better.
Taking it altogether the golf is both good and difficult, and besides
that Frilford is essentially one of those places where it is good to be
alive with a golf club in one’s hand—even if one uses it indifferently
—and whither one looks forward to returning with a very keen
enjoyment.
The undergraduates of Cambridge, when they have not the time to
go to Worlington, now play golf at Coton, a pleasant little village
enough that lies off the Madingley Road. I must spare a word or
two, however, for the old course at Coldham Common, because I
am quite sure that it was the worst course I have ever seen, and
many others would probably award it a like distinction. The way to
Coldham was suggestive of the pleasures that awaited one there, for
it led down that most depressing of Cambridge streets, the
Newmarket Road, and through the most unattractive slums of
Barnwell. After voyaging for some distance along the Newmarket
Road, one turned down a particularly black and odorous lane,
crossed a railway bridge, and reached a flat, muddy expanse of
grass, of which the only features were a railway line and some rifle
butts. I should also perhaps include among its features a particularly
pungent smell, which we always believed—I know not with how
much truth—to proceed from the boiling down of deceased horses
into glue.
On arriving outside the precincts of the club-house one was at once
surrounded and nearly swept from one’s legs by a yelling mob of
caddies of most villainous appearance, who were supposed, quite
erroneously, to be under the control of a well-meaning but
deservedly superannuated policeman. Anyone who played there
regularly soon found himself made over, body and soul, to one of
these ruffians, and then exchanged the solicitations of the general
mob for the unceasing importunities of his own particular henchman
in the matter of cast-off clothing.
In addition to the regular corps of caddies there was an irregular
body of younger depredators who had no official position, and
earned a precarious livelihood by stealing or retrieving balls. They
enjoyed considerable opportunities, because there were on the
Common a good many muddy ditches—the only natural hazards—
and along the edges of these ditches the youth of Barnwell took up
strategic positions at stated intervals. Sometimes considerations of
policy dictated that they should retrieve the errant ball, and return it
to its owner for a penny. Sometimes they would dexterously stamp
the ball into the mud, pretend to hunt for it with a great show of
energy, and pocket it at their leisure when the owner had
abandoned the search. This was an easy matter enough, for the
mud was of the softest and thickest, and the ball would frequently
bury itself on alighting without any help from the human foot. How
our visitors from Blackheath and Yarmouth could bear it I now find a
difficulty in understanding, and it says much for their enthusiasm
and friendliness that they came to play against us year after year.
They put up with it manfully, and very jolly matches we used to
have. Indeed, to quote J.K.S., “the smile on my face is a mask for
tears,” and I could almost wish to strike another ball at Coldham. I
must admit to having enjoyed myself very much there, almost as
much as on another course of woeful greens and superlative
muddiness—the old Athens course at Eton.
Coton I do not know well, but though an enthusiastic captain of
Cambridge once told me that the greens were as good as the best
seaside ones, I am disposed to think he was romancing. There is
another flourishing course on the Gog-Magog hills, where there is at
least a charming view, and twelve or thirteen miles away is Royston.
Here there is a truly splendid view over miles and miles of the flat
country, for the course lies on a piece of breezy downland perched
high above its surroundings. A very jolly place it is whereon to play
golf, though the golf perhaps is not of the highest class. It is a
course of steep hills and deep gullies, and there is much climbing to
be done and much putting on perplexing slopes. Some of these
gullies form wonderful natural amphitheatres, and I always like to
think that in one of them was fought the battle for the championship
of England between Peter Crawley, the ‘Young Rump Steak,’ and Jem
Ward, ‘the Black Diamond.’ That the fight took place on Royston
Heath we know from Boxiana, but the exact battlefield has become
obscured by the mists of time.
Better than all these courses, however, is Worlington, the home of
the Royal Worlington and Newmarket Golf Club, who kindly allow the
University to use their course and play their matches there. To get
from Cambridge to Worlington is rather a serious undertaking, for
although the station, Mildenhall, is but a little over twenty miles
away, the progress made by the infrequent trains is of the most
leisurely. Still, we do get there in time, passing poor deserted
Coldham Common on the way, and the golf is good enough to repay
us for all our trouble. Worlington is not unlike Frilford in appearance,
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