Many pregnant women worry a little too much about the wrong things, and pay too little attention to issues that can genuinely harm their pregnancy and baby. If you tend toward worrying in the first place, there's plenty of fodder on the internet to keep you on high alert (killer cat litter, toxic sushi, collapsing cribs). Even laid-back moms-to-be may have moments of anxiety when the nurse is searching for the baby's heartbeat on the ultrasound, or when seemingly strange symptoms arise. Add the surge in pregnancy hormones, and you've got a surefire recipe for angst.
But pregnancy risks are generally low—especially for healthy women—and don't warrant a high level of concern on the part of most moms-to-be. That's why we asked experts to provide a reality check on 10 of the things pregnant women worry about most, based on a recent March of Dimes survey (the number beside each worry is the percentage of respondents who reported having that concern). "If you keep reminding yourself of the facts, it will reduce speculation, which in turn reduces worry and stress," says Sari Shepphird, Ph.D., a psychologist in Los Angeles. Also, she says, instead of worrying about things you can't control (that martini you had before you knew you were pregnant), focus on what you do have control over (how much weight you gain during pregnancy).
Here's the bottom line on some of the fears you're likely to face during pregnancy, along with issues you might want to pay more attention to. Plus, we tell you what really counts—the simple things you can do to move past worry and improve your chances of having a healthy pregnancy and baby.
Reality Check: About 97 of every 100 babies born in the U.S. arrive without a major birth defect, such as spina bifida or Down syndrome. That's the optimist's way of viewing the 3 percent risk of delivering a baby who does have one. Plus, many birth defects, such as club foot, webbed toes, and even some heart defects, are minor or very treatable. "Surgical treatments are available nowadays, and many of them are very successful," says Richard Olney, M.D., a clinical geneticist at the National Center on Birth Defects and Developmental Disabilities in Atlanta.
If you're not in a higher-risk group, the chances that you'll have a baby with a birth defect may be even lower: Risk factors include diabetes, epilepsy, smoking, drinking alcohol, and obesity, although for 70 percent of all birth defects, the cause is unknown.
What You Can Do: Act as if you're pregnant as soon as you decide you want a child (or even before—half of all pregnancies in the U.S. are unplanned). "Most structural birth defects occur as early as a week or two after you miss your period," explains Michael Lu, M.D., associate professor of obstetrics and gynecology at the David Geffen School of Medicine at the University of California, Los Angeles. Waiting until you know you're pregnant may be too late to prevent these defects.
Take at least 400 micrograms of folic acid daily to reduce the risk for neural-tube defects, such as spina bifida; eat a healthy, balanced diet; avoid fish that contain mercury; stop drinking alcohol, smoking cigarettes or using recreational or over-the-counter drugs; don't eat undercooked meat or change the cat's litter box (both are possible sources of toxoplasmosis, an infection that can cause birth defects); lose weight, if needed; and make sure your blood sugar levels are normal.
Reality Check: The risk of miscarriage is probably lower than you think. For women younger than 35, it's 10 to 12 percent; for 35- to 39-year-olds, it's 18 percent. (It does rise to 34 percent for women 40 to 44 years old.) But a great many pregnancies are lost so early that a woman never even realizes that she conceived. What's even more reassuring is that by the time you see a heartbeat on an ultrasound (usually by week six or seven), the chance of having a miscarriage drops to less than 5 percent, says Lu.
What You Can Do: Remind yourself that most miscarriages occur because of chromosomal abnormalities that cannot be prevented; research does not show that exercise, sex, or even heavy lifting can cause a miscarriage. One lifestyle caveat: Recent studies have shown that drinking two or more cups of coffee a day may increase your risk, as may contracting certain infections, including sexually transmitted diseases and gum disease.
Reality Check: Everyday stressors like having to work late, getting stuck in traffic, or arguing with your husband are not likely to pose a risk to your pregnancy or your child. But ongoing major stress accompanied by depression (the two often go hand-in-hand) may increase your risk of preterm delivery or having a low-birth-weight baby or a child with long-term behavioral issues.
"If you are impaired in some way by the stress—you aren't able to get along with your co-workers or partner, say—that's when it may have an impact," says Tom O'Connor, Ph.D., a professor of psychiatry and psychology at the University of Rochester Medical Center in New York. "If your stress doesn't reach that level, it may not be significant in terms of pregnancy complications," he says.
What You Can Do: For ongoing stress or depression, see a cognitive behavioral specialist who can teach you coping strategies, such as questioning the anxiety-causing chatter in your head. She can also teach you relaxation exercises and visualization to lower your stress hormone levels. You can even use the breathing exercises taught in childbirth classes. While practicing deep breathing, imagine what concerns you as you're inhaling; then, while exhaling, picture yourself releasing the thought or concern that is on your mind. You can also use a phrase like "let it go" when you breathe out, says Shepphird.
Reality Check: Prematurity is a legitimate concern. However, worrisome as pre-term birth is, the great majority of babies in the U.S. are born after 37 weeks, which is considered full term. An estimated 12 percent are born preterm, which increases their risk of health problems, but keep in mind that 70 percent of them are born between weeks 34 and 37. These so-called "late-term" babies still have increased risks, but they are less vulnerable than the tiniest ones. The biggest risk factors for preterm birth are having had a previous premature delivery, being pregnant with multiples, and having certain uterine or cervical abnormalities. Still, about half of women who deliver prematurely don't fall into any high-risk category.
What You Can Do: Obesity, high blood pressure, and diabetes are risk factors for prematurity, so try to maintain a healthy weight and make sure your blood sugar and blood pressure levels are normal. Avoid smoking, alcohol, and recreational drugs (all are linked to prematurity), get good prenatal care and make sure you have all your necessary immunizations and have any infections (even minor ones) treated promptly, as infections are a leading cause of preterm birth. Ongoing major stress can also trigger preterm labor, so be sure to treat any severe anxiety or depression. Many mood-altering medications are considered safe during pregnancy; ask your doctor which ones might be best for you.
Reality Check: We're not going to tell you labor doesn't hurt—most women rate it as a 7 or 8 out of 10 on the pain scale—but you have options when it comes to easing both your pain and your fear of it. If you want to avoid medication, there's much you can do to reduce the pain and the anxiety surrounding it, such as laboring in a tub of water, changing positions often during labor and practicing relaxation techniques like guided imagery.
Or, you may want to opt for pain meds. If you're worried about the risks, rest assured that today's epidurals are safe and mom-friendly. Though you may have heard that pain medications prolong labor, they don't prolong the first—and longest—stage of labor, and may even shorten it, says Cynthia A. Wong, M.D., a professor of anesthesiology at Northwestern University Feinberg School of Medicine in Chicago. Epidurals do tend to lengthen the shorter "pushing" phase because they dull the otherwise intense urge to push, but there's no convincing evidence that they increase the risk of Cesarean section or low Apgar scores for your newborn.
What You Can Do: First, educate yourself about all your pain-relief options and their risks and benefits. If you are trying to avoid using medication, research suggests that a birthing coach or doula can help you "go natural" by reminding you to breathe, talking you through the stages of labor and reassuring you that nothing is wrong as the pain intensifies. Also learn what to expect, because the unknown can cause more anxiety. "If you know exactly what is causing the pain, it can reduce your anxiety," says Erika Bleiberg, a doula in Glen Ridge, N.J. Anxiety can cause tension, which can make breathing more difficult and the pain worse, she adds. Sign up early for a childbirth course, such as Lamaze, the Bradley Method or HypnoBirthing; classes fill up fast.
Also have a birth plan, but don't make absolute decisions beforehand. "Women get disappointed and feel guilty when they have a plan and things change," Wong says. If you're on the fence and not sure how you'll handle the pain, don't try to be a hero and wait until you can't stand it anymore. It takes at least 20 to 30 minutes between the time you say, "Give me the drugs!" until they've been administered and you feel relief.
Reality check: Most experts recommend avoiding raw fish while pregnant because of the risk of being exposed to bacteria and parasites (these infections are often difficult to treat during pregnancy because some medications can be unsafe). But your actual risk may be quite low. "If sushi chefs are well trained and freeze fish adequately before serving it raw, the risk should be extremely low," says Jeffrey Jones, M.D., of the U.S. Centers for Disease Control and Prevention. The other concern, though, is the mercury in some fish: Tuna can be high in this toxin.
What You Can Do: Rest assured that if you desperately need to quell a sushi craving or you had some sushi before you knew you were pregnant, chances are you're fine. To keep mercury consumption down but still benefit from the healthy omega-3 fatty acids in certain seafood, do not eat more than 6 ounces of fresh tuna a week, but do eat up on things to 12 ounces of canned light tuna or other low-mercury seafood, such as shrimp, wild salmon, catfish, sardines, and anchovies.
Reality Check: You may have heard reality TV star Bethenny Frankel (or even one of your friends or family members) say that breastfeeding was "the hardest thing in the world." The truth is, 90 percent or more of women can successfully breastfeed, given patience, realistic expectations and support. Most women think they will click with the baby right away and breastfeed effortlessly. If they don't, many new moms worry that they have an unsolvable problem. "It takes two to three weeks before the mother and baby really know each other and the milk production matches the baby's needs," says Laura Viehmann, M.D., a pediatrician in Pawtucket, R.I.
What You Can Do: Before you give birth, imagine yourself happily nursing your baby, and have a lactation counselor or doula lined up to provide expert advice if you need it. Also consider visiting a breastfeeding support group before your baby is born. "Women who have seen other women breastfeed are much more able to do so successfully," Viehmann says.
Nipple pain is one of the most common reasons women give up on nursing, but this can be avoided with a good latch-on technique. If you experience even a little pain when nursing, seek help immediately.
Another concern new moms have is that the baby is not getting enough milk, but your expectations may be too high. Newborns only drink about 1 1/2 ounces of milk in the first 24 hours, and only a few ounces a day in the next few days, because you'll produce colostrum— the calorie-dense, nutrient-rich "pre-milk"— before your milk comes in on day four or so.
Finally, try to surround yourself with people who will be positive and supportive of your efforts to breastfeed. "It's a lot harder if you have people around you suggesting that you give the baby a bottle," Viehmann says.
Reality Check: This is a valid concern, especially for the 41 percent of women who gain too much weight during pregnancy and for those who were very overweight before they got pregnant.
What You Can Do: Stick to the Institutes of Medicine guidelines for weight gain during pregnancy and you'll have an easier time taking it off later. If you're normal weight (your body mass index, or BMI, is 18.5 to 24.9), gain 25 to 35 pounds; if you're underweight (BMI less than 18.5), gain 28 to 40 pounds; if you're overweight (BMI 25 to 29.9), gain 15 to 25 pounds; and if you're obese (BMI 30 or higher) gain 11 to 20 pounds, though some experts believe obese women should stay at the low end of that range.
Try to stay active during your pregnancy and start exercising after giving birth as soon as you get the green light from your Ob-Gyn. Studies show that diet and exercise together to 12 ounces of canned light tuna or other low-mercury seafood, such as shrimp, wild salmon, catfish, sardines and anchovies. can help you lose weight postpartum faster than either tactic alone. And breastfeed: Recent research found that if you stay within the prenatal weight-gain guidelines and feed your baby nothing but breast milk for the first six months, you'll likely lose all your pregnancy weight during that time.
Reality Check: There's some evidence that being on your feet all day or having a job that requires heavy lifting may raise your risk of preterm labor, but the research is inconsistent.
What You Can Do: If you're at increased risk for preterm labor, you will be advised to avoid heavy lifting and prolonged standing. Worried about either? Talk to your boss about switching to a job that allows you to sit more or take more frequent seated breaks.
Reality Check: Though it always makes the news when a woman delivers in a taxi or on the bathroom floor, in real life, it's rare. In a study from England, 137 out of 31,140 babies were born before they arrived at a hospital over a five-year period—that's less than a 1 percent chance. If it's your first baby, you should have plenty of time: From the time your cervix is dilated 4 centimeters (when experts say you should head to the hospital) you still face an average of six hours for the first stage of labor (when your cervix dilates to 10 centimeters) plus another two hours of serious pushing, says Siobhan Dolan, M.D., M.P.H., an associate professor of clinical obstetrics and gynecology and women's health at the Albert Einstein College of Medicine in the Bronx, N.Y. If it's your second baby, the first stage of labor usually lasts two to 10 hours.
What You Can Do: Most women don't need to worry about this if they follow the guidelines above. If you had a very quick labor previously or you live far from a hospital, you should check in with your doctor or midwife sooner rather than later, Dolan says.
In the March of Dimes survey, fewer than half of the pregnant women said they were concerned about the following issues, all of which, experts say, pose serious potential risks.
1. Getting an Infection Infections can be more serious during pregnancy and lead to complications such as preterm birth. Even a common urinary tract infection can lead to a dangerous kidney infection and preterm birth when you're pregnant, so see your doctor immediately if you have symptoms of infection, such as fever, inflammation or pain. "Things that you might sit on when you're not pregnant should be addressed more quickly when you are," says Ob-Gyn Siobhan Dolan, M.D., M.P.H.
2. Gaining too much weight A three-state survey found that 41 percent of pregnant women are gaining more than the recommended amount of weight, the U.S. Centers for Disease Control and Prevention reports. Doing so can put you at risk of pregnancy complications, prematurity, birth defects, retaining the weight postpartum, and having an overweight child. Try to eat twice as healthy when you're pregnant, not twice as much.
3. Not exercising enough Only 23 percent of pregnant women get the recommended 30 minutes or more of moderate exercise a day, according to a recent study. Lack of exercise can contribute to excessive weight gain, loss of strength and stamina just when you're going to need them most, and pregnancy complications. If you're not exercising yet, start with leisurely short walks, then gradually increase your speed and walking time.
4. Using home cleaning products Try to avoid using bleach and other strong chemicals or use them only in well-ventilated areas, says Ted Schettler, M.D., science director of the Science and Environmental Health Network and co-author of In Harm's Way: Toxic Threats to Child Development. The same is true for home improvement projects like painting or refinishing. Find nontoxic alternatives whenever possible, and forgo air fresheners, pesticides, and lawn chemicals entirely.
5. Developing gestational diabetes About 6 to 8 percent of pregnant women develop gestational diabetes, which can raise the risk of serious pregnancy complications, and the numbers are growing. Plus, new research is showing that even expectant moms with borderline gestational diabetes—elevated blood sugar levels that are below the current cutoff point—have an increased risk of complications like preeclampsia, preterm delivery, having a too-large baby, and needing a C-section. Exercise regularly, watch your sugar intake, and cut back if you've been diagnosed or told your blood sugar is elevated.