Pregnancy: Womb growth restriction (Intrauterine Growth Restriction -IUGR)

Sometimes during pregnancy the unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb.   Delayed growth puts the baby at risk for certain health problems during pregnancy, delivery and after birth. These health problems include: low birth weight, decreased oxygen levels, low blood sugar, low Apgar scores, trouble maintaining body temperature, abnormally high red blood cell count, difficulty handling the stress of vaginal delivery, aspiration of stool passed while in the uterus which can lead to breathing problems and low resistance to infection.   Severe cases can lead to stillbirth or may cause long term growth problems.

The main symptom of IUGR is a small for gestational age baby. Specifically, the baby’s estimated weight is below the 10th percentile — or less than that of 90% of babies of the same gestational age.

Depending on the cause of IUGR, the baby may be small all over or look malnourished. They may be thin and pale and have loose, dry skin. The umbilical cord is often thin and dull instead of thick and shiny.

Not all small babies have a problemIf the mother is small, it may be normal for her baby to be small. 

IUGR has many possible causes. A common cause is a problem with the placenta. The placenta is the tissue that joins the mother and fetus, carrying oxygen and nutrients to the baby and permitting the release of waste products from the baby.

The condition can also occur as the result of certain health problems in the mother, such as:

  • Advanced diabetes
  • Lupus
  • Infections
  • Kidney disease or lung disease
  • Malnutrition or anemia (low red blood cells)
  • Clotting disorders
  • High blood pressure or heart disease
  • Smoking, drinking alcohol, or abusing drugs
  • Other possible causes include chromosomal defects in the baby or multiple gestation (twins, triplets, or more).
  • Additionally, an unborn baby may not get enough oxygen and nutrition from the placenta during pregnancy because of: high altitudes or preeclampsia or eclampsia.

Your obstetrician has many ways to estimate the size of babies during pregnancy. One of the simplest and most common is measuring the distance from the mother’s fundus (the top of the uterus) to the pubic bone. After the 20th week of pregnancy, the measure in centimeters usually corresponds with the number of weeks of pregnancy. A lower than expected measurement may indicate the baby is not growing as it should. There are also other ways to assess your baby’s health which include:

Ultrasound. The main test for checking a baby’s growth in the uterus, ultrasound involves using sound waves to create pictures of the baby. The ultrasound exam lets the doctor see the baby in the uterus with an instrument that is moved over the mother’s abdomen.

An ultrasound can be used to measure the baby’s head and abdomen.  Your obstetrician or health care provider can compare the measurements to growth charts to estimate the baby’s weight. Ultrasound can also be used to determine how much amniotic fluid (liquid that surrounds your baby in the womb) is in the uterus. A low amount of amniotic fluid could indicate a problem.

Doppler flow. Doppler flow is a technique that uses sound waves to measure the amount and speed of blood flow through the blood vessels. This test is used to check the flow of blood in the umbilical cord and vessels in the baby’s brain.

Weight checks. Your obstetrician will routinely check and record your weight at every prenatal checkup. Weight gain can be used to measure the growth of your unborn baby.

Fetal monitoring. This test involves placing sensitive electrodes on the mother’s abdomen. The electrodes are held in place by a lightweight stretchable band and attached to a monitor. The sensors measure the rate and pattern of the baby’s heartbeat.

Amniocentesis. In this procedure, a needle is placed through the skin of the mother’s abdomen and into her uterus to withdraw a small amount of amniotic fluid for testing. Tests may detect infection or some chromosomal abnormalities.

The best way to manage Intrauterine growth restriction depends on the severity of growth restriction and how early the problem started in the pregnancy. Generally, the earlier growth restriction begins and the more severe it is, the greater the risk to the unborn baby. Careful monitoring of  the unborn baby, using tests such as ultrasound, Doppler flow, and fetal monitoring, may be helpful.

Although it is not possible to reverse intrauterine growth restriction, there are ways to help slow or minimize the effects.

  • Improve nutrition: Some studies have shown that increasing the mother’s nutrition may increase the baby’s weight gain and growth in the uterus.
  • Bed Rest: Bed rest may help improve circulation to your baby.
  • Early delivery or cesarean section( C section): If  the condition puts your baby’s health in danger, the doctor may decide to deliver the baby early. If the doctor believes the baby is too weak for the stresses of labor and delivery, or if the baby has problems during labor, a cesarean section (C section) may be safer.

This condition can occur even when a mother is perfectly healthy.  There are things you can do to reduce risks and increase the odds of a healthy pregnancy and baby.

  • Keep all of your prenatal appointments. Detecting potential problems early allows you treat them early.
  • Be aware of your baby’s movements. A baby who doesn’t move often or who stops moving may have a problem. If you notice changes in your baby’s movement, call your doctor.
  • Discuss your medications with your obstetrician.  Sometimes a medication a mother is taking for another health problem can lead to problems with her unborn baby.
  • Eat healthfully.  Healthy foods and ample calories help keep your baby well nourished. If you are unable to get healthy foods needed, please discuss with your obstetrician as there may be local resources available to help supplement your diet (WIC or other community resources).
  • Get plenty of rest. Rest will help you feel better and it may even help your baby grow. Try to get eight hours of sleep(or more) each night.  Naps for hour or two in the afternoon is also good for you.
  • Practice healthy lifestyle habits. If you drink alcohol, take drugs, or smoke, stop for the health of your baby.


MedlinePlus: Intrauterine Growth Restriction


Shaken Baby Syndrome


Shaken Baby syndrome is a severe form of head injury caused by violently shaking an infant or child. It usually occurs in children younger than 2 years old but may be seen in children up to the age of 5. The violent shaking may result in severe injuries to the infant including permanent brain damage and may cause death.

All of these factors make infants highly vulnerable to whiplash forces:

  • A baby’s head is large and heavy in proportion to his or her body. For this reason, when a baby is dropped or thrown, he or she will tend to land on his head.
  • There is space between the brain and skull to allow for growth and development.
  • Babies’ neck muscles and ligaments are weak and not fully developed.
  • An infant’s skull is soft and pliable

When an infant or toddler is shaken, the skull is not yet strong enough to absorb much force. The force, therefore, is transmitted to the brain, which rebounds against the skull. This can cause bruising of the brain, swelling, pressure, and bleeding.

The large veins along the outside of the brain are also vulnerable and may tear with these injuries. Damage to these veins can lead to further bleeding, swelling, and increased pressure. This can easily cause permanent, severe brain damage or death.

Shaking an infant or small child may cause other injuries, such as damage to the neck, spine, and eyes. Eye damage is very common and may result in loss of vision.

Shaken baby syndrome is seldom an accident. The injuries are almost always caused by non-accidental trauma in other words, child abuse. An angry parent or caregiver may shake a baby to punish or quiet him or her. Many times they do not intend to harm the baby.

In rare instances, these types of injuries may be caused accidentally by actions such as tossing the baby in the air or jogging with the baby in a backpack. Shaken baby syndrome does not result from gentle bouncing or play.


  • Change in behavior, irritability
  • Lethargy, sleepiness
  • Decreased alertness
  • Loss of consciousness
  • Pale or bluish skin
  • Vomiting
  • Convulsions (seizures)
  • Poor feeding
  • Not breathing (apnea)

There are usually no outward physical signs of trauma, such as bruising, bleeding, or swelling. An ophthalmologist examining the infant’s eyes may detect retinal hemorrhage (bleeding behind the eye) or detachment.

First Aid:

  • Call the local emergency number (such as 911). For a severe head injury such as this, immediate emergency treatment is necessary.
  • If the child stops breathing before emergency help arrives, begin CPR.
  • If the child is vomiting:
    • If you don’t suspect a spinal injury, turn his or her head to the side to prevent choking and aspiration.
    • If you suspect a spinal injury, CAREFULLY roll the whole body to the side as one unit (logrolling) while protecting the neck to prevent choking and aspiration.
  • If the child has a convulsion, follow instructions for seizure first aid.

Do Not:

  • DO NOT pick up or shake the child to attempt to wake him or her up.
  • DO NOT attempt to give anything by mouth.

Call immediately for emergency medical assistance if:

  • A child exhibits any of the above signs or symptoms.
  • You suspect a child has sustained this type of injury


  • NEVER shake a baby or child, whether in play or in anger.
  • Do not hold your baby during an argument.
  • If you find yourself becoming annoyed or angry with your baby, put him in the crib and leave the room. Try to calm down. Call someone for support.
  • Call a friend or relative to come and stay with the child if you feel out of control.
  • There are resources available such as a local crisis hotline or child abuse hotline.
  • Seek the help of a counselor and attend parenting classes.
  • Do not ignore the signs if you suspect child abuse in your home or the home of someone you know.

REMEMBER:  Crying is normal for babies.  Crying is one way babies communicate. Excessive crying is a normal phase in infant development;  babies cry most between 2 and 4 months.  Prolonged, inconsolable crying generally lessens when babies are around 5 months old.  Most babies who cry a great deal are healthy and stop crying spontaneously.  You are not a bad parent if your baby continues to cry after you have done all you can to calm him or her.  Remember, this will get better.

When a baby cries, there are steps you can take to try to comfort him or her.  First, check for signs of illness or discomfort like a dirty diaper, diaper rash, teething, fever, or tight clothing.  Maybe your baby hungry or needs to be burped. Rub his/her back, gently rocking him/her; offer a pacifier; sing or talk; take a walk using a stroller or a drive in a properly secured car seat. Call the doctor if you think the child is ill.

REMEMBER when you feel frustrated, angry, or stressed while caring for your baby, take a break. Call a friend, relative, neighbor, or a parent helpline for support. Put your baby in a crib on his or her back, make sure the baby is safe, and then walk away for a bit, checking on him or her every 5 to 10 minutes. Be aware of signs of frustration and anger in yourself and others caring for your baby and call or go to see your health care professional if you have anger management or other behavioral concerns. Also, make sure others caring for your baby see a health care professional if they easily become angry or frustrated around your baby.

It may help to think of this as the Period of PURPLE Crying® as defined by the National Center for Shaken Baby Syndrome (NCSBS). PURPLE, stands for: Peak Pattern: Crying peaks around 2 months, then decreases. Unpredictable: Crying for long periods can come and go for no reason. Resistant to Soothing: The baby may keep crying for long periods. Pain-like Look on Face. Long Bouts of Crying: Crying can go on for hours. Evening Crying: Baby cries more in the afternoon and evening.  Most importantly, remember things will get better, be patient with yourself and your baby and stay calm!

Preterm Birth during Pregnancy


When a baby is born at least three weeks before a baby’s due date (or less than 37 weeks—full term is 40 weeks) it is called a preterm birth. Important growth and development occur throughout pregnancy—especially in the final months and weeks. Many organ systems, including the brain, lungs, and liver need the final weeks of pregnancy to develop fully.

If you are healthy and you are having a normal pregnancy, current research indicates that delivery should not be scheduled before 39 weeks gestation.  The earlier a baby is born, the more severe his or her health problems are likely to be. Some premature babies require special care and spend weeks or months hospitalized in a neonatal intensive care unit called a neonatal intensive care unit or NICU.

Also, there is a higher risk of serious disability or death the earlier the baby is born. Some problems that a baby born too early may face include: breathing problems, feeding difficulties, vision problems, developmental delay, hearing impairment and cerebral palsy.  Preterm births also may cause emotional and economic burdens for families.

Pregnant women can take important steps to help reduce their risk of preterm birth and improve their general health. These steps are to quit smoking, avoid alcohol, get prenatal care as soon as you think you may be pregnant and throughout the pregnancy and seek medical attention for any warning signs or symptoms of preterm labor.

Even if a woman does everything “right” during pregnancy, she still can have a premature baby. There are some known risk factors for premature birth. For example, one risk factor is having a previous preterm birth. Additionally, although most black women give birth at term, on average, black women are about 60% more likely to have a premature baby compared to white women.

Other factors include carrying more than one baby (twins, triplets, or more), problems with the uterus or cervix, chronic health problems such as high blood pressure, diabetes, blood clotting disorders and certain infections during pregnancy.

Although most babies born just a few weeks early do well and have no health issues, some do have more health problems than full term babies. For example, a baby born at 35 weeks is more likely to have jaundice, breathing problems and have to stay longer in the hospital.

In most cases, preterm labor begins unexpectedly and with no known cause. It’s important to seek care if you think you might be having preterm labor, because your doctor may be able to help you and your baby. Warning signs include contractions every 10 minutes or more often, change in your vaginal discharge (leaking fluid or bleeding from the vagina), pelvic pressure, low, dull backache, cramps that feel like menstrual cramps and abdominal cramps with or without diarrhea.

A progesterone medication may prevent preterm birth among women who have had a prior preterm birth.   If you think you are experiencing preterm labor, it is important that you see a doctor right away. If you are having preterm labor, the doctor may be able to give you medicine so that the baby will be healthier at birth.

The Centers for Disease Control and Prevention website provides some helpful information on prevention:

You can also learn more about caring for your of your premature baby from the Healthy Children website sponsored by the American Academy of Pediatrics:

Pregnancy, Stages of Labor and after Delivery

There is no way to determine with any certainty when your labor will start. Due dates are just an estimation and point of reference. It is normal for labor to start as early as three weeks before that date or as late as two weeks after it. The following are signs that labor is probably not far away.

  • Lightening. This occurs when your baby’s head drops down into your pelvis in preparation for delivery. Your belly may look lower and you may find it easier to breathe as your baby no longer crowds your lungs.  You may also feel an increased need to urinate, because your baby is pressing on your bladder. This can occur a few weeks to a few hours from the onset of labor.
  • Bloody show. A blood-tinged or brownish discharge from your cervix is the released mucus plug that has sealed off the womb from infection. This can occur days before or at the onset of labor.
  • Ruptured membranes. When the membrane holding the amniotic sac that surrounded 19182and protected your baby ruptures you will have a gush of water or fluid leaking from your vagina. This can occur hours before labor starts or during labor. Most women go into labor within 24 hours. Your obstetrician may need to induce labor  if it does not  occur naturally during this time frame to prevent infections and delivery complications.
  • Contractions. Although it’s not unusual to experience periodic, irregular contractions (uterine muscle spasms) as your labor nears, contractions that occur at intervals of less than 10 minutes are usually an indication that labor has begun.

diagram-stages-of-labor-and-delivery (1)

Stage 1. During this stage of labor contractions are frequent helping your cervix to dilate so your baby can pass through the birth canal. Discomfort at this stage is still minimal. Your cervix will begin to dilate and efface, or thin out. If your contractions are regular, you will probably be admitted to the hospital during this stage and have frequent pelvic exams to determine how much the cervix is dilated. As the cervix begins to dilate more rapidly you may feel pain or pressure in your back or abdomen during each contraction. You may also feel the urge to push or bear down, but your doctor will ask you to wait until your cervix is completely open. As your cervix fully dilates to 10 centimeters, contractions are very strong, painful, and frequent, coming every three to four minutes and lasting from 60 to 90 seconds.

Stage 2. Stage 2 begins when the cervix is completely opened. At this point, your doctor will give you the OK to push. Your pushing, along with the force of your contractions, will propel your baby through the birth canal. The fontanels (soft spots) on your baby’s head allow it to fit through the narrow canal. Your baby’s head crowns when the widest part of it reaches the vaginal opening. As soon as your baby’s head comes out, your doctor will suction amniotic fluid, blood, and mucus from his or her nose and mouth. You will continue to push to help deliver the baby’s shoulders and body. Once your baby is delivered, the umbilical cord is clamped and cut. 

Stage 3. After your baby is delivered, you enter the final stage of labor. In this stage, you deliver the placenta, the organ that nourished your baby inside the womb.

Each woman and each labor is different. The amount of time spent in each stage of delivery will vary. If this is your first pregnancy, labor and delivery usually lasts about 12 to 14 hours; subsequent pregnancies usually are shorter periods of time.

Just as the amount of time in labor varies, the amount of pain women experience is different, too. The position and size of your baby and strength of your contractions can influence pain, as well.  Discuss with your obstetrician methods to control pain during labor.

After you deliver your baby your body will go through transitions as you recover from childbirth. Emotionally you may experience irritability, sadness, or crying, commonly referred to as the “baby blues,” in the days or weeks after delivery. These symptoms occur in up to 80% of new mothers and may be related to physical changes (including hormone changes and exhaustion) and your emotional adjustment to the responsibilities of caring for a newborn. If these problems persist, inform your doctor or other health professional right away;  as you could be experiencing postpartum depression, a more serious problem that affects between 10% and 25% of new mothers.

If you need to have an episiotomy (cut made by your doctor in the area between the vagina and the anus) to help deliver the baby or prevent tearing or if the area was torn during birth, the stitches may make walking or sitting difficult. Ibuprofen or acetaminophen can help ease the pain. (Don’t take aspirin if you’re breastfeeding.) In some cases, particularly if you have an extensive tear, you may need prescription pain medication for relief.   Shortly after you give birth, you will be able to start taking warm soaks in the tub or in a sitz bath for 20 minutes three times a day.  Doing Kegel exercises will help to restore muscle tone, stimulate circulation, and speed healing. It’s important that you drink plenty of fluids and make sure to get enough roughage in your diet.  Hemorrhoids (swollen varicose veins in the anal area) are common after pregnancy and delivery as well as constipation. Hemorrhoids, episiotomies, and sore muscles can cause discomfort with bowel movements.  Stool softeners can help make having a bowel movement easier.

Your breasts may be swollen for several days as your milk comes in. Nursing right away in the hospital will help to decrease your discomfort and help you to bond with your baby. While nursing your baby you may experience contractions, after giving birth you will continue to experience contractions for a few days as your uterus returns to its normal size. Nursing your baby helps this process.

The most important thing to remember after you arrive home with your baby is to take it easy, don’t take on any unnecessary chores and if family and friends offer to help cook a meal or go food shopping, let them!  Save your energy for taking care of your baby and yourself, so your body can heal and you can enjoy your time with your baby!

Protecting Your Baby

There’s no greater joy than helping your baby grow up healthy and happy. That’s why most parents choose immunization. Giving your baby the recommended immunizations by age two is the best way to protect your baby from 14 serious diseases, like measles and whooping cough.


Raising a child comes with many decisions. Some are a matter of taste, like what color to paint the nursery. Others are essential, especially when it comes to safety, like baby proofing your home for potential hazards. But, what about the hazards that you can’t see and that can cause serious illness, disability, or even death in young children? Immunization gives you the power to protect your baby.  You may have never seen a case of polio or diphtheria, but they still occur in other countries. All it takes is a plane ride for these diseases to arrive in your community. One example is measles. Measles is not very common in the United States due to vaccination, but it is still common in many parts of the world.    Measles can spread quickly among unvaccinated people. This year, the United States is experiencing a record number of reported measles cases.  Many of these cases have been associated with people who got infected while in the Philippines, where a large outbreak is happening. Most of the measles cases in the United States occurred in people who were not vaccinated or whose vaccination status was unknown.

There are myths/misinformation that has been promoted about immunizations.

MYTH #1: Vaccines aren’t safe. FACT: Vaccines are held to the highest standard of safety. Extensive testing is required by law before a vaccine can be licensed. Once in use, vaccines are continually monitored for safety and effectiveness. The United States currently has the safest, most effective vaccine supply in history.

MYTH #2: Vaccines cause autism. FACT: The clear consensus in the scientific community is that there is no association between vaccination and autism. Research shows autism rates are the same in vaccinated and unvaccinated children. Twenty-three studies have tested hundreds of thousands of children and found no link between autism and vaccines. The American Medical Association, American Academy of Pediatrics, the Institute of Medicine, and World Health Organization have all maintained that there is no connection between vaccines and autism.

MYTH #3: Combination vaccines or multiple vaccines given at the same time are dangerous. FACT: Before combination vaccines are licensed for use, extensive studies are done to ensure safety and effectiveness. Similar studies are done before multiple vaccines are recommended to be given at the same time.  Both practices are safe.

MYTH #4: There is a lot of mercury (thimerosol) in vaccines, which is dangerous. FACT: Extensive research has failed to show any consistent link between thimerosal in vaccines and any health condition including autism.  Thimerosal was removed from all routine child vaccines in 2001.

MYTH #5: We don’t need to vaccinate kids anymore for the same diseases we had as children.  FACT: Recent history continues to demonstrate that when vaccination rates dip in the population, these diseases rebound. Small pox is the only disease that has been eliminated world wide and against which we no longer need to be vaccinated.

MYTH #6: Only children need vaccinations. FACT: Vaccine-preventable diseases continue to be a threat throughout our lives. Adolescents need boosters for many childhood diseases, some college age students need protection from meningitis, adults need vaccines for shingles and pneumonia, and everyone needs the flu vaccine and, especially for those around infants, the pertussis vaccine.

MYTH #7: A “holistic” lifestyle will bolster our immune systems and protect us from disease. FACT: Certainly there are steps we can take to reduce our risk of contracting or getting seriously ill from vaccine preventable diseases, such as washing our hands and maintaining a healthy lifestyle. However, research has shown over and over that vaccination is by far the safest and most effective way to avoid infection with these diseases.

MYTH #8: Only the elderly need to get vaccinated for the flu.  FACT: Everyone 6 months old and older should get the flu vaccine. Flu vaccines are especially important for people who fall within high risk groups, including the elderly, pregnant women, young children, and individuals with certain underlying health conditions. Children are two-to-three times more likely to develop influenza than adults. The H1N1 influenza pandemic was a reminder of how serious influenza can be.  In 2009-2010 infants less than 1 year old had the highest rates of hospitalization from H1N1, and adults 50 and older, with underlying medical conditions, were mostly likely to die from the virus once they were hospitalized.

MYTH #9: Too many vaccines can overwhelm the immune system.  FACT: Before a vaccine is licensed, extensive studies are done to ensure that the vaccine produces an effective immune response and does not overwhelm the immune system when given alone, in combination with other vaccines, or, if necessary, in multiple doses over time. The current schedule of recommended vaccinations for all ages is perfectly safe for the vast majority of the population.

More information on common misconceptions about vaccines can be found at the Centers for Disease Control on vaccines.  Your pediatrician can provide additional information as well about the recommended childhood immunization schedule which is designed to protect infants and children early in life, when they are most vulnerable.








I appreciate the visits to the website and posts.   I still need 10 more women who are 18 year old and older to complete the survey which asks three questions about the HealthePregnancy information I post.   It only takes less than five minutes to answer the questions. Here is the link to the questionnaire for my Doctorate of Nursing Practice project.   Please copy and paste this link into your web browser, then hit enter and the survey will pop up.  Also, if there is any topic of interest you would like more information about, I would be happy to blog it!

Immunizations, Pregnancy and Your Baby

IM1Did you know that your baby gets disease immunity (protection) from you during pregnancy? This immunity will protect your baby from some diseases during the first few months of life, but immunity decreases over time. Babies need to be vaccinated starting at birth to stay protected against 14 serious and potentially life threatening diseases.    All vaccines are tested for safety under the supervision of the FDA. The vaccines are checked for purity, potency and safety, and the FDA and CDC monitor the safety of each vaccine for as long as it is in use.

It is safe, and very important, for a pregnant woman to receive the inactivated flu vaccine.  A pregnant woman who gets the flu is at risk for serious complications and hospitalization. This vaccine can prevent serious illness in the mother during pregnancy. All  women who will be pregnant (any trimester) during the flu season should be offered this vaccine.  If you have an allergy to an ingredient in a vaccine such as eggs in the influenza vaccine, talk to you obstetrician or primary care physician.   A number of vaccines, especially live-virus vaccines, should not be given to pregnant women, because they may be harmful to the baby. (A live-virus vaccine is made using the live strains of a virus.) Some vaccines can be given to the mother in the second or third trimester of pregnancy, while others should only be administered either at least three months before or immediately after the baby is born.

The following vaccines are considered safe to give to women who may be at risk of infection:

·         Hepatitis B: Pregnant women who are at high risk for this disease and have tested negative for the virus can receive this vaccine. It is used to protect the mother and baby against infection both before and after delivery. A series of three doses is required to have immunity. The 2nd and 3rd doses are given 1 and 6 months after the first dose.

·         Influenza (Inactivated)

·         Tetanus/Diphtheria/Pertussis (Tdap): Tdap is recommended during pregnancy,preferably between 27 and 36 weeks’ gestation, to protect baby from whooping cough. If not administered during pregnancy, Tdap should be administered immediately after the birth of your baby.

Whooping Cough (Pertussis): Whooping cough is one of the most common vaccine-preventable diseases in the United States. It is caused by bacteria that spread easily from person to person through personal contact, coughing, and sneezing. It can be very serious for babies and can cause them to stop breathing. Pregnant women should receive a dose of Tdap during each pregnancy, preferably at 27 through 36 weeks – to protect themselves and their baby. In addition, all family members and caregivers (like babysitters or grandparents) of infants should also get vaccinated with Tdap.

Important Vaccines to Consider for Women Planning a Pregnancy

Rubella (German measles): Rubella infection in pregnant women can cause unborn babies to have serious birth defects with devastating, life-long consequences, or even die before birth. Make sure you have a pre-pregnancy blood test to see if you are immune to the disease. Most women were vaccinated as children with the combination measles, mumps, rubella vaccine (MMR) but you should confirm this with your doctor. If you need to get vaccinated for rubella, you should avoid becoming pregnant until one month after receiving the MMR vaccine and, ideally, not until your immunity is confirmed by a blood test.

Many vaccine-preventable diseases, rarely seen in the United States, are still common in other parts of the world. A pregnant woman planning international travel should talk to her obstetrician about vaccines against preventable diseases she may be exposed to while traveling.  Information about travel vaccines can also be found at  the Center For Disease Control’s traveler’s health website at

It is safe for a woman to receive routine vaccines right after giving birth, even while she is breastfeeding. A woman who has not received the vaccine for the prevention of tetanus, diphtheria and pertussis (Tdap) should be vaccinated right after delivery.  This can reduce not only your risk but the risk of your baby as well. Also, if you are not immune to measles, mumps and rubella and/or varicella (chicken pox) your obstetrician may recommend you be vaccinated before leaving the hospital.

Pregnancy is a good time to learn about childhood vaccines. Parents-to-be can learn more about childhood vaccines from the CDC parents guide and review the child and adolescent vaccination schedules. This information can be downloaded and printed at There has been a great deal of misinformation/myths about immunizations and it is important for you to have accurate information about immunizations.



Where should your baby sleep?  The American Academy of Pediatrics (AAP) recommends that babies sleep in the same room as their moms for the first 4-6 months (but not in the same bed- room-sharing without bed-sharing).

Your baby should have his/her own sleep space, separate from yours.   Use a crib that meets current safety standards. The Consumer Product Safety Commission Web site ( has the latest information. Make sure the mattress fits snugly in the crib.  If you cannot afford a crib, call Cribs for Kids ( or 1-888-721-CRIB (2742)) for more information.  Sleeping in a bed, on a couch, in a chair, or a recliner with a baby doubles the risk of sleep-related death; it is best to have a firm sleep surface covered by tight fitting crib sheet.

Safe sleep picture

Do not use pillows, bumper pads or heavy blankets.  Do not keep soft, loose, or fluffy objects or stuffed toys in your baby’s bed. Do not use wedges or anything to help position your baby. These items can cause babies to get caught or suffocate.  The American Academy of Pediatrics says bumper pads in cribs can strangle, suffocate or trap children and there’s no evidence that bumper pads can stop kids from getting hurt.  Babies should always be put on their backs to sleep. This even goes for naps.

Tummy time is important for babies to develop normally. Babies should spend time daily on their tummies when they are awake. They should be watched while they are on their tummies. If your baby falls asleep on his/her tummy- turn him/her to his/her back.  Babies less than 4 months old may get caught in a position that makes it hard for them to breathe. If your baby falls asleep in a car seat or swing, move him/her to a crib or other safe place as soon as possible.

Sudden Infant Death Syndrome (SIDS) means the sudden death of a baby when no cause of death can be found after an autopsy and death investigation is complete. The exact cause of SIDS is not known. SIDS is not caused by vaccinations or vomiting/choking. It is most common in babies between 1 and 4 months old. Some research suggests that there may be problems with the part of the brain that controls breathing. Some babies have a higher risk of dying of SIDS. These include: Premature babies, babies exposed to tobacco smoke and babies exposed to some drugs.

The American Academy of Pediatrics has provided recommendations on a safe sleeping environment that can reduce the risk of all sleep-related infant deaths, including SIDS. Three important additions to the recommendations include:

  • Breastfeeding is recommended and is associated with a reduced risk of SIDS.
  • Infants should be immunized. Evidence suggests that immunization reduces the risk of SIDS by 50 percent.
  • Bumper pads should not be used in cribs. There is no evidence that bumper pads prevent injuries, and there is a potential risk of suffocation, strangulation or entrapment. Keep soft objects or loose bedding out of the crib. This includes pillows, blankets, and bumper pads.  Wedges and positioners should not be used.
  • Always use a firm sleep surface. Car seats and other sitting devices are not recommended for routine sleep.
  • Don’t smoke during pregnancy or after birth.
  • Offer a pacifier at nap time and bedtime.
  • Avoid covering the infant’s head or overheating.
  • Supervised, awake tummy time is recommended daily to facilitate development and minimize the occurrence of positional flat head.