Introduction

Giving birth to a child is one of life’s most intense experiences. And the nine months of pregnancy are an exciting time for many women and their partners. They may find their feelings ranging from joy and hope to worries and fears: How will everything go? Am I doing things right? How will life change once the baby has arrived?

From conception to birth, a woman’s body goes through a number of astonishing changes as it prepares to carry and grow a new life. A new organ, the placenta, is formed to supply the unborn child with everything he or she needs. The woman’s body retains more water, and a larger volume of blood circulates than before. Both of these changes become noticeable early on in the form of increased body weight. The mammary glands in the breasts prepare to produce milk. Connective tissue, ligaments, tendons and muscles become more flexible to allow for natural birth. All of these changes are triggered and maintained by hormones. During pregnancy, the body produces more hormones than it ever will at any other time.

The course of pregnancy

In early pregnancy, the physical changes are hardly noticeable. Skin may appear rosy because of increased circulation of blood. But most pregnant women notice that their body is changing: Many of them feel tired faster, their appetite changes, their breasts feel tender, and they may feel nauseous, especially in the morning (“morning sickness”).

Hormonal changes often influence a woman’s emotions, particularly in the first three months of pregnancy. Women might react more sensitively than they otherwise would, and might change their opinions about some things. And it's not always easy to adjust to the new challenges that lie ahead – especially if the pregnancy wasn't planned.

The second trimester of pregnancy is often the most pleasant for women. Their body has now completely adjusted to the pregnancy, but the size of their belly and their body weight are still not too much of a problem in everyday life. Most women start feeling emotionally balanced again, and some develop a special energy and feel good in their body. At this point the child’s movements are usually quite noticeable.

During the final trimester, the child matures quickly, and gets bigger and heavier. Towards the end of the pregnancy, most women have problems associated with their growing belly, and everyday tasks gradually become more difficult. In the ninth month, the focus of pregnancy shifts to the upcoming birth – women may start feeling more excited about, but also more daunted by, what is about to happen.

Everyday life

Everyday life also changes over the course of a pregnancy: Preparing for the arrival of the new baby takes up quite a bit of time. Most pregnant women gradually start to need more and more time to do everyday tasks, and working women go on maternity leave towards the end of the pregnancy.

It is common for women to pay more attention to their health than they used to. This includes thinking about questions related to nutrition and exercise: What should I eat, and do I need to take dietary supplements? How much weight gain is still considered normal? Can I continue to do sports and, if so, what do I need to consider?

Because alcohol and nicotine can cause serious harm to the unborn child, the vast majority of women don't drink alcohol or smoke during pregnancy. Many women use a planned pregnancy as an occasion to give up smoking. Smoking during pregnancy increases the risk of things like miscarriage, preterm birth and low birth weight.

But it's not always easy for women who smoke to quit, and a lot of them will need help doing so. It's not clear whether nicotine replacement therapy is suitable for pregnant women. Other programs for quitting are probably just as effective.

Pregnancy-related problems

Some women feel fully healthy in pregnancy, and some feel even healthier than ever before. But many have typical problems associated with pregnancy. These tend to change over the months: Nausea is a common problem at the start. Later on, as more weight is gained, problems may include back pain, heartburn, water retention, varicose veins, having to go to the toilet a lot, or sleep problems.

Because these problems are often seen as being associated with a larger positive change, and they usually go away without treatment, most pregnant women cope well with them. And a number of things can be done to relieve pregnancy-related problems.

Illnesses

If women become seriously ill in pregnancy, they nearly always worry about their child as well. When it comes to taking medication, pregnant women do in fact need to be careful. This is also true when it comes to certain infectious diseases that might harm the child.

Some medical conditions, such as pre-eclampsia, only develop during pregnancy. Women who have gestational diabetes are more likely to develop pre-eclampsia. Some pregnant women who have a chronic condition like asthma or diabetes wonder whether they can continue to take their medication. The answer is yes, and it is usually even necessary to do so. For example, not getting enough oxygen during an asthma attack would be more dangerous for the baby than possible drug side effects.

Prenatal examinations

Nowadays, pregnant women receive a lot of medical care. Routine preventive examinations are used to check whether the child is developing normally and if the woman is healthy. In Germany, women who don't have any special risk factors are offered three ultrasound exams during pregnancy. More ultrasounds may be needed later on to look into any irregularities.

In addition to the ultrasound scans and blood tests, urine tests are also done. A test for gestational diabetes is offered, too. In Germany, special maternity guidelines (“Mutterschafts-Richtlinie”) determine what examinations and tests are to be done, and how.

Healthy pregnant women who aren't particularly at risk are often offered other examinations as well, such as prenatal diagnostics. But these aren't always necessary, and the consequences of some of these tests are often not clear. Oversimplifying a bit: In Germany, everything that is medically necessary is covered by statutory health insurers. People who would like to have “more” – like 3D ultrasound images or prenatal diagnostic tests – will need to pay for it themselves.

One of the screening tests offered to pregnant women in Germany is the HIV test (AIDS test). If a pregnant woman is infected, it is almost always possible to protect the child from infection as long as it is detected early enough.

Birth

Towards the end of pregnancy, most women want labor to finally start, but also have mixed feelings about the birth. Even though many women carefully prepare for it, nobody knows what it will actually be like. It's normal to feel at least a little daunted. The course a birth takes can only be planned to a certain degree – for example, how long it will take, how painful it will be, and whether there will be any complications. These things are only clear once the baby is there.

Nowadays there are a number of ways to relieve labor pain. If the pain becomes too bad, medication can help. Local anesthetics are the most effective medications. Some are also suitable if a Cesarean section needs to be performed. These substances don't harm the child.

If the due date has already passed, waiting for childbirth can become a real test of patience. Being one to two weeks late is usually no cause for concern, but after that the risk of health problems in the child increases somewhat. The birth is usually induced two weeks after the due date at the latest.

Children who are born long before their due date often need special care. If there is reason to believe that a baby will be born too early (preterm), the chances of a healthy start to their life can be improved, for example by using medication to help their lungs mature faster.

After the birth

Right after childbirth, tests are done to check on the baby’s general wellbeing and see whether everything is alright. This group of tests is called "U1" in Germany, and it includes checking the baby's heart sounds and pulse. Most babies are born healthy, though.

Within the first two days of the birth, babies who have statutory health insurance can have a "pulse oximetry" screening test free of charge. This test is used to detect serious, but rare, heart problems that can then be treated earlier.

After birth, the mother’s body recovers gradually. It takes a while for everything to heal and for the womb to return to normal. If all goes well, the first few weeks with the new baby can be a special, peaceful and happy time. Many fathers also plan a break from their work to get to know the newborn baby and help support their partner.

In Germany, statutory health insurers cover the costs of help and support from a midwife until the baby is two months old. During the first ten days following the birth, the midwife makes daily calls. A midwife’s advice and active support are a great help for many mothers and their families.

For some time after childbirth, a lot of women weigh more than they did before becoming pregnant. It usually takes about half a year to get back to their original weight. But even if that doesn't happen, the extra weight is usually only a health problem in women who became very overweight during pregnancy. Right after giving birth isn't a good time to try to lose weight. Combining changes in diet with a lot of exercise can help in the long term.

Despite all the joy they may feel about their new baby, the hormonal changes following childbirth – coupled with all the changes in everyday life – can take a real emotional toll on women: Happiness and stress often go hand in hand. Things can easily start to feel overwhelming if women don't get enough help. Some also get the “baby blues,” a short phase of severe mood swings and inexplicable sadness after giving birth. If this sadness lasts longer, it may be a sign of postnatal depression. Then help from outside might be needed.

Baby's first year

In a child's first year of life, a lot of attention is paid to making sure they are growing well and with no problems. One main topic is often food – breastfeeding or the right kind of formula milk in the first few months, and later which baby food. Babies put on weight very quickly, so they also need to eat a lot. But because their stomachs are not yet fully developed, lots of babies often spit up a little milk or food, which can be bothersome, but it's usually not a cause for concern.

Further information

A lot of information (in German) about pregnancy, childbirth, and the time afterwards can be found on the website of the German Federal Centre for Health Education (BZgA), Familienplanung.de. The section on pregnancy provides mothers and fathers with answers to many questions about the course of pregnancy, early childhood development, screening tests, childbirth and the time after birth.

Sources

• Beckermann M, Perl FM. Frauen-Heilkunde und Geburts-Hilfe: Integration von Evidence Based Medicine in eine frauenzentrierte Gynäkologie. Basel: Schwabe; 2004.
• Rath W, Gembruch U, Schmidt S (Ed). Geburtshilfe und Perinatologie: Pränataldiagnostik - Erkrankungen - Entbindung. Stuttgart: Thieme; 2010.

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

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