Pregnant moms giving birth

What happens to your body during childbirth

Childbirth is challenging and complications occur, but women's bodies are designed to give birth. The shape of the pelvis, hormones, powerful muscles and more all work together to help you bring your baby into the world - before, during and after childbirth.

How your body prepares for labour

Here are some of the ways your body will prepare both you and your baby for the birth ahead.

Braxton Hicks contractions

In the weeks or days before you start having proper contractions, you may experience Braxton Hicks contractions. This is your uterus tightening then relaxing. These contractions don't usually hurt and are thought to help your uterus and cervix get ready for labour.

Braxton Hicks contractions may become more regular as you get closer to the time of birth, but unlike labour contractions, they don't change the shape of the cervix and are sometimes referred to as 'false labour'. Your midwife can tell you if you're experiencing Braxton Hicks contractions or if you are in labour by doing a vaginal examination to look at your cervix.

Changes to the cervix

As labour gets closer, your cervix softens and becomes thinner, getting ready for the dilation (widening) that will allow the baby to enter the vagina. You may also see a 'show', which is a pinkish plug of mucus, stained with blood.

Engagement

Your baby may move further down your pelvis as the head engages, or sits in place over your cervix, ready for the birth. Some women feel they have more room to breathe after the baby has moved down. This is called 'lightening'.

Rupture of the membranes, or 'waters breaking'

Some women find the sac of amniotic fluid containing the baby breaks before labour, contractions start and the fluid runs (or gushes) out of the vagina. This is referred to as rupture of the membranes, or 'waters breaking'.

Let your maternity team know when your waters have broken and take notice of the colour of the fluid. It is usually light yellow. If it is green or red, tell your maternity team since this could mean the baby is having problems.

If your waters have broken but you have not started having regular contractions within 24 hours, you may need your labour to be induced because there is a risk of infection. Your midwife or doctor will talk to you about this.

How will you know when labour has started?

Movies often show women suddenly being struck by painful contractions and rushing to hospital. In real life, many women are not sure if they have actually started their labour.

You may feel restless, have back pain or period-like pain, or stomach disturbances such as diarrhoea.

Labour officially begins with contractions, which start working to open up the cervix. You should phone your midwife when your contractions start, although you probably won't be encouraged to come to the hospital or birthing centre until your contractions are closer together.

In preparation for labour, your baby may move further down your pelvis as the head engages, or sits in place over your cervix.

How the pelvis is designed for childbirth

Your pelvis is located between your hip bones. Women typically have wider, flatter pelvises than men, as well as a wider pelvic cavity (hole) to allow a baby to pass through.

The organs sitting in a woman's pelvis include the uterus, cervix and vagina, which are held together by a group of muscles. During childbirth, the muscles at the top of your uterus press down on the baby's bottom. Your baby's head then presses on your cervix which, along with the release of the hormone oxytocin (see 'How hormones help you give birth', below), brings on contractions. Your cervix should dilate so your baby can pass through it.

Your pelvis has bones and ligaments that move or stretch as the baby travels into the vagina. Your baby also has spaces between the skull bones called 'sutures', and the gaps where the sutures meet on the skull are called fontanelles. This allows for the baby's head to mould as the skull bones meet or overlap, allowing it to fit more easily as it travels through your pelvis.

How hormones help you give birth

Your body produces hormones that trigger changes in your body before, during and after childbirth. Here's how they work to help you deliver your baby.

Prostaglandin Before childbirth, a higher level of prostaglandin will help open the cervix and make your body more receptive to another important hormone, oxytocin.

Oxytocin This hormone causes contractions during labour, as well as the contractions that deliver the placenta after the baby is born. These post-birth contractions, including more that can occur during breastfeeding, help your uterus shrink back to its normal size. Oxytocin and prolactin are the two main hormones that produce and let down breast milk for your baby. Skin-to-skin contact between a mother and baby helps to release more of these hormones.

Relaxin The hormone relaxin helps soften and stretch the cervix for birth, while helping your waters break and stretching the ligaments in your pelvis to allow the baby to come through.

Beta-endorphins During childbirth, this type of endorphin helps with pain relief and can cause you to feel joyful or euphoric.

'Baby blues' After birth, your hormone balance can change again, and this is believed to cause the ‘baby blues’ in some women. You may feel teary, anxious and irritable and your mood can go up and down.

When childbirth doesn’t go to plan

Sometimes, complications can occur before or during childbirth that mean things don’t go as expected.

Sometimes, labour needs to be induced or started. There are a few ways to induce labour, including the mother being offered synthetic prostaglandin. This is inserted into the vagina to soften the cervix and start contractions.

If contractions slow down or stop during labour, the mother may be offered synthetic oxytocin from a drip to increase the contractions. In both these cases contractions can come on strongly and more pain relief may be needed. Your maternity team should explain the benefits and risks of this with you before you agree to it.

The baby could be in a posterior or breech position, not ideally placed above the cervix before the birth. Your maternity team may need to use forceps or a vacuum to help turn the baby or help the baby travel out of the vagina. Sometimes a caesarean is needed.

In rare cases, a mother may experience cephalopelvic disproportion (CPD), which is when the baby’s head is too big to fit through the pelvis. A diagnosis of CPD is usually made when labour hasn’t progressed and synthetic oxytocin has not helped. A caesarean is usually the next step.

More information

If you have any questions about childbirth or pregnancy, you can call Pregnancy, Birth and Baby on 1800 882 436, 7 days a week, to speak to a maternal health nurse.

Learn more here about the development and quality assurance of healthdirect content.

U.S. Black Mothers Die In Childbirth At Three Times The Rate Of White Mothers : NPR

Wanda Irving holds her granddaughter, Soleil, in front of a portrait of Soleil's mother, Shalon, at her home in Sandy Springs, Ga. Wanda is raising Soleil since Shalon died of complications due to hypertension a few weeks after giving birth. Becky Harlan/NPR hide caption

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Becky Harlan/NPR

On a melancholy Saturday this past February, Shalon Irving's "village" — the friends and family she had assembled to support her as a single mother — gathered at a funeral home in a prosperous black neighborhood in southwest Atlanta to say goodbye.

The afternoon light was gray but bright, flooding through tall, arched windows and pouring past white columns, illuminating the flag that covered her casket. Sprays of callas and roses dotted the room like giant corsages, flanking photos from happier times: Shalon in a slinky maternity dress, sprawled across her couch with her puppy; Shalon, sleepy-eyed and cradling the tiny head of her newborn daughter, Soleil. In one portrait, Shalon wore a vibrant smile and the crisp uniform of the Commissioned Corps of the U.S. Public Health Service, where she had been a lieutenant commander. Many of the mourners were similarly attired. Shalon's father, Samuel, surveyed the rows of somber faces from the lectern. "I've never been in a room with so many doctors," he marveled. "... I've never seen so many Ph.D.s."

At 36, Shalon had been part of their elite ranks — an epidemiologist at the Centers for Disease Control and Prevention, the pre-eminent public health institution in the U.S. There she had focused on trying to understand how structural inequality, trauma and violence made people sick. "She wanted to expose how people's limited health options were leading to poor health outcomes," said Rashid Njai, her mentor at the agency. "To kind of uncover and undo the victim-blaming that sometimes happens where it's like, 'Poor people don't care about their health.' " Her Twitter bio declared: "I see inequity wherever it exists, call it by name, and work to eliminate it."

Much of Shalon's research had focused on how childhood experiences affect health later on — examining how kids' lives went off track, searching for ways to make them more resilient. Her discovery in mid-2016 that she was pregnant with her first child had been unexpected and thrilling.

Then the unthinkable happened. Three weeks after giving birth, Shalon collapsed and died from complications of high blood pressure.

The researcher working to eradicate disparities in health access and outcomes had become a symbol of one of the most troublesome health disparities facing black women in the U.S. today: disproportionately high rates of maternal mortality. The main federal agency seeking to understand why so many American women — especially black women — die, or nearly die from complications of pregnancy and childbirth had lost one of its own.

Even Shalon's many advantages — her B.A. in sociology, her two master's degrees and dual-subject Ph.D., her gold-plated insurance and rock-solid support system — had not been enough to ensure her survival. If a village this powerful hadn't been able to protect her, was any black woman safe?

The sadness in the chapel was crushing. Shalon's long-divorced parents had already buried both their sons; she had been their last remaining child. Wanda Irving had been especially close to her daughter — role model, traveling companion, emotional touchstone. She sat in the front row in a black suit and veiled hat, her face a portrait of unfathomable grief. Sometimes she held Soleil, fussing with her pink blanket. Sometimes Samuel held Soleil, or one of Shalon's friends.

A few of Shalon's villagers rose to pay tribute; others sat quietly, poring through their funeral programs. Daniel Sellers, Shalon's cousin from Ohio and the baby's godfather, spoke for all of them when he promised Wanda that she would not have to raise her only grandchild alone.

Soleil, nearly a year old, at home. Becky Harlan/NPR hide caption

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Becky Harlan/NPR

Soleil, nearly a year old, at home.

Becky Harlan/NPR

"People say to me, 'She won't know her mother.' That's not true," Sellers said. "Her mother is in each and every one of you, each and every one of us. ... This child is a gift to us. When you remember this child, you remember the love that God has pushed down through her for all of us. Soleil is our gift."

The memorial service drew to a close, the bugle strains of taps as plaintive as a howl. Two members of the U. S. Honor Guard removed the flag from Shalon's coffin and held it aloft. Then they folded it into a precise triangle small enough for Wanda and Samuel to hold next to their hearts.

Racial disparity across incomes

In recent years, as high rates of maternal mortality in the U.S. have alarmed researchers, one statistic has been especially concerning. According to the CDC, black mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women's health. Put another way, a black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but 243 percent more likely to die from pregnancy- or childbirth-related causes. In a national study of five medical complications that are common causes of maternal death and injury, black women were two to three times more likely to die than white women who had the same condition.

That imbalance has persisted for decades, and in some places, it continues to grow. In New York City, for example, black mothers are 12 times more likely to die than white mothers, according to the most recent data; in 2001-2005, their risk of death was seven times higher. Researchers say that widening gap reflects a dramatic improvement for white women but not for blacks.

The disproportionate toll on African-Americans is the main reason the U.S. maternal mortality rate is so much higher than that of other affluent countries. Black expectant and new mothers in the U.S. die at about the same rate as women in countries such as Mexico and Uzbekistan, the World Health Organization estimates.

What's more, even relatively well-off black women like Shalon Irving die and nearly die at higher rates than whites. Again, New York City offers a startling example: A 2016 analysis of five years of data found that black, college-educated mothers who gave birth in local hospitals were more likely to suffer severe complications of pregnancy or childbirth than white women who never graduated from high school.

The fact that someone with Shalon's social and economic advantages is at higher risk highlights how profound the inequities really are, said Raegan McDonald-Mosley, the chief medical director for Planned Parenthood Federation of America, who met her in graduate school at Johns Hopkins University and was one of her closest friends. "It tells you that you can't educate your way out of this problem. You can't health care-access your way out of this problem. There's something inherently wrong with the system that's not valuing the lives of black women equally to white women."

Raegan McDonald-Mosley was one of Shalon's closest friends. The two used to jog together in Patterson Park, in Baltimore. Ariel Zambelich for ProPublica hide caption

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Ariel Zambelich for ProPublica

Raegan McDonald-Mosley was one of Shalon's closest friends. The two used to jog together in Patterson Park, in Baltimore.

Ariel Zambelich for ProPublica

For much of American history, these types of disparities were largely blamed on blacks' supposed susceptibility to illness — their "mass of imperfections," as one doctor wrote in 1903 — and their own behavior. But now many social scientists and medical researchers agree, the problem isn't race but racism.

The systemic problems start with the type of social inequities that Shalon studied — differing access to healthy food and safe drinking water, safe neighborhoods and good schools, decent jobs and reliable transportation.

Black women are more likely to be uninsured outside of pregnancy, when Medicaid kicks in, and thus more likely to start prenatal care later and to lose coverage in the postpartum period. They are more likely to have chronic conditions such as obesity, diabetes and hypertension that make having a baby more dangerous. The hospitals where they give birth are often the products of historical segregation, lower in quality than those where white mothers deliver, with significantly higher rates of life-threatening complications.

Those problems are amplified by unconscious biases that are embedded in the medical system, affecting quality of care in stark and subtle ways. In the more than 200 stories of African-American mothers that ProPublica and NPR have collected over the past year, the feeling of being devalued and disrespected by medical providers was a constant theme.

There was the new mother in Nebraska with a history of hypertension who couldn't get her doctors to believe she was having a heart attack until she had another one. The young Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. The Arizona mother whose anesthesiologist assumed she smoked marijuana because of the way she did her hair. The Chicago-area businesswoman with a high-risk pregnancy who was so upset at her doctor's attitude that she changed OB/GYNs in her seventh month, only to suffer a fatal postpartum stroke.

Wanda Irving holds a photograph from the funeral of her late daughter Shalon Irving as she goes through a trunk full of her mementos and possessions. She plans to keep the trunk for when her granddaughter Soleil gets older. Becky Harlan/NPR hide caption

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Becky Harlan/NPR

Over and over, black women told of medical providers who equated being African-American with being poor, uneducated, noncompliant and unworthy. "Sometimes you just know in your bones when someone feels contempt for you based on your race," said one Brooklyn, N.Y., woman who took to bringing her white husband or in-laws to every prenatal visit. Hakima Payne, a mother of nine in Kansas City, Mo., who used to be a labor and delivery nurse and still attends births as a midwife-doula, has seen this cultural divide as both patient and caregiver. "The nursing culture is white, middle-class and female, so is largely built around that identity. Anything that doesn't fit that identity is suspect," she said. Payne, who lectures on unconscious bias for professional organizations, recalled "the conversations that took place behind the nurse's station that just made assumptions; a lot of victim-blaming — 'If those people would only do blah, blah, blah, things would be different.' "

In a survey conducted this year by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, 33 percent of black women said that they personally had been discriminated against because of their race when going to a doctor or health clinic, and 21 percent said they have avoided going to a doctor or seeking health care out of concern they would be racially discriminated against.

Black expectant and new mothers frequently said that doctors and nurses didn't take their pain seriously — a phenomenon borne out by numerous studies that show pain is often undertreated in black patients for conditions from appendicitis to cancer. When Patrisse Cullors, a co-founder of the Black Lives Matter movement who has become an activist to improve black maternal care, had an emergency C-section in Los Angeles in March 2016, the surgeon "never explained what he was doing to me," she said. The pain medication didn't work: "My mother basically had to scream at the doctors to give me the proper pain meds."

But it's the discrimination that black women experience in the rest of their lives — the double whammy of race and gender — that may ultimately be the most significant factor in poor maternal outcomes.

Shalon posed in the nursery while pregnant with Soleil. Courtesy of Wanda Irving hide caption

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Courtesy of Wanda Irving

Shalon posed in the nursery while pregnant with Soleil.

Courtesy of Wanda Irving

"It's chronic stress that just happens all the time — there is never a period where there's rest from it. It's everywhere; it's in the air; it's just affecting everything," said Fleda Mask Jackson, an Atlanta researcher who focuses on birth outcomes for middle-class black women.

It's a type of stress for which education and class provide no protection. "When you interview these doctors and lawyers and business executives, when you interview African-American college graduates, it's not like their lives have been a walk in the park," said Michael Lu, a longtime disparities researcher and former head of the Maternal and Child Health Bureau of the Health Resources and Services Administration, the main federal agency funding programs for mothers and infants. "It's the experience of having to work harder than anybody else just to get equal pay and equal respect. It's being followed around when you're shopping at a nice store, or being stopped by the police when you're driving in a nice neighborhood."

An expanding field of research shows that the stress of being a black woman in American society can take a physical toll during pregnancy and childbirth.
Chronic stress "puts the body into overdrive," Lu said. "It's the same idea as if you keep gunning the engine, that sooner or later you're going to wear out the engine."

As women get older, birth outcomes get worse. ... If that happens in the 40s for white women, it actually starts to happen for African-American women in their 30s.

Michael Lu, a disparities researcher and former head of the Maternal and Child Health Bureau of the Health Resources and Services Administration

Arline Geronimus, a professor at the University of Michigan School of Public Health, coined the term "weathering" for stress-induced wear and tear on the body. Weathering "causes a lot of different health vulnerabilities and increases susceptibility to infection," she said, "but also early onset of chronic diseases, in particular, hypertension and diabetes" — conditions that disproportionately affect blacks at much younger ages than whites. Her research even suggests it accelerates aging at the molecular level; in a 2010 study Geronimus and colleagues conducted, the telomeres (chromosomal markers of aging) of black women in their 40s and 50s appeared 7 1/2 years older on average than those of whites.

Weathering has profound implications for pregnancy, the most physiologically complex and emotionally vulnerable time in a woman's life. Stress has been linked to one of the most common and consequential pregnancy complications, preterm birth. Black women are 49 percent more likely than whites to deliver prematurely (and, closely related, black infants are twice as likely as white babies to die before their first birthday). Here again, income and education aren't protective.

The repercussions for the mother's health are also far-reaching. Maternal age is an important risk factor for many severe complications, including pre-eclampsia, or pregnancy-induced hypertension. "As women get older, birth outcomes get worse," Lu said. "If that happens in the 40s for white women, it actually starts to happen for African-American women in their 30s."

This means that for black women, the risks for pregnancy start at an earlier age than many clinicians — and women— realize, and the effects on their bodies may be much greater than for white women. In Geronimus' view, "a black woman of any social class, as early as her mid-20s should be attended to differently."

That's a concept that professional organizations and providers have barely begun to wrap their heads around. "There may be individual doctors or hospitals that are doing it [accounting for the higher risk of black women], but ... there's not much of that going on," Lu said. Should doctors and clinicians be taking into account this added layer of vulnerability? "Yeah," Lu said. "I truly think they should."

A framed photograph of Shalon in uniform hangs on the wall in her home. She worked at the Centers for Disease Control and Prevention in Atlanta, studying how social determinants like food deserts can affect one's health. Becky Harlan/NPR hide caption

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Becky Harlan/NPR

A high-pressure life

Shalon Irving's history is almost a textbook example of the kinds of strains and stresses that make high-achieving black women vulnerable to poor health. The child of two Dartmouth graduates, she grew up in Portland, Ore., where her father's father was pastor of a black church. Even in its current liberal incarnation, Portland is one of the whitest large cities in the U.S., in part a vestige of the state's founding by Confederate sympathizers who wrote exclusion of blacks into their constitution.

Thirty years ago, Portland was a much more uncomfortable place to be black. African-American life there was often characterized by social isolation, which Geronimus' research has shown to be especially stressful. Her father, Samuel Irving, spent years working for the railroad and later for the city but felt his prospects were limited by his race. Her mother, Wanda Irving, held various jobs in marketing and communications, including at the U.S. Forest Service. In elementary school, Shalon was sometimes the only African-American child in her class. "There were many mornings where she would stand outside banging on the door wanting to come back into the house because she didn't want to go to school," her mother recently recalled.

Shalon's strategy for fitting in was to be smarter than everyone else. She read voraciously, wrote a column for a black-owned weekly newspaper, and skipped a grade. Books and writing helped her cope with trauma and sorrow — first the death of her 20-month-old brother Simone in a car accident when she was 6, then the fracturing of her parents' marriage, then the diagnosis of her beloved older brother, Sam III, with a virulent form of early-onset multiple sclerosis when he was 17. Amid all the family troubles, Shalon was funny and driven, with a fierce sense of loyalty and "a moral compass that was amazing," her mother said.

She was also overweight and often anxious, given to daydreaming (as she later put it) about "alternative realities where people hadn't died and things had not been lost." When it came time to go away to college, she chose the historically black Hampton University in Virginia. "She wanted to feel that nurturing environment," Wanda said. "She had had enough."

By then, Shalon had noticed that many of her relatives —her mother's mother, her aunts, her far-flung cousins — had died in their 30s and 40s. Her brother Sam III sardonically joked that the family had a "death gene," but Shalon didn't think that was funny. "She didn't understand why there was such a disparity with other families that had all these long lives," Wanda said. Shalon nagged her father to stop smoking and her mother to lose weight. She set an example, shedding nearly 100 pounds while managing to graduate summa cum laude. At the start of graduate school at Purdue University, she was a svelte 138 pounds, "very classy and elegant, a lot like her mom," said Bianca Pryor, a master's student in consumer behavior who became one of her closest friends.

Bianca Pryor, a Bronx-based consumer behavior researcher, became lifelong friends with Shalon. They were pregnant at the same time. Melissa Bunni Elian for ProPublica hide caption

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Melissa Bunni Elian for ProPublica

Bianca Pryor, a Bronx-based consumer behavior researcher, became lifelong friends with Shalon. They were pregnant at the same time.

Melissa Bunni Elian for ProPublica

West Lafayette, Ind., felt as white as Portland. For support, Shalon relied on a cherished circle of "sister friends," as she called them. "There's this feeling that we're carrying the expectations of generations, the first ones trying to climb the corporate ladder, trying to climb in academe," Pryor said. "There is this idea that we have to work twice as hard as everyone else. But there's also, 'I'm first-generation; I don't know the ropes; I don't how to use my social capital.' There's a bit of shame in that ... this constant checking in with yourself — am I doing this right?"

Much of Shalon's pressure was self-imposed: She was pursuing a double Ph.D. in sociology and gerontology, focusing on themes she would return to often — the long-term effects of early-childhood trauma and maltreatment, the impact of the parent-child relationship on lifelong health. She finished in under five years, once again with highest honors — "one of the best writers I've had in my academic career," her adviser, sociologist Kenneth Ferraro, said.

Next, Shalon decided to pursue a second master's degree, this time from Johns Hopkins. She was also juggling family responsibilities. Wanda had followed Shalon around the country, working in nonprofit management. "They were like the Gilmore Girls," Pryor said. In 2008, Sam III joined them in Baltimore to take part in a study for an experimental MS therapy. With his family's support, he had managed to finish college and run a poetry-slam nonprofit for kids. His next goal was to walk across the stage to receive his diploma instead of using his wheelchair. In February 2009, while he was doing physical rehab to regain strength in his legs, a blood clot traveled to his lung, killing him at the age of 32. Afterward, Wanda and Shalon clung to each other more tightly than ever.

Wanda and Shalon were so close, "they were like the Gilmore Girls," one friend said. Courtesy of Wanda Irving hide caption

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Courtesy of Wanda Irving

What Shalon wasn't prepared for was how unfulfilled she was. After Johns Hopkins, she had worked on the front lines helping at-risk infants, teenage girls, and mothers with HIV/AIDS. She was passionate about improving food and housing security to reduce people's risk for high blood pressure and other cardiovascular problems. At the CDC, it bothered her that she rarely met the people behind the data she was analyzing. As a consultant for Michelle Obama's anti-obesity initiative Let's Move! "she might see the numbers, but I don't think she actually saw that little girl or little boy have a healthier lunch," Pryor said.

The stress and frustration triggered the old corrosive self-doubts. But gradually, Shalon saw a way out of the box. She joined the CDC's Division of Violence Prevention, refocusing on issues around trauma and domestic abuse — a mission she saw as "liberating" for African-American women, Wanda said. She started a coaching business called Inclusivity Standard to advise young people from disadvantaged backgrounds who wanted to get into college or grad school and organizations seeking to become more diverse. And she decided to write a self-help book, on the theory that many people in the communities she cared about couldn't afford psychotherapy or didn't trust it. "She was one of those people — one thing is just not enough," said her co-author, Habiba Tran, a therapist and life coach with a multicultural clientele. "One modality is just not enough. One way of [reaching people] is just not enough."

"No words have been created to adequately capture the fear and love and excitement that I feel right now," Shalon, shown here with her puppy, Lady Day, wrote to her daughter. Courtesy of Wanda Irving hide caption

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Courtesy of Wanda Irving

"No words have been created to adequately capture the fear and love and excitement that I feel right now," Shalon, shown here with her puppy, Lady Day, wrote to her daughter.

Courtesy of Wanda Irving

Becoming a mother

Shalon couldn't remember a time when she didn't want to be a mother. But her romantic life had been a "20-year dating debacle," she admitted in the manuscript of her self-help book, in part because "I am deathly scared of heartbreak and disappointment, and letting people in comes with the very real risk of both. "

In 2014, when Shalon was 34, medical problems forced the issue. For years she had been suffering from uterine fibroids — nonmalignant tumors that affect up to 80 percent of black women, leading to heavy menstrual bleeding, anemia and pelvic pain. No one knows what causes fibroids or why blacks are so susceptible. What is known is that the tumors can interfere with fertility — indeed, black women are nearly twice as likely to have infertility problems as whites, and when they undergo treatment, there's much less likelihood that the treatments will succeed. Surgery bought her a little time, but her OB/GYN urged her not to delay getting pregnant much longer.

Shalon had spent her adult years defying stereotypes about black women; now she wrestled with the reality that by embracing single motherhood, she could become one. The financial risk was substantial — she had just purchased a town house in the quiet Sandy Springs area north of Atlanta, and her CDC insurance covered artificial insemination only for wives using their husbands' sperm. In Portland, no one would have blinked an eye at an unmarried professional woman having a child on her own, but in Atlanta, "there is very much a vibe there that things should happen in a certain order," Pryor said. "And Shalon was not having that at all. She was like, 'Nope, this is what it is.' "

The gamble — funded with her parents' help — ended in a series of devastating failures. In September 2015, in the midst of an unsuccessful fertility treatment, Shalon was alarmed to discover that her right arm had become swollen and hard. Doctors found a blood clot and diagnosed her with Factor V Leiden, a genetic mutation that makes blood prone to abnormal clumping. Suddenly a part of the family's medical mystery was solved. Wanda's mother had died of a pulmonary embolism; so had Sam III; so had other members of their extended family. But no one had been tested for the mutation, which is primarily associated with European ancestry. Had they known they carried it, maybe Sam's deadly blood clot could have been prevented. It was a what-if too painful to dwell on.

By April 2016, Shalon had given up. She had a new boyfriend and was on her way to Puerto Rico to help with the CDC'S Zika response, working to prevent the spread of the virus to expectant mothers and their unborn babies. There, she discovered she'd gotten pregnant by accident. Her excitement was tempered by fear that the baby might have contracted Zika, which can cause microcephaly and other birth defects. But a barrage of medical tests confirmed all was well.

More good news: A few weeks later, her friend Pryor learned she was pregnant, too. "All right," she told Shalon, "let's finally go after our rainbows and unicorns! Because for so long it was just dark clouds and rain."

Bianca and her 1-year-old son, Everton, in her Bronx, N.Y., apartment. Bianca had her own pregnancy emergency; Everton was born at just 24 weeks. Melissa Bunni Elian for ProPublica hide caption

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Melissa Bunni Elian for ProPublica

Bianca and her 1-year-old son, Everton, in her Bronx, N. Y., apartment. Bianca had her own pregnancy emergency; Everton was born at just 24 weeks.

Melissa Bunni Elian for ProPublica

In reality, Shalon's many risk factors — including her clotting disorder, her fibroid surgery, the 36 years of wear and tear on her telomeres, her weight — boded a challenging nine months. She also had a history of high blood pressure, though it was now under control without medication. "If I was the doctor taking care of her, I'd be like, 'Oh, this is going to be a tough one,' " her OB/GYN friend McDonald-Mosley said.

Shalon got through the physical challenges surprisingly well. Her team at Emory University, one of the premier health systems in the South, had no trouble managing her clotting disorder with the blood thinner Lovenox. They worried that scarring from the fibroid surgery could result in a rupture if her uterus stretched too much, so they scheduled a C-section at 37 weeks. At several points, Shalon's blood pressure did spike, Wanda said, but doctors ruled out pre-eclampsia and the numbers always fell back to normal.

Wanda blamed stress. There was the painful end to Shalon's romance with her baby's father and her dashed hopes of raising their child together. There were worries about money and panic attacks about the difficulties of being a black single mother in the South in the era of Trayvon Martin and Tamir Rice. Shalon told everyone she was hoping for a girl.

Steeped in research about how social support could buffer against stress and adversity, Shalon joined online groups for single mothers and assembled a stalwart community she could quickly deploy for help. "She was all about the village," Njai, her CDC mentor, said. "She'd say, 'I'm making sure that when I have my baby, the village is activated and ready to go.' "

She poured more of her anxious energy into finishing the first draft of the book. She sent Tran the manuscript on Jan. 2, the day before the planned C-section, then typed one last note to her child. Boy or girl, its nickname would be Sunny, in honor of her brother Sam, her "sunshine." "You will always be my most important accomplishment," she wrote. "No words have been created to adequately capture the fear and love and excitement that I feel right now."

A photograph of Shalon with newborn daughter Soleil and mother Wanda is displayed on a shelf in Shalon's home next to the stuffed monkey that was given to Soleil in the hospital after she was born. Becky Harlan/NPR hide caption

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Becky Harlan/NPR

A photograph of Shalon with newborn daughter Soleil and mother Wanda is displayed on a shelf in Shalon's home next to the stuffed monkey that was given to Soleil in the hospital after she was born.

Becky Harlan/NPR

Sporadic postpartum care

Until recently, much of the discussion about maternal mortality has focused on pregnancy and childbirth. But according to the most recent CDC data, more than half of maternal deaths occur in the postpartum period, and one-third happen seven or more days after delivery. For American women in general, postpartum care can be dangerously inadequate — often no more than a single appointment four to six weeks after going home.

"If you've had a cesarean delivery, if you've had pre-eclampsia, if you've had gestational diabetes or diabetes, if you go home on an anticoagulant — all those women need to be seen significantly sooner than six weeks," said Haywood Brown, a professor at Duke University medical school. Brown has made reforming postpartum care one of his main initiatives as president of the American Congress of Obstetricians and Gynecologists.

The dangers of sporadic postpartum care may be particularly great for black mothers. African-Americans have higher rates of C-section and are more than twice as likely to be readmitted to the hospital in the month following the surgery. They have disproportionate rates of hypertensive disorders and peripartum cardiomyopathy (pregnancy-induced heart failure), two leading killers in the days and weeks after delivery. They're twice as likely as white women to have postpartum depression, which contributes to poor outcomes, but they are much less likely to receive mental health treatment.

If they experience discrimination or disrespect during pregnancy or childbirth, they are more likely to skip postpartum visits to check on their own health (they do keep pediatrician appointments for their babies). In one study published earlier this year, two-thirds of low-income black women never made it to their doctor visit.

Meanwhile, many providers wrongly assume that the risks end when the baby is born — and that women who came through pregnancy and delivery without problems will stay healthy. In the case of black women, providers may not understand their true biological risks or evaluate those risks in a big-picture way. "The maternal experience isn't over right at delivery. All of the due diligence that gets applied during the prenatal period needs to continue into the postpartum period," said Eleni Tsigas, executive director of the Preeclampsia Foundation.

All of the due diligence that gets applied during the prenatal period needs to continue into the postpartum period.

Eleni Tsigas, executive director of the Preeclampsia Foundation

It's not just doctors and nurses who need to think differently. Like a lot of expectant mothers, Shalon had an elaborate plan for how she wanted to give birth, even including what she wanted her surgical team to talk about (nothing political) and who would announce the baby's gender (her mother, not a doctor or nurse). But like most pregnant women, she didn't have a postpartum care plan. "It was just trusting in the system that things were gonna go OK," Wanda said. "And that if something came up, she'd be able to handle it."

The birth was "a beautiful time," Wanda said. Shalon did so well that she persuaded her doctor to let her and Soleil — French for "sun" — leave the hospital after two nights (three or four nights are more typical). Then at home, "things got real," Pryor said. "It was Shalon and her mom trying to figure things out, and the late nights, and trying to get baby on schedule. Shalon was very honest. She told me, 'Friend, this is hard.' "

C-sections have much higher complication rates than vaginal births. In Shalon's case, the trouble — a painful lump on her incision — started a week after she went home. The first doctor she saw, on Jan. 12, said it was nothing, but as she and her mother were leaving his office, they ran into her regular OB/GYN, Elizabeth Collins, whom Shalon trusted completely. Collins took a look and diagnosed a hematoma — blood trapped in layers of healing skin, something that happens in about 1 percent of C-sections. She drained the "fluctuant mass" (as her notes described it), and "copious bloody non-purulent material" poured out from the 1-inch incision. Collins also arranged for a visiting nurse to come by the house every other day to change the dressing.

What troubled the nurse most, though, was Shalon's blood pressure. On Jan. 16 it was 158/100, high enough to raise concerns about postpartum pre-eclampsia, which can lead to seizures and stroke. But Shalon didn't have other symptoms, such as headache or blurred vision. She made an appointment to see the OB/GYN for the next day, then ended up being too overwhelmed to go, the visiting nurse noted on Jan. 18. In that same record, the nurse wrote that Shalon had to change the dressing on her wound "sometimes several times a day due to large amounts of red drainage. This is adding to her stress as a new mom." Her pain was 5 on a scale of 10, preventing her from "sleeping/relaxing." Overall, Shalon told the nurse, "it just doesn't feel right." When the nurse measured her blood pressure on the cuff Shalon kept at home, the reading was 158/112. On the nurse's equipment, the reading was 174/118.

Under current ACOG guidelines, those readings were high enough to warrant more aggressive action, Tsigas said, such as an immediate trip to the doctor for further evaluation, possibly medication, and more careful monitoring. That is especially true for someone with a history of hypertension and multiple other risks. "We need to look holistically at the risk factors irrespective of whether or not she had a diagnosis of pre-eclampsia," Tsigas said. "If somebody has a whole plateful of risk factors, how are you treating them differently?"

"It would have made sense to admit her to the hospital for a complete work-up," including chest X-ray, an echocardiogram to evaluate for heart failure, and titration of her medication to get her blood pressure to normal range, wrote one doctor, a leading expert on postpartum care, who agreed to look at Shalon's records at ProPublica's request but asked not to be identified. The doctor said that the communication about signs of stroke seemed insufficient and that it would be more "common practice" to assess her that day to find out what was wrong.

Instead, Shalon was given an appointment for the next day, Jan. 19, with an OB/GYN at Women's Center at Emory St. Joseph's, which handled her primary care. By then, Shalon's blood pressure had fallen to 130/85 — considered on the high end of normal — and there were "no symptoms concerning for postpartum [pre-eclampsia]," the doctor wrote in his notes. He wrote that Shalon was healing "appropriately" and thought her jumps in blood pressure were likely related to "poor pain control." Wanda and Shalon left feeling more frustrated than ever.

At home over the next couple of days, Wanda noticed that one of Shalon's legs was larger than the other. "She said, 'Yeah, I know, Mom, and my knee hurts, I can't bend it.' "

When McDonald-Mosley looked over the voluminous medical records a few months later, what jumped out at her was the sense that Shalon's caregivers (who declined to comment for this story) didn't seem to think of her as a patient who needed a heightened level of attention, despite the complexity of her pregnancy.

"She had all these risk factors. If you're gonna pick someone who's going to have a problem, it's gonna be her. ... She needs to be treated with caution." The fact that her symptoms defied easy categorization was all the more reason to be vigilant, McDonald-Mosley said. "There were all these opportunities to identify that something was going wrong. To act on them sooner and they were missed. At multiple levels. At multiple parts of the health care system. They were missed."

Shalon's other friends were growing uneasy, too. Pryor had her own pregnancy emergency — her son was born very prematurely, at 24 weeks — so she couldn't be in Atlanta. But she and Shalon talked often by phone. "She knew so much about her body one would think she was an M.D. and not a Ph.D. To hear her be concerned about her legs — that worried me." Pryor encouraged her, " 'Friend, are you getting out of the house? Are you going for your walks?' She told me, 'No, I'm on my chaise lounge, and that's about as much as I can do. ' "

Life coach Tran was so upset at Shalon's condition that she took her frustrations out on her friend. "I was cussing her out. 'Go to the f****** doctor.' She's like, 'I called them. I talked to them. I went to see them. Get off my back.' "

Shalon took this selfie with her father, Samuel, and Soleil on the morning of Jan. 24. Twelve hours later, she collapsed. Courtesy of Wanda Irving hide caption

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Courtesy of Wanda Irving

"There is something wrong"

On the morning of Tuesday, Jan. 24, Shalon took a selfie with her father, who had been visiting for a few days, then sent him to the airport to catch a flight back to Portland. Toward noon, she and Wanda and the baby drove to the Emory Women's Center one more time. This time, Shalon saw a nurse practitioner. "We said, 'Look, there's something wrong here; she's not feeling well,' " Wanda recalled. " 'One leg is larger than the other; she's still gaining weight — 9 pounds in 10 days — the blood pressure is still up. There's gotta be something wrong.' "

The nurse's notes confirmed Shalon had swelling in both legs, with more swelling in the right one. She noted that Shalon had complained of "some mild headaches" but didn't have other worrisome symptoms, like blurred vision. She checked the incision — "warm dry no [sign/symptom] of infection" — and noted Shalon's mental state ("cooperative, appropriate mood & affect, normal judgment").

" 'You guys have to realize she just had a baby. Don't worry about it, things are calming down,' " Wanda recalled the nurse telling them. " 'We'll send her down for an ultrasound to see if she has a clot in her leg.' " Shalon's blood pressure was back up to 163/99, so the nurse also ordered a pre-eclampsia screening.

Both tests came back negative. "So they're saying, 'Well if there's no clots, there's nothing wrong,' " Wanda recalled. As Wanda remembers it, Shalon was insistent: "There is something wrong, I know my body. I don't feel well, my legs are swollen, I'm gaining weight. I'm not voiding. I'm drinking a lot of water, but I'm retaining the water." As Wanda recalls it, the nurse told them, "There is nothing we can do; you just have to wait, give it more time." Before sending Shalon home, the nurse gave her a prescription for the blood pressure medication nifedipine, which is often used to treat pregnancy-related hypertension.

A large, framed photograph of newborn Soleil and mother Shalon hangs in Soleil's nursery. Shalon painted the nursery light blue shortly before Soleil was born. Becky Harlan/NPR hide caption

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Becky Harlan/NPR

A large, framed photograph of newborn Soleil and mother Shalon hangs in Soleil's nursery. Shalon painted the nursery light blue shortly before Soleil was born.

Becky Harlan/NPR

Shalon and Wanda stopped at the pharmacy, then decided to go out to dinner with the baby. While they ate, they talked about a trip Shalon had planned for the three of them to take in just a few weeks. Ever since Sam III had died, Wanda and Shalon had made a point of traveling someplace special on painful anniversaries. To mark his 40th birthday and the eighth anniversary of his death, Shalon had gotten the idea of going to Dubai. ("It's cheap," Shalon had told Wanda. "The money is worth so much more there. It's supposed to be beautiful.") She had long ago purchased their tickets and ordered the baby's passport. Now Wanda was worried — would she be feeling well enough to make such a big trip with an infant? Shalon wasn't willing to give up hope just yet. Wanda recalls her saying, "I'll be fine, I'll be fine. "

They got home and sat in Shalon's bedroom for a while, laughing and playing with the baby. Around 8:30 p.m., Shalon suddenly declared, "I just don't know, Mom, I just don't feel well." She took the blood pressure medication from Wanda and got ready for bed. An hour later, Wanda heard a terrifying gasping noise. Shalon had collapsed.

The news spread quickly among her colleagues at the CDC. William Callaghan, chief of the maternal and infant health branch, recalled in March that his boss, who had visited Shalon at the hospital, called to let him know. "It was a chilling phone call," said Callaghan, one of the nation's leading researchers on maternal mortality. "It certainly takes, in that moment, what I do, it made it very, very, very concrete. ... This was not about data, this was not about whether it was going up or it was going down. It was about this tragic event that happened to this woman, her family."

Northside decided against an autopsy, telling Wanda and Samuel that there was nothing unusual about Shalon's death, they recalled. (The hospital declined to comment.) So Wanda paid $4,500 for an autopsy by the medical examiners in neighboring DeKalb County. The report came back three months later. Noting that Shalon's heart showed signs of damage consistent with hypertension, it attributed her death to complications of high blood pressure.

Soleil plays with her nanny. Becky Harlan/NPR hide caption

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Becky Harlan/NPR

Soleil plays with her nanny.

Becky Harlan/NPR

Raising Soleil

Wanda moved into Shalon's tidy town house to care for Soleil. Even though Shalon's villagers fulfilled their pledges at the memorial service, coming by often to give Wanda a break, the first months were borderline unbearable — the baby was colicky, prone to gastric problems that kept both of them up all night. Wanda's grief was endless, bottomless, but she couldn't let it interfere with her duties to Soleil. "She's the only reason I get up every morning, pretty much," Wanda said.

Eventually the colic went away and Soleil thrived. In June, Wanda and her 5-month-old granddaughter drove to Chattanooga, Tenn., for the annual meeting of U.S. Public Health Service scientists. A new honor — the Shalon Irving Memorial (Junior) Scientist Officer of the Year Award — had been created to celebrate Shalon's legacy, and Wanda had been asked to say a few words. She handed the baby to one of Shalon's CDC colleagues and took the small stage.

"Striving for excellence is a choice," she told the audience through barely suppressed tears. "It is a commitment. ... It's a struggle to become the person you want to be. It's harder than you want. It takes longer than you want. And it takes more out of you than you expected it should."

Shalon personified excellence, Wanda said. "I don't know if Shalon became the woman that she ultimately wanted to be. But I do know that she wanted to be the woman she was."

Wanda holds Soleil's hands as she learns to walk. Becky Harlan/NPR hide caption

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Becky Harlan/NPR

Wanda holds Soleil's hands as she learns to walk.

Becky Harlan/NPR

One Saturday afternoon in October, Wanda received a book that friends of Shalon's from the Epidemic Intelligence Service had compiled, titled Letters to Soleil. She put Soleil on her lap and said, "I'm gonna read you some letters about your mom." One thing Wanda has tried never to do is cry in front of Soleil. But as she began reading the letters, she was sobbing. "And Soleil just kept looking at me — she couldn't understand what was going on. And about a minute later she took my glasses off with her hands and put them down and then laid her head right on my chest and started patting me. Which made me cry all the more."

As Soleil got older, Wanda looked forward to doing the kinds of things with her that Shalon had looked forward to: reading to her, traveling with her, taking her to gymnastics and music classes. "She wanted Soleil to go to Montessori school, so I'm looking for a Montessori school for her," Wanda said. "She wanted her to be christened; we got her christened."

Now 10 months old, Soleil has her mother's eyes, energy and headstrong yet sweet disposition, coming into Wanda's bed every night and waking her early to play. "She'll bite my nose and kick me — 'Nana, time to get up! Time to get up!' That's what keeps me motivated."

A week or so after the memorial service, Wanda came across a letter that Shalon had written to her two years earlier, around the sixth anniversary of Sam III's death. Shalon had left it among the other important items on her computer, trusting that if something ever happened to her, Wanda would find it. The letter reads like a premonition: Shalon was contemplating the prospect of her own premature death — and of her beloved mother having to endure one more unbearable tragedy.

I am sorry that I have left you. On the particular day that I am writing this I have no idea how that may have occurred but know that I would never choose to leave.

I know it seems impossible right now, but please do not let this break you. I want you to be happy and smile. I want you to know that I am being watched after by my brothers and grandma and that we are all watching you. Please try not to cry. Use your energy instead to feel my love through time and space. Nothing can break the bond we have and you will forever be my mommy and I your baby girl!

General information and advice for all pregnant women during the coronavirus pandemic

Information for pregnant women and their families.

This information is not intended to meet your specific individual health care needs based on your medical condition. This information is not a clinical diagnostic of your health condition. If you are concerned about your health or general well-being, we strongly recommend that you contact your healthcare provider if necessary.

General information and advice for all pregnant women during the coronavirus pandemic.

Question: What effect does the coronavirus have on pregnant women?

Generally, pregnant women are not more likely to become seriously ill than other healthy adults if they become infected with the coronavirus. The vast majority of pregnant women are expected to experience only mild or moderate cold/flu symptoms. Cough, fever, shortness of breath, headache, and loss of smell are suspected symptoms of coronavirus infection.

The development of severe complications, such as pneumonia, is more common in older people, people with a weakened immune system, or people with long-term chronic illnesses. So far, there is no evidence that pregnant women who have contracted the coronavirus are at greater risk of developing serious complications than any other healthy person. Our advice remains the same: if you feel that your health is deteriorating or not getting better, you should contact your OB/GYN or antenatal clinic.

Question: What effect will the coronavirus have on my child if I am diagnosed with this infection?

Since this is a very new virus, we are just beginning to learn about it. There is no evidence to suggest an increased risk of miscarriage.

Emerging evidence suggests that transmission from a woman to her baby during pregnancy or childbirth (vertical transmission) is likely. There are two cases reported in which this seems likely, but it is reassuring that both children have been discharged from the hospital and are healthy. In all previously reported cases worldwide, infection was detected at least 30 hours after birth. It is important to emphasize that in all recorded cases of the development of coronavirus in newborns, the child was healthy after birth.

Based on current data, it is considered unlikely that if you are infected with the coronavirus, it will cause developmental problems in your child.

In China, some babies are born prematurely to women with coronavirus symptoms. However, it is not clear whether the coronavirus caused these premature births, or whether the delivery was carried out earlier in accordance with the decision of the doctor, for the benefit of the women's health.

Q: What can I do to reduce my risk of contracting the coronavirus?

The most important thing to do is to follow the general requirements. For pregnant women and other members of their families, this includes:

regular handwashing;

use a tissue when you or someone in your family coughs or sneezes, throw it away and wash your hands;

avoid contact with anyone showing symptoms of coronavirus. These symptoms include high fever and/or cough;

avoid using public transport if possible;

work from home if possible;

avoid going to public places because the infection spreads easily in enclosed spaces;

avoid meeting friends and relatives. Keep in touch using remote technologies such as phone, internet and social media;

Use phone or online services to contact your doctor or other essential services.

Question: I am pregnant, what should I do?

As a precaution, you should follow general medical advice about social distancing.

Stay away from public places and avoid those with symptoms of an acute respiratory infection when going out to buy food, exercise, and visit antenatal clinics.

If you are in your third trimester of pregnancy (more than 28 weeks), you should be especially mindful of social distancing and minimizing any contact with other people.

Q: Do I have to attend my antenatal and postnatal appointments at the antenatal clinic?

Yes. When you are healthy, it is indeed very important that you continue with your scheduled medical visits.

If you have symptoms of a possible coronavirus infection, you should contact your doctor to postpone your routine visits until the end of the isolation period.

If you are currently healthy and have had no complications from previous pregnancies, the following practical advice may be helpful:

If you have a scheduled examination or visit in the coming days, please contact your antenatal clinic to obtain and agree on a plan for your follow-up. Visit times may change.

If you have been advised to attend an examination or make an appointment at an antenatal clinic, it is because the need for this appointment is greater than the risk of contracting the coronavirus. Antenatal care is essential to maintaining a healthy pregnancy, so we strongly encourage you to meet deadlines if you are asked to. If you have any doubts about this, please discuss them with your obstetrician-gynecologist.

Regardless of your personal situation, please consider the following:

Maternity and child health systems are important and have been developed over many years to reduce the chance of complications for women and children. The risk of not attending antenatal care includes harm to you, your baby, or both of you, also in the context of the coronavirus. It is very important that you keep in touch with your antenatal clinic and continue to attend your scheduled appointments when you feel well. If you have any concerns, please contact your OB/GYN doctor, but please note that medical staff are now working at a higher workload.

If you have coronavirus symptoms, please contact your antenatal clinic and they will arrange the right place and time for your visits. You will be asked to come to the doctor's appointment alone or reduce the number of people with you to one. At this time, we ask that children do not accompany you.

You may need to cut back on your prenatal visits. Your obstetrician-gynecologist will tell you about this. We assure you that this change will be made as safely as possible, given the available data on the safe number of visits required. Please do not reduce the number of visits without first agreeing with your doctor.

Q: What should I do if I get a fever or fever or both when I am pregnant?

If you develop a fever or cough, or both, while pregnant, you should contact your doctor for advice on isolation, which you must follow in accordance with current regulations. However, please also be alert to other possible causes of fever during pregnancy. Specifically, these include bladder infections (cystitis) and other conditions. If you have any burning or discomfort when urinating, or any unusual vaginal discharge, or have any concerns about your baby's movements, contact your healthcare provider who can provide further advice.

Q: What should I do if I think I may have or have been exposed to the coronavirus?

You should contact your antenatal clinic to let them know that you have symptoms suggestive of coronavirus, especially if you have an appointment within the next 7 days.

Q: How will I get tested for coronavirus?

The process of diagnosing coronavirus infection is changing rapidly. If you really need to take a test, you will take it just like everyone else, regardless of whether you are pregnant.

Q: What should I do if I test positive for coronavirus?

If your coronavirus test is positive, you should contact the antenatal clinic to inform them of your diagnosis. If you have no symptoms or mild symptoms, you will be advised to recover at home. If you have more severe symptoms, you may be referred to a hospital for treatment.

Question: Can I pass the coronavirus to my child?

Because this is a new virus, there are limited data on caring for women with coronavirus infection when they have just given birth. A small number of infants were diagnosed with coronavirus shortly after birth, so it is possible that infection could have occurred in the womb, but it is not yet known exactly when transmission occurred before or after birth. The medical team will maintain strict infection control measures during your birth process and monitor your baby closely.

Question: Will my child be tested for coronavirus?

If you have a confirmed or suspected coronavirus when your baby is born, doctors who specialize in newborn care (neonatal doctors) will examine your baby and advise you about care, including whether they need to be tested.

Q: Will I be able to breastfeed my baby if I have suspected or confirmed coronavirus?

Yes. There is no evidence that the virus can be carried or transmitted in breast milk. The well-recognized benefits of breastfeeding and the protection it provides to infants outweigh any potential risks of transmission of coronavirus through breast milk. As long as your baby is healthy and does not require neonatal care, you will stay together after delivery.

The main risk of breastfeeding is close contact between you and your baby, because if you cough or sneeze, it may contain droplets that are contaminated with the virus, which leads to infection of the baby after birth.

Discussing the risks and benefits of breastfeeding should take place between you and your neonatologist.

When you or someone else is feeding your baby, the following precautions are recommended:

Wash your hands before touching your baby, pump, or bottles;

avoid coughing or sneezing at your baby while breastfeeding;

consider wearing a mask while breastfeeding;

follow the instructions for cleaning the breast pump after each use;

If you choose to feed your baby with formula or expressed milk, it is recommended that you strictly adhere to the sterilization guidelines. If you express breast milk in the hospital, you should use a special breast pump.

Question: Is there an increased risk for me or my baby after giving birth?

There is no evidence that healthy women who have recently given birth are at increased risk of contracting the coronavirus. The immune system of a recently pregnant woman is considered normal if she does not have other forms of infection or an underlying disease. You should eat well, should exercise moderately and make sure that social distancing is observed. Children, including newborns, do not appear to be at high risk of becoming seriously ill with this virus. However, meticulous hygiene is essential for family members living in the home. Everyone who enters the home should follow standard hygiene precautions, including handwashing, and be careful when handling your child if they have symptoms of any illness, including the coronavirus.

It is very important that your child is eating well and gaining weight, and if you have any concerns please contact your doctor.

Do not delay seeking medical care if you have concerns about your child's health during a pandemic. Call your doctor if your child has a fever, lethargy, irritability, poor appetite, or any other symptoms that may concern you.

Pregnant Dad Syndrome | How to help a pregnant wife

The signs of pregnancy in women are well known to everyone: the stomach grows, strange taste preferences appear, and mood swings occur. Usually during pregnancy, the mother leads a less active lifestyle, sleeps longer and eats more. What is dad doing at this time? As a partner, he often also adjusts to a changed lifestyle. And ... it changes not only inside, but also externally. His general motor activity decreases, nausea occurs in the morning, his tummy grows, drowsiness appears, etc.

Proven is the fact that the hormonal background of the "pregnant dad" is different from the pre-pregnancy state. The amount of testosterone (male hormone) decreases, and the level of estrogen and prolactin (female hormones) increases. Most likely, these changes are secondary, that is, they come after a changed daily routine, the nature of nutrition, and are more common in men who are sensitive, attentive and caring.

Whatever changes happen to your husband, remember that he is also human. He may have his own fears, weaknesses and worries before the upcoming fatherhood. Try to let your husband understand how important he is to you, talk to him about your feelings, consult, confess your love. Spend time together more often, go for walks, go to concerts, exhibitions and visits. Pregnancy is not a disease, but a wonderful state of waiting for a baby. And if two people share it, it's wonderful!
Coping with the difficulties of pregnancy together

The body of each woman is individual, but some changes are observed in almost all expectant mothers. Many of them may have never been experienced by a woman before pregnancy, so they can be worrisome. Some of the changes are spiritual, some are physical. Some are due to the action of hormones, others are the consequences of an increase in the abdomen and body weight.

Here are the most common inconveniences encountered in mid-pregnancy:

• Edema.
• Problems of the gastrointestinal tract: constipation, accumulation of gases, belching, heartburn.
• Varicose disease of the lower extremities.
• Expansion of the veins of the vagina.
• Spasms of calf muscles.
• Back pain.
• Pain in the womb and duck walking.
All these conditions are temporary, but neither doctors nor modern medicines are able to save the expectant mother from them. And, perhaps, only dad can significantly brighten up the life of mom. How?

There are many ways to please a pregnant woman. Here are the 10 most faithful of them:

1. Accompany the woman to the appointment with the doctor and ultrasound
It is pleasant for the expectant mother to realize that her beloved man is nearby, or at least outside the office door, in which she experiences not the most pleasant sensations. She will be able to share her experiences and the news she heard from the doctor with her dad, when they are still fresh and not blocked by the comments of her friends on the phone.

2. Give small gifts regularly
It is not necessary to give a new iPhone, a car or a ring. Even the most modest gift will be a wonderful sign of attention.

3. Giving flowers
Flowers are especially pleasing when they are given just like that, for no reason. Dad can set a recurring reminder on the phone for a specific day of the week.

4. Talk about your love
There are magic words in the world, and of course they are about love.

5. Cook breakfast
Even if a man does not know how to cook at all, he is able to build breakfast - boil eggs, make toast, brew delicious tea. Does not work? Then you can bring your favorite dessert from the restaurant after a business dinner.

6. Invite to a restaurant
It is sometimes useful to take a break from pregnancy. Oddly enough, many women do not want to go to the cinema during pregnancy - it is dark and noisy there. As an option, you can consider going to the theater, to a concert. Or you can just buy a new movie and watch it at home.

7. Massage
Massage your wife - this is the sacred duty of every future dad. Massage technique is not important, gentle touches are important.

8. Help around the house
During pregnancy, mom does not need to breathe dust or carry bags of groceries. Any woman will appreciate the opportunity to take a break from worries if her husband takes on these responsibilities.

9. Forgive breakdowns and tantrums
Change plans every five minutes and demand the impossible? Oh, how familiar! But sometimes a man just needs to agree with a woman so that she immediately changes her mind and acts sensibly.

10. Compliments
Most women get prettier during pregnancy, but they don't even know it! It is in the power of a man to convince a woman how beautiful she is!
Did any of these points get you hooked? Or did you come up with something of your own? Regular evening walks in the park? Shopping trips together? Discussing plans? Don't wait for a man to guess or read this article. Just ask him to do something that will change your pregnant life for the better.
Preparing for childbirth

A woman prepares for childbirth in special courses. Dad can also attend such courses, especially if he is planning a partner birth. But at the same time, many organizational issues lie on it, which you need to think about in advance, even during pregnancy.

• Organization of transportation to the maternity hospital
This is the duty of the Pope. He may not have a car, but it is desirable for him to organize the transportation of his wife to the hospital. How and what car to go? Which route? How quickly can you get to the hospital? Let there be no surprises in this matter for both of you.

• Collection of things for the maternity hospital
In fact, it is necessary to collect not one, but as many as three bags for the maternity hospital - in the maternity block, in the postpartum department and for discharge! And don't forget the documents! The help of the pope will be especially relevant if you have to go to the hospital when the woman has already begun contractions or the water has broken. She is noticeably nervous in this situation, and the composure of a man can do a good job.

• Arrangement of a children's room
Many parents start renovations while they are expecting a child. This is understandable, because the living space needs to be adapted for a new tenant. Repair dust and noise are not very compatible with an interesting situation, so it would be wiser if dad joins the home improvement.

A partner is also a partner in Africa

If the family decides on a partner birth, then this is one situation, but if the mother goes to the birth alone, this does not mean that the father can relax and do nothing. What business could he have? What should he do?
• Be as free from work as possible on the date of delivery and for a few weeks after it
Childbirth is something that concerns all family members and does not happen so often. Despite the fact that the man is not in the hospital, the very fact that he worries about his family, without being distracted by something else, will give the woman in labor strength.

• Stay in touch
Dad needs to take care of topping up his phone and his wife's phone. Before the expected date of birth, you need to regularly charge them, do not forget to turn on the sound. Alas, we often forget about such simple things. Often women are frustrated just because their phone runs out during childbirth, runs out of money on it, or they can't get through to their husband because he's unavailable!

• Be around
A well-known picture is a sleeping husband in a car near the walls of the maternity hospital. Yes, it's still relevant. Although in many maternity hospitals it is already possible to wait in a cafe, in a hall, in a corridor, etc. In any case, the closer the future dad is to the hospital, the better.

• Be ready to help
Sometimes relatives are required to buy something, go somewhere, help make a decision. After the birth, dad's help will also be needed: to bring things for the woman and the child to the postpartum department, buy something from the dowry, organize an extract.

Born - not free

When the time comes to pick up the child and wife from the hospital, dad should be fully armed.

It is not necessary to decorate the walls of the maternity hospital, it is better to prepare the apartment for the arrival of mother and baby. It should at least be clean. A young mother will also appreciate if a bouquet of flowers, balloons and, possibly, a poster (or at least a piece of paper) with a touching inscription will be waiting for her in the apartment. Dad needs to think about how to organize transportation from the hospital home. If you are accompanied by relatives on discharge, who will then go to visit you, you will need to buy a simple treat. Do not plan long feasts. Baby and mom need rest now.

Going to be discharged, dad should not forget women's, children's things, a camera or a video camera. Be sure to buy flowers for the wife and the medical staff!

At the maternity hospital, upon discharge, a woman should be given an exchange card, a certificate from the registry office for registering the child, a sheet with recommendations and conclusions about the baby’s health, indicating the procedures performed and the vaccinations made. The husband needs to check if the wife has forgotten these documents.

Now dads often organize a solemn discharge - balloons that fly into the sky, a limousine, musical accompaniment, professional photography and video filming. Think about whether you want it and whether it will please you. If you answered yes twice, go ahead.
As you can see, pregnancy and childbirth are a lot of things for mom and dad. How to do everything and not forget anything? Write lists! A wife should write to her husband what to do! It's easier for men to navigate. Not all of them know how to take the initiative and can immediately understand the situation. To shrug and say: “But mine didn’t think of it before” - this is not about moms, mom is, first of all, a manager. If this science of managing people is not familiar to you yet, then it's time to start mastering it.
Memo for future dads

How to organize help for a mother with a child after childbirth?

1. Define your male childcare responsibilities and stick to them. The more specific they are, the better. You can bathe the child. You can take the child and nurse him, say from 6 to 8 in the morning, giving the wife a chance to sleep. You can walk with the baby, go grocery shopping, buy diapers and baby water, etc.
2. Choose what appeals to you and suits your daily routine, and do it constantly. Such regularity will allow you to cope with the role of the father at first and give mom time to rest and recover faster after childbirth.
3. You can register a child and receive a birth certificate within 30 days after his birth. In order for your mother not to go to the registry office or the MFC, take these chores on yourself.
4. A newborn person also needs certificates! Don't forget about it! Registration, medical insurance, foreign passport - these are just some of them. But it is still necessary to draw up documents for receiving benefits and, if this is not the first child, maternity capital. It all takes time and effort, do not tear the mother away from the child, do it yourself.
Cut-outs:

Nothing brings two people closer than pregnancy, childbirth, and the birth of a child. After all, it is during this period that it is important for mom and dad to be a team and act together.
If a woman wants a man to help and do something specific during pregnancy, childbirth and after them, then you need to talk about it directly, and not wait for him to guess
In recent years, in many schools for childbirth, separate courses for dads have appeared, that is, mom and dad are preparing for childbirth according to different programs.