For those who want to become pregnant, but haven't yet achieved their goal, there have been great advances in fertility treatments. The knowledge of the risks of those treatments has improved along with the treatments themselves.

Home pregnancy tests allow women now to predict early, and with great reliability, whether or not they are really pregnant in the first place. Several of the leading manufacturers offer tests that are now easier to read (and harder to mis-read). They have tests that are now so sensitive that some women will need to exercise prudence in using them too early, to avoid false positives.

Once pregnancy is confirmed, choosing the right physician and hospital becomes a big concern. But there are so many channels of information today that the choice is made much easier than ever before. Personal recommendation is still hugely important. But the Internet has made finding out information about who is good and who isn't (and what 'good' really means) simple.

Some women choose to forego a regular physician, at least for delivery, and select a midwife instead. These are no longer the wise village elder woman, but trained professionals with close relations with a licensed OB/GYN (OBstetrics and GYNaecology). They have the experience and training to assist in a birth, and often the time to devote exclusive attention to a woman on that critical day.

Women will want to pay close attention to developing a good exercise and nutrition plan during the time of these changes. Maintaining optimal health for both mother and baby is a natural goal. Here again, the information available is top-notch and plentiful. As always, a critical eye is helpful to sort the wheat from the chaff, but there's plenty of wheat around.

An expectant mother will want to plan her pregnancy carefully, including (and especially) that final phase - labor and delivery. She'll want to investigate Lamaze or other training courses. Pain control options, whether to use anesthesia or have a Caesarean, and other issues can be complex. But taking the time to carefully weigh the pros and cons will be high on anyone's list.

Getting information about possible danger signs such as vaginal bleeding, severe cramps and other not-so-common, but still possible, events is a good thing to do. Forewarned is forearmed. With adequate knowledge, most things can be treated to keep potentially serious problems down to minor annoyances.

It sounds like a big course of study - and it is. But mothers have a big incentive to dig in to find the resources they need to handle these big changes. Then, they can start in anew to learn all about parenting.

One of those results from the simple and obvious physical change - a woman's body becomes larger and rounded as the baby increases in size. Weight gain and the space occupied produce a familiar shape. Attitudes over the centuries have evolved, with contemporary views very mixed.

Among some, that change is celebrated, even venerated. It's taken as a sign of life, something to be cheered. Unfortunately, others may - while recognizing its inevitability - regard that change as, at best, a 'necessary evil' of sorts.

The problem, when it is a problem, can be increased - often unwittingly - when a partner makes comments that are interpreted negatively. Sometimes those are interpreted accurately, other times they may be distortions exaggerated by natural hormonal changes. In either case, thinking about attitudes can help one approach the issue more rationally. Knowing what to expect and thinking about possible strategies for addressing it is half the battle.

In general, women with a positive self-image before pregnancy will retain it throughout. But weaknesses in self-esteem, basing it on the wrong foundation, can be exposed during times of radical change, such as pregnancy. That is often found where a woman has attached significance to her appearance to the point of resting her self-esteem on her looks. As those looks change, self-esteem can be affected.

One way to deal with the emotional rollercoaster that comes with changing hormones, restricted physical capacity and a changing body shape is to focus firmly on the positive.

Most mothers report a sense of awe when babies start to move, and rightly so. Reproduction is one of the most astounding facts of human existence. The movement and sounds that fetuses generate are signs of a healthy new life coming into being. Being fully conscious of those events provides opportunities to put marks on the 'great!' side of the ledger. That helps balance out the 'not so great' side.

Another helpful technique, one oriented toward dealing with remarks from others, involves taking them in context. An old saying is 'consider the source', and it contains wisdom. If a machine were to make a rude comment, anyone would dismiss it. When faced with comments made by some people, the same response is warranted. In other cases, it's beneficial to regard some as well-meaning, if perhaps ill-educated. It doesn't pay to put too much weight on comments from such people or events.

There are many factors involved in making the difficult decision between vaginal and Caesarean delivery.

The level of pain experienced isn't simply a matter of being 'tough' or committed to 'natural' childbirth. It can have an effect on the baby's well-being, too. Being in labor for hours on end, enduring painful contractions, carries risks. Stress produces hormones that the baby is exposed to, along with the mother. Contractions can produce harmful effects on the child and mother. Rectal tearing, in which the mother tears rectal tissue from straining, is a potential problem.

Vaginal childbirth carries other risks. Breech birth, wrapped umbilical cords and other conditions - while relatively less common - do occur. Breech, in which the baby's butt is toward the vaginal opening rather than its head, isn't the only other possible position. Intermediate positions happen as well. Tangled umbilical cords can strangle the newborn or cut off oxygen. Forceps deliveries and other techniques are sometimes required in such cases.

In some cases, the baby's head may be so large as to produce vaginal tearing, which extends recovery time. Or it may become lodged in the opening for extended periods, presenting a risk to the baby's life and the mother's well-being. Drugs may be needed to induce vaginal relaxation.

But Caesarean sections come with their own set of risks.

Cutting through the abdominal wall, along with the pelvic muscles and uterus constitutes major surgery. Though the procedure is less painful than vaginal birth, the recovery can be extended, especially since anesthesia is required in this case. A (usually subtle) scar is always produced, which some women may find unattractive or undesirable.

Any drugs used during delivery are taken up by the baby, since it shares fluid with the mother until after birth. Anesthesia, in rare cases, has caused neurological problems for newborns. These can be long lasting.

You'll want to investigate some immediate practical matters, such as whether a physician you are considering is part of your insurance company's list. You'll want to find out whether the doctor has a good relationship with the hospital you intend to use and whether that hospital accepts the same insurance coverage. As part of that research, you'll want to find out whether billing, co-pay and other issues can be handled simply.

You'll want a doctor that is likely to be available when and as you need him or her. The best physician is of no use to you if they can't see you on short notice. Most pregnancies go from start to finish without a hitch, but when a doctor is needed, he or she is generally needed right away. If that person isn't available, they should have a backup you trust in emergency situations.

You should ask any physician you're considering how long they've been in practice, and what their C-section percentage is. Most are between 15-20%. This gives you some idea of their views on risk. You should ask also about their views on the use of anesthesia and other factors surrounding pain control.

Talking to nurses they've worked with (those at the hospital, not the ones employed by the doctor) is a good way to get some opinions. Be sure to ask more than one. Even the best physician won't necessarily be the favorite of every nurse.

You'll want to ensure that the physician you see regularly is the one who will deliver your baby. Avoiding surprises is near the top of any prospective mother's list and a doctor who knows your history personally is essential. And, you'll want to ensure that they will be present during the entire process. Doctors who flit in and out during labor don't inspire confidence during stressful times.

But there are other, less cut and dried topics that you'll want to explore, too.

It's not necessary that the physician be Mister Rogers and a friend to all womankind. But they should treat you with respect and show genuine concern for your welfare. They should be willing to answer questions without being patronizing. You should feel at ease talking to them. That helps build confidence in their medical judgment.

They should be honest with you, without being unfeeling. Given a choice, most mothers would naturally want someone with excellent medical skills. That's absolutely basic. But those skills can be exercised in many ways. Finding a physician that treats you as a complete person, not just a laboratory experiment to be properly completed, will put you more at ease.

Exploring a little bit about their general philosophy is not a bad idea. They don't have to share your religion, your political views or your beliefs in general. But knowing they are someone you can 'work with' on a nearly year-long effort with such a hugely important outcome will make things go much smoother for all concerned.

Early pregnancy nausea and vomiting occurs in about half of pregnant women, beginning about two weeks after the first missed period. This lasts usually no longer than the first trimester, but that can feel like a very long time under these circumstances.

Mild nausea is common, but any extreme condition may be a sign of hyperemesis gravidarum. That can lead to dehydration and electrolyte imbalance. Discuss the possibility with your physician so you can be tested, if needed. Late pregnancy nausea can occur as well, from twisted or obstructed bowels.

Eating small, frequent meals is preferable to larger ones three times per day. Certain fruits can help, such as berries, peaches and cantaloupe. Taking needed liquids between, rather than with, meals is helpful. That will produce less stomach expansion. Avoid carbonated drinks.

Heartburn is another common condition. As a result of hormonal and other changes, the odds of experiencing it are higher during pregnancy. Increased levels of progesterone are thought to be a prime culprit, since it causes loosening of the sphincter, driving acid up into the esophagus. It also slows the emptying of stomach contents, which can be a contributing factor.

Changes in nutrition can help alleviate the problem. Avoid high fat foods, chocolate (yes, that's a tough one to give up) and fried foods. Foods high in raffinose, such as cabbage, broccoli and lettuce should be reduced as they tend to produce gas. Cutting down on caffeine and alcohol and quiting smoking are essential lifestyle changes, at least for the duration.

Common antacids, such as TUMS (also a good source of calcium) are a good idea. Not only is the material helpful, but sucking on them contracts the esophagus, which helps reduce the problem.

Constipation is a common problem, both during and immediately after pregnancy. Medically, constipation is defined as an inability to move the bowels more than three times per week. But most women will regard themselves as constipated if they can't eliminate at least once per day.

The condition can occur from many causes, including psychological ones. If rectal tearing occurred during delivery as a result of straining, the rectum takes a while to heal. Women, many unconsciously, try to hold stool to avoid the pain of defecation. After a C-section the bowel can be temporarily paralyzed, a condition called an 'ileus'.

Walking can help relieve symptoms, since it often eases tension and loosens the bowels. Drinking the right kinds and amounts of fluid will also help. Some vitamin and mineral supplements can be beneficial, such as extra, easily digested calcium. Commercial laxatives should be avoided, but there are special types that physicians sometimes prescribe, such as Docusate.

About two weeks after the first missed period, about half of pregnant women experience nausea. It can occur once per day or almost all day and persists (for some) throughout the first trimester. That can make it difficult to decide when a stomach condition is a serious problem, such as hypertension. Here again, err on the side of caution. Better to appear weak in the eyes of some than to risk the health of your baby.

Severe pelvic or abdominal pain goes beyond what might accompany gastrointestinal upset. In the early months of pregnancy, it may be a sign of a tubal pregnancy. A 'tubal' is a condition in which the fertilized ovum attaches to the fallopian tube rather than further down, in the uterus. Later on, it may signal that the placenta has separated from the uterus.

If you experience this kind of pain, seek attention right away. Only a medical professional can provide the diagnostic experience and tools to get an objective answer. They won't always know with certainty, but your odds are better with them. Don't rely on 'old wives tales'.

Mild fever can occur in pregnancy as it can at any other time. But if the fever rises above 100F (37.8C) it's time to seek attention. Infection or viral illness can cause premature labor and a high fever can put your baby at risk. Don't panic, just get yourself on the phone and discuss the situation with your physician.

Severe headache, swollen eyes or face or blurred vision can be an indicator of toxemia. This occurs when toxic substances are present in the blood stream. Apart from the discomfort, they may well be relatively harmless. The condition may be due to eclampsia, the result of hypertension. The only way to tell is to be tested. Other symptoms include flashing lights in front of the eyes and sharp pains under the rib cage.

After about four to five months, movement from the developing fetus should be common, occurring a few times every hour. Mothers are readily aware of these movements. Any substantial reduction in frequency or persistent lack of movement should be discussed with your doctor. Fetal distress is one possibility, but a correct diagnosis can only be supplied by a professional.

Any kind of vaginal discharge or bleeding should be checked right away, especially if it occurs more than two weeks prior to the due date. After that time, fluid leak may be a sign that your 'water has broken', but have it checked anyway. Any sign of bleeding suggests the possibility that the sac has separated from the uterus. This should be dealt with immediately.

There's a wide variation among women in many aspects of the process. The length of time is different for everyone and from child to child. The amount of pain differs. And the post-birth consequences will vary for each individual person and baby. In 75% of women who carry to term, delivery is within 12 hours. Only 2% will be in labor for more than 24 hours.

During the active delivery phase contractions are frequent, though there are breaks in between. Here that training you spent so many hours to practice kicks in. Proper breathing technique differs between the resting phase and the contraction and pushing phase. Use both.

Drugs are an option but both mothers and physicians try to keep them to a minimum. Anything the mother receives still makes its way into the child. Pain medication crosses the placenta and can slow the baby's heart rate and make breathing sluggish.

Analgesics are enough for most women, but they can produce side effects such as rapid heartbeat or nausea. A regional block may be appropriate for some women. This can offer pain relief without interfering with the ability to push, but it's not for everyone. Hot pads, ice packs and a hand to hold can often substitute for the time needed to get through the toughest phases.

Develop a plan with your physician well in advance to cover all the possibilities.

Transition is the interval during which the cervix dilates the final two centimeters (about an inch). It produces the most intense and frequent contractions, but may last only a few minutes. Rarely is it longer than an hour. Here again, breathing techniques and a good partner are great aids to staying focused and minimizing pain.

Deep breaths are best for those resting periods, short and sharp ones for the period of active pushing. Shallow chest breathing is best for the most intense contractions. This helps keep the blood well oxygenated and the mother focused as well as possible on something other than the pain.

When the widest part of the baby's head has moved into the birth canal, the second stage has begun in earnest. Contractions slow to four or five minutes apart. When the head is even with the lower pelvic bones, it's said to be at '0' station. It will progress through 1, 2, 3, and so on, measured by the baby's exit.

Pregnancy brings many changes. Hormone levels go wild, you gain weight and (later) movement becomes increasingly difficult. Changes in the level of progesterone, estrogen and others produce softening of the ligaments around joints. Strain on internal organs, the back and legs is inevitable. At the same time, you'll put on almost 30 lbs. Go easy.

Sometimes a general malaise sets in. Regular, appropriate exercise can help relieve much of that and help put your body in the best shape possible for labor. That optimizes your comfort and your growing baby's health.

The first step is to adopt a kind of Hippocratic Oath of Pregnancy: First, Do No Harm. That ancient principle from the Greeks is still valid, more so during pregnancy. Some women are used to running five miles, doing every station at the weight machine or performing Pilates an hour a day. That will have to change fairly quickly.

But maintaining a good exercise regimen is still possible, just change your workout to fit your changing body. Eliminate crunches or any other form of exercise that stresses the abdominals or back. Go with lighter weights. Avoid jerky movements and forego squats which can separate the placenta from the uterus.

Breathing properly during exercises performed while pregnant is essential. Correct breathing technique anytime is important, but you're now breathing for two. The baby receives oxygen through the umbilical and keeping the blood fully oxygenated is imperative.

Keep in mind that your resting heartbeat will increase by about 8 beats per minute during the first few weeks. Blood volume increases substantially as you progress. Factor that in when you consider any cardio exercise.

Hydrate at an appropriate amount throughout the day. That means small sips over a longer time frame, rather than large intake at a given time. Eating should follow the same pattern - four to five small meals per day is preferable to three larger ones.

Before beginning a workout, warm up gently. Perform easy stretches and be prepared to rest often for a few minutes at a time. Light cardio is the key to a healthy circulatory system, so important during these months.

Pregnancy shifts your center of gravity forward, stressing the spine and back muscles. To ease that aching back, swimming is one of the best forms of exercises. It also gives a very low stress but active cardio workout.

Yoga is a favorite for many. It helps achieve peace of mind and provides gentle movements that provide the needed stretching, while building good leg and arm strength. It gives also low impact on the back.

With a good program, you'll reduce cramps, improve circulation and increase energy. You'll lower your resting heart rate and keep fit.

If you feel any dizziness, swelling or experience any kind of vaginal bleeding or discharge discontinue at once and consult a medical professional.

False labor is one of the trickiest issues pregnant women have to deal with. Packing the car, rushing to the hospital, disrupting a mate at work and more are all normal parts of delivery. Not generating false alarms is going to be high on anyone's wish list.

The first step is simply to accept an inescapable fact: no one can predict with certainty when labor begins (yet). A due date is nothing more than a best estimate. Those estimates have improved with the greater accuracy of early pregnancy tests, but they are still not 100% reliable.

Only about 5% of women who carry their babies to term actually deliver on the estimated date. Dates vary from a few days to a few weeks before or after. That doesn't mean that delivering early is necessarily delivering prematurely. There is simply a natural variation in how long pregnancy lasts. Due dates are specified for the average, that's all.

There are some signs to look for that labor has begun, however.

During a first pregnancy, babies will often move slightly into the birth canal two to three weeks before the onset of labor. An attentive mother can detect that movement. It may be easier to breathe, due to the shift away from the diaphragm. At the same time, pressure on the bladder may increase, leading to more frequent urination.

Past the first child, this movement may be less pronounced, and will tend to occur much later, sometimes only a few hours before labor begins.

Throughout pregnancy, it's normal to experience contractions. The baby moves, your muscles react. Hormonal changes induce neural events that lead to contraction. These random events don't indicate much. But as the third trimester advances, they can increase in frequency and intensity.

As they come more often and stronger, mothers report they experience heightened energy and may feel compelled to take on projects around the house. Working off some of that energy is a healthy thing, particularly since (as the day approaches) they often just 'want it to be over'.

A small mucus plug that sealed the cervix during pregnancy can stretch and break apart, even before 'water breaks'. This pinkish mucus is a normal discharge. Deep red fluid or blood should be investigated at once as a possible sign of tearing of the placenta from the uterus.

Most experts and women agree that the less medication taken or anesthesia given the better, both for mother and child. When used the amounts are so low that problems are very rare, but anything that enters a woman's bloodstream will affect the child during delivery. Training can help minimize the need.

Preparation well before the onset of labor is the first step. Lamaze or Bradley training is helpful, in order to learn good breathing and relaxation techniques. It's difficult to focus on the process rather than the pain when you're in the moment, but training can get her part way there. Attending with a partner is particularly helpful.

Some training involves learning focusing techniques - zeroing in on the need to push or the progress, rather than the discomfort. Others may emphasize distraction - counting, remembering a specific event clearly and so on. Those who have practiced yoga may find many of the ideas familiar. Several weeks practice before labor begins is a minimum, but there should be no substantial gap in time. Train up to the day.

Physical comfort can be enhanced by a variety of methods. Hot or cold packs can ease cramping. Sipping warm tea or ice water is sometimes helpful. That will need to be kept to a minimum, though. If general anesthesia has to be given, doctors will require minimal liquid intake beforehand. Anesthesia can produce nausea and vomiting. Disgorging under anesthetic is potentially dangerous, since it can lead to choking.

Some hospitals will use tubs of water or even showers to maximize physical and mental comfort during labor. A good soak can ease back tension and aid a sense of well being. Techniques like these don't require any training or practice, just the ability to remember to use them when needed. A partner can help here, too.

Adjust your body as needed during the process. Talk over with your physician in advance his or her working needs and your options. Working together during the process is less stressful if things have been talked out ahead of time.

Still, there are women who experience great pain during birth, and it can vary from one delivery to the next. For those women, a range of medical options are available.

A general pain medication can range from over-the-counter remedies to mild narcotics. It's important to be able to focus and participate during the process, so doctors keep the dosage to a minimum whenever possible. Stronger narcotics to ease pain can be used if necessary.

Local anesthetic is no longer an automatic choice. Studies revolving around the neurological effects on the baby have made doctors and mothers very conservative. But the types and dosages used very rarely present a problem. There's no such thing as zero risk, but the odds are so low that this is a valid option.

A regional block, epidural or spinal, refers not to specific medication but simply the way it's administered. The drug is injected into a space at the base of the spinal column. The purpose is the same: to numb pain in the vaginal and back areas where the pain is most intense. Here again, doctors are cautious but the option is still used safely in thousands of cases every year.