Month Six

Ripening

WEEK TWENTY-FIVE

• Baby is 14 inches and 2 pounds.

WEEK TWENTY-SIX

• Baby is remaining about 14 inches and 2 pounds.

• Baby’s eyes are developing and will open soon.

• He or she continues to practice breathing by taking gulps of amniotic fluid.

WEEK TWENTY-SEVEN

• Baby is holding strong around 14 inches and 2 pounds.

• Lungs are rapidly developing.

WEEK TWENTY-EIGHT

• At the start of your third trimester, baby’s growth remains on par with the last couple of weeks.

• Lungs are fully matured.

• Baby can smell what you’re smelling.

• You can start doing “kick counts” this week (see page 147).

East-West Fetal Development

In Chinese medicine, month six is governed by the Stomach system. The Stomach is paired with the digestive functions of the Spleen that we explored in month five. Where the Spleen is more about what you’re taking in, the Stomach breaks down and uses that material for fuel. From an Eastern and Western point of view, when the Stomach isn’t adequately processing, it rebels and creates symptoms such as acid regurgitation (reflux) and hiccups.

Let’s also remember that baby is starting to physically compress the stomach now. So, there is some inevitable revolt. The best strategy is to eat frequent small meals from here on out and minimize dry, dehydrated foods like crackers, popcorn, and dried fruit, which can leach the moisture out of the stomach and intestines, contributing to constipation, or spicy foods, which can agitate the lining of the stomach and intestines even more.

Third Trimester Checkup

Your six-month checkup will monitor baby’s growth and position and look at the amount of amniotic fluid and the position of the placenta.

Body Art

Fifty percent of body ornamentation is done on women these days. Pre-existing tattoos and piercings, besides potentially becoming distorted if they’re in an area that is growing and stretching, for the most part don’t interfere with pregnancy. Some exceptions are that nipple piercings can impair breastfeeding, and in an emergency, oral piercings may interfere with managing opening an airway. I recommend taking your jewelry out during this period to be extra safe.

There is also some very loose debate about introducing tattoo pigments into other areas of the body during an epidural (this is only relevant for low-back tattoos) and creating the potential for some subsequent health problems, but again, this is a very controversial idea. However, knowing that there’s a potential risk might factor into your decision-making process about having an epidural.

Third Trimester Vaccine Considerations

A current recommendation by the Center for Disease Control (CDC) and American College of Obstetricians and Gynecologists (ACOG) is to get a diphtheria, tetanus, and pertussis (DTaP) vaccine during your third trimester, with the idea that it passes along passive immunity to your newborn. They are usually administered between twenty-seven and thirty-six weeks, because they take a couple of weeks to kick in.

It is worth noting that the CDC states “the benefits of vaccinating pregnant women usually outweigh potential risks when the likelihood of disease exposure is high, when infection would pose a risk to the mother or fetus, and when the vaccine is unlikely to cause harm, but the effectiveness of maternal antibodies in preventing infant pertussis is not yet known.” You can factor this in to your ongoing exploration of your choices around vaccines and continued exploration of the risk-to-benefit ratio. Alongside considering your own circumstances, incorporating information from your healthcare providers can help you arrive at your best decision.

Vascular Changes

Vascular (circulation) changes are normal during pregnancy because of the upped estrogen levels and increased blood volume, which can cause expansion and congestion of your blood vessels.

Spider veins can appear on your face, neck, and arms. Varicose derives from the Latin varix, which means “twisted,” and these bulging veins can twist along throughout your body both in visible areas as well as on your vulva or present as rectal hemorrhoids. This type of bulging comes from the same mechanism that causes other types of fluid leakage during pregnancy, such as edema (swelling) in your face, eyelids, and extremities. These blood flow issues can also cause flushing in your face, changes in your body temperature, and a generally marbled look. Support stockings and pregnancy belts, along with consistent, moderate exercise, are the main ways to support your vascular system at this stage.

Bleeding Gums

Many women complain of sensitive gums that are more prone to bleeding during pregnancy. A rise in hormones can alter your body’s response to normal bacteria and predispose you to inflammation or periodontal infections even to the point of potentially causing benign tumors on your gums. Obvious prevention through brushing, flossing, and regular dental checkups is essential for maintaining oral health. Make sure your dentist is up to date on appropriate pregnancy-safe dental hygiene.

Bleeding gums may also be indicative of preeclampsia. So, be sure to check in with your healthcare provider about that.

Leg Cramps

Many women experience leg cramps in the second half of pregnancy. This can be from increasing weight placing demands on your muscles, and if your level of exercise has slowed a bit and you’re recovering from the carbohydrate intake of the first trimester, there may also be a buildup of lactic and pyruvic acids, which are by-products of sugar and starch, and get more concentrated when there’s less blood flow in the legs.

The solution is to move. Walk (with comfy, supportive shoes), swim, stretch, and wiggle your toes at any given opportunity. At the same time, stay hydrated with electrolytes and boost up on calcium-rich foods (found in month one) and magnesium sources such as the Morning Mocktail recipe (page 27).

As ever, we return to the science behind the folklore. The old “I’m pregnant and craving pickles” thing might just indicate another iteration of a pregnant woman knowing exactly what she needs. An easy way to get electrolytes and magnesium in is through pickle juice, which has been shown to help relieve muscle cramps. Professional athletes use this remedy for endurance—and let’s face it, pregnancy is an endurance exercise.

NOTE: If leg cramps are a constant versus occasional pain, check in with your practitioner to rule out a blood clot.

IN A PICKLE WITH CRAMPS?

This pickle juice cocktail works wonders to replenish you. About an hour before bedtime, dilute half a glass (about 4 ounces) of pickle juice with half a glass of water and drink. This timing targets when cramps are most likely to strike (during sleep) but leaves you time for a bathroom stop before bed.

For another good cramp remedy, see the recipe for the Electrolyte Refresher in month one.

ESSENTIAL OIL MOUTHWASH FOR SWOLLEN GUMS

Myrrh is a traditional herb that used to be as valuable as gold, and it will probably be held in equally high esteem by you when use it as a mouthwash. Some of myrrh’s active ingredients are antimicrobial, antiseptic, and anti-inflammatory and contribute to reducing infection and pain in your sore gums when used topically. In fact, Greek soldiers used to apply myrrh oil to wounds to stop the bleeding.

You can make an easy and effective anti-inflammatory mouthwash by mixing together two drops of myrrh essential oil with a cup of warm water and using it as a daily rinse.

DAILY SALTWATER RINSE

There’s an ocean of things to deal with in pregnancy, and you can add the discomfort in your gums to this list, in the second trimester in particular. Let the sea soothe you with this easy saline mouthwash:

Pour one teaspoon of good quality sea salt into a cup of warm water and swish and spit before bed.

What to Pack for the Hospital

If you’re planning to give birth in the hospital, here’s a short list of what you should pack. The main thing to remember is to travel light. You’ll be bringing more home than you came with. Once labor begins, most women don’t use many props, and if you imagined you’d be interspersing contractions with meandering activities, I’d advise that even if you have the wherewithal for that, use your in-between times to really rest:

• A change of clothes, including underwear and comforting items such as slippers and a robe

• Something to read or watch in case you stay at the hospital during very early labor

• A hair band, if your hair is long enough to pull back off your face

• Toiletries

• A camera

• A large exercise ball (great for sitting on or draping over during labor)

• Blanket and warm baby clothes (including hat) for taking baby home

• Diapers if you have a special preference. Otherwise, the hospital will give you some

• Some hearty food for after the birth—either bring or enlist someone to bring for you

• Make sure to have your car seat installed in advance so you don’t have to struggle with it at the hospital.

While you’re undergoing a hospital birth, you can’t eat or drink, so don’t bother to bring snacks. The rationale for this is that you may need anesthesia during birth interventions, but, ironically, a nonhydrated, low-blood-sugar laboring woman is less likely to muster the stamina for a full birth process and so potentially will need that very intervention. It may be worth discussing with your physician that there was a large study of over 3,000 women that concluded women should be free to eat and drink what they please during labor to see if there’s any wiggle room to snack as needed.

Restless Leg Syndrome

Restless leg syndrome (RLS) has been shown to be associated with a number of complications in pregnancy such as preeclampsia and increased rates of C-sections. Some thoughts around the contributors to RLS are low iron and ferritin levels, and vitamin D and calcium deficiency. So, boost up on foods rich in these, and supplement if needed.

Anemia

Is your healthy glow of pregnancy fading—or have you even experienced one yet? You might not just be experiencing the normal lack of verve that can come with being in the late stages of pregnancy. You might actually have anemia. It can be difficult to tease out the symptoms of anemia from normal pregnancy symptoms, but be alert for feeling not only fatigued, but also weak and dizzy. Other anemia symptoms can include headaches, shortness of breath, irritability, heart palpitations, restless leg syndrome, running colder than usual, and paleness.

Incidentally, the concept of vampires came from a real disease called porphyria and its associated cravings—characterized in part by anemia. Before we had good diagnostic sense, these anemic folks who looked very pale and craved blood were monsterized. However, we can learn from this history. Food cravings are often indicative of what we need, like bloody, red meat for anemia. Sometimes, though, our bodies guide us astray in an attempt to get certain nutrients. For instance, pica is the craving for nonfoods like paper, clay, sand, paint, or ice in an effort to get appropriate nutrients. So, do check your cravings against the list on pages 42–44 of actual iron-rich and blood-building foods.

It’s important to treat anemia in pregnancy, and the first place to turn is iron. Iron is present in every cell in the body and is essential for the production of hemoglobin, which is the protein in red blood cells that carries oxygen. During pregnancy, you have 50 percent more blood (by volume) than normal, so naturally you require more iron to make more hemoglobin to support that additional circulation and nourish the needs of the placenta and baby. Additionally, proper iron can minimize the potential of preterm birth, decrease risk of needing a blood transfusion after birth, and has been linked to an aspect of offsetting postpartum depression.

Iron deficiency is a less severe gradient of iron-deficient anemia. The highest iron demands actually happen during the third trimester, when requirements for absorbed iron increase, and if you enter into actual anemia (hemoglobin measures less than 110 g/L in the first and third trimester and less than 105 g/L in the second trimester), or if your ferritin (a protein in the cells that stores iron) is less than 30 microg/l, you should consider supplementation of 80 to 100 mg of ferrous iron per day. (You can halve that dose if your ferritin is 30 to 70 microg/l.)

As a more general guideline, supplementing with 40 mg ferrous iron per day from eighteen weeks on appears to adequately prevent iron deficiency and iron deficiency anemia in most women, not only during pregnancy but also postpartum, and, of course, focus on getting iron from food sources.

To maximize iron absorption, take iron pills on an empty stomach with water or orange juice (the vitamin C helps with absorption). Avoid taking them with milk, because calcium interferes with absorption. Other hinderers include coffee and tea.

ALWAYS KEEP IRON PILLS AWAY FROM CHILDREN THAT MIGHT ALREADY BE IN YOUR HOUSEHOLD. A SINGLE ADULT DOSE CAN BE POISONOUS FOR A SMALL CHILD.

When you are iron deficient, your gut is already primed for higher iron absorption. Iron supplementation, however, can lead to constipation. In an attempt to not compound the issue, check out the constipation section (pages 88–91) for how to offset some of the unwanted side effects of iron supplementation.

Sickle Cell Disease

Sickle cell disease (SCD) is the most common inherited disease worldwide. It can lead to numerous health problems, but is most readily associated with anemia and intermittent, severe pain. It also happens to be a secondary protection against malaria (many people with SCD happen to inhabit malaria-infested areas), which can remind us that many things that seem dire may have hidden benefits, but of course this is a serious disease in and of itself, and even more so in pregnancy. Pregnant women with SCD should seek out a multidisciplinary team with experience in high-risk pregnancies and receive regular monitoring for preeclampsia and fetal growth changes.

Iron-Rich Foods

Pregnancy-friendly, iron-rich foods that you can’t eat enough of include apricots (fresh and dried), beans (especially butter beans and lima beans), beef, beets, blackstrap molasses, broccoli, chicken, dates, figs, lentils, leafy greens, oatmeal, potatoes (with the skin on), prunes, pumpkin seeds, raisins, salmon, sardines in oil, sesame seeds, spinach, tofu, turkey, wheat germ, and whole grain breads.

Hypertension (High Blood Pressure), Preeclampsia, and Edema

During early pregnancy, the heart works about 50 percent harder to supply important organs such as the uterus with more blood flow. The pressure your uterus puts on the blood vessels that return blood from your legs to your heart and the pressure on the nerves in your lower body result in blood flow and fluid changes. This pressure apexes around sixteen to twenty weeks into pregnancy, and can present as hypertension (high blood pressure) and/or edema—fluid accumulating under the surface of your legs, which makes them appear swollen.

During pregnancy, there is also an increased retention of sodium (salt), which leads to even more fluid retention. These things together can create the ever-so-sought-after cankles. High blood pressure (defined as 140/90 or more) can have some notable repercussions. It’s important to talk to your medical practitioner if you are suffering from it.

Edema in the lower body without a rise in blood pressure is not dangerous, but it can cause symptoms such as pain, feelings of heaviness, cramps (especially at night), and pins and needles. When edema is present in conjunction with raised blood pressure, it’s important to look out for preeclampsia.

The kidneys are also an integral part of the physiology of blood pressure changes, and changes in kidney function during pregnancy can contribute to some of the blood pressure complications. But, when the heart and kidneys are both working overtime, preeclampsia is even more of a risk.

If you have a pre-existing kidney disease, this adds into the mix, on top of the normal, pregnancy-related enhanced kidney function that’s normal. Although this poses a potential risk for preeclampsia, many women experience a temporary resolve in their underlying or pre-existing conditions while pregnant. Other risk factors for preeclampsia include diabetes mellitus, thrombophilia, pre-existing hypertension, a first-degree relative who’s had preeclampsia, a father who was born from a pregnancy complicated by preeclampsia, or low vitamin C levels. If you have increased risk factors, these can be hints to start to preemptively manage and closely monitor any warning signs.

It’s normal for blood volume and pressure changes to occur and for the heart to work a little harder during pregnancy, but true hypertension happens in one out of every ten pregnancies. The typical signs of preeclampsia are a rapid rise in blood pressure along with protein in the urine (although not every woman exhibits these symptoms). Additional tests may reveal an elevation of uric acid in the urine and a decrease in the glomerular filtration rate, which speak to how hard the kidneys are working.

There are several reasons to be wary if you are at risk for preeclampsia. Short-term complications include risk of preterm delivery, cesarean section, placental abruption, central nervous system (CNS) injuries such as seizures (eclampsia), strokes, kidney damage, and liver damage—including HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). Sometimes the above can result in fetal growth restriction or respiratory difficulties in baby. Having said all of this, multiple studies have shown that preeclampsia may have some protective effects against mothers developing malignant cancers. So, nature may have some wisdom if you’re facing preeclampsia.

In addition to working with your physician to determine if you need management with medication (generally diuretics, which, although they are typically considered safe for breastfeeding, can decrease milk production; so take that into account if you’re having any trouble with breast feeding), close monitoring of you and baby to determine the earliest time to safely induce delivery may be an appropriate solution. The delivery of the baby (and of course the placenta) usually helps preeclampsia begin to resolve and minimizes potential threats to you or baby.

Relaxin

Relaxin is a hormone that is secreted during pregnancy and plays a role in helping to widen the blood vessels to accommodate the increased flow and pressure. Keeping an eye out for low relaxin levels in the first trimester may be a helpful indicator for increased potential for developing preeclampsia later in pregnancy.

Babymoon

A honeymoon was originally called such because newly married couples were given enough mead (honey wine) to get them intoxicated enough to discover nuptial bliss, but pregnancy is a far more sobering experience, and a little pre-baby jaunt may be just the recipe to restore some adventure and intimacy. I don’t necessarily recommend flying while pregnant (see travel section), so think about planning a pleasant and relaxing road trip, or even plan a staycation in your home or area.

I’m of the school that life doesn’t stop when you have a baby. So, I don’t think of the babymoon as the last vestige of your freedom, but life certainly will change. As you ready yourself for the next stage, consider planning a treat for you and yours to focus on each other and set the precedent of your existing relationship being the primary relationship—even after baby. After all, this is the foundation that burgeoned a baby in the first place.

Pregnancy-Related Skin Conditions

Here’s the skinny on your skin: As blood flow increases during this trimester to accommodate the growing metabolic needs of your baby, you’ll experience increased blood flow to organs such as your kidneys. This brings more blood to your vessels, which also increases oil-gland secretion. Along with increases in androgen levels (thought of as a male hormone, but present in both men and women), this can lead to development or worsening of acne. From a Chinese medicine perspective, skin conditions often involve the blood in a different way: “excess” (generated from things such as too many spicy foods) or “deficiency” (which can correlate to or be ebbing toward anemia—boost up on iron-rich foods for this). The point is that most skin conditions have a dietary relationship, which is a great first-line approach during pregnancy anyway.

Skin conditions during pregnancy have a few basic categories:

1. Something you already had that changes during pregnancy

2. Something hormone related

3. Something unique to pregnancy

If you have a known skin issue such as eczema or psoriasis, it can change during pregnancy—usually for the better. On the flip side, other splotches and blotches can arise during pregnancy. Fear not—most of these things spontaneously resolve after birth. In the meantime, you can always check in with your dermatologist.

Stretch Marks

You may be on the home stretch, yet only thinking about your stretch marks. Stretch marks, which usually look like pink or purple bands on areas where your body is growing to accommodate baby, occur in up to 90 percent of pregnant women by the third trimester. They are caused by the literal stretching of the skin, amplified by the effects of hormones such as relaxin that affect the skin’s elastic fibers.

Stretch marks are mostly an issue of genetics—you either will or won’t get them. But since they can be itchy, there are some strategies for tending to them. You can take a warm (not hot) bath with a couple of cups of very finely ground oatmeal or make (or buy) a soothing salve to apply. By the way, gotu kola has been studied for its effect in successfully preventing stretch marks. So, look for a cream that contains this plant, or blend up a homemade concoction using its extract (see Stretch Mark Oil recipe).

HONEY MASK WITH NUTMEG

Here’s a basic at-home topical treatment for soothing blemishes or irritations.

Take a palmful of honey, which is antibacterial and moisture rich, and a pinch of nutmeg, which acts as an exfoliant, and rub them together. Apply to your face, neck, chest, or just about anywhere you’re breaking out. Let the mask sit for ten to fifteen minutes. Wash away with warm water.

The honey will drip right off—no sticking, only a healthy glow!

OATMEAL BATH FOR ITCHY SKIN

Put one cup of oatmeal into a coffee filter or a muslin bag and tie it shut with a rubber band or string. Toss it into the bath as you fill the tub up with tepid (never hot, while pregnant) water, and when full, you can add an optional cup of buttermilk. Soak in your sanctuary for at least ten minutes.

Eczema and Psoriasis

A Turkish physician from the 1400s recommended acupuncture for eczema in his canonical medical text, and modern research would support this finding—acupuncture has been compared to antihistamines for its equivalent effect to relieve itching, which in a deeper sense means addressing the root of the inflammation that’s presenting topically.

And as mentioned before, anti-inflammatory dietary strategies are the first course of action for these persistent and unseemly skin flares (see the Easy Anti-Inflammatory Eating Plan for Candida sidebar for food and eating suggestions).

Hyper-Pigmentation

Nearly all women experience some pigment changes during pregnancy, mostly around the areolae or armpits. Scars and moles can darken too. At a certain stage, you really can’t mask a pregnancy, especially since 70 percent of women experience melasma, or “mask of pregnancy.” It appears as a brownish or yellowish coloration on the face, kind of like a semipermanent decoration for a masquerade ball. Staying out of the sun can lessen the detriment. As with most changes in pregnancy, these pigmentation issues usually resolve postpartum.

STRETCH MARK OIL

(Makes about one cup of oil)

Ingredients

⅓ cup almond, apricot, or jojoba oil (or a combination of all of them)

¼ cup macerated oil such as calendula or rose oil (you can make this in advance by soaking dried calendula flowers and/or rose petals in one of the above carrier oils for two weeks, then straining out the solids)

3 tablespoons avocado and/or hempseed oil

1 tablespoon evening primrose oil

1 teaspoon vitamin E oil

30 drops pregnancy-safe essential oil such as mandarin or ylang ylang

15 drops alcohol-free gotu kola extract (essential for its role in diminishing stretchmarks)

Mix all ingredients together and bottle, then rub-a-dub-dub onto your belly and breasts daily. Store in the fridge between uses.

Another down-and-dirty stretch mark solution is to simply use cocoa butter.

Itching

Itching is a common skin irritation during pregnancy. Usually it’s just annoying, but sometimes it can indicate intrahepatic cholestasis of pregnancy (ICP) or jaundice of pregnancy. With this, the itching is usually the most intense on the palms of the hands and the soles of the feet, but it can be also unwieldy on the abdomen and other parts of the body.

Did You Know That Your Baby’s Cells Can Migrate to Your Skin During Pregnancy?

The abdominal rash known as polymorphic eruptions of pregnancy (PEP), previously known as PUPPP, is the most common pregnancy-specific skin situation, which usually involve the appearance of skin lesions after week thirty-four. It happens in about one out of three pregnancies, usually in the third trimester. We don’t know why it happens, but PEP most likely involves the interaction between your and baby’s immune systems. There’s really nothing to do about it, but know that it usually goes away about three weeks after birth.

ICP can cause vitamin K deficiency, which can lead to blood-clotting issues. If you have gallstones or a family history of gallstones, look out for ICP. Its presence during pregnancy can be associated with a higher risk of premature delivery. So if you’re inordinately itchy, find out what’s going on by investigating with your healthcare provider.

Impetigo Herpetiformis

Impetigo herpetiformis is a rare skin disorder that can appear during the second half of pregnancy. Whether this disorder is specific to pregnancy or is simply exacerbated by it is controversial. In addition to the pus-filled bumps (usually on the thighs, inner groin, and extremities), signs and symptoms of impetigo herpetiformis can include nausea, vomiting, diarrhea, fever, chills, and enlarged lymph nodes, usually without itching.

Western treatment for impetigo herpetiformis usually involves corticosteroids and antibiotics. Of course, your healthcare provider and/or dermatologist will help you properly differentiate what’s going on and develop a course of action from there.

Lyme Disease

Pregnant or not pregnant, having Lyme disease, a bacterial infection, is a complicated matter. If you’ve been in an area with woodland creatures—especially if you know you’ve had a tick bite and you have symptoms such as persistent fatigue, joint aches, headaches, and/or a rash that looks like a bull’s eye, Lyme disease is definitely something to rule out. But as Lyme disease also has a host of nonspecific symptoms, such as fatigue, which can be easily rolled into the pregnancy presentation, it can be hard to diagnose, and treatment strategies vary. Doxycylin is the first antibiotic of choice in Western medicine, but it can’t be used in pregnancy because of the risks to the baby, including permanent discoloration of teeth and a possible impact on bone formation. So, you’ll need to work with your team on looking at other antibiotics and treatment options.

There has been some great evidence that using a comprehensive herb and supplement regime as an effective approach for targeting Lyme disease. If the tick is still on you, lemon eucalyptus extract inhibits the tick from binding to the skin. Herbal therapy and supplements can continue to act on symptoms from an infection through the enhancement of natural killer-cell activity, which fights infection (antioxidants, astragalus, and mushroom b-glucan), inhibition of proinflammatory cytokine production with antioxidants (turmeric, EPA/DHA—basically fish oil—and boswellia), inactivation of the fibrinolytic system (COQ-10 and vitamin E), inhibition of tight junction degradation (vitamin D and N-acetylcysteine), and repair of the blood brain barrier (vitamin D and ginkgo biloba).

Human Immunodeficiency Virus (HIV) and Pregnancy

HIV can be a daunting diagnosis in general, and especially as an expecting mother, but there are many efficacious methods and medications available for reducing mother-to-child transmission.

While being HIV positive does not preclude having a healthy baby, there are some things you should do to help prevent passing the virus on. In most instances, HIV doesn’t cross the placenta. So, the likely modes of transmission happen during birth and breastfeeding. C-sections have been shown to reduce baby’s exposure, and if you opt for a vaginal delivery, avoiding an episiotomy (which increases the baby’s potential exposure to blood) may help minimize risk as well. Although, bear in mind you may likely tear involuntarily. Most evidence points to limiting breastfeeding to six months, depending on your individual health status, or opting out of breastfeeding altogether.

HIV is not particularly different than many health concerns during pregnancy in that, alongside any appropriate medication, managing your nutrition is the optimal route for bolstering your and baby’s immunity. Additionally, if you’re not going to breastfeed, but are concerned about your baby getting the best possible nutrients, you have some relatively good options for high-quality formula these days and ways to enhance formula. See resource section for a formula recommendation.

Kick Counts

Starting around week twenty-eight, you may want to begin counting the number of kicks and other types of movement you feel from baby. This is an easy and noninvasive way to connect with and check on your baby.

You may notice that your baby is the most active after you eat or after exercise—these are good times to monitor the kicking. Lie on your left side to increase circulation and allow baby a full breadth of activity. According to American Congress of Obstetricians and Gynecologists (ACOG), you should feel at least ten movements (kicks, flutters, rolls, etc.) within a two-hour period. Look out for any deviations in your baby’s normal routine.

If you notice a significant change, especially over a period of a few days, and after trying to kick start the kick counts with a good-sized meal and ice water to spark baby, check in with your healthcare provider.

Fetal Hiccups

It is a hiccup in your pregnancy, so to speak, but not a worrisome one. Fetal hiccups usually feel like a muscle twitch and are basically the baby practicing reflexes to prepare for activities such as eating and breathing. You can approach them much the same way as you do kick counts to monitor your baby’s normal movement, which is the best gauge when assessing “normal.”

Checklist for Month Six

• You can preregister at the hospital to avoid paperwork upon your arrival. This includes if you are intending to have a home birth and may need to be transported to the hospital.

• Identify a birth and/or postpartum doula if you’re opting for this support.

• Start doing kick counts.

• Pick up items from the “What to Pack for the Hospital” checklist on page 136.