Q: We're expecting our first baby on June 8, but still plan to go on our yearly trip to a lake house in Idaho with friends. It's during the second week of July, and she'll be 6 weeks old by then. We're worried about the effects of altitude. What do you think?

A: First, let's talk about the trip itself. I hope that all will run smoothly with your baby's birth- that she'll come out on time, you'll feel well and rested, and nursing will be a breeze. That can happen, and often does. However, you could deliver early or be up to two weeks overdue. Your recovery could be like clockwork, or you could feel consistently rundown. Nursing could be a challenge, or your baby could be a natural. Unfortunately, until you're living it, you just can't know.

So, planning such a big trip so close to this time is risky. Technically, your baby shouldn't even travel for the first 6 to 8 weeks of life. Sometimes urgent circumstances might require you to travel with a young infant, but trips should be the exception, not the rule, at this time. I think you might want to reconsider that vacation- or ask your friends if they can postpone to August.

As for the change in altitude, many babies are born in altitude, and infants can generally handle minor changes ... but I think that's the least of your concerns with a 6 week old.

Q: How can I explain to my husband that a doula won't replace him at our baby's birth?

A: This is a great question for you and your husband to explore with doulas you're interviewing. A quality doula can clearly communicate, in words and deeds, that your marriage or partnership is the primary relationship, while your association with a doula has a beginning, middle, and end. For example, ina prenatal session, I'll often bring a food soak for the mom and, as her feet are immersed, ask the dady to simply hold her hand and be present. It marks a beautiful moment in the pregnancy, with lovely music playing and sweet smells of essential oils, but it also demonstrates her triad of support for labor- the expectant dad alongside the mom-to-be and the doula positioned at her feet.

Have your husband ask the doulas you meet with how they plan to involve him in labor. Also, you might try sharing with him these real-life birth anecdotes from my practice that show dads' importance in the delivery room:

One father learned a chant in a prenatal visit and quietly but powerfully sang it to his laboring wife; she was enraptured in his arms hearing their baby's birth song.

Another dad said out loud to his partner how beautiful and how powerful she was while preparing for a Cesarean birth.

A third father sat in the hospital bathroom for more than two hours, holding his wife's shoulders as she pushed on the toilet, whispering affirmations in Italian in her ear.

One more dad typed out a psalm and put it in his left-hand pocket; later, while his newborn baby was in the warmer, he whispered it in baby's ear.

Q: I'm black and my husband is Latino. We're expecting a baby boy. I'm wondering what's the likelihood of the baby having sickle-cell disease. Should we get genetic testing?

A: Genetic testing isn't really a factor here. To get a more accurate evaluation of your family's risk, ask your doctor to send some of your blood for a test called hemoglobin electrophoresis, which will indicate whether you carry the sickle gene. About 1 in 12 African-Americans and 1 in 18 Hispanic-Americans have the sickle-cell trait.

Sickle-cell disease is what's called an "autosomal recessive genetic disorder," meaning that two abnormal genes are needed for a baby to have sickle-cell disease. The disease occurs in about one in every 500 African-American births. So, there is roughly a 1 in 864 risk of a baby being born with sickle-cell disease toa couple like you two.

If you discover that you have one normal gene (A) and one sickle gene (S), have your partner tested. When each parent carries one normal gene and one sickle gene, every pregnancy has a 25% chance of a baby born with normal blood; a 25% chance of sickle-cell disease; and 50% chance of the baby being an unaffected carrier. If both of you have normal genes, you cannot have a child with sickle-cell diease.

Q: I'm in my second trimester and the doctor suspects I have placenta previa. Will I have to have a C-section? I wish there were some way around it.

A: You might not have to have surgery- if it turns out you don't have placenta previa. The condition causes the placenta to overlap your cervix, which needs to dilate to allow delivery of the baby. The concern is that as the cervix dilates, the placenta could tear and bleed, which is dangerous for you, the mother. But the relationship of the placenta to the cervix isn't as clear in your second trimester as it is when you get close to full term.

This is because by the middle trimester, your placenta has already grown large in size, but your uterus will expand a lot more before you deliver. So, it can be difficult to determine by ultrasound where the placenta is actually growing into the uterus or just touching it.

At 27 weeks, there's still a 51% chance that what your doctor's seeing isn't really a previa. There are several types of placenta previa: "Total" means the cervix is completely covered, while "partial," or "marginal," and "low-lying" mean the obstruction is less than complete. If your doctor already sees total previa, the odds may not be as sunny that it will resolve itself.

As your uterus enlarges, your ob/gyn should be able to tell if you really have placenta previa. Once you're at 28 weeks, if yu still have a possible diagnosis, your doctor may put you on pelvic rest, which means no sex or pelvic exams, and possibly limit your exercise. And if it turnsout that you do have placenta previa, a C-section will be the safest way to deliver.

Q: I'm very anxious about my baby being separated from me in the hospital. What can I do?

A: You have strong and powerful maternal instincts! When a first-time mom can say out loud in her pregnancy that she wants to stay with her baby, she's activating a powerful mothering space within. Anxiety is often a sign of deep body wisdom.

My first advice would be to recognize this cue. The period immediately after delivery is very much a crucial time. Evidence is clear that skin-to-skin contact between babies and mothers makes for optimal hormonal changes, better temperature regulation, fewer stress hormones, and more stable blood sugar levels. Babies also have an easier time breastfeeding when they're not separated from their mothers.

So, your first task is to call the labor and delivery nurse manager at your hospital and determine its standard of care for a healthy baby. Many offer 24-hour rooming in, which keeps mothers and babies together. Other facilities require a four-hour nursery stay, when the baby's heart rate and temperature stabilization is examined away from the mom. If your hospital follows the latter course, consider a different location, or at the very least inquire about whether these procedures could be delayed a few hours so you can be with your baby.

Also, communicate with your partner about when you want visits outside of medical staff. Family and friends may be loving and supportive, but many first-time moms have later told me they regret not taking more time with just their partners and babies. For the first few hours, as you hold and rock your baby, sing lullabies, and recover together, you may need and want privacy. It's a very emotionally intimate time, and a powerful threshold you're crossing, from partners to parents. Think about it.

Q: My mother-in-law has offered to come and stay with us for two weeks after our new baby comes. She's a nice woman, and an excellent cook, but shouldn't my husband and I bond with our baby alone for the first few weeks?

A: This is one of my favorite questions. You see, you're a lucky new mom and just don't know it yet. I'm not sure who started the myth that new parents need weeks alone at home to bond with their baby, but it's a bad one. I'm always so grateful to the extended family when they come to the first office visit with the new parents.

When you're discharged from the hospital, you likely haven't slept well in three of four days; you're recovering from delivery; and nursing and caring for your baby is still so new. Your partner can be a huge help- but it takes many hands. He's thrown into the role of caring for this entire new little family while you recuperate and focus on the baby. Why not let your mother-in-law be there to lend a hand? She can be an extra set of arms to hold your child so you can finally sleep; cook you healthy, nourishing meals; and tidy up so you don't get distracted by what a mess the house is.

We're meant to have babies with aunts, mothers, and sisters within walking distance, but because of how our world is today, we're often on the other side of the country from those special people. Accept your mother-in-law's help, especially since you seem to like her, and let her come during the first few weeks. You'll need her, and you'll be sad to see her go- I promise.

Q: This is my second pregnancy, and a dark spot that cropped up on my forehead during my first pregnancy has reappeared with a vengeance. It never really went away, and now it’s so dark people ask if something’s on my face. Is there anything I can do about it while I’m pregnant?

A: I recommend you show the dark spot to your doctor. It may be a type of skin discoloration called melasma, which is usually first noticed in pregnancy or once you start taking birth control pills. But, if the darkening is limited to a small area, it could be any number of skin conditions. Melasma often spreads around the eyes, forehead, and cheeks, which explains its other common name, “pregnancy mask.”

If your spot is melasma, a dermatologist will usually recommend delaying treatment until several months after delivery because the pigmentation often fades, as yours did, when your hormones normalize. Pregnancy hormones are the true cause of the discoloration—they stimulate additional melanin, the pigment that darkens skin when it’s exposed to sunlight. During pregnancy, staying out of the sun and using a broad-spectrum sunscreen daily can help decrease the discoloration.

Treatment after pregnancy includes kojic acid, azelaic acid, and tretinoin creams, which have been shown to improve the appearance of melasma. Occasionally, chemical peels or topical steroid creams work. In severe cases, a doctor might recommend laser treatments. In any case, it’s important to ask your doctor about the spot.


Stephen H. Weiss, M.D., is an ob/gyn and instructor at the Emory University School of Medicine in Atlanta.

Q: What are ways that I can connect and bond with my baby before she is born? How can my partner get involved, too?

A: Consider multi-sensory activities that allow you to focus inward, like making a collage for your baby, drawing or painting images of birth, sculpting with clay, singing, even gardening or baking bread. These pursuits settle the mind and give you space to connect your heart with your growing baby. They’re also powerful tools to prepare you for birth!

How? In labor, your dominant brain shifts from the left (or rational) brain, to the right—the brain of color and sound. This change ensures that the body releases the hormones mom and baby need during delivery. Labor also induces alpha-brain waves, which are slower, allow sudden insight, and foster a meditative kind of mind, somewhere between waking and sleeping. Accessing this quiet mind during pregnancy through creative endeavors, such as making art, not only gives you time with your baby, it also familiarizes you with your body’s optimal state during delivery.

As for getting him involved, dads I’ve served as a doula for often wanted specific tips about engaging in their partners’ pregnancies. Most guys genuinely want to be useful and helpful, but need exact tasks that will meet your needs. Some specifics he can try:

• Driving you to a prenatal yoga or exercise class each way, creating a special time to talk about the baby, and giving him a quiet hour—perhaps with a coffee and a book at the café next door?

• Starting a journal or setting up a blog to record pregnancy moments and images and thoughts for your baby.

• Buying pregnancy tea and brewing it for you in a travel mug as you leave for work, or packing healthy snacks for your desk drawer and writing a love note or favorite quote on the bag.


Jill Wodnick, M.A., is a certified doula, prenatal yoga instructor, and owner of Montclair Maternity, a childbirth education center in New Jersey.

Q: I’m pregnant with twins and have questions about vaccinations. Do I need to give the babies the first Hepatitis B shot while they’re in the hospital? I’ve heard so much conflicting information about vaccines, and I’m very confused. Do I have to decide before I deliver?

A: No, you don’t have to decide before you deliver. The babies can get their initial Hepatitis B shot at their first doctor visit. After that, the first series of vaccines isn’t given until two months. By that time, you’ll have had several appointments with your pediatrician and had the chance to talk with him or her about vaccines.

I will say that, for the current generation of parents, it can be hard to understand the seriousness of the illnesses these vaccines prevent, because in our lifetimes, vaccines have prevented them for the most part. We haven’t seen how bad chicken pox can be; we don’t know about whooping cough. And as an M.D., I can promise you that sickness and death truly can be associated with these diseases.

I had a 2-year-old daughter when the chicken-pox vaccine was introduced. I thought it would be OK for her to get the chicken pox naturally—I had it as a kid and I was fine. Shortly after, I rotated through the pediatric intensive care unit as part of my residency training. There were two children in the unit with complications from chicken pox. One had a severe pneumonia, and the other had an inflammation of the brain. I chose to give my 2 year old the chicken-pox vaccine at her next checkup.

I recommend the American Association of Pediatrics vaccine schedule to the families I see in my practice. You can find information
regarding vaccines at www.aap.org and www.cdc.gov.


Lisa Dana, M.D., is a pediatrician at Golden Gate Pediatrics in San Francisco and a clinical faculty member at University of California, San Francisco.

Q: I'm having trouble staying asleep. What can I do?

A: Have you considered that your interrupted sleep could be preparing you to meet your baby's needs? Human babies are dependent creatures who need lots of attention, often in the middle of the night, which seems to me a valid enough reason for pregnancy's strange sleep patterns, especially in the third trimester. According to yogic thought, the early morning-between 2 and 5 a.m.- is when the separations between mother and fetus are thinnest.

If you look at your sleep difficulties like this, they transform from a frustration into an opportunity. Rather than fight your body's need to be awake, embrace the space to connect with your growing baby. Take a bath, color, journal, or write positive thoughts for your labor and first few weeks as a parent. You can even try meditative, contemplative household tasks such as sweeping the floor.

Of course, you'll need to set up your schedule so you can nap or rest in the afternoon. Ask your boss about altering your workday so you can take a break between 1:30 and 3:30 p.m. Tell your partner you'll need this quiet time on the weekends, too. Try using a pregnancy relaxation audio CD like my Prenatal Peace & Calming to generate deeper levels of rest-it works well in your parked car or an office "nap room."