What's the number-one concern of pregnant women?

Pregnancy is an exciting time in a woman's life, but it can also be a nerve-wracking one. All of a sudden you're focused not just on your health, but on that of your baby as well — and at a time when you're dealing with new body changes and a lot of unknowns.

Enter the Mommy Docs: Dr. Alane Park, Dr. Allison Hill and Dr. Yvonne Bohn, stars of the television show Deliver Me. These three female OB/GYNs just released a new book, The Mommy Docs' Ultimate Guide to Pregnancy and Birth, to help women navigate conception, pregnancy, labour, and the few months post-childbirth — from their perspectives as mothers and doctors. We sent these questions from Chatelaine readers to Dr. Park and Dr. Hill to get their advice on everything from breastfeeding to labour recovery to exercise during pregnancy and infertility.

Q: Many women want to breastfeed but find they have issues: the baby won't latch, they can't make enough milk, the baby prefers bottles to the breast. What can they do to help, knowing that it's recommended that infants stay on breast milk as long as possible?

Dr. Hill: Breastfeeding should be a beautiful time for bonding with your newborn, but unfortunately many new moms struggle with milk production, latching, and breast pain. The best thing a woman can do is have patience. Learning any new task takes time. Finding a comfortable, relaxed environment for nursing can make all the difference. In addition, a trained lactation consultant can observe your nursing technique and give advice on how to make it easier for you and your baby.

Q: What is the number-one concern your female patients have about childbirth?

H: The most common concern women have about childbirth is whether or not they will be able to have a vaginal delivery. Unfortunately, most times, the decision for a cesarean is not made until the labor process has begun. The most common reasons a woman has a cesarean are that her baby doesn't fit through the birth canal or doesn't tolerate labor. These situations usually cannot be predicted, leaving many moms worried and wondering.

Q: What are some of the risk factors for tearing during childbirth, and what can be done to prevent or lessen it?

H: The risk of tearing during a vaginal delivery depends on many factors. The most important is the size of the baby. In addition, the size of the vaginal opening and the ability of the muscles to stretch adequately also plays a role. We recommend to avoid excessive Kegel exercises during pregnancy, which tighten the vaginal muscles and make they less elastic. In addition, if a mom can deliver the baby slowly over time so the muscles can stretch and relax, she will experience less tearing.

Q: Why did you decide to focus a section on the "fourth trimester" — the period after childbirth?

H: We found that the fourth trimester — or the first three months after delivery — was often much more challenging than the pregnancy or even the labor itself. The physical and emotional exhaustion is something that a new mom may not be able to prepare for. We think it is important for pregnant women to think about their plan for after the delivery just as much as they delivery itself. Who is going to help them at home? Do they plan on going back to work right away? Will they be breastfeeding? Attention to these details ahead of time can make the transition to motherhood comfortable and seamless.

Q: Do you think that we're seeing more infertility these days than in the past, or are people just more aware of fertility issues and more likely to seek help?

H: Infertility affects about five percent of women but that number is on the rise because women are waiting until later in life to try to get pregnant.  By age 35, the fertility rate is half of that of a women in her 20s.  After age 42, the chance of getting pregnant spontaneously drops to approximately one percent.

Q: The average weight in North America has increased over the past 30 years — how does being overweight or obese affect pregnancy for the mother and the baby? What can be done to lessen those effects?

Dr. Park: Here are some staggering statistics: One-third of American women are of normal weight; one-third are overweight; and one-third are obese. Complications related to obesity in the non-pregnant state are well known — diabetes, high blood pressure, stroke, certain cancers, joint problems, and liver and gallbladder disease to name a few. And unfortunately, there are definite risks associated with being overweight or obese during pregnancy as well, including diabetes; preeclampsia (high blood pressure during pregnancy); increased risk of Cesarean delivery; increased complications like infections or blood clots associated with vaginal or Cesarean deliveries; increased birth defects in the baby; and decreased ability to detect birth defects with an ultrasound. Overweight or obese women are at increased risk for having very large babies. Large babies often lead to Cesarean deliveries or complicated vaginal deliveries. In addition, studies have shown that women with pre-pregnancy obesity birth babies who are at increased likelihood of being overweight as children and adults themselves.

Many of the complications just mentioned can be avoided by maintaining a normal healthy weight before and during pregnancy. We recommend eating an extra healthy 300 calories a day to gain the recommended 25-35 pounds for normal weight women. Please eat lots of fresh vegetables and lean protein. Of course, we also encourage some form of exercise. Exercise will not only help you maintain a healthy weight, it will also make you feel great.

Q: Midwives are covered by public health care in some Canadian provinces. How can having a midwife be helpful to a woman and her partner during pregnancy and labour?

P: The three of us have enormous respect for midwives, particularly because we were trained by them during our residency program with our low-risk, uncomplicated patients. If you are a low-risk pregnant mom and wish not to deliver in a hospital setting, there are probably more midwives than OB/GYN physicians who deliver at birthing centers and homes to fulfill your wishes. Experienced midwives also know when to transfer the care of their patients as complications arise. In addition, midwives, like physicians, are very caring and thoughtful about every woman’s needs during the pregnancy and the birth.

Q: Are there exercises that women can do to make labour easier?

P: We are big fans of regular exercise during your pregnancy to keep you and your baby healthy. In particular, prenatal yoga may help you to stretch your entire body, but in particular your lower back, pelvis and hips to ease the pushing process during your labor.

Q: What are the risks associated with using pain medications and interventions like epidurals during labour? What benefits might be associated with making that choice?

P: Receiving any form of pain medication during labor is a matter of personal choice. In the U.S., more than 50 percent of women give birth with an epidural or spinal block. Both epidurals and spinals are considered safe and quite effective. The most obvious advantage to having an epidural is pain relief. Sometimes, just letting go of that pain-created tension allows the cervix to open up quickly. Risks associated with epidurals and spinals are rare and include low blood pressure, spinal headaches, fever, increased labor time, and increased pushing time. Other forms of pain management include IV narcotics, general anesthesia, and local anesthesia.

Of course, there are nonpharmacologic pain management alternatives including relaxation, massage, acupuncture, labor coach, doula participation, walking, showering, bathtubs, and birthing balls. Q: How long does it take to heal after a vaginal delivery? How about a Cesarean delivery?

P: In general, whether you deliver vaginally or by Cesarean, you will feel significantly better after about two weeks. Vaginal lacerations will heal faster than a Cesarean scar on your uterus and abdomen. It will take about six weeks for your uterus to return to its normal size. And we advise moms to wait six to eight weeks before resuming exercise routines and sex with your partner.