Pregnancy Podcast

The nausea is fading, your energy is returning, and your bump is starting to show. The second trimester is often called the easy stretch, but it brings some big milestones and decisions. Learn when you will likely feel your baby move, what the anatomy scan checks, and which tests to expect. You will also find what is worth planning now while you feel your best.

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The second trimester runs from week 13 through week 27. For many women, this is the most comfortable stretch of pregnancy.

Nausea usually fades, energy often returns, and your bump starts to show. Still, every pregnancy is different, and it is normal if you do not feel your best yet. These weeks also bring big milestones, from the first kicks to seeing your baby in detail at the anatomy scan.

If you want to follow along week by week, the 40 Weeks podcast has a short episode for every week of pregnancy.

Your baby’s bones are hardening, and their lungs and nervous system continue to mature. Fingerprints and footprints form, and hair grows on their head and eyebrows. A fine, soft hair called lanugo also covers their body. Lanugo helps hold a waxy coating called vernix caseosa on their skin, which protects it from the amniotic fluid around them. Later in this trimester, fat starts to build up under their skin, helping keep them warm after birth.

Your baby is also getting busier. Their movements become more coordinated, and they settle into cycles of sleep and activity. They make sucking motions and swallow amniotic fluid, which is practice for feeding after birth.

At week 14, the way your baby is measured changes. Until now, doctors measure babies from crown to rump because their legs are curled up. From week 14, the measurement runs from crown to heel. This is why your baby seems to double in length in a single week. The jump comes from the new measurement, not a growth spurt.

At 14 weeks, your baby is about 5.8 inches, or 14.7 centimeters, long. They weigh about 3.3 ounces, or 93 grams, about the size of a peach. By week 20, your baby is about 10.1 inches, or 25.7 centimeters, long and weighs about 11.7 ounces, or 331 grams. That is roughly the size of a sweet potato. By week 27, your baby is about 14.4 inches, or 36.6 centimeters, long. They weigh about 2.3 pounds, or 1,055 grams, about the size of a cabbage. These weights come from a widely used fetal growth standard, and every baby grows at their own pace.

Around week 16, you may notice the first flutters. Many moms describe them as bubbles or a butterfly flapping its wings. By week 20, most women feel more distinct pokes and kicks. If this is not your first pregnancy, you may notice those early flutters sooner. The timing varies. For example, if your placenta attaches to the front wall of your uterus, called an anterior placenta, it can cushion your baby’s movements. As a result, you may feel them a little later or less strongly. This is common and not a sign that anything is wrong.

Feeling your baby move can be just as special for your partner. They usually have to wait a bit longer to feel kicks from the outside. When your baby is active, invite them to rest a hand on your belly. Around week 23, your provider can usually hear your baby’s heartbeat with a regular stethoscope. The episode on ultrasound during pregnancy explains this and other ways to check on your baby between visits.

Your bump usually becomes noticeable during the second trimester. As your baby grows, your body catches up with all the changes that were happening on the inside.

Gaining weight is one of the more noticeable changes. After a small gain in the first trimester, weight gain usually becomes steady from now on. According to the Institute of Medicine guidelines, the recommended pace in the second and third trimesters depends on your body mass index, or BMI, before pregnancy. If your BMI was under 18.5, the guideline is about 1 to 1.3 pounds per week. For a BMI of 18.5 to 24.9, it is about 0.8 to 1 pound per week. For a BMI of 25 to 29.9, it is about 0.5 to 0.7 pounds per week. Finally, for a BMI of 30 or higher, it is about 0.4 to 0.6 pounds per week.

These numbers are guidelines, not a test you pass or fail. Your energy needs rise too. The American College of Obstetricians and Gynecologists, or ACOG, estimates that you need about 340 extra calories a day in the second trimester. That is less than eating for two suggests, so food quality matters more than quantity.

Women vary all over the spectrum in how they feel about their body image during pregnancy. Some mothers love their growing bump, while others struggle with how quickly their bodies are changing. No matter how you feel, it is on the spectrum of normal.

According to ACOG, most sexual activity is safe when your pregnancy is healthy. Your baby is protected by the amniotic fluid, the strong muscles of your uterus, and the mucus plug that seals your cervix. Your desire may rise or fall from one trimester to the next, and both are normal. As your belly grows, lying on your side or being on top may feel more comfortable. Orgasm can cause cramping, and light spotting after sex is common. However, call your provider if you have heavy bleeding or severe cramps that do not ease. Your provider may advise against sex if you have certain complications, such as placenta previa or a higher risk of preterm labor, so ask if you are unsure. For the most part, as long as you are comfortable with it, you should be good.

Many first trimester symptoms ease in the second trimester, and a few new ones appear. These are the most common symptoms in this window and what you can do about them.

For most women, morning sickness eases by about week 14. However, research shows that nausea continues past 20 weeks for up to 15% of women.

If you are still sick, you are not doing anything wrong, and treatment can help. Fatigue is most common in the first and third trimesters, so many women get a welcome burst of energy now. The constant urge to urinate also tends to ease, although it often returns later as your baby grows.

Early tenderness usually fades, but your breasts keep growing. Most moms go up one to two cup sizes over pregnancy. Your band size may change too, because your rib cage expands to make room for your baby. A supportive, comfortable bra helps. Take advantage of a free professional fitting to take the guesswork out of sizing if you need to size up. However, hold off on nursing bras until around 36 weeks, since your size may still change.

Around the middle of pregnancy, often from about 16 weeks, your body starts making colostrum, your baby’s first milk. Some women notice small amounts of yellowish fluid leaking from their nipples during pregnancy, and many never do. Both are normal. Not leaking does not mean your body is not producing colostrum.

Pregnancy hormones can bring a range of skin changes. The good news is that most of them fade after your baby is born. Stretch marks often appear late in the second trimester or in the third, on your belly, breasts, hips, butt, and thighs. They start out pink, red, or purple and fade over time to lines lighter than your skin. Genetics plays the biggest role in whether you get them, which, unfortunately, you cannot control.

A review of topical treatments found no clear evidence that any cream or oil prevents stretch marks. One small study from 1991 followed 80 women and found fewer stretch marks with a cream that combined Centella asiatica with vitamin E and collagen. Moisturizing will not prevent stretch marks, but it can ease the itch of stretching skin.

You may also notice a dark line running down the center of your belly, called the linea nigra. It often appears in the second trimester and fades after birth. Some women develop melasma, which causes darker patches on the forehead, cheeks, nose, or upper lip. Sun exposure makes melasma more noticeable, so a hat and sunscreen can help.

Back pain is common, and research estimates that it affects 40 to 70% of women in the second trimester. Your growing belly shifts your center of gravity forward. In addition, the hormone relaxin loosens the ligaments that support your spine. Good posture, supportive low-heeled shoes, and gentle exercise can help. ACOG also suggests heat or cold, with a heating pad on its lowest setting and only for short periods.

You may also feel a sharp or stretching pain on one or both sides of your lower belly or groin. This is called round ligament pain, and it happens as your growing uterus stretches the ligaments that support it. According to MedlinePlus, it is most common between 18 and 24 weeks. Moving slowly and changing positions can help, and a maternity support belt may ease it too.

Later in this trimester, you may notice your belly tighten for a minute and then relax. These practice contractions, called Braxton Hicks contractions, are usually irregular and ease when you rest or change position. Contractions that come regularly or keep getting stronger are different, and they warrant a call to your doctor or midwife.

Constipation actually peaks in the second trimester. A meta-analysis found that it affects about 34% of women in the second trimester, compared with 21% in the first and 30% in the third. Fiber, water, and movement are your first line of defense. Heartburn can also start or get worse as your uterus grows, and smaller, more frequent meals can help.

A stuffy nose is another surprise for many expecting moms. According to research, pregnancy rhinitis affects up to 30% of expecting mothers. It can start at any point, although it is most common in the third trimester.

Increased vaginal discharge is also common during pregnancy. Normal discharge is thin and white or clear, with a mild smell. If it bothers you, a thin panty liner can help you stay comfortable. Check in with your provider if the discharge turns green or yellow, has a strong odor, or comes with itching, soreness, or pain. These can signal an infection.

Most pregnancy safety guidance still applies in the second trimester, and the pregnancy basics episode covers it in depth. A few points matter more now. The Food and Drug Administration recommends avoiding nonsteroidal anti-inflammatory drugs, or NSAIDs, from 20 weeks on, unless your provider advises otherwise. These include ibuprofen and naproxen, and they can lead to low amniotic fluid. Low-dose aspirin prescribed by your provider is the exception. For pain relief, ask your provider about acetaminophen, and see the episode on Tylenol and other over-the-counter medications for the latest research.

As your belly grows, sleeping on your side usually becomes the most comfortable option. A pillow between your knees or a full-length body pillow can help. If you wake up on your back, try not to panic.

If you feel good, keep moving. Regular exercise is safe for most women, and you can modify nearly any activity as your body changes.

During the second trimester, most practices schedule prenatal care visits every four weeks. ACOG now encourages tailoring the number and type of visits to your needs, although most practices still follow the traditional schedule.

These visits are usually quick. Your provider checks your blood pressure and weight, may test a urine sample, and listens to your baby’s heartbeat with a handheld Doppler. Starting around week 24, many providers also measure your fundal height, the distance from your pubic bone to the top of your uterus. From about 24 to 38 weeks, this number in centimeters should roughly match how many weeks pregnant you are. According to ACOG, a difference of a few centimeters either way is normal.

Never hesitate to ask questions. These tips can help you make the most of every prenatal appointment. If your visits feel rushed, there are practical ways to get more out of them.

The anatomy scan is a detailed ultrasound that usually happens between 18 and 22 weeks. ACOG recommends at least one standard ultrasound in every pregnancy, typically in this window.

During the scan, a sonographer measures your baby and examines their major organs and structures. These include the heart’s four chambers, the brain, spine, kidneys, bladder, and stomach. They also check the location of your placenta, your amniotic fluid levels, and your baby’s growth.

The scan often takes 30 to 45 minutes or longer. If your baby is not in a helpful position, you may be asked to walk around or come back another day. This does not mean anything is wrong.

Most parents can learn their baby’s sex at this scan if they want to know. According to a systematic review and meta-analysis, ultrasound is about 99% accurate for sex in the second trimester. Many parents already know from cell-free DNA screening, or cfDNA screening. If you want it to be a surprise, tell the sonographer at the start.

Sometimes the scan picks up a small finding called a soft marker, like a bright spot on the heart or a tiny cyst in the brain. These are common in healthy babies. In fact, with a normal cfDNA screening result, an isolated soft marker is usually considered a normal variant. If anything comes up, ask what it means and what happens next.

If your partner can attend only one appointment this trimester, make it this one. It is a special chance to see your baby together. And if a finding does come up, you will not be processing it alone.

Your doctor or midwife will offer several prenatal tests in this window. Some are routine, and others are optional. A screening test estimates the chance that your baby has a condition, and a positive screen does not mean your baby has it. Only a diagnostic test can confirm a condition. You choose which tests to have.

The quad screen is a blood test that screens for trisomy 21, trisomy 18, and neural tube defects like spina bifida. It is done between 15 and 22 weeks. It is somewhat less accurate than the first trimester screen, and cfDNA screening is more accurate than both for the common trisomies. If you had a first trimester screen, your provider may combine the two results into an integrated screen. Current guidance is to choose one screening approach rather than several, because multiple screens can give conflicting results.

Amniocentesis is a diagnostic test, usually done between 15 and 20 weeks. Under ultrasound guidance, your provider uses a thin needle to collect a small sample of amniotic fluid. The test is more than 99% accurate for chromosomal conditions, and it can also detect neural tube defects. Because it is invasive, it carries a small risk. A 2015 systematic review and meta-analysis put the added risk of pregnancy loss from the procedure at about 0.11%, and a 2019 meta-analysis estimated about 0.3%. Both figures are low, and risk is lower at experienced centers. Most parents only consider amniocentesis after a positive screening result or because of family history.

Between 24 and 28 weeks, you will likely be offered screening for gestational diabetes. According to the Centers for Disease Control and Prevention, or CDC, it affects about 8% of pregnancies. The first step is the glucose challenge screening. You do not need to fast. You drink a sweet glucose solution and have your blood drawn one hour later. A result above a set threshold, usually 130 to 140 milligrams per deciliter, leads to a three-hour glucose tolerance test. Most women who screen positive do not have gestational diabetes.

For the three-hour test, you fast for at least eight hours. Then your blood is drawn before a larger glucose drink and every hour for three hours afterward. If you have risk factors, like gestational diabetes in a past pregnancy, your provider may test you earlier. Some providers offer alternatives to the glucose drink, like eating jelly beans, so it is worth asking. The gestational diabetes episode breaks down testing and treatment. The episode on prenatal testing in the second half of pregnancy covers the tests that come next.

Your blood work at your first appointment showed whether you are Rh positive or Rh negative. If you are Rh negative and your baby is Rh positive, your immune system can make antibodies against your baby’s blood cells. This mainly affects future pregnancies. A shot of Rho(D) immune globulin, commonly called RhoGAM, prevents this. It is usually given around 28 weeks, with another dose after birth if your baby is Rh positive. You may also need a dose after bleeding, an injury to your belly, or an amniocentesis. A newer option is fetal RhD genotyping, a cfDNA blood test that shows your baby’s Rh status. ACOG supports this test, and if it shows your baby is Rh negative, you do not need RhoGAM during pregnancy. Availability varies, so ask whether it is offered.

The window for the Tdap vaccine, which helps protect your baby from whooping cough, opens at week 27, the last week of the second trimester. The CDC and ACOG recommend one dose during each pregnancy, between weeks 27 and 36.

If you have not had a flu vaccine yet, it may come up now. The CDC recommends flu vaccination in any trimester, and ACOG also recommends it during pregnancy. On the COVID-19 vaccine, the two organizations differ. ACOG recommends vaccination during pregnancy, while federal guidance changed in 2025 and has been in flux since. Vaccination should always involve informed consent, so talk with your doctor or midwife about what is right for you. Like any intervention, it is your choice to opt in or opt out.

Some changes in blood pressure are normal during pregnancy. However, research shows that hypertensive disorders affect about 10 to 20% of pregnancies in the United States. These include chronic hypertension, gestational hypertension, and preeclampsia, which usually develops after 20 weeks. This is why your provider checks your blood pressure at every visit.

Preeclampsia does not always cause noticeable symptoms. When it does, signs include a severe headache that does not go away and vision changes, like seeing spots. Other signs include pain in your upper belly, trouble breathing, and sudden swelling in your face or hands. If you are diagnosed with any type of high blood pressure, expect closer monitoring. You may have more frequent visits, check your blood pressure at home, and have extra ultrasounds to track your baby’s growth.

If you have risk factors for preeclampsia, your provider may recommend low-dose aspirin. ACOG advises starting it between 12 and 28 weeks, ideally before 16 weeks, so this conversation often happens early in the second trimester.

Intrahepatic cholestasis of pregnancy, or ICP, is a liver condition in which bile acids build up in your blood. The hallmark is intense itching without a rash, often on the palms of your hands and soles of your feet. It most often shows up in the third trimester, although it can start earlier.

ICP is uncomfortable but does not pose serious risks to you, and it goes away after birth. However, it is linked to a higher risk of complications for your baby, such as preterm birth. A blood test can diagnose it. To ease the itching, the Society for Maternal-Fetal Medicine recommends a medication called ursodiol. It also recommends delivery between 36 and 39 weeks, depending on your bile acid levels. If you notice itching on your palms or soles, call your provider rather than waiting for your next visit.

Most aches and changes in the second trimester are normal. However, some symptoms warrant a call right away, even between appointments.

Call if you have vaginal bleeding or fluid leaking from your vagina. The same goes for contractions or cramps that feel like your period. Pressure in your pelvis or a low, dull backache that will not go away also needs a call. The National Institute of Child Health and Human Development lists all of these as reasons to be checked. Back pain that comes on suddenly or comes with a fever also needs a call.

Call right away for a severe headache that does not go away, vision changes, or pain in your upper belly. Trouble breathing or sudden swelling in your face or hands is also urgent. In addition, let your provider know about itching on your palms or soles, a fever, or burning when you urinate. Vomiting that keeps you from holding down liquids also warrants a call. Later in pregnancy, once you know your baby’s usual pattern, a noticeable drop in movement is also a reason to call. Above all, trust yourself. If something feels off, call.

Your emotional health deserves the same attention as your physical health. ACOG recommends screening for depression and anxiety later in pregnancy, not only at your first visit. If worry, sadness, or feeling overwhelmed lingers, tell your provider. You can also learn evidence-based tools to manage stress. Help is available any time through the National Maternal Mental Health Hotline, which you can call or text 24 hours a day at 1-833-TLC-MAMA, or 1-833-852-6262.

With more energy, the second trimester is the perfect time to tackle the bigger items on your list. Getting a head start now can make the final months feel calmer.

As your baby grows, your favorite jeans will eventually stop cooperating. There are hacks to stretch your regular clothes a little longer, but maternity clothes designed for a pregnant belly are far more comfortable. You do not need to spend a fortune on a new wardrobe. A few basics go a long way, and secondhand shops and hand-me-downs from friends are great options. Please do not suffer in uncomfortable clothes.

If you want to take a trip or a babymoon, the second trimester is usually the best time to go. Nausea has often faded, and the discomfort and fatigue of late pregnancy have not set in. Later on, you may also feel less comfortable being far from your care provider or the place you plan to give birth.

According to ACOG, flying is safe for pregnant women without complications. Keep your seatbelt fastened whenever you are seated, low on your hips and below your belly. Airlines set their own rules late in pregnancy, so check before you book. Long trips can raise your risk of blood clots, so stay hydrated, get up and walk often, and consider compression socks. In the car, ACOG recommends wearing the lap belt below your belly and the shoulder belt across your chest. Before you go, check with your provider, look up any travel notices from the CDC for your destination, and confirm how your insurance covers you away from home. The episode on traveling while pregnant has more tips for staying healthy and comfortable.

The second trimester is a great time to learn about birth and life with a newborn. If you plan to take a childbirth class, signing up now gives you time to finish before the final weeks. Start exploring your options and the experience you want, which is the foundation of your birth plan. It also helps to prepare for breastfeeding by learning how it works and where to get support. This is also a good time to start looking for a pediatrician and decide whether cord blood banking is right for your family.

Now is a good time to start researching maternity and paternity leave. Find out what your employer offers, what your state provides if you are in the United States, and how much of your leave will be paid. If you or your partner is self-employed, think about how you will step away from work. You will finalize the details closer to your due date, but knowing your options early makes planning easier.

Childcare deserves an early start too. If you plan to return to work, explore your options, from a family member or nanny to a daycare center. Child care can have long waitlists in some areas, so it helps to begin your search now. The episode on finding the right childcare covers your options, costs, and the questions to ask.

Building your baby registry fits naturally into the second trimester. By now, you are past the overwhelm of early pregnancy and have the energy to think about what your baby will need. A registry helps you stay organized and gives friends and family an easy way to support you. If you are not sure what you actually need, the baby essentials list breaks down the must-haves, the nice-to-haves, and what you can skip.

Your partner can play a big role this trimester. Encourage them to come to the anatomy scan and as many appointments as they can, in person or by video. The planning in this window is also a great place for your partner to help out, from researching leave and childcare to building the registry. Ask them to take on some of the reading and research, too. If you do not have a partner, lean on friends or family so you are not going through this alone. The episode on your partner’s role covers more ways they can support you.

The second trimester is often the most comfortable stretch of pregnancy, and it is also one of the busiest. Most moms feel their baby move between 16 and 20 weeks, and the anatomy scan is your most detailed look at how your baby is growing. Many symptoms in this window are normal and manageable. However, bleeding, leaking fluid, regular cramping, a severe headache, or itchy palms and soles all warrant a call. Use the energy you have now to get ahead on planning that can feel overwhelming later. Before your anatomy scan, decide whether you want to learn your baby’s sex, and ask your provider how and when you will get the results.

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You are pregnant, and your body already feels different, even though no one else can tell yet. The first trimester brings some of pregnancy’s biggest changes. It is often when you keep the news to yourself and wonder whether what you feel is normal. Here, you will learn how your baby grows through week 12 and which symptoms to expect. You will also learn what to expect at your first prenatal visit and when to share your news.

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Pregnancy is counted in weeks, starting from the first day of your last period. This means weeks one and two happen before you conceive. Most people ovulate and conceive around week three, and a test may turn positive around week four or five. Your due date falls at 40 weeks, and the first trimester runs through week 12.

These early weeks can feel long. You may have plenty of symptoms but no bump, and you may be keeping the news to yourself. If you want to follow along week by week, the 40 Weeks podcast has a short episode for every week of pregnancy.

At conception, your baby is a single cell. Over the next 10 weeks, that cell develops into a tiny fetus, and every major organ system begins to form. The heart starts working early, and by the end of the first trimester, it pumps blood through your baby’s body. Meanwhile, facial features take shape, arms and legs grow longer, and fingers and toes separate. By 12 weeks, your baby is even sprouting fingernails.

Your baby also moves long before you can feel it. According to a review of fetal movement research, an embryo starts moving by about 7.5 weeks. Two to three weeks later, ultrasound can capture movements of the arms, legs, and head, and even hiccups. However, you likely will not feel any of this until the second trimester.

At 12 weeks, your baby measures about 2.1 inches, or 5.4 centimeters, from crown to rump, about the size of a plum. Early in pregnancy, doctors measure babies from the top of the head to the bottom because their legs are curled up. Starting at week 14, measurements switch to crown to heel.

Your baby weighs roughly 2 ounces, or 58 grams, at 12 weeks. Keep in mind that weight estimates this early vary widely, and other apps may show a much lower number. The study behind this figure did not validate it before 14 weeks. For now, length is the more reliable measure.

Hormones drive most of what you feel in the first trimester. Soon after conception, the cells that will become the placenta start producing human chorionic gonadotropin, or hCG. This is the hormone a pregnancy test detects. According to research, hCG supports the corpus luteum, the structure left in your ovary after ovulation, so it keeps producing progesterone until the placenta takes over. hCG levels climb quickly and typically peak around 10 weeks.

Progesterone and estrogen rise steadily as well. Together, these hormones are behind many first trimester symptoms, from nausea to fatigue to sore breasts. They can also affect your mood. Feeling excited one minute and weepy or anxious the next is common. If worry or low mood lingers, let your care provider know. The episode on managing anxiety in the first trimester has practical strategies.

Morning sickness is the common name for nausea and vomiting during pregnancy. According to research, it affects 70 to 80% of expecting mothers. Despite the name, it can strike at any time of day. For some women, it lasts all day. Symptoms usually start before week nine and ease by about 14 weeks. For up to 15% of women, nausea continues past 20 weeks, according to a review.

Recent research has shed light on why it happens. A 2023 study in the journal Nature identified a hormone called growth differentiation factor 15, or GDF15, as a major driver of pregnancy nausea. The placenta makes GDF15 in large amounts. Women with lower levels before pregnancy appear more sensitive to the sharp rise in early pregnancy. In addition, hCG, estrogen, and a heightened sense of smell likely play a role.

What helps varies from person to person. The American College of Obstetricians and Gynecologists, or ACOG, suggests eating small, frequent meals so your stomach is never empty. Keeping crackers by your bed to eat before you get up can help too. Bland foods and cold meals with less aroma are often easier to tolerate. Sip fluids throughout the day, especially if you are vomiting. For many women, vitamin B6 is the next step. ACOG recommends it as a safe first-line treatment, and there are prescription options if it is not enough.

Morning sickness can take a real toll on your quality of life, especially when few people know you are pregnant. You do not need to tough it out, because treating symptoms early can keep them from escalating. On the severe end is hyperemesis gravidarum, which research shows affects about 0.3 to 3% of pregnancies. It involves persistent vomiting, dehydration, and weight loss, and it needs medical care. For a complete guide to remedies and medications, see the episode on navigating morning sickness.

Feeling completely wiped out is one of the most common early symptoms, and rising progesterone plays a big role. Pregnancy fatigue is most common in the first and third trimesters, so your energy should return in the second trimester. In the meantime, listen to your body. Rest, nap, or go to bed early when you can. Research shows that sleep supports nearly every system in your body, and simple, evidence-based ways can improve the quantity and quality of your sleep.

Sensitive, tender, or sore breasts are often one of the very first signs of pregnancy. Soreness can start as soon as one to two weeks after conception. Hormonal changes, extra fluid, and your breasts preparing for breastfeeding can cause this. Fortunately, this early soreness usually eases in the second half of the first trimester.

Many women also notice their breasts growing in the first trimester as the milk ducts multiply. Your areolas may get larger and darker, and the veins in your breasts may become more visible as your blood volume increases. A supportive, comfortable bra can help, including a soft bra for sleep. Because your size will likely keep changing, there is no need to buy nursing bras yet. The episode on breast changes covers what to expect in more detail.

If you feel like you are always looking for a bathroom, you are not alone. Early in pregnancy, your blood volume rises, and your kidneys filter more of it. A systematic review of 29 studies found that kidney filtration increases by up to 40 to 50% as early as the first trimester. More filtering means more urine. At the same time, your growing uterus presses on your bladder. The urge often eases in the second trimester and can return later as your baby grows. However, burning or pain when you urinate can signal a urinary tract infection, so tell your provider.

Food cravings and aversions are usually strongest in the first trimester. In one study, about three-quarters of women reported food cravings during pregnancy, most often for sweet and salty foods. Aversions can be just as intense, and meat and strong-smelling foods are common culprits. You may have heard that a craving signals a nutrient your body needs. For example, if you crave oranges, you need more vitamin C. Research does not support that theory. Instead, cravings seem to come from a mix of changes in taste and smell, emotions, and cultural expectations. Enjoying the foods you crave is fine in moderation. On hard days, eating something is better than eating nothing.

Progesterone relaxes smooth muscle, including your digestive tract, so digestion slows down. The iron in your prenatal vitamin can add to the problem. A meta-analysis found that about 21% of women have constipation in the first trimester, and it often gets worse in the second. Diet and lifestyle changes are the first line of defense. ACOG recommends about 25 grams of fiber a day. Increase fiber gradually, drink plenty of water, and keep moving. If that is not enough, talk to your provider before trying a laxative. The episode on relieving constipation covers which options have the best evidence.

Congestion might seem like an odd pregnancy symptom, but pregnancy rhinitis affects up to 30% of expecting mothers, according to a review. Rising hormones and increased blood volume cause your nasal tissues to swell. As a result, you may notice congestion, snoring, or occasional nosebleeds. It can start at any point in pregnancy, including the first trimester, and it typically clears up after your baby is born.

Most women do not start to show until the end of the first trimester or the beginning of the second. You may show sooner if you are expecting twins or if this is not your first pregnancy. Despite the idea of eating for two, ACOG says you do not need extra calories in the first trimester if you are carrying one baby. Weight gain guidelines from the Institute of Medicine assume a gain of about 1 to 4.5 pounds in the first trimester. If nausea makes eating hard, you may gain nothing at all or even lose a little. Most weight gain comes later.

Most pregnancies continue without a problem, but pregnancy loss is more common than many people realize. According to ACOG, early pregnancy loss happens in about 10% of clinically recognized pregnancies, and about 80% of all losses happen in the first trimester. About half are caused by chromosomal abnormalities that occur by chance as the embryo develops. In other words, a miscarriage is almost never caused by something you did. Research has not shown that exercise, sex, or working causes early pregnancy loss.

An ectopic pregnancy is different. It happens when a fertilized egg implants outside the uterus, most often in a fallopian tube. According to ACOG, it occurs in about 2 in 100 pregnancies, and it cannot continue safely. Warning signs include vaginal bleeding and pain on one side of your abdomen. Sudden severe pain, shoulder pain, or feeling faint can mean an emergency. This is why one-sided pain is on the list of reasons to call right away.

If you experience a loss, you are not alone, and support is available. The episodes on miscarriage, pregnancy loss, and ectopic pregnancy cover the research, what to expect, and how to care for yourself.

Some symptoms are normal in the first trimester, and others warrant a call. Vaginal bleeding is one that worries many expecting parents. According to MedlinePlus, up to 1 in 4 women have bleeding at some point in pregnancy, and it is most common in the first trimester. Light spotting is often harmless. Even so, let your doctor or midwife know about any bleeding so they can decide whether you need to be seen.

Call right away if you have heavy bleeding, bleeding with cramping, or sharp pain on one side of your abdomen. The same goes for a fever, feeling faint, or vomiting that keeps you from keeping liquids down. Above all, trust yourself. If something feels off, call. That is exactly what your care team is there for.

Once you see a positive test, you will hear plenty of advice about what to avoid. The pregnancy basics episode covers the evidence in depth, including where there is more nuance than you may think. These are the essentials for the early weeks.

Start a prenatal vitamin if you have not already. ACOG recommends 400 micrograms of folic acid daily to help prevent neural tube defects, which develop very early. Avoid alcohol, smoking, vaping, and cannabis. If you drank before you knew you were pregnant, try not to stress. ACOG acknowledges that serious harm is unlikely. Check any prescription or over-the-counter medications with your doctor or midwife. However, do not stop a prescribed medication on your own.

ACOG guidelines recommend keeping caffeine under 200 milligrams a day. Food safety matters more now. Many foods are on the do-not-eat list, like unpasteurized dairy and juice, deli meats, and undercooked meat or seafood. Like everything, these guidelines tend to be conservative, and there is more nuance to them. Some activities are also generally off-limits, like cleaning the litter box. Most sources will tell you to avoid hot tubs, saunas, and anything else that raises your core temperature. That is because overheating in the first trimester has been linked to neural tube defects. Again, the research has more nuance, and the Pregnancy Podcast has episodes that dig into almost all of these.

Healthy habits matter too. Build your diet mostly on whole foods, and stay hydrated. ACOG recommends 64 to 96 ounces of water a day. Regular exercise during your pregnancy is safe for most women and is linked to a lower risk of complications like gestational diabetes and preeclampsia. If you already exercise, you can usually keep going with some modifications.

Your first prenatal visit usually happens around week eight. The wait can feel long, and there is a separate episode on what to do before your first appointment. The first visit is often the longest one of your pregnancy, because there is a lot to cover.

Your doctor or midwife will go over your health history, including your periods, past pregnancies, medications, and family history. Next, expect a physical exam, which may include a pelvic exam and a Pap test if you are due for one. You will also give a urine sample and have blood drawn. According to ACOG, this first round of tests checks your blood type and Rh factor, your iron levels, and your immunity to certain infections. It also screens for infections like HIV, hepatitis B, and syphilis. Your glucose results give a baseline and can flag the need for earlier gestational diabetes screening. Your provider will check your blood pressure at this visit and every visit after it to watch for hypertension.

At this visit, your provider will also calculate your body mass index, or BMI, and recommend a weight gain range based on ACOG guidelines. If your BMI is under 18.5, the range is 28 to 40 pounds. It is 25 to 35 pounds for a BMI of 18.5 to 24.9, 15 to 25 pounds for 25 to 29.9, and 11 to 20 pounds for 30 or higher. In addition, ACOG recommends screening for depression and anxiety at this first visit. Bring your questions, a list of any medications you take, and the date of your last period.

After this visit, most practices schedule appointments every four weeks through the second trimester. ACOG now encourages tailoring the number and type of visits to your needs, although most practices still follow the traditional schedule.

Many practices do a transvaginal ultrasound at this visit. It confirms your pregnancy and measures your baby to help set your due date. You may hear your provider call the flicker on the ultrasound cardiac activity rather than a heartbeat. A 2024 consensus statement00811-1/abstract) recommends that term because the heart is still forming. According to Mayo Clinic, you may be able to hear the heartbeat with a handheld Doppler by about 12 to 14 weeks. If your provider cannot pick it up early on, try not to panic. Your baby’s position and where your placenta is can make it harder to hear.

Vaccines may come up at your first appointment. ACOG recommends the flu and COVID-19 vaccines during pregnancy, and you can get either one in any trimester. The Centers for Disease Control and Prevention, or CDC, also recommends a flu shot during pregnancy. On COVID-19, the two organizations differ. Federal guidance on COVID-19 vaccines during pregnancy changed in 2025 and has been in flux since, while ACOG continues to recommend vaccination. Two other vaccines come later in pregnancy. Tdap protects against tetanus, diphtheria, and whooping cough, and a separate vaccine protects your baby from respiratory syncytial virus, or RSV. Like any medical decision, vaccination should involve informed consent. Learn more about the flu vaccine and the COVID-19 vaccine in pregnancy, and talk with your doctor or midwife about what is right for you.

Your doctor or midwife will offer several prenatal tests in the first trimester. Some are routine, like the blood work at your first visit. Others are optional, and you choose whether to have them.

It helps to understand two types of tests. A screening test estimates the chance that your baby has a condition. A positive screening result does not mean your baby has that condition. Only a diagnostic test can confirm it. Most tests are also noninvasive, meaning they use your blood, urine, or an ultrasound and pose no risk to your baby.

Cell-free DNA screening, or cfDNA screening, is a blood test that analyzes fragments of DNA from the placenta that circulate in your bloodstream. You can have it starting at 10 weeks. It is the most accurate screening test for Down syndrome and other common chromosomal conditions, and it can also reveal your baby’s sex. The Society for Maternal-Fetal Medicine recommends making it available to all pregnant patients.

Some practices also offer the first trimester screen. This combines a blood test with an ultrasound measurement at the back of your baby’s neck, between 11 weeks and 13 weeks, 6 days. A study in the New England Journal of Medicine found it detects about 85% of cases of Down syndrome, with a false positive rate of 5%.

If a screening result is positive, you may be offered a diagnostic test. Chorionic villus sampling, or CVS, tests a small sample of placental tissue between 10 and 13 weeks. It is highly accurate. A systematic review and meta-analysis put the added risk of pregnancy loss from the procedure at about 0.22%.

You may also be offered carrier screening, ideally before pregnancy or early on. This blood test checks whether you carry a gene for an inherited condition, such as cystic fibrosis or spinal muscular atrophy, without having it yourself. ACOG recommends offering it to everyone. If you are a carrier, your partner can be tested. For most of these conditions, your baby is only at risk if you both carry a gene for the same condition.

Before any test, ask your provider when to expect results and how you will get them. For a full walkthrough of every option, see the episode on prenatal testing in the first half of pregnancy.

Pregnancy hormones can make your gums more sensitive to plaque, so swollen or bleeding gums are common. Pregnancy gingivitis often starts in the first trimester. According to ACOG, about 40% of pregnant women have some form of periodontal disease. ACOG and the American Dental Association both recommend regular dental care during pregnancy, and cleanings and x-rays are safe. Make dental care a priority by scheduling a visit and telling your dentist you are pregnant. At home, brush twice a day with a soft toothbrush and floss daily. The Q&A on how pregnancy affects your oral health goes deeper.

Now is a good time to understand how you will pay for prenatal care and birth, because those costs add up quickly. According to a 2025 analysis of people with employer insurance, pregnancy, birth, and postpartum care cost an average of about $20,400. Of that, families paid about $2,700 out of pocket. Costs were higher for a cesarean birth, at about $29,000 in total, than for a vaginal birth, at about $15,700.

If you have insurance, call your insurer to learn what your plan covers for prenatal care and birth. Ask about your deductible and out-of-pocket maximum, and confirm that your doctor or midwife and your hospital are in network. Many plans have limited coverage for a birth center or home birth, so check early if you are considering one. Tax-advantaged accounts, like a flexible spending account or health savings account, let you pay for qualified medical expenses with pre-tax dollars.

If you are not in a financial position to get insurance, resources can help. According to CDC data, Medicaid paid for about 40% of births in the United States in 2024. You may also qualify for subsidies through healthcare.gov. The hospital or birth center where you plan to give birth may offer reduced rates based on income, and you may be able to negotiate a payment plan. Even if money is tight, you have options. The episode on health insurance and birth costs explains how your insurance works and ways to lower your costs.

When to announce your pregnancy is a personal decision. Many parents wait until around 12 weeks to share the news widely. By then, you have usually had your first appointment and seen your baby on an ultrasound. The chance of a loss is also much lower by then, according to the March of Dimes.

You do not have to choose between telling everyone and telling no one. Many people tell a few close friends or family members early, so they have support through the harder days of the first trimester. Then they share with everyone else later. Talk with your partner so you are on the same page about when and how to share.

Telling your employer is a separate decision. You may want to tell your manager sooner if morning sickness affects your work or you need time off for appointments. Otherwise, you can wait until you are ready. The Q&A on deciding when to share your pregnancy at work walks through the timing.

A supportive partner can make the first trimester much easier. Your partner may not feel your nausea or exhaustion, but they can take on more around the house. Cooking is a good place to start, especially if food smells trigger your nausea. Keeping snacks and drinks you can tolerate within reach helps too. On hard days, it means a lot when your partner acknowledges that what you feel is real, rather than brushing it off as normal.

If your partner can attend your first appointment, in person or by video, encourage them to come. It is a big moment, and hearing everything firsthand helps them feel included and ask their own questions. If you do not have a partner, lean on friends or family so you are not going through this alone. I strongly encourage you to bring your partner to every appointment, if possible.

Nausea, exhaustion, and sore breasts are common in the first trimester, and most of these symptoms ease as you reach the second trimester. Light spotting is often harmless, but tell your provider about any bleeding. Your first prenatal appointment, usually around week 8, is the longest one, and it sets your due date and starts your routine testing. Most screening tests in these weeks are optional, and a positive screen is not a diagnosis. Before your first appointment, write down the date of your last period, the medications you take, and any symptoms that worry you. Ask your doctor or midwife which symptoms warrant a call between visits, and call right away if you have heavy bleeding, bleeding with cramping, or cannot keep liquids down.

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Once you see a positive pregnancy test, everyone seems to have advice. Learning the pregnancy basics helps you sort the rules that matter from the ones with more nuance. You may hear that you should cut out coffee, never eat sushi, and stay out of hot tubs. Some of that advice is backed by solid research, and some is far more cautious than the evidence supports. This guide covers when prenatal care starts, what to truly avoid, and where there is more nuance than you may think. It also covers the few habits worth building right now.

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One of the first pregnancy basics to understand is how pregnancy is counted. Almost everything in your prenatal care is timed by it. Pregnancy is measured in weeks, starting from the first day of your last menstrual period. This means conception usually happens around week three, so you are already counted as two weeks pregnant on the day you conceive. As a result, your due date falls at 40 weeks.

Your care provider will estimate your due date from your last period, an early ultrasound, or both. According to the American College of Obstetricians and Gynecologists, or ACOG, a first-trimester ultrasound is the most accurate way to date a pregnancy. Keep in mind that your due date is an estimate, not a deadline. Your baby is likely to arrive sometime in the weeks around it.

Pregnancy is also divided into three trimesters. The first trimester runs through week 12. The second trimester covers weeks 13 through 27. Finally, the third trimester starts at week 28 and lasts until your baby is born.

If you want to follow along week by week, the 40 Weeks podcast has a short episode for every week of pregnancy.

Your care provider is the cornerstone of your prenatal care and birth experience. You will work closely with this person throughout your pregnancy to make important decisions. Their training matters, and so do your comfort and trust. Ultimately, who your care provider is will shape your experience and how your baby enters the world.

In the United States, obstetrician-gynecologists attend most births. These are physicians with medical and surgical training. Midwives are another option. A certified nurse-midwife is a registered nurse with graduate-level midwifery training who can practice in hospitals, birth centers, and homes. Certified midwives complete the same graduate training and national exam without a nursing background. Certified professional midwives train specifically for births outside the hospital. Where each type of midwife can practice depends on state law.

Which provider fits you often depends on where you plan to give birth. According to the Centers for Disease Control and Prevention, or CDC, about 98% of births in the United States happen in a hospital.

It is also an option to have your baby at a birth center, or at home.

When choosing your care provider, do your research, explore your options, and shop around for the right fit. Your health insurance can also affect which providers and birth locations are covered, so check early. Ideally, you find the right provider from the start. However, you can always change to another doctor or midwife if you do not feel supported.

Most practices still follow a traditional prenatal schedule, and this is what you are most likely to encounter. Your first appointment is usually around week 8. After that, you typically see your care provider every four weeks through the second trimester. Starting at week 29, appointments move to every other week. Then, beginning in week 36, you see your provider weekly. If you go past your due date, appointments can be every few days. In total, typically, you can expect around 14 appointments.

This schedule has a long history. According to ACOG, formal models of prenatal care have changed very little since they were first published in 1930. In April 2025, ACOG released new guidance that moves away from a fixed number of visits. Instead, it recommends tailoring prenatal care to each person. This starts with an assessment of your medical, social, and practical needs, ideally before 10 weeks. For an average-risk pregnancy, evidence supports about 6 to 10 targeted visits.

The guidance also makes room for telemedicine and home monitoring, such as checking your own blood pressure.

However, a gap remains between this new guidance and what happens in most practices today. ACOG itself acknowledges that shifting a century-old approach to prenatal care will take time. As a result, you will most likely still see the traditional schedule.

If you have questions about how your care is structured, including whether some visits could be virtual, ask your doctor or midwife. You can also use these tips to make the most of every prenatal appointment.

Along the way, you will be offered routine blood work and several optional screening tests, such as cell-free DNA screening and glucose screening. The episodes on prenatal testing in the first half and second half of pregnancy explain each test and your options. Later in pregnancy, your provider will also recommend vaccines. This is a controversial topic, and there have been some discrepancies between different health organizations. These recommendations will not come until later in your pregnancy, and it is a great topic to discuss with your doctor or midwife.

Long lists of foods, drinks, and activities to avoid during pregnancy are easy to find. Many of these recommendations are intentionally conservative because they are written to apply to every pregnancy, including pregnancies with complications. For some items, avoiding them completely is clearly the right call. For others, there is more nuance. Understanding why something carries a risk can help you make informed decisions about what you are comfortable with. The episodes linked throughout this section explore each topic in more depth.

Alcohol is one of the first things to cut out once you see a positive pregnancy test. If you ask your doctor or midwife about it, you may hear that no amount is safe, or that an occasional glass of wine is fine. It is clear that drinking large amounts of alcohol is harmful. For this reason, major medical organizations, including the CDC, the American Academy of Pediatrics, and ACOG, advise against any alcohol during pregnancy.

Many expecting moms worry about a party night or two before they knew they were pregnant. If that is you, try not to stress. Many women have been in the same situation and gone on to have perfectly healthy babies. Even ACOG acknowledges that serious harm is unlikely if you drank before you knew you were pregnant. You cannot change the past, but you can make mindful choices from here. For the evidence on everything from that party night to whether you need to pump and dump while breastfeeding, see the episode on alcohol during pregnancy.

Smoking is another habit to stop as soon as possible. According to ACOG, tobacco use during pregnancy is linked to oral clefts, poor fetal growth, placental problems, preterm rupture of membranes, and low birth weight. The encouraging news is that quitting at any point benefits you and your baby, and the greatest benefit comes from quitting before 15 weeks.

In addition, the CDC notes that e-cigarettes and other nicotine products are not safe during pregnancy.

The same goes for cannabis and other recreational drugs. In 2025, ACOG updated its guidance and advises stopping cannabis use during pregnancy. Research has associated substance use in pregnancy, including cannabis, with preterm birth, low birth weight, and developmental delay. Much of this research is observational, but it is enough to warrant caution. If you are finding it hard to quit any substance, please talk to your care provider. Support is available, and asking for it is a strong step for you and your baby.

If you take any prescription medications, contact your doctor or midwife right away to make sure they are safe to continue during pregnancy. According to ACOG, some medications have been linked to birth defects, so anyone who prescribes you medication should know you are pregnant. At the same time, do not stop a prescribed medication on your own, because some conditions need ongoing treatment. For common over-the-counter options, like pain relievers and cold remedies, see the episodes on Tylenol and other over-the-counter medications and getting sick during pregnancy.

Be mindful of caffeine, but it is not necessarily off-limits. There is no definitive evidence showing an amount of caffeine that is 100% safe during pregnancy. Most studies use 200 milligrams per day as the cutoff for low or moderate intake, which aligns with the recommendation from ACOG and other health agencies. For perspective, the Food and Drug Administration reports that 12 ounces of regular brewed coffee typically contains 113 to 247 mg of caffeine. The same amount of black tea has about 71 mg, green tea about 37 mg, and a caffeinated soft drink 23 to 83 mg.

This means a single large coffee can put you near the 200 mg limit, so the size of your cup matters.

See the episode on caffeine during pregnancy and breastfeeding for a deep dive into how your body processes caffeine and what the research shows.

Some foods carry a higher risk of foodborne illness, and pregnancy makes you more vulnerable. According to the CDC, pregnant women are 10 times more likely to get a listeria infection.

Listeria is a bacterium that can make both you and your baby seriously ill. Cutting certain foods out of your diet can be hard, especially if they are foods you enjoy. A separate episode on food safety during pregnancy goes beyond the typical do-not-eat list and includes a few foods that rarely appear on it.

Pasteurization heats foods to kill bacteria and other germs, and it also extends shelf life. The foods most likely to be unpasteurized are milk, juice, and some cheeses, so check labels for the word pasteurized. Deli meats also appear on most lists of foods to avoid because of the risk of listeria. Restaurants and companies that sell deli meats have a strong incentive to keep their food safe, and the risk is low. However, listeria can be serious during pregnancy. You could skip deli meats until after your baby arrives. Another option is a hot sandwich, since the CDC advises heating deli meat to 165°F (74°C) or until steaming hot to kill bacteria.

Fish is a great source of protein and omega-3 fats. ACOG recommends 2 to 3 servings (8 to 12 ounces in total) of fish per week, with a maximum of 6 ounces of albacore or white tuna.

ACOG’s current guidance lists the fish highest in mercury to avoid: bigeye tuna, king mackerel, marlin, orange roughy, shark, swordfish, and tilefish. One challenge is that limiting fish to 12 ounces a week can make it harder to get enough of the omega-3 fat DHA. There is a lot of nuance in the research, and you can learn more about eating fish during pregnancy.

It is also recommended to avoid raw or undercooked fish, such as sushi. Fish meant to be eaten raw is often frozen to kill parasites, but it can still carry bacteria or viruses. These risks exist for everyone. However, pregnancy makes you more vulnerable, and an infection could lead to serious complications for your baby.

Similar concerns apply to raw or undercooked meat and eggs. According to the CDC, undercooked meat and eggs, unpasteurized milk, and unwashed produce are among the foods most often linked to foodborne illness. The risk of food poisoning is always there, but with your baby on the way, you may want to be extra careful. Cooking meat and eggs thoroughly and washing fruits and vegetables go a long way.

Having a cat during pregnancy does not mean you need to keep your distance. The concern is cat feces, which can carry a parasite that causes an infection called toxoplasmosis. For most healthy adults, toxoplasmosis does not cause serious problems, and it is common. According to the CDC, over 40 million people in the United States are infected with the parasite. However, a first infection just before or during pregnancy can pose serious risks to your baby, including hearing loss, vision problems, and intellectual disabilities.

If you have been infected before, you are likely immune, and that immunity also protects your baby. Unfortunately, most women are not immune. In national survey data from 2009 to 2010, only about 9% of women ages 15 to 44 had antibodies to the parasite. In other words, roughly 9 in 10 women of childbearing age are not protected.

Toxoplasmosis screening is not routine in the United States. For this reason, the simplest approach is to ask your partner, a friend, or a family member to clean the litter box.

You can also get toxoplasmosis from soil where cats have buried their waste, as well as from undercooked meat, according to the CDC. If you have an outdoor cat or stray cats nearby, wear gloves while gardening and wash your hands thoroughly afterward. Try not to touch your face while you work, and always wash fruits, herbs, and vegetables before eating them.

An elevated core body temperature, especially in the first trimester, has been linked to neural tube defects and other complications. A neural tube defect is a problem with the development of the baby’s brain or spine.

This is why hot yoga, hot tubs, saunas, and even hot baths come with warnings. As with many pregnancy topics, the research has more nuance.

ACOG advises against hot yoga and hot Pilates because of the risk of overheating. Interestingly, a small study compared core temperatures during yoga in a room at 70°F (21.1°C) and a room at 92°F (33.3°C). It found no difference in how much core temperature rose.

That said, the participants were not pregnant, and many hot yoga classes are heated above 100°F (38°C), so the results have limits.

ACOG also recommends avoiding hot tubs and saunas. In one study of 20 women who were not pregnant, most chose to get out of the hot tub or sauna because they felt uncomfortable before their core temperature reached a concerning level. This suggests that normal, brief use is unlikely to raise your temperature to a dangerous point. Still, a few minutes now and then is very different from long daily sessions, so get out as soon as you feel too warm. A warm bath is fine, as long as it is not scalding. For comprehensive research, see the episode on heat exposure during pregnancy.

Many women become more mindful about chemical exposures during pregnancy, since some substances can cross the placenta. Pregnancy can also heighten your sense of smell and make your skin more sensitive, which may change how you react to products. Some household cleaners, like strong drain or oven cleaners, are particularly harsh. If possible, have your partner or someone else use these. Otherwise, wear gloves, work in a well-ventilated area, and spray cleaners onto a cloth rather than directly onto surfaces. Choosing fragrance-free and milder formulas is an easy way to reduce your exposure. For more guidance, see the episode on safe cleaning products.

There are a few skincare ingredients you should be mindful of during pregnancy. The biggest concern is vitamin A compounds called retinoids.

Oral isotretinoin, a prescription medication for severe acne, is strongly linked to birth defects and should never be taken during pregnancy. Topical retinoids, like tretinoin (Retin-A), retinol, retinaldehyde, and retinyl palmitate, are absorbed through the skin in only small amounts. Still, ACOG generally recommends avoiding them during pregnancy. Whether to stop a retinol you love is a personal decision to make with your provider, and the retinol Q&A walks through the research.

ACOG also advises against other prescription acne medications during pregnancy, including hormonal therapies and tetracyclines. On the other hand, ACOG notes that over-the-counter products with benzoyl peroxide, azelaic acid, salicylic acid, or glycolic acid may be used to treat acne during pregnancy.

If you like your current skincare products and they do not contain ingredients ACOG cautions against, there is no need to change a thing. If you start reacting differently because your skin is more sensitive, it may be time to cut back or try something new. Choosing fragrance-free products is one simple way to reduce your exposure to added chemicals. You can always bring a product to your next prenatal appointment and ask about it. For a deeper dive into ingredients and marketing claims like “non-toxic,” see the guide to pregnancy-safe skin care.

Healthy habits are some of the most important pregnancy basics. Finding out you will be a parent is a perfect time to start. The foundation is simple: eat well, stay hydrated, get enough sleep, and move your body. You do not need to overhaul everything at once, because small, consistent steps add up.

During pregnancy, your body has higher nutritional needs to support your energy and your baby’s growth and development. Whether you already eat well or need to make some changes, this is an ideal time to build healthy habits. That might mean adding more fruits and vegetables, cutting back on sugar, or being more mindful of your food choices. Despite the idea of eating for two, ACOG states that you need no extra calories in the first trimester if you are pregnant with one baby. In the second trimester, you need about 340 extra calories per day, and in the third trimester, about 450.

These numbers are general estimates, and few people count every calorie, so focus on the quality of what you eat.

Nutrition is individual, and many people have different opinions on the best diet. That said, the closest thing to an ideal diet is one built on whole foods. Lily Nichols, a registered dietitian nutritionist and certified diabetes educator, calls this “real food” in her book, Real Food for Pregnancy. She writes, “In a nutshell, real food is made with simple ingredients that are as close to nature as possible and not processed in a way that removes nutrients.” I highly recommend her book if you want an evidence-based deep dive into what to eat during pregnancy.

At your first appointment, your provider will likely calculate your body mass index, or BMI, and use it to recommend a weight gain range. The guidelines are based on your BMI before pregnancy, so no single number applies to everyone. For example, the recommended range is 25 to 35 pounds for a normal BMI. If you start out underweight, the range is 28 to 40 pounds. It is 15 to 25 pounds if you start out overweight, and 11 to 20 pounds if you start out with obesity.

Most of that weight is your baby and everything supporting your baby. The episode on pregnancy weight gain covers the full guidelines and what actually matters beyond the scale.

Ideally, you start taking a prenatal vitamin before you get pregnant. The next best time to start is as soon as you find out you are expecting. Your need for certain nutrients increases during pregnancy, and it is hard to meet those needs through diet alone. Prenatal vitamins contain higher amounts of nutrients like folate, folic acid, and iron than standard multivitamins.

Folic acid is especially important early on. According to ACOG, taking 400 micrograms of folic acid daily for at least a month before pregnancy and during pregnancy helps prevent neural tube defects.

ACOG notes that this development happens very early, often before you know you are pregnant, so starting a prenatal vitamin right away matters.

Your gut does much more than digest food. It plays a key role in your immune system, mood, and overall health. A review00238-X/abstract) found that probiotic supplementation during pregnancy appears to be protective. For example, probiotics may improve insulin resistance and lower the risk of gestational diabetes. They may also help with anxiety and depression, support healthy vaginal bacteria, and ease symptoms like constipation. In addition, the researchers found links to a lower risk of group B strep, preeclampsia, and eczema in breastfed babies.

You can get probiotics from foods like yogurt, kefir, and fermented vegetables, or from a supplement. The episode on probiotics and gut health covers pregnancy-safe probiotic foods, the risks and benefits of supplements, and how to choose one. As with any supplement, please check with your doctor or midwife before you start.

According to the United States Geological Survey, up to 60% of your body is water. Every cell needs it to function. Water helps regulate your body temperature, aids digestion, and carries nutrients and oxygen to your cells. These processes are just as important for your baby, and your water needs increase during pregnancy. In addition, not drinking enough can worsen common symptoms like constipation, Braxton Hicks contractions, edema (swelling), and migraines.

Research also links hydration with your baby’s development. A study of more than 19,000 mothers from the National Birth Defects Prevention Study found that drinking more water in early pregnancy was associated with lower odds of several birth defects. These included neural tube defects, oral clefts, and congenital heart defects. This type of study shows an association, not proof that water prevents birth defects. A much smaller study of 38 women found that babies born to dehydrated mothers had lower birth weight and length and smaller head and chest measurements.

ACOG recommends drinking 64 to 96 ounces (1.9 to 2.8 liters) of water every day.

One of the simplest ways to check your hydration is the color of your urine. Ideally, it is a light shade of yellow. For more on staying hydrated, the best water sources, and electrolytes, see the episode on hydration and drinking water.

A growing body of research shows how essential sleep is for nearly every system in your body. This includes learning, memory, mental health, appetite, immune function, metabolism, gut health, and cardiovascular health. During pregnancy, sleep matters even more. A meta-analysis of 120 studies including more than 58 million pregnant women linked poor sleep with higher rates of preeclampsia, gestational diabetes, cesarean birth, and preterm birth. Most of this research is observational, so it shows an association rather than proof that poor sleep causes these outcomes.

Fatigue is very common early in pregnancy, and you will likely sleep more. Surveys show that sleep increases in the first trimester to an average of 7.4 to 8.2 hours.

Listen to your body and give yourself permission to rest. A few simple habits can also make a big difference. Try to get natural light in the morning to help set your internal clock. In the evening, dim the lights and cut back on screens to support your body’s natural melatonin. A consistent sleep schedule, even on weekends, helps too.

For more, see these evidence-based tips to sleep better during pregnancy.

Regular activity can lower your risk of complications like gestational diabetes, preeclampsia, and cesarean birth. It also supports healthy weight gain and can ease common symptoms like constipation and back pain. In addition, staying active improves your physical and mental health in the short and long term.

ACOG recommends at least 150 minutes of moderate-intensity aerobic activity each week.

Moderate activity moves your large muscles enough to raise your heart rate and get you sweating. You can still talk, but you cannot sing. This could be anything from a brisk walk to gardening chores like raking, weeding, or digging. According to ACOG, if you are healthy and your pregnancy is normal, it is safe to continue or start regular physical activity. It is a good idea to talk about your exercise plans with your provider at an early prenatal visit.

Organizations like ACOG base their recommendations on evidence, but they apply them to all pregnant women and tend to be conservative. As a result, some advice can leave expecting moms afraid to do anything with even minimal risk. The truth is that nearly every form of exercise can be modified to be safe during pregnancy.

If you already have a routine, you can usually continue as long as it feels good and your provider does not raise any concerns. Separate episodes offer in-depth information on exercise, cardio, strength training, and yoga.

If you are not very active right now, walking is something nearly everyone can do. Even a daily walk around the block is a good start. A review of walking during pregnancy found that it is associated with a lower risk of gestational diabetes. In one study included in the review, blood sugar levels were 4% to 21% lower after a 25- to 40-minute low-intensity walk. Walking was also associated with a 33% lower risk of preeclampsia and a 29% to 44% lower risk of gaining more weight than recommended.

Both the time and distance walked appeared to matter. Plus, some evidence suggests walking supports a healthy birth weight and a lower risk of preterm birth.

Stress during pregnancy can affect your baby, both through physical changes in your body and by raising your risk of certain complications. How much you and your baby are affected depends largely on how your body responds to stress and how well you can turn that response off. The good news is that understanding your stress response and using evidence-based tools to manage it can reduce these effects. The episode on stress during pregnancy covers the research and practical strategies.

Social connection is an often-overlooked factor that can greatly benefit your mental health. A study that looked at 27 stress indicators during pregnancy found that social support did the most to separate women with healthy stress levels from those with psychological or physical stress. The researchers defined social support as having people to talk to, spend time with, and rely on for practical help. Pregnancy can feel isolating, especially early on when you may not have shared the news. When and how you announce your pregnancy is up to you. Many people wait until about 12 weeks because, according to ACOG, most pregnancy losses happen in the first trimester. Either way, please prioritize your connections and lean on your support system when you need it.

Your partner can be one of your most important sources of support. If possible, bring them to prenatal appointments so they can ask questions and better understand what you are experiencing. The more you include them now, the better they can advocate for you during birth and support you afterward. The episode on your partner’s role covers this in depth.

Depression and anxiety are not only a postpartum concern. In one study summarized by ACOG, about a third of women who screened positive for depression after birth first developed symptoms during pregnancy.

For this reason, ACOG recommends screening for depression and anxiety at your first prenatal visit, again later in pregnancy, and after birth.

If you are struggling with persistent worry, sadness, or feeling overwhelmed, please tell your doctor or midwife. You can learn more in the episode on managing anxiety in the first trimester and beyond. You can also reach the National Maternal Mental Health Hotline 24 hours a day by calling or texting 1-833-TLC-MAMA (1-833-852-6262).

A few things are clear, like avoiding alcohol, smoking, and cannabis. Most other pregnancy rules have nuance, and once you understand the evidence, you get to decide what you are comfortable with. A prenatal vitamin with folic acid matters most in these very early weeks, so start one now if you have not already. Stress that turns into persistent worry or sadness deserves attention during pregnancy, not only after birth. At your first appointment, bring a list of every medication and supplement you take. Add any skincare products or workouts you are unsure about, and ask which ones to keep. The next episode in this series covers the first trimester, including what happens at that first appointment

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It is late, you are finally lying down, and the burning starts again. Heartburn during pregnancy affects roughly 4 in 10 expecting mothers, and the advice is all over the place. Some of it is folklore. Some of it points to medications that were pulled from shelves years ago. In this episode, you will learn why pregnancy makes heartburn so much worse, which simple changes actually have research behind them, how the medication options compare on safety, and the one type of pain that is not heartburn at all.

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What Heartburn Actually Is

Despite the name, heartburn has nothing to do with your heart. It happens when stomach acid rises into your esophagus, the tube that carries food from your mouth to your stomach. That acid irritates the lining and creates a burning feeling in your chest or throat. You may also hear it called acid indigestion or acid reflux.

Most of the action happens at a ring of muscle called the lower esophageal sphincter. It sits where your esophagus meets your stomach. Its job is to open when you swallow and stay closed the rest of the time. When that muscle relaxes at the wrong moment, or stomach pressure overwhelms it, acid flows backward.

Every heartburn treatment works in one of three ways. Some reduce how much acid your stomach makes. Others neutralize acid that is already there. The rest help keep acid where it belongs. Once you know that, the long list of options becomes much easier to sort through.

Why Pregnancy Causes Heartburn

Three changes stack up during pregnancy, and each one makes reflux more likely. First, progesterone relaxes smooth muscle throughout your digestive tract, including the lower esophageal sphincter. A valve that should stay shut becomes less reliable.

Second, your digestion slows down. That is useful, because slower digestion gives your body more time to pull nutrients from your food for your baby. The tradeoff is that food sits in your stomach longer, so acid has more chances to back up.

Third, your growing uterus takes up space your other organs used to have. As a result, it presses on your stomach and pushes everything upward. That is why heartburn so often gets worse in the final months. Research on heartburn in pregnancy points to these same causes, plus weight gain.

How Common Heartburn Is and When It Starts

You will see wildly different numbers for how common heartburn during pregnancy is. Older estimates ranged anywhere from 17% to 80%. That range is so wide that it does not tell you much.

A 2025 systematic review and meta-analysis was the first to pool global data on this question. It included 21 studies with nearly 9,500 pregnant women. Overall, reflux symptoms affected about 41% of them. In the studies that also included women who were not pregnant, the odds of reflux symptoms were about eight times higher during pregnancy. The numbers also climb as pregnancy goes on. In that analysis, about 26% of women had symptoms in the first trimester and 33% in the second trimester. By the third trimester, that rose to about 56%. In other words, the prevalence of heartburn increases as your pregnancy progresses.

For most women, heartburn fades quickly after birth. However, that is not universal. According to a 2022 review, about 20% of women continue to have reflux symptoms after birth, and heartburn during pregnancy makes postpartum reflux more likely. If you are one of them, it helps to know which treatments are preferred while breastfeeding, and we will cover that.

When Heartburn Is Not Just Heartburn

Pain in your upper abdomen during the second half of pregnancy can be a warning sign of preeclampsia or a related complication called HELLP syndrome. HELLP stands for hemolysis, elevated liver enzymes, and low platelet count. This pain is easy to mistake for bad heartburn.

The Preeclampsia Foundation describes it as pain that usually sits under the right ribs. It can be confused with heartburn, gallbladder problems, the flu, or indigestion. Sometimes it also reaches the right shoulder. The foundation is clear: pain in this area should never be brushed off; call your provider right away.

I don’t want you panicking that your heartburn may be something more serious, so here are a few features that help you tell the two apart. Heartburn is a burning feeling that tends to rise toward your throat, and it usually eases with an antacid. By contrast, the American College of Obstetricians and Gynecologists lists persistent, severe pain under the right ribs or in the upper middle of your abdomen that does not respond to medication as a severe feature of preeclampsia. Heartburn that settles with an antacid is reassuring. Upper abdominal pain that doesn’t resolve warrants a call to your doctor and midwife.

According to the same guidance, the main symptoms of HELLP syndrome are pain in the upper right abdomen and a general feeling of being unwell, which occur in up to 90% of cases. Nausea and vomiting occur in about 50%. Other warning signs of preeclampsia include swelling in your face or hands, a headache that will not go away, and changes in your vision, such as spots or blurriness. Sudden weight gain, shortness of breath, and new nausea or vomiting after mid-pregnancy are also on the list.

The overwhelming majority of heartburn during pregnancy is exactly what it seems. The goal is not to worry every time your chest burns. The goal is to know which pain deserves a closer look or a call to your provider. For a full breakdown of these warning signs, including after birth, listen to the episode on hypertension during pregnancy.

When It Might Be GERD

Serious complications from heartburn are rare. If your symptoms are persistent and severe, though, you could be diagnosed with gastroesophageal reflux disease, usually shortened to GERD.

GERD is a chronic condition in which stomach acid frequently flows back into the esophagus. Symptoms include heartburn, regurgitation of food or sour liquid, and difficulty swallowing. Occasional reflux is common in anyone. By contrast, doctors diagnose GERD when reflux becomes frequent or severe enough to affect daily life. If you had GERD before pregnancy, it may become more troublesome now. If heartburn started for the first time at 30 weeks, the cause is usually simpler. You are most likely dealing with an ordinary pregnancy symptom.

Diet Changes for Heartburn During Pregnancy

For most women, diet and lifestyle changes are the first line of defense. There is evidence that for mild symptoms, these changes may be all you need. Start with trigger foods. Fatty, greasy, spicy, and acidic foods are the usual culprits, so consider limiting them and noticing how you feel afterward. Your triggers may not match anyone else’s. For that reason, a food journal can help. Writing down what you eat and when symptoms start can reveal patterns you would otherwise miss.

Timing your drinks matters too. Drinking between meals rather than with them keeps your stomach from getting overly full, which reduces pressure on the lower esophageal sphincter. Don’t cut back on fluids, just time them differently.

Green vegetables may also help. In one small study of 64 pregnant women, those who ate green vegetables more often were less likely to develop heartburn. It was a small, observational study, so it cannot prove cause and effect. Still, it’s one more reason to add more greens to your diet.

Some women find that yogurt or milk helps, and others swear by family remedies. The research on most home remedies is thin. Still, if something is easy, low-risk, and safe during pregnancy, it is reasonable to try it. Finding what works for you may take some trial and error.

How and When You Eat

Large meals put pressure on your stomach and make reflux more likely. Eating smaller portions more often reduces that pressure. This can also help with morning sickness, which is important because heartburn and reflux are linked to how severe nausea and vomiting are during pregnancy. Eat slowly and chew thoroughly. Digestion begins in your mouth, where saliva starts breaking food down. The more work your mouth does, the less your stomach has to do.

Chewing gum after a meal is an intervention that has some research behind it. In one study, researchers measured acid in the esophagus of 12 people with reflux and 24 people without it after a standard breakfast. Chewing gum for an hour afterward reduced acid exposure in both groups. The effect was strongest in people with reflux, and it lasted up to three hours. A separate randomized study of 31 people with reflux symptoms tested a shorter window. Chewing sugar-free gum for just half an hour after a meal significantly reduced acid in the esophagus. The reason is simple. Chewing makes saliva, saliva is alkaline, and swallowing more often washes acid back down.

Walking after meals is often recommended for heartburn, but the research is not as strong. In that same study, an hour of walking after eating helped only the people with reflux, and the effect was mild and brief. Gum did considerably better. A walk after a meal still has plenty of benefits. It just should not be your main tool for heartburn.

What you do after eating matters too. Lying down lets acid travel more easily into your esophagus, so stay upright after meals. Try to finish eating two to three hours before bed, which gives your stomach time to empty. In fact, a systematic review of lifestyle changes for reflux found that in randomized trials, late evening meals increased acid exposure while lying down compared with earlier meals.

Finally, look at what you are wearing. Tight clothing adds pressure to your midsection. In a small study of 14 people with reflux, a tightly cinched belt doubled their reflux episodes after a meal. That study did not include pregnant women. Still, it shows how pressure on your stomach can push acid upward. Loose, comfortable clothing or maternity pants with a soft waistband are a better choice. You deal with a lot during pregnancy. You don’t need to deal with uncomfortable clothing.

Nighttime Heartburn and Sleep

According to a 2022 review, reflux affects emotions, eating, and daily functioning, but it most significantly impacts sleep. If heartburn is keeping you awake, here are some steps you can take to address it.

Sleeping on your left side is one of the most useful changes you can make. A systematic review and meta-analysis found that sleeping on your left side reduced both how long acid stayed in the esophagus and how long it took to clear. This held true compared with sleeping on your right side and on your back. Interestingly, the right side and the back performed similarly.

The same review included a randomized trial of a wearable device that vibrated when people rolled onto their right side. Compared with a sham device, it increased time on the left side and improved nighttime reflux symptoms. You do not need a gadget. The takeaway is that deliberately favoring your left side works. The evidence comes from only three studies, but they all point in the same direction. Conveniently, doctors already recommend sleeping on your left side during pregnancy for other reasons.

Raising the head of your bed is the other change worth making. In a randomized trial of 39 people with reflux, researchers raised the head of the bed by 20 centimeters, which is about 8 inches, for 6 weeks. About 69% improved their reflux symptoms with the bed raised, compared with 33% while sleeping flat. However, quality-of-life scores did not change, and about half the participants reported some side effects, so the authors called for more research.

How you raise your bed matters. These studies raised the bed itself rather than stacking pillows. Pillows may simply bend you at the waist, so blocks under the head of the bed or a wedge that supports your whole upper body is closer to what was studied.

Your Prenatal Vitamin and Heartburn

Iron supplements are well known for causing digestive side effects, and nearly every prenatal vitamin contains iron. If your stomach symptoms started shortly after you began a prenatal vitamin or a separate iron supplement, pay attention. The form of iron makes a difference. Ferrous sulfate is the most common form and the one most associated with digestive side effects. Gentler options include ferrous bisglycinate, also called chelated iron. A higher-quality prenatal vitamin typically uses a gentler form of iron to begin with.

The timing of when you take your prenatal vitamin matters too. Stomach acid helps your body absorb iron, and antacids reduce that acid. For that reason, one review advises against taking antacids within two hours of iron and folic acid supplements. Calcium, which is in many antacids, can also interfere with iron absorption. Spacing them out protects the nutrients you take your prenatal vitamin for in the first place.

Digestive Enzymes

The case for digestive enzyme supplements is plausible on paper. Enzymes help break down carbohydrates, proteins, and fats. In theory, faster digestion empties your stomach sooner, which leaves less time for acid to push upward. Unfortunately, nobody has tested that for heartburn. I could not find research on digestive enzymes for heartburn or reflux in pregnancy, or even in people who are not pregnant.

There is also a safety question. Many popular enzyme products contain papain, an enzyme that comes from papaya latex, the milky sap of the fruit. In a study in rats, crude papaya latex triggered uterine contractions similar to those caused by oxytocin and prostaglandin. In uterine tissue from rats late in pregnancy, those contractions became sustained spasms. Ripe papaya juice, by contrast, had no significant effect, and rats that ate ripe papaya had normal pregnancies.

These are animal findings, and no research shows that papain supplements cause contractions in people. Still, with no evidence that these products help heartburn and a plausible reason for caution, I would skip papain-containing enzyme supplements during pregnancy. As with any supplement, check with your doctor or midwife first.

How the Step-Up Approach Works

When diet and lifestyle changes are not enough, medication is a reasonable next step. Most providers use a step-up approach. You start with lifestyle changes, then move to antacids and alginates, then histamine 2 (H2) blockers, and then proton pump inhibitors (PPIs) if needed. At each step, you see whether it is working before moving up. The 2022 review lays out this treatment ladder for both pregnancy and breastfeeding.

That ladder reflects expert consensus, but the trial evidence underneath it is not overwhelming. A Cochrane review looked for randomized trials of heartburn treatments in pregnancy. It found nine trials with 725 women, but five of those trials did not contribute any usable data.

What the review did find is still useful. In two trials with 256 women, those who took medication were more likely to get complete heartburn relief than those who took a placebo or nothing. Side effects were similar between the groups. In addition, one small trial found that sucralfate beat diet and lifestyle advice for complete relief. Another trial of 36 women looked at acupuncture. It did not report on heartburn relief itself, although the women who had acupuncture said they slept and ate better. The authors described the data as limited and called for more trials. This explains why your provider may suggest trying something and seeing how it goes. The research to give you a more precise answer does not exist yet.

Like everything during pregnancy, you are weighing the risks, or unknown risks, of a medication against the benefit of relief. The severity of your symptoms and their effect on your quality of life both matter. Heartburn that wakes you up every night is a different problem from heartburn after one spicy dinner. As with any medication, run it by your doctor or midwife first, even if it is sold over the counter.

Antacids

Antacids neutralize stomach acid that is already there, which makes them the fastest option for relief. Because very little is absorbed into your bloodstream, they are a common first choice during pregnancy.

The active ingredient matters. Calcium carbonate works quickly and is the active ingredient in Tums. Magnesium hydroxide also acts quickly and has a mild laxative effect, which some women welcome. Rolaids contain both. Aluminum hydroxide works more slowly but lasts longer, though it may contribute to constipation. Sodium bicarbonate is the one to avoid. One review found it can lead to fluid overload and metabolic alkalosis, which is a disruption of your body’s acid balance, in both you and your baby. That includes plain baking soda dissolved in water, which is a common home remedy for heartburn.

Alka-Seltzer is a good example of why you need to read package labels. The original version contains sodium bicarbonate and aspirin. Aspirin is a medication to discuss with your provider during pregnancy, and the dose in those tablets is far higher than the low dose sometimes prescribed to help prevent preeclampsia. Other products under the same brand use calcium carbonate instead. Read the active ingredients rather than trusting the brand name, and see the guidance on over-the-counter medications during pregnancy for more on pain relievers.

There is also a limit to how many calcium antacids you should take. Tums are easy to eat like candy. Even so, the review advises pregnant women to limit antacid intake to no more than 1,000 milligrams of elemental calcium per day. Too much can cause calcium-alkali syndrome, which involves high blood calcium, an acid-base imbalance, and kidney strain. Follow the dosing on the package rather than treating them as unlimited.

The good news is that after you have your baby, antacids are generally considered acceptable while breastfeeding. That is mainly because calcium, magnesium, and aluminum are poorly absorbed.

Many antacids also contain artificial colors, corn syrup, or other additives. Check the inactive ingredients if that matters to you, because formulas vary a lot between brands.

Alginates

Alginates come from seaweed, and they work differently from every other option. When they meet stomach acid, they form a gel that floats on top of your stomach contents. That gel sits like a lid over the pocket of acid that collects near the top of your stomach after a meal. Most alginate products also include an antacid, so you get quick neutralizing plus longer-lasting protection.

Alginates don’t get much attention in the United States, yet they have some of the best pregnancy-specific research of any option. A randomized, double-blind trial compared an alginate product with a magnesium and aluminum antacid gel in 100 pregnant women under 36 weeks. All of them had heartburn at least twice a week. Both treatments reduced heartburn frequency and intensity, with no meaningful difference.

In an open-label study described in a review, 150 pregnant women used an alginate product as needed for four weeks, and everyone knew what they were taking. More than half felt relief within 10 minutes. Their blood sodium and potassium levels barely changed, which is important because some alginate products contain sodium.

Because very little alginate is absorbed, alginates are also considered acceptable while breastfeeding. There is one caveat here. Formulas differ by country, so a familiar brand name may not match the one studied. Look for sodium alginate or alginic acid on the label, and ask your pharmacist if you are unsure.

H2 Blockers

H2 blockers reduce how much acid your stomach makes. They block histamine receptors on the acid-producing cells in your stomach lining. As a result, symptoms ease, and an irritated esophagus has time to heal. They take longer to start working than antacids, but the relief lasts longer.

Older advice often lists Zantac, and that information is now out of date. Zantac’s original active ingredient was ranitidine. In April 2020, the U.S. Food and Drug Administration asked manufacturers to withdraw all ranitidine products from the market. The reason was a contaminant called N-nitrosodimethylamine or NDMA, which is a probable human carcinogen. Its levels in ranitidine increased over time and at higher storage temperatures.

A product called Zantac 360 is back on shelves, but it contains famotidine instead. Today, the main options are famotidine (Pepcid and Zantac 360) and cimetidine (Tagamet). Lower doses are sold over the counter, and higher doses require a prescription.

Safety data on these during pregnancy are reassuring. A meta-analysis on the safety of H2 blockers in pregnancy compared 2,398 women who took H2 blockers in at least the first trimester with 119,892 women who did not. It found no increased risk of birth defects, pregnancy loss, preterm birth, or babies born small for their gestational age. Those are large numbers for a pregnancy safety question.

If you are breastfeeding, famotidine is generally the preferred H2 blocker. Research shows it passes into breast milk in the smallest amounts and lasts the longest.

Proton Pump Inhibitors

Proton pump inhibitors, often called PPIs, are the strongest acid reducers. They block the proton pump in your stomach lining, the final step in acid production. Doctors use them for GERD, ulcers, and erosive esophagitis, which involves damage and inflammation in the esophagus lining.

PPIs do not provide the immediate relief antacids do. Relief may take one to four days, so they are meant for severe or persistent symptoms rather than the burning you feel right now. Some are sold over the counter, and others require a prescription. Common brands include Prilosec (omeprazole) and Nexium (esomeprazole). Prevacid is lansoprazole, and Protonix is pantoprazole. Aciphex is rabeprazole, and Dexilant is dexlansoprazole.

On safety, a decade-long study of nearly 2.7 million pregnancies examined first-trimester PPI use. Overall, PPIs were not associated with a substantial increase in birth defects. The researchers did see small increases in major birth defects and heart defects. However, analyses comparing siblings suggested PPIs are unlikely to be major teratogens, which are substances that cause birth defects. Researchers pointed to other differences between families as a likely explanation for the small signal.

No single PPI stood out, except for one. Esomeprazole, sold as Nexium, was linked to a small increase in major birth defects. Higher doses of PPIs were also linked to a modest increase in risk. This is why PPIs sit at the top of the ladder. The 2022 review notes they are generally reserved for complications or for symptoms that have not responded to other treatments. That is not because they are considered dangerous. There is simply no reason to start with the strongest option when a gentler one may work.

If you need a PPI while breastfeeding, very little passes into breast milk. In addition, stomach acid breaks PPIs down, so your baby likely absorbs even less than what reaches the milk.

Other Prescription Options

There are also some prescription options. Sucralfate is a mucosal protectant. Rather than changing your stomach acid, it sticks to the lining of your digestive tract and forms a barrier against acid. According to the 2022 review, one gram taken three times a day has managed reflux symptoms without problems for mothers or babies. Because very little is absorbed, it is considered safe during pregnancy.

Metoclopramide speeds up stomach emptying and tightens the lower esophageal sphincter. A study of 3,458 babies exposed in the first trimester found no link with major birth defects, low birth weight, preterm birth, or other serious problems around birth. However, the U.S. Food and Drug Administration has placed its strongest warning, called a boxed warning, on metoclopramide. The concern is tardive dyskinesia, a movement disorder reported with high-dose or long-term use. As a result, it is a conversation for your provider rather than a first choice.

Acid-Reducing Medications and Your Baby

Research has linked acid-reducing medications during pregnancy to childhood asthma, and the context matters a lot here. A meta-analysis of eight population studies found that these drugs were associated with about a 45% higher risk of asthma in childhood. The link appeared for both PPIs and H2 blockers. Other studies, summarized in the 2022 review, have also found associations with eczema and hay fever.

Now for the context. None of the studies in that meta-analysis adjusted for every known confounder, which is an outside factor that can create a misleading link. The review points to the mother’s own asthma as a likely main confounder. Asthma runs in families, and asthma and reflux often occur together.

A study of nearly 200,000 children adds an important clue. Children had a similar increase in asthma risk when their mothers took PPIs in the year after pregnancy but not during it. A medication taken after birth cannot affect a baby’s development in the womb. The authors concluded that the link may reflect the mothers’ underlying conditions, although they could not rule out an effect of the drugs.

Where does that leave you? These are observational findings that cannot prove cause and effect. You also have to weigh them against symptoms that may be wrecking your sleep and quality of life. That is a real tradeoff, and it is exactly the kind of decision to make with your doctor or midwife.

Ground Rules for Any Medication

An article in the American Family Physician Journal summarizes generally accepted guidelines for over-the-counter medications during pregnancy. A few apply directly to heartburn.

If you can, avoid medications in the first 12 weeks. The first trimester is when your baby’s major organs and body systems form, which makes it the most sensitive period for development. Fortunately, you’re also least likely to experience heartburn then.

Use the lowest effective dose for the shortest time. Skip extra-strength and long-lasting versions, because they mean more exposure. Also avoid combination products that treat several symptoms at once. Some heartburn products include ingredients for gas, bloating, or upset stomach, and there is no reason to take medicine for a symptom you do not have.

Brand Name vs. Generic Medications

You have many options: name brands or less expensive generic options. Some argue that if the active ingredients are identical, there is no difference between taking a generic and a brand-name medication. If the active ingredients are identical, then that would be true. Unfortunately, there is a lot of fraud in generic drug manufacturing. An excellent episode of the Drive Podcast features Peter Attia, M.D., and Katherine Eban, an investigative journalist, discussing widespread fraud in the generic drug industry. That conversation compelled me to spend a little more on brand-name medications only.

Heartburn and Your Baby’s Hair

An old wives’ tale says that lots of heartburn during pregnancy means your baby will be born with a full head of hair. According to the same tale, no heartburn means a baby with very little hair. Interestingly, there may be some truth to it.

A study of 64 women compared heartburn severity during pregnancy with how much hair their babies had at birth. Of the 28 women with moderate to severe heartburn, 23 had babies with an average or above-average amount of hair. Of the 12 women with no heartburn, 10 had babies with less than average hair or none at all. The researchers propose that pregnancy hormones both relax the esophageal sphincter and influence fetal hair growth.

My own experience matched it, though. I did not get heartburn during my first pregnancy, and my son was essentially bald at birth. I had frequent heartburn in my second pregnancy, and my daughter had a lot more hair when she was born. So maybe there is some truth to this wives’ tale.

The Bottom Line on Heartburn During Pregnancy

Heartburn during pregnancy is common and usually worsens as your pregnancy progresses. The best evidence-backed interventions cost nothing, including smaller meals, sugar-free gum after eating, an earlier dinner, sleeping on your left side, and raising the head of your bed. If you need more relief, antacids, alginates, H2 blockers, and PPIs all have reasonable safety data, and the goal is the lowest step that works. If you experience heartburn, bring it up with your doctor or midwife so you can discuss the best options for your specific situation.

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Your provider offers you a flu shot, and you are not sure what to do. You have heard it protects your baby. You have also heard it barely worked last year and that the guidance keeps changing. Both have some truth to them, and you have choices beyond just opting in or opting out. In this episode, you will learn what the research shows about the flu shot during pregnancy, how safe it is, how well it works, when to get it, and which shot to ask for.

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Why the Flu Is Riskier During Pregnancy

Influenza, or the flu, is a contagious respiratory illness. It spreads through droplets when someone coughs or sneezes. You can also pick it up from a surface and then touch your face. Symptoms include fever, cough, sore throat, muscle aches, headache, and fatigue. Unlike a cold, which builds gradually, the flu usually hits suddenly and hard. Symptoms typically last about a week, although a cough can linger.

In most healthy adults, the flu runs its course without complications. Pregnancy changes that picture. Your heart pumps more blood, and your lungs work harder. Your immune system also shifts to protect both you and your baby. In fact, a Stanford University study found that pregnant women have an unusually strong immune response to the flu. This may help explain why pregnant women tend to get sicker. As a result, complications like pneumonia and hospital stays are more likely.

The 2009 flu pandemic showed how serious this can be. In its first months, pregnant women accounted for 5 percent of all reported deaths from the pandemic virus. The researchers behind this CDC analysis concluded that pregnant women faced a disproportionately high risk of dying. Thankfully, most flu seasons are far milder than a pandemic. Still, pregnancy adds risk every season.

The flu can also affect your baby through fever, one of its main symptoms. A review of 46 studies linked fever during pregnancy to a higher risk of certain birth defects. For this reason, both preventing the flu and treating a fever matter.

The Flu in Babies and Young Children

Babies cannot get a flu shot until they are six months old. That leaves them without their own protection when the flu is most dangerous. According to the CDC, the flu sends between 6,000 and 25,000 children younger than five to the hospital each year. Flu deaths in children during regular seasons have ranged from 37 to 297 per year. The 2024-25 season reached the top of that range. It is easy to assume these are children with other health problems. However, that is often not the case. In the 2024-25 season, about 6 in 10 children younger than five hospitalized with the flu had no underlying medical condition.

These statistics may sound scary. This helps explain why the flu vaccine is advocated for the medical community.

How the Flu Shot Protects Your Baby

A vaccine shows your immune system an inactivated virus or a piece of one. Your body learns to recognize it and makes antibodies, which takes about two weeks. During pregnancy, those antibodies cross the placenta and give your baby temporary protection. This is called passive immunity. It fades over the first few months, but it covers your baby until they can get their own shot. This is the main principle underlying why some vaccines are recommended during pregnancy.

Randomized controlled trials, the strongest type of study, have tested this benefit. In one trial, more than 2,100 pregnant women received either a flu shot or a placebo. The flu shot cut confirmed flu by about half in the mothers. It also cut flu by about half in their babies during the first six months. Other studies show a similar pattern. For example, a 2024 study looked at babies younger than six months. When their mothers got a flu shot during pregnancy, they were 39% less likely to be hospitalized with the flu. Protection was strongest in babies younger than three months, at 53%.

After birth, you continue to pass antibodies through breast milk. This adds protection. However, according to the American College of Obstetricians and Gynecologists, it does not match the antibodies your baby gets through the placenta. The people around your baby matter too. That is why some parents ask family members to get vaccinated before visiting a newborn.

Why the Flu Shot Changes Every Year

The flu virus changes constantly. Small changes add up from season to season, a process called antigenic drift. Occasionally, flu viruses from different animals swap genetic material and create an entirely new strain. That is how pandemics like the one in 2009 begin. Because the virus keeps changing, one shot cannot protect you for life. Each year, the World Health Organization recommends which strains to include in the vaccine. It has done this since 1973, using surveillance data from around the world. In the United States, the Food and Drug Administration then selects the final strains. After that, manufacturers need about six months to produce the vaccine.

Since the strains are picked months ahead, every flu shot is a prediction. When the prediction matches the viruses that circulate, the vaccine works better. When the virus drifts after the selection, it works less well.

Flu season peaks in winter, so the Northern and Southern Hemispheres each get their own vaccine. Cold, dry air helps the virus survive, and people spend more time indoors. There is also a theory that lower vitamin D levels in winter play a role.

The Controversy Surrounding Vaccines

Vaccines are one of the most polarizing topics in pregnancy and parenting. Some professionals dedicate their careers to studying vaccine safety. Meanwhile, people on every side feel very strongly about them. As a result, information that appears neutral may still push a pro-vaccine or anti-vaccine agenda.

Most of what you will find from medical organizations and online is strongly in favor of vaccination. At the same time, many parents have real questions about safety, long-term effects, and who funds the research. Those questions deserve honest answers rather than dismissal. My goal is to give you the research as it is, including its limitations. Then you can weigh the evidence and decide what is right for you.

The Role of the CDC and WHO

In recent years, trust in public health agencies has dropped. Some people also worry about the influence of drug companies on the Centers for Disease Control and Prevention and the World Health Organization. However, both run some of the largest disease tracking systems in the world. Much of the flu data in this episode comes from them. The landscape has also shifted. The United States has withdrawn from the World Health Organization. Even so, CDC scientists took part remotely in the February 2026 meeting that chose this season’s strains.

In the United States, the Advisory Committee on Immunization Practices traditionally advises the CDC on vaccines. In 2025, Robert F. Kennedy Jr., the Secretary of Health and Human Services, replaced the committee’s members. The new committee then changed several recommendations. In March 2026, a federal court paused the new appointments and the votes the committee had taken. That ruling is under appeal. We can likely expect more changes to come.

Federal guidance has long shaped the advice of the American College of Obstetricians and Gynecologists, or ACOG. In turn, ACOG shapes what your doctor or midwife recommends. Earlier in 2026, however, ACOG stepped away from the federal committee. In June, it released its own maternal immunization schedule, which 13 medical organizations endorsed. The point here is that there is some disagreement between what these health agencies or medical organizations are recommending.

Flu Shot Guidance for 2026-27

For the flu shot, federal guidance and ACOG agree. Because of the legal uncertainty, the CDC did not issue new recommendations from its advisory committee this year. Instead, it updated its interim clinical considerations in September 2026. Those keep the existing recommendation in place: an inactivated or recombinant flu shot in any trimester. ACOG recommends the same, along with several other major medical groups.

All three strains in this season’s vaccine are new compared to last year. One is an H3N2 strain chosen to better match subclade K, the virus behind last season’s surge. Every flu shot this season is trivalent. In other words, it targets three strains: two influenza A strains and one influenza B strain.

How Well the Flu Shot Works

No flu shot prevents every case. To measure how well it works, researchers compare vaccinated and unvaccinated people who end up at the doctor or in the hospital with the flu. These are observational studies, so they have limitations. Still, they give us some data on how the shot performs in the real world. According to the CDC, one study found that a flu shot lowered a pregnant woman’s risk of flu hospitalization by an average of 40%. This study tracked hospitalizations over six years. The researchers adjusted for factors like the flu season and other health conditions.

How well the shot works also changes from year to year. When the vaccine matches the circulating viruses, the CDC reports that it lowers the risk of a doctor visit for the flu by 40-60%. Since 2003, effectiveness has ranged from about 10-60%, depending on the season. Recent seasons show the swings: 36% in 2021-22, then 30%, 44%, and 56% in the next three seasons.

Last season shows what happens with a mismatch. After the strains were picked, the H3N2 virus drifted into a new version called subclade K. That version caused most H3N2 infections last season. As a result, early estimates put overall effectiveness at about 36%.

Is the Flu Shot Safe During Pregnancy?

Doctors have given flu shots to pregnant women for decades, and a large body of research looks at their safety. A systematic review of 40 studies looked at preterm birth, low birth weight, babies born small, birth defects, and pregnancy loss. It did not find increased risks. In fact, it found some evidence that the flu shot may protect against preterm birth and low birth weight.

That research has limitations. Most of these studies are observational, which means researchers track outcomes instead of randomly assigning who gets the vaccine. Critics point to something called the healthy vaccinee bias. People who choose to get vaccinated tend to be healthier to begin with. As a result, vaccines can look safer and more effective than they really are. The randomized trials help address this. However, they mainly measured protection, and they are too small on their own to rule out rare problems.

The flu shot also triggers inflammation, which is part of how any vaccine works. One study measured this inflammatory response in pregnant women. Inflammation also plays a role in preeclampsia and preterm birth, so this is a fair question. The researchers found the vaccine response was much milder and shorter than the response to the flu itself. Still, they said more research should confirm that this mild response is harmless in pregnancy.

Long-Term Effects on Your Baby

Animal research adds another layer. Studies in mice show that activating a mother’s immune system can affect brain development in her offspring. Most of this research uses substances that mimic a serious infection, not a vaccine. A 2026 mouse study compared the two directly. The flu vaccine caused only mild, temporary behavior changes in the offspring. By contrast, the substance that mimics infection had much stronger effects on the developing brain.

In humans, a Canadian study followed more than 104,000 children up to age five. Their mothers had the 2009 pandemic flu vaccine or no vaccine during pregnancy. The study found no link with most health outcomes. It did find a small increase in asthma, which the researchers said other factors may explain.

Flu Shot Side Effects

There are side effects and most are mild and last a day or two. The most common include:

Fainting can happen with any shot, and serious allergic reactions are rare.

The Flu Shot and Autism

Autism is one of the most common concerns parents raise about vaccines. In November 2025, the CDC changed its website on this topic. It now says that “vaccines do not cause autism” is not an evidence-based claim. Major medical groups, including the American Academy of Pediatrics, strongly disagreed.

The first large study on this question was published in 2017. It followed nearly 197,000 children in California. Overall, it found no link between a flu shot during pregnancy and autism. However, it found a small increase in risk when mothers got the shot in the first trimester. The researchers noted this result could be due to chance, because they tested many time periods. They also called for more research.

Several large studies followed. A 2022 study of nearly 85,000 mothers and children in Southern California found no link. About a third of the vaccinated mothers in that study got their shot in the first trimester. A 2020 Swedish study of the 2009 pandemic flu vaccine also found no link, including for first-trimester vaccination. Most recently, a 2025 study from Israel followed more than 153,000 children. At first glance, autism was slightly more common in children of vaccinated mothers, at 3.6% compared to 2.9%. However, that gap disappeared once the researchers accounted for other differences between the two groups of mothers.

All of these are observational studies, so none can prove the flu vaccine has zero effect. On the other hand, the flu is not risk-free for a developing baby either. A large Norwegian study linked fever during pregnancy to a small increase in autism risk. Fever is a main symptom of the flu.

Taken together, the human research has not found a link between the flu vaccine during pregnancy and autism. If timing is a concern for you, waiting until after the first trimester is one option. That is where the one early signal appeared, and the first trimester is the most sensitive period for development.

The 2017 Miscarriage Study

In 2017, a study made headlines for linking the flu shot to miscarriage. It looked at women who got a flu shot in the 28 days before a first-trimester miscarriage. The link only appeared in women who had also been vaccinated the season before. The study covered the 2010-11 and 2011-12 flu seasons. Notably, the researchers stated that their results did not show the vaccine caused miscarriage. They called for more research.

ACOG responded at the time: “In evaluating all of the available scientific information, there is insufficient information to support changing the current recommendation, which is to offer and encourage routine flu vaccinations during pregnancy regardless of the trimester of pregnancy.”

That further research did happen. In 2019, the same research group published a follow-up study covering the next three flu seasons and more than 1,200 miscarriages. It found no link between the flu vaccine and miscarriage. That included women who had been vaccinated the season before.

As with any intervention during pregnancy, the decision is yours, and it should be based on informed consent.

When to Get the Flu Shot

You can get the flu shot in any trimester. Because protection takes about two weeks to build, the CDC says the ideal time is September or October. If you miss that window, a later shot can still help, since the flu often circulates into the spring.

Your stage of pregnancy can also shape the timing. According to the CDC’s interim guidance, a shot in July or August is reasonable if you are in your third trimester then. That earlier timing has been linked to better protection for your baby after birth. On the other hand, the CDC suggests waiting until September or October if you are in your first or second trimester.

The research on timing and your baby’s protection is mixed. One study found that a shot in the second or third trimester gave babies protective antibodies. The key was getting it at least 15 days before birth. The 2024 study in the United States found protection was strongest with a third-trimester shot, at 52%. By comparison, protection was 17% with a first or second trimester vaccine. However, a larger study from Ontario found similar protection in every trimester, at about 64% overall.

Fewer studies focus on the first trimester, since it is such a critical period of development. For this reason, some expecting parents and care providers prefer to wait until after it. Remember, you have options beyond opting in or opting out, and the timing is one of these.

Getting Other Vaccines at the Same Visit

You may also be offered other vaccines around the same time. The Tdap vaccine is recommended between weeks 27 and 36 of pregnancy. The RSV vaccine is given between weeks 32 and 36 during the fall and winter. According to ACOG, you can safely get these at the same visit as your flu shot.

There is one nuance. The Adacel Tdap vaccine package insert describes a clinical trial that gave Tdap and a flu shot together. In that trial, the antibody response to pertactin was lower than with Tdap alone. Pertactin is one part of the vaccine that helps you build immunity to whooping cough. Despite this, ACOG and the CDC consider it safe to give them together. If you would rather space them out, that is an option to discuss with your doctor or midwife. It makes sense to know there’s a lot of pressure in the medical community to get people vaccinated, and the easiest way to satisfy that is to administer vaccines as early as possible.

Choosing Your Flu Shot

Several flu vaccines can be given during pregnancy, including Afluria, Fluarix, FluLaval, Fluzone, Flucelvax, and Flublok. ACOG does not prefer one brand over another. Its statement is that pregnant individuals should receive any licensed, recommended, age-appropriate, inactivated, or recombinant flu vaccine during any trimester.

A few vaccines are not options during pregnancy. The nasal spray vaccine contains a live, weakened virus, so it is not recommended until after your baby is born. The high-dose and adjuvanted shots are for adults 65 and older. In addition, the first mRNA flu vaccine, mFlusiva, was recently approved only for adults 50 and older.

Most flu vaccines grow in fertilized chicken eggs and contain trace amounts of egg protein. Flucelvax, approved in 2012, grows in cells from dog kidneys and is egg-free. Flublok, approved in 2013, uses insect cells and is also egg-free. It contains three times as much hemagglutinin as most other flu shots. That is the virus protein your immune system learns to recognize. If you have an egg allergy, the CDC now says any flu vaccine is fine, with no extra precautions.

Some flu shots contain trace amounts of formaldehyde from processing, far less than what is naturally in your blood. Some also contain gelatin as a stabilizer. If you are vegan, no flu shot is completely free of animal-derived ingredients.

Thimerosal in Flu Shots

Thimerosal is a preservative that contains mercury. Manufacturers only use it in multidose vials, which hold several doses. Single-dose prefilled syringes do not contain it. In June 2025, the Advisory Committee on Immunization Practices voted for thimerosal-free, single-dose flu shots for pregnant women and all adults. However, the court paused that vote too. This season, about 99% of the supply is thimerosal-free, yet at least one multidose vial is back on the market. If you want to avoid thimerosal, ask for a single-dose prefilled syringe.

Medical offices and pharmacies order their vaccines months before flu season. So your options may depend on what your doctor or midwife carries. It’s not like your doctor will give you a menu of options to choose from. They typically stock one type. If you prefer a specific type or brand, call ahead or check with local pharmacies.

If You Get the Flu While Pregnant

Because the flu can be more serious during pregnancy call your doctor or midwife as soon as you have flu symptoms. Prescription antiviral medicine works best when you start it early. In the 2009 pandemic, some pregnant women started treatment more than four days after their symptoms began. They were six times more likely to need intensive care than women treated within two days.

According to the CDC, oseltamivir, sold as Tamiflu, is the preferred treatment during pregnancy. If you are very sick, it can still help after the first 48 hours. On the other hand, the CDC does not recommend baloxavir, sold as Xofluza, during pregnancy or breastfeeding. There are no safety data for it.

For a fever, acetaminophen remains the main option during pregnancy. It has its own controversy, which you can learn about in the episode on Tylenol during pregnancy. For rest, fluids, and over-the-counter medicines, see the episode on getting sick during pregnancy.

According to the CDC, some symptoms need emergency care right away:

The Bottom Line on the Flu Shot During Pregnancy

The flu tends to hit harder during pregnancy, and your baby cannot get a flu shot until six months old. That is why the flu vaccine is recommended during pregnancy to protect you and to protect your baby. A flu shot lowers the risk of hospitalization for both of you. However, it will not prevent every case, and how well it works changes each season. Most of the safety research is reassuring, and some questions remain open.

A lot of things during your prenatal visits don’t feel like a choice. It’s presented as, “This is what’s happening at your appointment today.” It’s important that you understand you always have choices beyond simply opting in or out. You can choose when to get it and which type of shot you receive. If you would like to avoid thimerosal, ask for a single-dose prefilled syringe. As with any intervention, you always have the option to decline. It’s really up to you to weigh the risks and the benefits and decide what you are comfortable with and what choice is the right one for you and your baby. Hopefully, after this episode, you feel more empowered to do that.

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If you are lying awake at night, you are in good company. Pregnancy insomnia and other sleep problems affect the majority of expecting mothers, from heartburn and leg cramps to a racing mind at 3 a.m. Then your baby arrives, and sleep gets disrupted in a whole new way. In this episode, you will learn what drives the most common pregnancy sleep problems, what the research says helps, and which remedies and medications have evidence behind them. You will also learn what to expect from sleep with a newborn, a common feeding myth, and one safety step every exhausted parent should know.

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Why Sleep Gets Harder During Pregnancy

Sleep during pregnancy comes with a frustrating paradox. Your body needs sleep more than ever, yet pregnancy makes restful sleep harder to get. In an article on sleeping for two, the author writes, “Despite the seemingly imperative need for healthy sleep and our body’s attempt to promote it, many of the normal physiologic and psychological changes accompanying pregnancy make restful sleep all but impossible.”

One of the most detailed looks at this comes from a study of 2,427 pregnant women. Every participant reported waking up frequently during the night. The study also tracked the specific reasons, and those numbers come up throughout this episode.

If you have not already, the episode on evidence-based tips to improve your sleep is a great place to start. It covers why sleep during pregnancy matters, how sleep works, and the everyday habits that make the biggest difference. This episode builds on that by focusing on specific problems and the research on how to solve them.

Difficulty Getting Comfortable

79% of pregnant women reported difficulty finding a comfortable position. As your body changes, the positions that feel good and the support you need will change too.

Most people sleep in the same position out of habit. If you usually sleep on your stomach, that will become difficult once your belly starts to grow. Sleeping on your back has its own downsides. It can make snoring and sleep apnea worse. In addition, as your uterus grows, it can press on your intestines and on your vena cava. Your vena cava is the large vein that carries blood from the lower half of your body back to your heart. Pressure on this vein can reduce blood flow back to your heart, which can reduce blood flow to your uterus and your baby. For this reason, the American College of Obstetricians and Gynecologists generally recommends avoiding sleeping on your back in the second and third trimesters.

A lot of research has looked at sleep position and stillbirth. The strongest evidence comes from an individual participant data meta-analysis that pooled data from several studies of women who were at least 28 weeks pregnant. Going to sleep on your back was associated with higher odds of late stillbirth compared with going to sleep on your left side. However, going to sleep on your right side had similar odds to the left side. The researchers concluded that the left and right sides appear equally safe.

It is also completely normal to wake up on your back. Research shows that most pregnant women spend some time on their backs during the night, even when they try not to. This research focuses on your going-to-sleep position because that is the position you are likely to spend the most time in. If you wake up on your back, simply roll to your side and go back to sleep. Worrying about your position will not help your sleep. You can learn more about sleeping positions during pregnancy and whether you should worry about sleeping on your back in separate episodes.

Pregnancy Pillows

If you are having trouble getting comfortable, pillows can make a big difference. Pregnancy pillows give you support where you need it most. Supporting your bump takes some of the pressure off from the weight of your belly. A pillow behind your back can keep you from rolling over and help you stay on your side. Putting a pillow between your knees can take pressure off your hips and help keep your spine aligned, which may also help with back pain. You may need to experiment with different pillows and positions to find what works best for you.

Getting Up to Go to the Bathroom

Frequent trips to the bathroom are one of the most common reasons you wake up at night. 83% of pregnant women said frequent urination disrupted their sleep. Hormonal changes, your growing uterus pressing on your bladder, and your increased fluid needs all play a role. You should not cut back on fluids. Instead, try to front-load your water intake earlier in the day and drink a little less in the hour or two before bed. Emptying your bladder right before bed can also help.

If you do need to get up to go to the bathroom, avoid turning on bright lights. Bright light tells your brain it is time to wake up, which can make it harder to fall back asleep. A dim nightlight in your bathroom or hallway lets you find your way safely. You might consider a nightlight with a red bulb, since warmer, dimmer light is less stimulating.

Heartburn at Night

Heartburn is another common culprit. It is a burning feeling in your chest that happens when stomach acid moves up into your esophagus. It is very common during pregnancy. Progesterone relaxes the muscle that normally keeps stomach acid where it belongs, your growing uterus puts pressure on your stomach, and digestion slows down. Lying down can make all of this worse, which is why heartburn often flares at night.

There are several simple things you can try. Eat smaller meals and avoid foods that trigger your heartburn, such as spicy, fatty, or greasy foods. Try to finish eating two to three hours before you go to bed so your stomach has time to empty. If heartburn wakes you up, use pillows or a wedge to raise your head, chest, and upper body. If lifestyle changes are not enough, talk to your doctor or midwife about medication. The in-depth episode on heartburn covers the research on the safety of antacids, H2 blockers, and proton pump inhibitors during pregnancy. As with any medication, check with your care provider first, even if it is available over the counter.

Stuffy Nose and Snoring

Nasal congestion is a common and frustrating pregnancy symptom, and it can make it hard to breathe comfortably at night. Pregnancy hormones and increased blood volume can cause your nasal lining to swell. This is sometimes called pregnancy rhinitis.

Congestion is one reason snoring becomes more common during pregnancy. Loud snoring in the third trimester has an estimated prevalence of 14% to 45%. While snoring may seem like more of a problem for your partner, some research links it to pregnancy outcomes. One study found that snoring during pregnancy was a risk factor for cesarean birth and smaller babies. Another study found that snoring during pregnancy was linked to more daytime sleepiness, but only in women who did not snore before pregnancy.

To ease congestion and snoring, you can try a saline spray or rinse, especially before bed. A humidifier can keep the air from getting too dry. Nasal strips may help keep your nasal passages open, and raising your head with pillows can also help. Sleeping on your side rather than your back reduces snoring too.

Snoring is more common in people with a higher BMI. Outside of pregnancy, reaching a healthy weight is one long-term way to reduce snoring. However, pregnancy is not the time to try to lose weight. Instead, focus on healthy weight gain during pregnancy and talk to your provider if snoring is a concern.

Sleep Apnea During Pregnancy

Snoring sits on a spectrum called sleep-disordered breathing. At the more serious end is obstructive sleep apnea. With sleep apnea, your airway repeatedly narrows or closes during sleep, causing pauses in breathing. These pauses are often followed by gasping or choking, lowering your oxygen levels and disrupting your sleep. 19% of pregnant women have symptoms of sleep-disordered breathing.

Growing evidence shows that sleep-disordered breathing matters during pregnancy. A large study tested first-time mothers for sleep-disordered breathing at home in early and mid-pregnancy. Researchers found that sleep-disordered breathing was independently associated with preeclampsia, high blood pressure disorders of pregnancy, and gestational diabetes. Other evidence links symptoms of sleep-disordered breathing with unplanned cesarean births. In addition, research shows that women with sleep apnea are at higher risk for preterm birth and smaller babies.

The good news is that sleep apnea is treatable. Bring it up with your doctor or midwife if you snore loudly or your partner notices pauses in your breathing. The same is true if you wake up gasping or feel exhausted despite a full night in bed. Extreme fatigue can have several causes, and sleep apnea is one worth ruling out. Your provider may refer you for a sleep study.

The most effective treatment is a CPAP machine, which stands for continuous positive airway pressure. You wear a mask over your nose, or your nose and mouth, that gently pushes air into your airway to keep it open. CPAP can take some getting used to, but it can be used during pregnancy. Some people use an oral appliance instead, which holds your jaw and tongue in a position that keeps your airway open. Sleeping on your side and raising your head can also help. For more detail, this review covers sleep-disordered breathing during pregnancy in depth.

Restless Legs Syndrome

Restless legs syndrome is a neurological condition that causes uncomfortable sensations in your legs along with an urge to move them. Moving your legs brings temporary relief. These sensations are usually worse in the evening and at night, which is why they interfere with sleep. Restless legs syndrome is more common during pregnancy than in the general population, and it is most common in the third trimester. About 24% of expecting mothers experience it. The exact cause during pregnancy is not fully understood. Hormones such as estrogen, progesterone, and prolactin may play a role. Low iron and low folate are also linked to restless legs, so make sure you take a prenatal vitamin that contains these nutrients. You can read more in this review on restless legs syndrome and pregnancy.

The American Academy of Sleep Medicine updated its guidelines for restless legs syndrome in 2024. The first step is to address things that can make it worse. These include caffeine, alcohol, untreated sleep apnea, and certain medications, including antihistamines. The guidelines also recommend checking iron levels in anyone with significant symptoms.

The good news is that for most women, restless legs improve or go away soon after the baby is born. If your symptoms are bothering you, talk to your doctor or midwife. They can check your iron levels and discuss treatment options that are appropriate during pregnancy.

Leg Cramps

Leg cramps are sudden, involuntary contractions of the muscles in your calf or foot. They are often painful and usually strike in the middle of the night. Like restless legs, they are most common in the third trimester.

You may have heard that magnesium helps with leg cramps. A Cochrane review looked at eight randomized trials with 576 pregnant women. The trials tested oral magnesium, calcium, vitamin B, vitamin C, and vitamin D. For magnesium, the results were inconsistent. Some studies showed fewer cramps, while others showed little to no difference. The evidence for all of the supplements was rated low or very low quality, mainly because the studies were small. This updated review is less optimistic about magnesium than earlier versions. The bottom line is that we do not have strong evidence that any supplement prevents pregnancy leg cramps. If you are considering a supplement, talk to your provider first.

None of the trials looked at stretching, massage, or heat, but these are low-risk options you can try. Stretching your calves before bed has no downside. When a cramp hits, flexing your foot by pulling your toes toward your shin usually brings relief quickly. Staying hydrated, staying active during the day, and a warm bath or gentle massage before bed may also help.

Your Baby Is Moving

Even before your baby is born, they may keep you awake at night. During the day, your movement can rock your baby to sleep. Then, when you lie down to rest, your baby may start moving around. These active periods are normal and usually do not last long. While it can be frustrating to have your sleep interrupted, try to enjoy these moments.

Stress, Anxiety, and a Busy Mind

Stress is a state of mental or emotional strain that comes from difficult or demanding circumstances. Pregnancy brings plenty of both. Your body may be under physical stress from symptoms like morning sickness, heartburn, constipation, or aches and pains. Hormonal changes can make you more emotional. On top of that, you are preparing to be responsible for a new human, and it is natural for your mind to be busy.

Anything you can do to manage stress can help your sleep. A simple strategy is to write down whatever is on your mind before bed. Getting your worries or your to-do list onto paper can make it easier to let them go. If your anxiety is tied to something specific, like birth or maternity leave, taking a small step to prepare often relieves some of the pressure. There is a complete episode on stress during pregnancy with evidence-based tools. It can also help to remember that this phase is temporary. Physical discomforts will eventually go away. If you are anxious about birth, you will eventually be on the other side of it. Reminding yourself that a worry has an end point can take some of the anxiety away.

Vivid Dreams and Nightmares

Many women notice more vivid dreams during pregnancy. Most dreaming happens during REM sleep, when areas of your brain involved in visual processing, memory, and emotion are especially active. One theory, proposed by sleep researcher Dr. Matt Walker, is that dreaming acts like overnight therapy, helping you process emotional experiences. There is also evidence that dreaming can improve creative problem-solving.

There are a few reasons dreams may feel more intense during pregnancy. You are waking up more often, and you are more likely to remember a dream if you wake up during REM sleep. Your pregnancy and baby are also likely on your mind a lot, so it makes sense that they show up in your dreams. There is evidence that nightmares are more common during pregnancy, especially in the third trimester. Research also shows that nightmares are linked to daytime stress, so the stress strategies above may help.

There is no scientific evidence behind interpreting specific dream images, so try not to read too much into a strange or scary dream. Dreams about your baby, even upsetting ones, are very common and normal. You can learn more about dreams during pregnancy in a Q&A episode.

Pregnancy Insomnia

Insomnia means having trouble falling asleep, staying asleep, or waking up too early, even when you have the chance to sleep. To diagnose insomnia disorder, doctors generally look for sleep problems at least three nights a week for at least three months. Those problems also need to affect how you function during the day. Many of the issues in this episode can contribute to insomnia. For a general overview of the research, see this review. Pregnancy insomnia is very common. 57% of pregnant women had symptoms of insomnia. A meta-analysis found that the overall prevalence of insomnia in the third trimester was 42.4%.

Cognitive Behavioral Therapy for Insomnia

Many people assume the first treatment for insomnia is a sleeping pill. In fact, the first-line treatment is a specific type of therapy, and research during pregnancy is encouraging. Cognitive behavioral therapy for insomnia, often called CBT-I, is a structured program that targets the thoughts and habits that keep insomnia going. It usually runs for about six weeks and can be done with a therapist or through a digital program. It typically includes several parts:

Stimulus control retrains your brain to connect your bed with sleep. You go to bed only when you feel sleepy. If you cannot fall asleep after what feels like about 20 minutes, you get out of bed. Then, you do something calm in dim light and return when you feel sleepy. Sleep scheduling limits your time in bed to more closely match how much you are actually sleeping, which strengthens your sleep drive over time. The cognitive part helps you identify and reframe worries about sleep that make it harder to relax. Relaxation techniques and sleep habits round out the program.

CBT-I has been studied specifically in pregnancy. In a randomized clinical trial of 208 pregnant women with insomnia symptoms, a digital CBT-I program led to significantly greater improvements than standard treatment. Women who used the program had fewer insomnia symptoms, better sleep efficiency and sleep quality, and fewer symptoms of depression and anxiety. A second trial of 91 women nearing or entering the third trimester found that digital CBT-I reduced insomnia symptoms and increased sleep by about 32 minutes a night. Its authors also reported that CBT-I during pregnancy helped protect against sleep loss after childbirth.

These benefits may last beyond pregnancy. Researchers behind the 208-woman trial followed participants through six months after birth. Overall, the two groups did not differ significantly in their insomnia symptom severity after birth. However, at six months postpartum, about 53% of women who received CBT-I no longer had insomnia, compared with about 35% of women who received standard care. Women who received CBT-I during pregnancy also had improved symptoms of depression and anxiety through six months postpartum. More research is needed, but these results suggest that treating insomnia during pregnancy may help set you up for better sleep and mental health after your baby arrives.

A 2025 meta-analysis of 31 randomized trials with more than 3,300 pregnant women found that non-drug approaches to sleep significantly improved self-reported sleep quality. These approaches included therapy, relaxation, exercise, and more. Studies varied widely, so the exact size of the benefit is uncertain, but the overall direction is encouraging.

If you are dealing with insomnia, ask your doctor or midwife about CBT-I. They can refer you to a therapist trained in it or point you toward a digital program. In the meantime, a few CBT-I principles are easy to try tonight. If you wake up and cannot fall back asleep, do not pick up your phone. Try slow breathing, progressive muscle relaxation (tensing and releasing each muscle group), or a calming visualization. If you are still awake after a while, get up and do something relaxing in dim light until you feel sleepy again.

Relaxation and Audio Tools

Music and guided relaxation can help you wind down. Research shows that background music can help children sleep, and evidence shows that soothing music can improve sleep quality in adults. A study also found that music can shorten the time it takes to fall asleep. These studies were not done during pregnancy, but music is low-risk and easy to try. Calming music can reduce stress and help your body relax.

Guided meditations, breathing exercises, and body scans work similarly. There are many free recordings and apps available. The best one is the one you enjoy and will actually use. Many of these tools can become part of your bedtime routine or help you settle back down if you wake up during the night.

Sleep Medications During Pregnancy

About 4.5% of pregnant women report using sleep medication. Deciding whether to take any medication during pregnancy means weighing the benefit of treating your symptoms against the potential risks. Poor sleep has consequences, so this is a conversation worth having with your provider. In general, medication is best considered after trying the approaches in this episode.

Most over-the-counter sleep aids are antihistamines, and there are two main ones. The first is doxylamine. It is also paired with vitamin B6 in a prescription medication for morning sickness. According to MotherToBaby, studies of hundreds of thousands of women show that the doxylamine and B6 combination does not increase the risk of birth defects.

The second is diphenhydramine, which is found in Benadryl and many “PM” products. MotherToBaby notes that a few studies have suggested a higher chance of birth defects with use in the first trimester. However, these studies do not all agree, and no consistent pattern has been found. There are also a few reports of temporary withdrawal symptoms in newborns whose mothers took diphenhydramine every day throughout pregnancy. Some “PM” pain relievers combine diphenhydramine with acetaminophen, so it is worth reading about acetaminophen and other OTC medications during pregnancy as well.

Here is a practical tip. The same brand name can contain different ingredients. For example, some Unisom products contain doxylamine, and others contain diphenhydramine. Always check the active ingredient on the label. Also remember that antihistamines can make restless legs worse.

Prescription sleep medications include drugs like zolpidem, known as Ambien, and benzodiazepines. For zolpidem, MotherToBaby notes that some studies found women who took it during pregnancy were slightly more likely to deliver early or have smaller babies. However, those studies could not separate the medication’s effect from other factors, including the underlying sleep problem. Please discuss the risks and benefits of any sleep medication with your doctor, and run any over-the-counter sleep aid by your provider before taking it.

Melatonin During Pregnancy

Melatonin is a hormone your body makes to help regulate your sleep-wake cycle. It is also widely sold as a supplement. You should know that your body naturally makes more melatonin during pregnancy. According to MotherToBaby, melatonin levels are typically highest in the third trimester. The same source notes that melatonin supplements have not been well studied during pregnancy.

Keep a few other things in mind. Melatonin supplements are better at helping you fall asleep than helping you stay asleep, and they may be most useful for short-term situations like jet lag. The American Academy of Sleep Medicine does not recommend melatonin to treat trouble falling asleep or staying asleep in adults with insomnia.

Quality is another concern. In the United States, melatonin is sold as a dietary supplement, so the amount in the bottle may not match the label. A study of melatonin supplements found that only 29% contained an amount within 10% of the label. The rest ranged from 83% less to 478% more than the label stated. A more recent analysis of 25 melatonin gummy products found that 88% were inaccurately labeled. Actual melatonin ranged from 74% to 347% of the labeled amount, and one product contained no melatonin at all. If you are considering melatonin, talk to your provider first. If you do take it, look for a product that has been independently tested by a third party.

Melatonin and Breastfeeding

Melatonin is naturally present in breast milk, and it follows a daily rhythm. A systematic review of research on breast milk composition confirms that many breast milk components change over the course of the day. Melatonin in breast milk is typically low or undetectable during the day, rises in the evening, and peaks between about midnight and 3 a.m. Researchers have proposed that this rhythm may help babies develop their own sleep-wake patterns, although this is still an emerging area of research.

This connects to your middle-of-the-night routine. Some authors suggest nursing in the dark at night to avoid lowering the melatonin in your breast milk. This has not been tested directly, but keeping night feeds dim is low-risk and also makes it easier for you to fall back asleep.

If you are pumping breast milk, consider labeling your milk with the time of day you pumped. When possible, give your baby milk pumped during the day in the daytime and milk pumped at night in the evening. There is some early research on this. In a survey of 329 mothers, babies who were fed pumped milk at a different time of day than it was pumped took longer to fall asleep than babies fed in other ways. However, the same survey found that babies who were breastfed directly woke up more often at night. This was a small, preliminary study, so the results are far from settled. Still, labeling your milk is simple and has no downside.

LactMed is a fantastic resource for evidence on medications and breastfeeding. According to LactMed, “Melatonin has no specific use during breastfeeding, and no data exist on the safety of maternal use of melatonin during breastfeeding. However, doses higher than those expected in breastmilk after maternal supplementation have been used safely in infants. It is unlikely that short-term use of usual doses of melatonin in the evening by a nursing mother would adversely affect her breastfed infant, although some authors recommend against its use in breastfeeding because of the lack of data and a relatively long half-life in preterm neonates.” If you are considering melatonin while nursing, talk to your provider or your baby’s pediatrician first.

Sleep as a New Parent

Once your baby arrives, the reasons you wake up at night change. You can expect less sleep and more interruptions, especially in the early weeks. This is a normal part of caring for a newborn, and it is temporary. The habits in the episode on improving your sleep still apply, even when you are not getting eight hours. It also helps to know what is normal for your baby and what you can do to protect your own rest.

How Babies Actually Sleep

Newborns do not sleep in one long stretch. Instead, they sleep in short periods throughout the day and night. Their stomachs are small, and they need to eat often. Over the first several months, most babies gradually develop a day-night rhythm and begin to sleep for longer stretches at night.

You have probably heard the phrase “sleeping through the night.” In research, this usually means at least six hours in a row, which may not be what you consider a full night. Even by that definition, many babies are not there yet at six months or even a year. A study of 388 infants looked at this at 6 and 12 months. Depending on whether researchers used six or eight hours as the cutoff, between 28% and 57% of babies were not sleeping through the night. Importantly, not sleeping through the night was not linked to any problems with the baby’s development or with the mother’s mood. It was, however, linked to a much higher rate of breastfeeding.

The takeaway is that baby waking up at night is normal, and there is a wide range of what is typical. Adjusting your expectations can make a big difference in how you cope.

Does Formula Help You Sleep?

Breastfed babies tend to eat more often because breast milk is digested easily. Because of this, many parents assume that switching to or adding formula will help everyone sleep more. The research does not support that assumption for parents’ sleep.

A study that measured sleep with wrist-worn devices found no differences in sleep or daytime functioning between mothers who exclusively breastfed, exclusively formula-fed, or did both. The researchers concluded that choosing formula does not equate to better sleep for mothers. Another study of first-time mothers found that those who exclusively breastfed at one month actually got more sleep at night than those who used at least some formula.

Every family has to decide what feeding approach works best for them, and there are many valid reasons to use formula. If sleep is the main reason you are considering a change, it may help to try other strategies first.

Protecting Your Sleep in the Early Weeks

The advice to “sleep when the baby sleeps” is a cliché for a reason. When your baby naps, try to close your eyes, even for a short time. It is tempting to use that time to catch up on chores, but anything on your to-do list can wait. Your recovery and mental health matter more than a clean kitchen.

If you have a partner, work together to protect a longer stretch of sleep for each of you. For example, one parent might handle the early part of the night while the other sleeps, and then you switch. If you are breastfeeding, your partner can handle diaper changes and settling your baby after feeds, or give a bottle of pumped milk once breastfeeding is well established. Even one longer stretch of uninterrupted sleep can help you feel more human. This is also the time to accept help. Let family and friends bring meals, do laundry, or watch your baby while you nap. Planning for the fourth trimester before your baby arrives makes it much easier.

Sleep and Your Mood After Birth

Sleep and mental health are closely connected. Poor sleep can worsen your mood, and mood changes can make it harder to sleep. This can be especially frustrating as a new parent, when you have less control over your sleep. A meta-analysis found that poor sleep quality during pregnancy was linked to a higher risk of postpartum depression.

It is also worth knowing the difference between normal new-parent exhaustion and a sign that something more is going on. Please reach out to your doctor or midwife if you cannot sleep even when your baby is sleeping and you have the chance to rest. The same goes for feeling persistently sad, anxious, hopeless, or not like yourself. These can be signs of postpartum depression or anxiety, which are common and treatable.

Safe Sleep When You Are Exhausted

When you are sleep-deprived, your baby’s sleep safety becomes even more important. The American Academy of Pediatrics updated its safe sleep recommendations in 2022. They recommend placing your baby on their back to sleep, on a firm, flat surface with only a fitted sheet. In addition, babies should sleep in your room, close to your bed but on a separate infant sleep surface. This is ideally for at least the first six months.

One of the most important things for an exhausted parent to know is where not to fall asleep with your baby. Because the risk can be up to 67 times greater, the AAP strongly recommends never sleeping with your baby on a couch, sofa, or armchair. It is easy to doze off during a middle-of-the-night feeding. If you might fall asleep while feeding, the AAP notes that an adult bed is less hazardous than a sofa or armchair. Bed-sharing is still not recommended. Before you feed, remove pillows, blankets, and sheets from the area around your baby. If you do fall asleep, move your baby back to their own sleep surface as soon as you wake up.

It is also worth acknowledging that many families do share a bed with their baby. Not every expert group approaches this the same way. The Academy of Breastfeeding Medicine takes a risk-reduction approach and emphasizes that the greatest dangers come from specific circumstances. These include sleeping with your baby on a sofa or armchair, sleeping next to an adult who is impaired by alcohol, drugs, or sedating medications, smoking, and a baby born prematurely. Bed-sharing is a nuanced topic, and I will dig into the research in a future episode.

Sleep Trackers

Many devices can track your sleep, from smartwatches to rings. I have worn an Oura ring for years, and I find the data helpful. Accuracy varies by device. In a study, 35 adults wore three popular devices during an overnight sleep study. The Oura ring did not differ significantly from the gold-standard sleep test in estimating wake, light, deep, or REM sleep. However, that study only included healthy adults without sleep disorders. In general, consumer trackers are less reliable when sleep is fragmented, which describes a lot of pregnancy and newborn nights.

A tracker is only valuable if the data helps you. It can be encouraging to see that you are sleeping well, and it can help you notice how changes like an earlier caffeine cutoff affect your sleep. On the other hand, you can become too focused on the numbers. Researchers have coined the term orthosomnia to describe people whose preoccupation with perfect sleep data actually makes their sleep worse. If checking your sleep score stresses you out, take a break. How you feel during the day is still one of the best measures of your sleep.

Closing Thoughts

Pregnancy and early parenthood bring challenges to your sleep, and many of them are outside your control. The good news is that most of the common problems have practical solutions, and several have solid research behind them. Start with the issue that bothers you most, try one change at a time, and give it a little time to work. Most importantly, remember that this phase is temporary. Physical symptoms will ease after birth, and your baby’s sleep will gradually consolidate. In the meantime, be patient with yourself, accept help, and focus on getting the best rest you can.

Talking to Your Doctor or Midwife

A survey of 423 pregnant women found that only 39% had discussed their sleep with a health care provider at any point during pregnancy. Even among women with moderate to severe insomnia symptoms, only 57% had brought it up. Sleep problems during pregnancy are common, but that does not mean you have to live with them. Please do not hesitate to bring up sleep problems with your doctor or midwife.

Loud snoring, pauses in your breathing, severe restless legs, insomnia that lasts for weeks, or trouble sleeping along with changes in your mood are all worth discussing. Many of these issues are treatable, and your provider can help you find the right approach. As always, check with your care provider before taking any medication or supplement, even if it is available over the counter.

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Sleep during pregnancy is one of the most powerful tools you have for your health and your baby’s health, yet it is often one of the first things to slip. Your body is working harder than ever, and a long list of pregnancy changes can get in the way of a good night’s rest. The good news is that you have more control over your sleep than you might think. In this episode, you will find out how sleep actually works and what the research says about poor sleep in pregnancy. You will also walk away with simple, evidence-based tools to help you sleep better tonight, and habits that will serve you well on your adventure into parenthood.

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Why Sleep During Pregnancy Matters

Sleep is not just about feeling rested in the morning. A growing body of research shows that sleep supports nearly every system in your body. This includes learning, memory, mental health, appetite regulation, immune function, metabolism, gut health, and even your cardiovascular health. While you sleep, your body and brain can repair and rebuild. During pregnancy, those demands are higher than at any other point in your life.

Researchers have looked closely at what happens when sleep suffers during pregnancy. The largest analysis on this topic is a systematic review and meta-analysis of 120 studies that included more than 58 million pregnant women. It looked at poor sleep quality, sleeping too little or too much, insomnia, restless legs, and breathing problems during sleep. These sleep disturbances were associated with higher rates of preeclampsia, high blood pressure, gestational diabetes, cesarean birth, preterm birth, larger babies, and stillbirth.

Individual studies echo these findings. For example, research links sleep problems before and during pregnancy with preterm birth, as well as with sleep problems and temperament in children. Evidence also shows that disrupted sleep during pregnancy is linked to increased inflammatory markers. Other research connects poor sleep quality and short sleep with a higher risk of gestational diabetes.

Sleep may also play a role in labor. In one study of 131 women, women in their ninth month of pregnancy who slept less than six hours a night had longer labors and were 4.5 times more likely to have a cesarean birth.

Your sleep also affects your mental health. A study in China found that poor sleep quality in the second trimester was associated with stress and symptoms of depression. A meta-analysis of 16 studies with more than 12,000 women found that sleep disorders during pregnancy were linked to a higher risk of postpartum depression. When the researchers broke this down, poor sleep quality was associated with postpartum depression, but insomnia on its own was not. Some researchers have also proposed that poor sleep could affect the early relationship between mother and baby through fatigue, mood, and hormonal changes. That idea is still a hypothesis and is not proven, but it highlights how connected sleep is to the rest of your life.

If you are still trying to conceive, sleep matters for you and your partner. Evidence suggests that sleep helps regulate the hormones involved in fertility. For partners, one study linked short sleep in men with lower odds of conceiving each cycle, and another found that men with the most sleep disturbances had about a 25% lower total sperm count.

It is important to understand what this research can and cannot tell us. Most of these are observational studies, which means they show an association, not proof that poor sleep causes these outcomes. Many of the same factors that disrupt sleep, like high blood pressure or a higher BMI, can also affect pregnancy outcomes. If your sleep is not great right now, please do not panic. A few rough nights, or even a rough stretch, do not mean something bad will happen. The point of this research is to show how important sleep is during pregnancy, and that the effort you put into your sleep is worth it.

How Pregnancy Changes Your Sleep

Your sleep will likely look different in each trimester. Surveys show that sleep increases in the first trimester, to an average of 7.4 to 8.2 hours. By the third trimester, sleep decreases to an average of 6.6 to 7.8 hours.

Fatigue is most common in the first trimester. This is largely due to a surge in progesterone, a hormone that has a natural sedating effect. At the same time, your blood volume increases, your blood pressure drops, and your metabolism ramps up. All of those changes take energy and lead to fatigue which explains why sleep increases in the first trimester. In the second trimester, many women feel a welcome boost in energy. Then, fatigue often returns in the third trimester as your body carries more weight and sleep becomes more challenging.

Disrupted sleep is extremely common. In a study of 2,427 pregnant women, every single participant reported waking up frequently during the night. In addition, 38% reported not getting enough sleep, and 76% reported poor sleep quality. The point being, if you are struggling, you are not alone.

How Sleep Works

Understanding what drives sleep makes it much easier to understand why the tips we cover in this episode work. Two main systems control when you feel sleepy and when you feel alert.

The first is sleep pressure. From the moment you wake up, a chemical called adenosine gradually builds up in your brain. As more adenosine binds to receptors in your brain, you feel sleepier. Sleep clears it away, which is why you feel refreshed after a good night of sleep.

The second system is your circadian rhythm, which is your internal 24-hour clock. In the morning, your adrenal glands release cortisol. We often think of cortisol as a stress hormone, but it also plays an important role in helping you wake up and feel alert. Later in the evening, as it gets dark, your pineal gland releases melatonin, which signals to your body that it is time to sleep. Light is the most powerful signal your internal clock uses to stay on schedule.

Sleep Stages and Sleep Cycles

Sleep falls into two main categories. REM, or rapid eye movement sleep, gets its name from the quick eye movements that happen during this stage. Most dreaming happens during REM sleep, and it is important for memory, learning, and emotional processing. Everything else is non-REM sleep.

Sleep scientists group non-REM sleep into three stages, called N1, N2, and N3. The N simply stands for non-REM. N1 is the brief transition from wakefulness into sleep. N2 is a slightly deeper, light sleep, and it is where you spend the largest share of your night. N3 is deep sleep, which is when your body does much of its physical repair and supports your immune system.

A typical cycle moves from N1 to N2 to N3, back up to N2, and then into REM. Each cycle takes roughly 90 minutes, and most people go through four or five cycles a night. However, not every cycle looks the same. Earlier in the night, your cycles contain more deep sleep. Later in the night, they contain more REM sleep. This means that if you cut your night short, you lose a disproportionate share of your REM sleep. Every stage matters, so aim to give yourself enough time in bed to get through all your cycles.

How Much Sleep Do You Need?

The American Academy of Sleep Medicine and the Sleep Research Society recommend that adults sleep seven or more hours per night on a regular basis. Regularly sleeping less than that is associated with health problems, including weight gain, diabetes, high blood pressure, heart disease, and depression. There is no separate official recommendation for pregnancy. That said, your body is doing more work than usual, and many women find they require more sleep.

It is also worth adjusting your expectations. From pregnancy through the first years of your child’s life, your sleep will be disrupted in ways you cannot always control. This phase is temporary. In the meantime, the strategies in this episode can help you get the most out of the sleep you do get. You can apply them now, after your baby arrives, and at any stage of life.

Get Bright Light During the Day

Light is the main signal that sets your internal clock. For most of human history, people woke up with the sunrise and spent much of the day outdoors. After sunset, the only light came from fires. Today, many of us spend our days indoors and our evenings surrounded by bright artificial light. This can confuse your internal clock and interfere with melatonin. A large body of evidence supports getting bright light during the day and reducing it after dark.

The most useful time to get light is in the morning. Try to get outside within the first hour or so after you wake up. You do not need to look at the sun, and a short walk or a few minutes outside can work. On an overcast day, you may need to stay out longer because there is less light. Windows filter out a lot of light, so being outdoors is more effective than sitting by a window.

If you wake up before sunrise, turn on bright lights in your home. If you live somewhere with very little natural light, a light therapy lamp may help. Spending time outside throughout the day may also help. In a study of more than 400,000 adults, more time in daytime outdoor light was associated with fewer insomnia symptoms and an easier time getting up in the morning. When you can, take your breaks outdoors.

Keep Your Evenings Dim

Just as bright light during the day helps your internal clock, bright light at night can work against it. Nearly every light source in your home, from overhead lights to phones, tablets, and televisions, can signal to your brain that it is still daytime. In the evening, use only as much light as you need. Lamps are better than bright overhead lights, and dimmer is better than brighter.

Screens are a double problem because they emit light and keep your brain engaged. Ideally, you put your devices away an hour or so before bed. If you do use them, most phones and computers have a night mode that shifts the screen to warmer colors. On an iPhone or Mac, this is called Night Shift. On Windows, it is called Night Light, and most Android phones also have a Night Light setting. For your computer, there is also a free program called f.lux that works on both Windows and Mac. These settings are less effective than turning off your screen, but they are a step in the right direction.

Some people wear blue light-blocking glasses in the evening. The theory makes sense. However, the research on these glasses for sleep is limited and mixed, so think of them as an optional extra rather than a proven tool. Dimming your lights and putting your phone away will do more than wearing blue light-blocking glasses.

If you need to get up in the middle of the night, try to keep the lights low. A dim nightlight in the hallway or bathroom lets you move around safely without flooding your eyes with bright light. Even better if your nightlight has a red bulb. The cells in your eyes that signal daytime to your brain are most sensitive to blue light and much less sensitive to red. In a small study, melatonin recovered under red light but stayed suppressed under blue light. Keeping any light dim is what matters most, but red is the least disruptive choice.

Keep Your Bedroom Dark

Light during sleep matters too. Research shows that light exposure while you sleep can reduce your sleep quality. In a small study of 20 adults, sleeping with the room lights on for just one night led to less deep and REM sleep, a higher heart rate during sleep, and signs of higher insulin resistance the next morning. Another study found that light during sleep was linked to eye fatigue the next day, including tired, sore eyes and difficulty focusing.

Ideally, your bedroom is completely dark. Turn off or cover small lights from alarm clocks, chargers, and electronics. A piece of tape works well for this. If light comes in from outside, blackout curtains can make a big difference. A comfortable sleep mask is another simple and inexpensive option.

Keep Your Bedroom Cool

Another tool you can use is temperature. Your core body temperature naturally drops in the evening, and this drop helps you fall asleep and stay asleep. If you get too warm during the night, you are more likely to wake up. Many sleep experts suggest a bedroom temperature in the mid-60s Fahrenheit, around 65°F (18°C). Everyone is different, and pregnancy can make you run warmer than usual, so adjust based on what feels comfortable.

To keep cool, lower your thermostat at night, use a fan, or open a window. Layers of blankets make it easy to adjust if you get too warm or too cold. Breathable pajamas and bedding can also help.

It sounds counterintuitive, but a warm bath or shower before bed may help you fall asleep faster. Warm water draws blood to your skin. When you get out, that heat escapes, and your core temperature drops. A meta-analysis found that a bath or shower of as little as 10 minutes, taken one to two hours before bed, shortened the time it took to fall asleep. There is some nuance here for pregnancy. You do not need to switch to cold showers out of worry about overheating your baby. However, the studies used water as hot as a hot tub, and during pregnancy you want to avoid raising your core temperature too much. A comfortably warm bath or shower, rather than a hot one, is the way to go. You can learn more about heat exposure during pregnancy in a separate episode.

Wearing socks to bed may work on a similar principle. Warm feet help your body release heat, which is linked with falling asleep faster. One very small study found that bed socks helped people fall asleep sooner, so this is an easy, low-risk thing to try.

Keep Your Bedroom Quiet and Calm

Noise can wake you up or keep you in lighter sleep, even if you do not remember it in the morning. If you live somewhere noisy, a white noise machine or a fan can mask sounds. Earplugs are another option. If your partner snores, this is worth addressing together, since it can affect both of your sleep.

Your bedroom should feel like a sleep sanctuary. The goal is to train your brain to associate your bed with sleep. Reading or a calming routine in bed is fine for most people. However, working, scrolling, or watching TV in bed can keep your brain alert.

Keep a Consistent Sleep Schedule

Your internal clock works best with consistency. Going to bed and waking up at about the same time every day, including weekends, helps keep it on track. You probably use an alarm to wake up. It can also help to set a reminder to start winding down for bed. Many phones have a built-in sleep schedule feature that does this for you.

Everyone has a natural chronotype, which is your body’s preference for when to sleep and wake. Morning larks tend to go to bed and wake up early. Night owls naturally fall asleep and wake up later. This preference is largely genetic, so forcing yourself onto a schedule that fights your natural rhythm can be difficult. When you can, experiment with shifting your sleep window to find what works best for you.

Of course, a consistent schedule is not always realistic with work, other children, or a newborn. As a new parent, flexibility is essential. When you can control your schedule, consistency is ideal. When you cannot, do your best and know that this phase will not last forever.

Build a Bedtime Routine

Every parent will tell you that a bedtime routine helps children fall asleep. The same is true for adults. A routine signals to your brain that it is time to wind down. It can be anything that relaxes you. For example, you might turn off your devices an hour before bed and dim the lights. Then, take a warm shower, put on pajamas, brush your teeth, and read for a few minutes.

What you feed your mind before bed matters too. Intense shows, stressful news, or endless scrolling can keep your brain alert. On the other hand, reading, gentle stretching, journaling, or breathing exercises can help you relax. When you repeat the same steps each night, the routine itself becomes a cue for sleep.

Exercise Regularly

Exercise and sleep support each other. A systematic review found that exercise can improve sleep, and good sleep can help you get more out of your workouts and recover better. For pregnancy specifically, a systematic review and meta-analysis of randomized controlled trials found that women who exercised regularly had significantly better sleep quality.

The American College of Obstetricians and Gynecologists recommends at least 150 minutes of moderate-intensity aerobic activity each week during pregnancy. Moderate activity means moving your large muscles enough to raise your heart rate and start sweating. If exercise is not a habit for you yet, it is never too late to start. Even a daily walk in your neighborhood can benefit you, your baby, and your sleep. You can learn more in the episode on exercise during pregnancy.

You may have heard that you should finish exercising several hours before bed. The research is more reassuring than that advice suggests. A meta-analysis of 23 studies found that evening exercise did not harm sleep in healthy adults. A later review found that intense exercise ending about an hour before bed might delay sleep, while exercise finished two hours before bed may even help. These studies did not include pregnant women. Still, the practical takeaway is that exercising in the evening may be fine, especially if that is the only time your schedule allows you to get in physical activity. If you notice it keeps you up, give yourself a little more time between your workout and bedtime.

Time Your Caffeine

The American College of Obstetricians and Gynecologists advises keeping caffeine under 200 mg per day during pregnancy, which is about one to two cups of coffee. So many things suddenly feel off-limits when you are pregnant, but caffeine is not one of them. There is a lot of nuance here, and many women enjoy a moderate amount of caffeine throughout pregnancy. After your baby arrives, caffeine also passes into breast milk, and babies clear it much more slowly than adults. You can learn more in the episode on caffeine during pregnancy and breastfeeding.

Caffeine works by blocking adenosine, the chemical that builds sleep pressure. When caffeine sits on those receptors, you feel more alert even though adenosine is still building up. Once your body clears the caffeine, that built-up sleep pressure can hit you all at once.

Caffeine stays in your system longer than many people realize. For most adults, it takes about five to seven hours for your body to clear half of it. For example, if the half-life is five hours, about a quarter of your morning coffee is still in your system ten hours later. Pregnancy slows this process even further, and the effect grows as your pregnancy progresses. This means caffeine lingers longer in the second trimester than the first, and longer still in the third.

A systematic review and meta-analysis of 24 studies found that caffeine reduced total sleep by about 45 minutes and increased the time it took to fall asleep. Based on their analysis, the researchers suggested finishing a regular cup of coffee at least 8.8 hours before bed to avoid losing sleep. These studies were not done in pregnancy. Because pregnancy slows how quickly you clear caffeine, an earlier cutoff is a good idea. Morning is the best time for your coffee or tea.

Alcohol and Sleep

The American College of Obstetricians and Gynecologists advises against any amount of alcohol during pregnancy, and the American Academy of Pediatrics states that no amount or type of alcohol is considered safe at any point in pregnancy. The research behind those recommendations is covered in the episode on alcohol during pregnancy and breastfeeding. Still, it is worth understanding how alcohol affects sleep, because this may be helpful at other stages of your life.

Many people feel that a drink in the evening helps them sleep, but that is not really the case. Alcohol is a sedative, and sedation is different from natural sleep. Alcohol disrupts sleep in two main ways. First, it fragments your sleep, so you wake up more often during the night. Second, it suppresses REM sleep, which is important for learning, memory, and emotional processing.

This matters for your baby too. Newborns spend a large portion of their day in REM sleep, which is critical for brain development. There is evidence that alcohol exposure during pregnancy or while breastfeeding can negatively affect a baby’s sleep, especially REM sleep.

Naps During Pregnancy

Naps are very common during pregnancy. In a study of 2,427 pregnant women, 78% reported taking daytime naps. A nap can help make up for lost sleep, but the length and timing matter.

Humans naturally experience a dip in alertness in the early to mid-afternoon. Sleep scientist Dr. Matt Walker, author of Why We Sleep, explains in a TED talk that this makes early afternoon a natural time to nap. He suggests that if you struggle to sleep at night, you may be better off skipping naps. If you do nap, a short nap earlier in the afternoon is less likely to interfere with your nighttime sleep.

There is also research specific to naps during pregnancy. A study of pregnant women found that the number of daytime naps had little effect on nighttime sleep. However, women who napped for more than 90 minutes had somewhat more disrupted and lower-quality sleep at night. In other words, naps can be a lifesaver during pregnancy. If you are tired and have the chance to rest, take it. Keeping naps under 90 minutes may help protect your nighttime sleep.

Closing Thoughts

Sleep is one of the most valuable investments you can make in your health and your baby’s health. Improving your sleep does not happen overnight, and you may need to experiment to find what works best for you. Start with one or two changes, like getting outside in the morning or setting a caffeine cutoff, and build from there.

It is also important to be kind to yourself. From pregnancy through the early years of parenting, your sleep will be disrupted in ways that are outside your control. Focus on what you can influence and let go of the rest. If specific symptoms like heartburn, leg cramps, or insomnia are keeping you awake, the next episode will cover the research on troubleshooting sleep during pregnancy and as a new parent.

Talking to Your Doctor or Midwife

A survey of 423 pregnant women found that only 39% had discussed their sleep with a health care provider at any point during pregnancy. Even among women with moderate to severe insomnia symptoms, only 57% had brought it up. Sleep problems during pregnancy are common, but that does not mean you have to simply live with them. If you are struggling with your sleep, please bring it up with your doctor or midwife. Ongoing sleep problems are worth addressing, and in some cases, poor sleep can be a sign of an underlying issue that is treatable.

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The room where you give birth has more influence over your labor than you might expect. Oxytocin is the key hormone driving labor, and stress hormones can interfere with it. So a birth environment that feels calm, safe, and private can help labor progress more efficiently and comfortably. The good news is that you have options no matter where you plan to give birth. Whether that is at home, in a birth center, or in a hospital room, small adjustments to lighting, sound, scent, and privacy add up. This episode covers the research on how your birth environment affects labor and birth, plus practical ways to make your birth space feel like yours.

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The Power of Your Birth Environment

In nature, most animals instinctively retreat to a quiet, safe place to give birth. If they sense danger, their bodies trigger a surge of fight-or-flight hormones, which can halt labor until the threat passes or they find safety. Humans operate the same way. Oxytocin, the key hormone driving labor, triggers contractions and keeps labor progressing. However, when stress hormones (catecholamines, commonly known as adrenaline and noradrenaline) are released, they can interfere with oxytocin production and slow labor. Creating a birth environment that feels calm, safe, and free of unnecessary stressors is essential to support labor’s natural progression. The more relaxed and secure you feel, the better your body can produce oxytocin, helping labor move forward smoothly.

Oxytocin plays a crucial role in birth, but its influence extends beyond labor. It’s the same hormone released during orgasm, often called the “love hormone” because it’s associated with connection, intimacy, and bonding. Oxytocin is present when you conceive, when you give birth, and when you bond with your baby. With that in mind, there is an argument that the environment you give birth in should be similar to the environment you make love in. That does not mean you need to give birth at home in a candlelit room. However, it is worth considering the details of your birth space.

Start with the basics, like where you will give birth, but go deeper. What is the lighting like? What sounds will you hear? Who will be in the room with you? These may seem like small details, but stacked together, they can significantly impact your experience. Labor progresses best when you feel safe and relaxed. No matter where you give birth, you can make adjustments to create an environment that supports you.

The Venue (Hospital, Birth Center, or Home)

Picture a typical hospital room. It is brightly lit and sterile. The main feature is a hospital bed, often surrounded by medical equipment. Hospitals are not known for being the most inviting or calming environments. However, many hospitals are making their labor and delivery wards more comfortable and relaxing. Some have installed dimmer switches, used warmer paint colors, and designed cabinets to conceal medical equipment.

If you are planning a home birth, you will have the most control over your environment. Birth centers are designed to feel more like a home than a hospital and can be a middle ground between the two. If you are early in your pregnancy and exploring your options for different birth venues or care providers, consider visiting several hospitals or birth centers. Each facility has a different atmosphere, and you may feel significantly more comfortable at one over another.

Your birth environment does not just affect you. It also affects how your baby adjusts to life outside the womb. Consider the environment your baby is experiencing right now. The womb is warm, dark, and quiet, a space where your baby feels safe. Birth is a dramatic transition from this familiar setting to a much colder, brighter, and louder world. Creating a calm, soothing space can make this transition easier for both of you.

The Evidence on Labor Room Environment

The idea that your labor room environment can influence your labor and birth experience is not just theoretical; evidence supports it.

A review of studies on the characteristics of physical birth environments and their effects on labor outcomes identified five main themes: “hominess,” whether spaces are comfortable for activity, demedicalization of the birth environment, accommodations for birth partners, and providing women with a sense of control over their birth environment. These themes consistently appear across research on how the physical birth environment influences labor outcomes. Conclusions are also similar across studies: providing a warm, welcoming birth space is crucial for positive birth experiences. It is clear that spaces where birthing mothers feel safe and supported help them find empowerment in situations where they have limited control.

Some hospitals offer dedicated birthing units separate from the traditional labor and delivery ward. These units provide a birth center-like environment while maintaining access to a hospital’s medical and technological resources. A Cochrane review of ten trials involving 11,795 women compared alternative bedroom-like birth settings within hospitals to conventional labor wards. Women who received care in an alternative birth setting were less likely to use pain medication or require oxytocin augmentation and were more likely to have a spontaneous vaginal birth. Researchers concluded that hospital birth centers are associated with lower rates of medical intervention and higher satisfaction levels without increasing risks to mothers or babies.

One study compared conventional and sensory delivery rooms designed to create a more calming environment. Sensory delivery rooms featured programmable calming lights, restful blurred images displayed on a wall-sized screen, and soothing sound effects. Researchers found that the cesarean rate was significantly lower in the sensory delivery room group (6.4%) than in the standard delivery room (10.7%). The study took place in Denmark, where the overall cesarean rate is about 20%. However, the two groups did not differ significantly in secondary outcomes such as episiotomy rates, use of vacuum extraction, meconium presence, Apgar scores, or labor duration.

A randomized clinical trial examined the use of Snoezelen rooms during birth. Snoezelen is a Dutch term for a controlled multi-sensory environment designed to promote relaxation. These rooms featured an overhead projector emitting green light with changing images, an aquarium with live fish, and light background music. Rooms also included oil-burning candles with the option to add lavender essential oil. Researchers found that Snoezelen rooms were associated with significantly lower pain intensity than standard labor rooms. Participants in the Snoezelen rooms reported an average pain score of 5.26, while those in the control group reported an average of 9.56.

A randomized controlled trial investigated the effect of a hospital birthing room designed to encourage mobility and upright maternal positions in labor on the rate of vaginal births. This took place at 22 hospitals in Germany and included 3,719 participants. They compared rooms where the bed was removed or covered in a corner of the room, and materials were provided to promote upright maternal positions and physical mobility. 89.1% of participants in the modified rooms had a vaginal birth, compared to 88.5% in the control group. Overall, this was not statistically significant, and during this study period, vaginal births increased in both groups. More research is needed to determine whether the environment alone drives these changes or if other factors, like provider behavior and patient motivation, play a larger role. Your environment shapes how you feel and influences how you move and respond during labor.

Evidence shows that upright positions can improve outcomes and shorten labor. A birth space designed to support mobility can encourage these beneficial positions. Learn more about which labor positions are evidence-based for shorter and easier labor in this episode.

A systematic review evaluated birth rooms for women with complex pregnancies. If you have complications, your only option for a birth venue is likely a hospital setting. 94% of women felt that the physical environment affected how easy or difficult it was to give birth. The authors noted that further research is needed to investigate different users’ needs from the environment and how safety features can be balanced with comfort to provide high-quality care and positive experiences for women.

Being in a hospital room surrounded by medical staff can be intimidating. A study observing women giving birth in differently designed rooms found that institutional authority permeated the birth environment, regardless of the room’s design. They identified a power imbalance between institutional demands and birthing women’s needs. Altering a room’s design is one step, and themes like giving women control over their environment could also apply to other aspects of the birthing process. This is why working with your doctor or midwife throughout your birth planning process is essential. When you work closely with your doctor or midwife, they are more of a team member than an intimidating authority figure.

How to Create a Supportive Birth Environment

Changes to your birth environment can influence your labor experience, and in recent years, hospitals have started prioritizing more comfortable, supportive spaces for patients. Many facilities have made design changes to make labor rooms feel less clinical and more inviting, and some have even added sensory rooms with elements designed to promote relaxation and support pain management. Hopefully, we will continue to see more of these improvements in hospital settings. In the meantime, there is a lot you can do to create a birth environment that supports you, no matter where you give birth.

Personalizing Your Birth Space

The room where you labor and give birth is your space, and you should feel comfortable making adjustments to suit your needs. Do not hesitate to rearrange items, use what is available, and add personal touches that help you feel at ease. This is your birth experience and your comfort matters. No need to tiptoe around or worry about inconveniencing doctors and hospital staff; your well-being is the priority. The more relaxed and in control you feel, the more positive your experience will be. Make the space yours.

Adjusting Lighting for Comfort

Even in a hospital filled with fluorescent lighting, you can adjust the brightness in your room. If dimmer switches are available, lowering the lights can create a calmer atmosphere. Otherwise, simply turning off some lights can make a difference. If your care provider or nurse needs brighter lighting for a specific procedure, ask them to dim or turn off the lights once it is no longer needed.

Candlelight can be soothing, but hospitals or birth centers typically prohibit open flames due to fire risk. A great alternative is battery-powered candles, which some birth centers may provide. If not, you can always bring your own.

Natural light can be a welcome alternative to artificial lighting if your room has windows. Adjusting the blinds or curtains allows you to control how much light enters the space.

Using Sound to Create a Calming Space

Sound can strongly affect your birth environment. Whether it is music, guided meditations, white noise, or ocean sounds, the right audio can help you relax and block out distractions. If you want to listen to specific music or sounds, create a playlist ahead of time and plan to bring a speaker or headphones in your hospital bag. If you plan to listen to meditations or other audio, headphones can help you focus while tuning out any surrounding noise. Hospitals can be busy and noisy, so having background sounds like music or ocean waves can help create a more peaceful atmosphere. This can also be useful if you or your partner need to rest.

You can request to have the volume lowered or turned off on monitors or machines that beep. This is helpful if you have continuous monitoring with an electronic fetal monitor. Even the volume of voices in the room can affect your environment. Do not hesitate to ask those present to speak softly if you prefer a quiet space. When your baby is born, they will recognize your and your partner’s voices. A quieter room will help them hear and connect with you.

Incorporating Scent for Relaxation

Your sense of smell can significantly influence your mood and environment. At home, you control the scents around you. In a birth center or hospital, you may encounter the smell of cleaning products or medical supplies, which may not feel comforting or relaxing. Bringing something from home, like a familiar blanket or a scented candle, can help create a more soothing atmosphere. Remember, even if you can’t light a candle because of hospital or birth center policies, it can still provide a pleasant scent.

Essential oils are becoming increasingly popular during labor. In a study of over 8,000 women who used various essential oils during labor, more than half rated them as helpful. Rose was found to be the most helpful for anxiety. In this group, the mothers who used essential oils had higher rates of spontaneous vaginal delivery and lower rates of epidural use. Lavender was most common in alleviating pain, followed by frankincense. 54% of women rated lavender as helpful, and 64% rated frankincense as helpful. Similar to those using aromatherapy for anxiety, there were higher rates of spontaneous vaginal delivery and lower rates of epidural use. Peppermint oil was used to treat nausea and vomiting. Of those who had an epidural (which can cause nausea), 44% found it helpful. Clary sage was most commonly used to augment contractions. 36% of mothers rated clary sage as helpful. 

Hospitals and birth centers may limit essential oils or prohibit diffusers. You can store oils on cotton balls in a Ziploc bag. If a particular scent is no longer helpful, it is much easier to seal up a bag and open a new one than to clear the air and get the smell out of an entire room.

Some oils like clary sage and myrrh are thought to stimulate the uterus and consequently are not recommended until you are in labor. Before using any essential oils during your pregnancy or labor, discuss them with your doctor or midwife. Learn more about the evidence on essential oils and their safety during pregnancy, birth, and postpartum in this episode.

Setting Boundaries for Visitors and Privacy

During labor and birth, you should be surrounded by people you trust and want in your space. If someone is present, it should be because you invited them. Do not let anyone pressure you into including them if you do not feel comfortable. This is your experience, and you can decide who is part of it. All birth venues have visitor policies, so check the rules at your birth location to plan accordingly.

Privacy is essential to your birth environment. Imagine how you would feel if someone visiting your home walked in unannounced. Some women request that anyone entering their labor room knock first. This is a reasonable request to get a heads-up before someone new walks in.

Ina May Gaskin has written extensively about pasmo. Pasmo is the idea that the presence of a male stranger can actually reverse cervical dilation during labor. I have also covered this in a past podcast episode. This does not mean men should be excluded from birth. There are many excellent male doctors, and I strongly support partners being present, regardless of gender. However, even a female nurse or doctor you have never met before can enter your room unexpectedly and feel like an invasion of privacy. Feeling secure in your space means not worrying about who might walk in, who can hear you, or who can see you. If it helps you feel more comfortable, keep doors closed and curtains drawn. Also set clear expectations about privacy with your care team and visitors.

Considerations for Birth Photography

Even in a private birth setting, you may want to invite a birth photographer or a close friend to document your experience. Birth photography can capture powerful and beautiful moments, and in hindsight, many parents wish they had taken more photos. If you are considering this, discuss your preferences with the photographer beforehand. This will help them plan for the lighting and environment you want.

Communicate any boundaries in advance. If there are moments you do not want your photographer to capture, make that clear so you feel completely comfortable. If the idea of someone taking pictures throughout labor feels overwhelming, you can skip it altogether. Another option is to wait until after the birth and have someone capture those first special moments once your baby has arrived.

If you want birth photos, coordinate with your care provider to understand any hospital or birth center guidelines on photography. If your partner or someone else will be taking photos, you may want to ask them to avoid using a flash to prevent distractions, especially when capturing your baby’s first moments.

Clothing for Comfort

What you wear during labor can greatly affect your comfort. Hospitals typically provide a standard gown, but these are not designed with comfort in mind. You can wear your own clothing, or nothing at all, if that feels best for you. A lightweight bathrobe or a specially designed labor gown can be good alternatives.

Any clothing you wear during labor may get stained by the fluids involved in birth, so choose something you do not mind getting messy. If you prefer not to wear a hospital gown, speak up and advocate for yourself—your comfort matters.

Creating a Personalized Environment

The more you can do to make your birth environment comfortable, the better. Before you go into labor, visit your hospital or birth center to see the space and brainstorm ways to make the room feel more like home.

A simple way to make your surroundings feel more familiar is to bring personal touches. This could include photos of loved ones, a drawing from an older sibling-to-be, or an affirmation to focus on during labor. Your birth space should feel like your space. If something would improve your comfort, pack it in your hospital or birth center bag. If something about the environment is not working for you, ask to adjust it, remove it, or turn it off. The more comfortable you feel in your surroundings, the more relaxed and focused you can be on meeting your baby.

Including Your Birth Environment in Your Birth Plan

While it is helpful to consider your birth environment in your planning, avoid including every detail in your birth plan. Your birth plan should be a one-page outline of your most important preferences. The Pregnancy Podcast has many resources to guide you in creating a birth plan:

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You walk into a room and cannot remember why. A word you use every day disappears mid-sentence. You read the same paragraph three times, and none of it sticks. Pregnancy brain is one of the most talked-about symptoms of pregnancy and one of the least understood. This episode covers what researchers actually find when they test memory and thinking during pregnancy. Learn why this feels more dramatic than what researchers can actually measure, and how long it lasts. Importantly, find out why pregnancy brain looks less like a decline and more like an upgrade. Plus, practical strategies that target what pregnancy brain affects.

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What Pregnancy Brain Actually Feels Like

Pregnancy brain, or baby brain, is the term for the forgetfulness, distraction, and mental fog that many expecting moms notice during pregnancy. After your baby arrives, the same experience often gets called mom brain or momnesia.

The experience is specific, and it looks pretty similar from one expecting mom to the next. You go to another room and forget why you came. A common word disappears in the middle of a sentence. An appointment you confirmed that same morning slips your mind completely. Then you set your keys down somewhere and spend ten minutes retracing your steps. These examples all have something in common. They involve failing to remember to do something, or failing to retrieve something you already know. Pregnancy brain is very common. Figures cited consistently across the literature land somewhere between 50-80%. So if you are dealing with this, you are not alone.

When Pregnancy Brain Starts and When It Peaks

The timeline is more consistent than you might expect. A meta-analysis found that measurable differences in general cognitive function, memory, and executive function develop mainly during the first trimester. Those differences are then most pronounced in the third trimester. That matches what many women describe. The fog often shows up early, alongside the fatigue and nausea of the first trimester. It tends to feel more prevalent in the third trimester, when sleep is most disrupted, and you have the most on your mind.

What Cognitive Testing Actually Finds

Here is where the research gets interesting, because it does not all point in the same direction. In the meta-analysis above, pregnant women scored lower than controls on general cognitive functioning, memory, and executive functioning. In other research, no significant differences in cognitive change as a function of pregnancy or motherhood were found. Late pregnancy was associated with a decline on one of four measures. The authors concluded that the hypothesis of persistent cognitive deterioration was not supported, and they suggested that earlier positive findings may reflect biased sampling. Both of those are careful studies. They disagree in part because they measured different things. This is a case where the overall evidence is mixed, and the useful answer requires more specifics.

Which Parts of Memory Change and Which Do Not

A 2025 systematic review gives us the specifics we need. Instead of asking whether memory declines, they broke memory apart and examined each type separately. The results are far more specific than the phrase pregnancy brain suggests.

Prospective memory shows the clearest effect. Prospective memory means remembering to do something in the future. Returning a call, taking a vitamin, mailing a form. This is the one domain where pregnant women consistently underperform. In one study, pregnant women were less likely than controls to remember to phone the lab on a scheduled day. They were also less likely to mail an envelope back the day after a visit.

Short-term memory shows no effect. Across studies using a standard digit span task, pregnant women and controls showed no difference. In a digit span task, you hear a list of numbers and repeat them back. It measures how much you can hold in your mind at one time. Implicit memory is also preserved, which covers the skills and habits you perform without conscious effort. This is everything you know how to do without thinking about it, like driving, typing, or riding a bike. Visual and spatial memory is also not reduced, so pregnancy has not been linked to any decline in recalling faces, objects, or images.

Results across the whole literature for verbal recall and verbal recognition are mixed. But in higher-quality studies, verbal recall and verbal recognition were unaffected. Intelligence and planning show no effect. Attention, processing speed, and cognitive flexibility remain inconclusive.

What does all of this mean? Taken together, pregnancy brain is not a broad decline in your thinking. It is a narrow effect on remembering to do things. The problem is that you rely on it constantly.

The Gap Between How It Feels and How It Measures

What women describe and what the tests find are two very different things. Consider one study that measured memory in pregnant and non-pregnant women in two ways. In the lab, the pregnant women performed just as well as everyone else. On the questionnaires, they reported problems across the board. Their performance slipped only in real life, on tasks that required remembering to do something later.

One more finding is worth noting. Research also shows that sleep deprivation predicts how forgetful a pregnant woman reports feeling, but it does not predict how she actually performs on memory tests. Poor sleep appears to shape the feeling more than the function.

Why That Gap Exists

So why do you feel so much more forgetful than the testing says you are? There are four likely reasons, and none of them mean you are imagining it.

The first is attention, not memory. A review of this research suggests that the cognitive effort involved in a memory task may underlie the impairment. Pregnant women may remember a task perfectly well, but then they assign it a low priority against everything else competing for their attention. You are preparing a nursery, finishing projects at work, and attending prenatal appointments. This is not a failure to remember. You are triaging what actually needs your attention.

The second is expectation. Pregnancy brain is a cultural expectation before it is ever a personal experience. Once you expect to be forgetful, you notice and attribute your lapses differently. Everyone loses a word occasionally. When you are pregnant, you attribute that lapse to pregnancy brain rather than being human.

The third is sleep. Sleep drives memory consolidation, and pregnancy disrupts sleep in many ways.

The fourth is all of the other contributing factors that come with pregnancy. Fatigue and stress both affect concentration in anyone, whether or not you are pregnant. One review of pregnancy memory research found that pregnant women are significantly impaired on some memory measures but not others. The affected measures were those that placed high demands on executive control. Executive control is the part of your brain that manages everything. It holds your plan, directs your attention, and allows you to switch between tasks. Think of executive control as the manager, not the filing cabinet. In other words, the tests pregnant women struggled with were the ones that demand the most from the manager. That is exactly what you would expect when attention is already stretched across a dozen things.

What Brain Imaging Shows

Alongside cognitive testing, a substantial body of brain imaging research now gives us more information. Let’s start with what drives this. Pregnancy involves massive hormonal changes and these hormones act on your brain, not just your body.

In a landmark study, researchers scanned women before conception and again after birth. To separate pregnancy itself from the experience of becoming a parent, they also scanned first-time fathers, men without children, and women who did not become pregnant. Only the women who had been pregnant showed changes. Gray matter volume decreased in regions involved in social cognition. Social cognition is how you read other people. Their emotions, their intentions, and what they need from you.

When researchers rescanned participants two years later, most reductions persisted, with a partial recovery in one cluster in the hippocampus. The hippocampus is central to memory. Newer work has built on this research. A precision imaging study scanned one first-time mother 26 separate times, from preconception through two years postpartum. Gray matter volume and cortical thickness decreased across pregnancy. Gray matter is where your brain does its actual processing. Cortical thickness is how thick the outer layer of that processing tissue is. At the same time, white matter microstructural integrity increased. White matter is the wiring that connects those processing areas to each other. Think of gray matter as the rooms in a house and white matter as the wiring running between them. During pregnancy, the rooms get smaller and the wiring gets better. That matters, because losing tissue while improving connections is not what deterioration looks like.

A much larger study then followed 179 women. Gray matter volume decreased by up to 4.9% across roughly 94% of the brain. It then partially recovered after birth. What matters is that the extent of change tracked with estrogen levels and maternal attachment. That connects this research directly to bonding with your baby.

Put those three studies together, and we have a consistent picture. Your brain changes measurably during pregnancy. Those changes concentrate in the areas involved in reading and responding to other people. Plus, these changes are tied to pregnancy hormones rather than the experience of parenting.

What the Brain Scans Do Not Explain

None of the research actually establishes that these structural changes cause your forgetfulness. Researchers have noted that they could only speculate that the brain changes contribute to the memory deficits associated with pregnancy. The imaging shows your brain is reorganizing, specifically in regions tied to social processing. It does not tell us why you cannot find your keys.

When we’re talking about a decrease in gray matter, that sounds very scary. Before you start worrying, you need to know researchers don’t interpret it as damage. They view it as synaptic pruning. This is the same refining process that reshapes your brain during adolescence. Pruning helps the brain become more efficient at whatever it needs to do next. This is good news because your brain isn’t deteriorating; it is preparing you for motherhood.

Where Pregnancy Brain Looks Like an Upgrade

If pregnancy reorganizes the brain around social processing, then testing women on word lists may be measuring the wrong thing entirely. When researchers test measures that apply to being a new mother, we see a different picture.

In one study, women in their third trimester completed a spatial associative memory task and were compared to women who had never been pregnant. A spatial associative memory task tests whether you can remember what goes where. Researchers show you images in specific locations, then later ask you to recall which image was where. The task included two kinds of images. Some were relevant to babies and parenting, and some were relevant to ordinary adult life. Pregnant women showed better retention on this task overall when they were tested again four weeks later. The researchers framed their findings directly against the idea of baby brain.

Another study found that pregnant women were better than non-pregnant women at recognizing faces they had seen only once. The effect was strongest for male faces of their own racial group. Researchers proposed this as a protective adaptation rather than a curiosity. This lines up with everything else we have covered. Brain imaging shows pregnancy reorganizes the regions that handle social processing. This study tested a social processing skill and found it sharper. Two completely different research methods point to the same conclusion.

A 2025 review pulled this literature together and argued for reframing mom brain around adaptive cognitive enhancement rather than deficit. Researchers have also proposed the term matrescence for the lifetime impact of motherhood on the brain, much as adolescence describes the transition into adulthood. That comparison is not accidental. It is the same synaptic pruning we talked about, the process that reshapes the adolescent brain, happening again in adulthood.

I know we have discussed a lot of research. A coherent theory underlies all of this. Pregnancy carries enormous metabolic demands, so energy gets reallocated. Functions that are not essential right now receive less. Functions that support recognizing your baby, reading their cues, and responding to them receive more. On this view, the forgetfulness is not a malfunction. It is the price you pay to upgrade your brain to be a better mom.

Mom Brain and the Postpartum Period

While a lot of pregnancy symptoms disappear after your baby is born, mom brain is not one of them. Research that compared memory during pregnancy and the postpartum period found a mixed picture. Of the seven studies, four found the decline persisted for weeks or months. Two found it resolved after birth. One study found an interesting difference. New moms were more likely to do something late than to forget it entirely. That is a very different problem than losing track of it altogether.

Realistically, the postpartum period stacks several things on top of each other. Your sleep is fragmented. Attention is split with an infant who requires continuous monitoring. On top of that, your mental load has gone up. It is also worth remembering that the reorganizing we talked about earlier is still underway. Your brain does not finish rewiring the day your baby is born. Some of that work continues to move through the first year. On the imaging side, research found structural changes still present two years after birth. Another study found partial recovery within months.

These two findings are easier to reconcile than they look. They were measuring different things on different timelines. The rebound happens fairly quickly after birth. It just does not go all the way back to where you started. Some of what changes during pregnancy recovers, and some of it seems permanent. The bottom line is that if you still have a bit of mental fog after you have your baby, this is not a sign that something’s wrong. It’s entirely normal.

What Happens to Your Brain in the Long Term

So far, we’ve talked about what happens to your brain during pregnancy and postpartum, but what about long term? Researchers analyzed brain scans from 12,021 middle-aged women. Women who had given birth showed less evidence of brain aging than women who had not, even after accounting for common genetic variation and other confounding factors. A follow-up analysis found the effect concentrated in striatal and limbic regions. The striatum sits deep in the brain and handles motivation, reward, and habit. The limbic regions handle emotion and memory. Both are heavily involved in caregiving. The strongest signal was in the accumbens, a region central to reward processing and to maternal behavior. The bottom line is that even if you have some deficits short-term, there are benefits in the long run.

Does a Second Pregnancy Make It Worse?

You may be wondering if effects are compounded with multiple pregnancies. A 2026 study examined how a second pregnancy affects the brain compared to a first. Rather than simply repeating what the first pregnancy did, a second pregnancy produced a distinct pattern. Some first-pregnancy effects were fine-tuned further. Other networks changed in ways the first pregnancy did not produce at all.

This study looked at brain structure rather than at memory performance, so it does not tell us how second-time mothers feel day to day. What it does tell us is that if you had pregnancy brain in your first pregnancy, there’s no research showing that it’s going to be worse the second time around.

Strategies That Actually Help

We’ve covered a lot of research, and you should have a better idea of why this happens and the benefits it can give you as you go into motherhood. None of this makes pregnancy brain less frustrating. Let’s go through a few strategies that can help you manage this.

Get It Out of Your Head and Into a System

I am a big fan of the brain dump and writing things down. Getting things into a notebook, a notes app on your phone, or a calendar takes them out of your brain. Then it’s one less thing you need to mentally remember. This works because prospective memory, remembering to do something later, is the one function that consistently takes a hit. Every item you write down is one your brain no longer has to remember.

Build Triggers Into Your Routine

Habits run without memory. The easiest way to build a habit is to attach it to something you already do. If you make tea every morning, keep your prenatal vitamin next to your tea. This solves the problem of forgetting to take your prenatal vitamin. The more of your routine that runs automatically, the less you have to actively remember. This is called habit stacking, and the formula is simple. After I do the thing I already do, I will do the new thing. That means after I pour my morning tea, I take my prenatal vitamin. After I plug in my phone at night, I check tomorrow’s calendar. Attaching the new habit to an existing one means you are not relying on memory to trigger it.

Protect Your Sleep

Sleep supports memory, mood, and concentration, and pregnancy interferes with all three. Improving your sleep is one of the highest-value things you can do, and there is a full episode on how to improve it.

Do Your Hardest Thinking When You Are Sharpest

If you have cognitively demanding work, schedule it when you are sharpest rather than when it lands on your calendar. If you are not a morning person, do not save your hardest thinking for 8:00 in the morning. Steady blood sugar helps too, so pay attention to how what you eat affects your focus across the day.

Offload What You Can

If a task can go to someone else, delegate. Your partner, family, and friends can absorb more than you probably ask them to. Getting comfortable with this now is also a genuinely useful skill for life with a newborn. Don’t try to do everything by yourself.

You should also take a look at what can simply be cut. Do you have to-do items on your list that are not really necessary? Are not necessary right now? It is easy to spend hours researching things that do not need researching yet. If you are in your first trimester, you do not need to have an opinion about diapers. Your attention is finite right now, so spend it on what is actually relevant to where you are.

Closing Thoughts

Here is what you need to take away from everything we have discussed today. Pregnancy brain is real, and it is far more specific than it feels, hitting mainly your ability to remember to do things. Meanwhile, your brain is reorganizing around the ability to recognize your baby and read what they need, and when researchers test that instead of word lists, pregnant women often do better rather than worse. Your brain is changing, but in ways that will help you better navigate being a mother.

Talking to Your Doctor or Midwife

As always, if anything is bothering you during pregnancy, you should bring it up with your doctor or midwife at a prenatal appointment. This is especially true if brain fog feels sudden or severe rather than gradual. Also mention it if it arrives alongside symptoms like dizziness, shortness of breath, heart palpitations, or headaches. Several common pregnancy conditions can affect concentration and memory. Low iron levels leading to anemia are near the top of that list. Thyroid problems, blood pressure concerns, sleep apnea, and fatigue are all part of that picture.

Both depression and anxiety affect concentration and memory, and both are common during pregnancy and after birth. If the fog comes with low mood, persistent worry, or a sense that you are not functioning the way you normally do, please talk with your doctor or midwife. They would much rather hear about it and rule things out than have you assume it is just pregnancy brain and manage on your own.

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Most breastfeeding resources are full of information on why you should keep going, and very short on practical help for when you are ready to stop. If you have gone looking for guidance on weaning, you have probably found long lists of reasons not to quit and anxiety-inducing articles about everything that can go wrong. Breastfeeding is amazing, but every mom will reach a point when she is ready to stop. When you reach that point, you should have access to evidence-based, judgment-free support. This episode is here to take the anxiety out of stopping breastfeeding. We cover when to wean, how to do it gradually and comfortably, how to lower your risk of complications, and how to handle the emotions that can come with closing this chapter. Plus, I will share the slightly ridiculous trick I used with both of my babies that made weaning so much easier.

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Why Weaning Gets So Little Support

Many breastfeeding resources are excellent when you are learning to nurse or troubleshooting a specific problem. Where they fall short is weaning. Instead of a clear how-to, what you usually find is a list of the benefits of breastfeeding, plenty of reasons not to quit, and tips for fixing issues so you can keep going. That support is valuable when you want to continue, but it leaves a gap when you are ready to stop. This episode fills that gap. If you want the full picture on breastfeeding itself, you can find every breastfeeding resource, episode, and article in one place on the breastfeeding page.

What Weaning Actually Means

The formal definition of weaning is introducing your baby to food other than breast milk. In this episode, we are using it the way most parents do, which is stopping breastfeeding. Weaning can be baby-led or mother-led, depending on who initiates it. A baby rarely decides to stop nursing entirely on their own before at least age two. As children get older, some do decide they are done, even when mom is not. Mother-led weaning is when you decide you are ready to stop and you start the process.

There is also a different thing called baby-led weaning, which refers to feeding solid foods. Rather than spoon-feeding purees, you offer foods your baby can pick up and feed themselves. References to weaning in this episode refer to weaning off the breast.

A Nursing Strike Is Not Weaning

Before you conclude your baby is ready to wean, it is worth ruling out a nursing strike. A nursing strike is when your baby suddenly refuses to breastfeed, and the key word is suddenly. This is not the same as weaning, which happens gradually and rarely occurs on its own before age two. Strikes can happen for all kinds of reasons, from something obvious like teething or a cold to something subtle like a change in the taste of your milk. A strike can be stressful, but it is almost always temporary. If your baby abruptly refuses the breast, keep expressing milk to protect your supply, avoid forcing feeds, and try nursing when your baby is sleepy or just waking. If you want a deeper walkthrough of strikes and other feeding issues, see troubleshooting common breastfeeding issues.

Dealing With Social Pressure

It can be hard to handle social pressure, both to keep breastfeeding and to stop. Someone in your life, and maybe everyone in your life, will have an opinion about how you feed your baby. Here is the truth: other people’s opinions do not matter. I know that is easier said than done. You need to do what is right for you and your baby, regardless of what anyone else thinks.

You might expect the comments to run in favor of breastfeeding, things like, “Why would you quit? It is so good for the baby,” or “Formula is so expensive, and breastfeeding is free.” For the record, breastfeeding is only free if your time and energy are worth nothing, which could not be further from the truth.

What can catch you off guard are comments in the other direction, like, “Oh wow, you are still breastfeeding?” A friend once told me I should stop soon before I wrecked my boobs. Excellent, thanks for that. It is worth noting that even the American Academy of Pediatrics has flagged this problem directly. In its breastfeeding policy statement, the AAP notes that mothers nursing past the first year often feel judged and may even hide it to avoid comments. In other words, the pressure is real and documented. It still should not have any bearing on your decision.

Reasons Mothers Choose to Wean

There are many reasons to wean, and all of them are valid. Some mothers stop for health reasons. You may need a medication that is not compatible with breastfeeding. The LactMed database is an excellent resource for checking whether a specific drug is safe while nursing. You may need a medical procedure that means pausing or stopping. Some mothers return to work after maternity leave and decide they do not want to keep pumping to provide milk. Some babies have food sensitivities that make a mother’s diet feel impossibly restrictive.

Another completely valid reason is that it is not working for you, and you do not want to keep going. The challenges of breastfeeding, both physical and emotional, are rarely discussed openly. If you want to continue, you deserve support and resources to make that happen. The same is true when it is time to stop. You do not owe anyone an explanation, a medical reason, or a certain number of months.

When to Wean

Only you can answer the question of when to stop breastfeeding. Every mom and baby is different. The current guidance from the American Academy of Pediatrics and the World Health Organization is straightforward. Both recommend exclusive breastfeeding for about the first six months, introducing solid foods around six months, and continuing to breastfeed alongside solids to two years or beyond for as long as it works for you and your child. These are recommendations, not requirements. Any amount of breast milk benefits your baby, and there is no threshold you must hit to have done it right.

Keep this in perspective as you decide. If you stop before your baby’s first birthday, you will replace breast milk with formula, because babies need breast milk or formula as their main nutrition for the first year. Your pediatrician is a great resource for questions about your baby’s nutrition and diet as you make this decision.

Some moments are simply not ideal for weaning. If you have another big transition underway, like a move, it may be worth waiting. Your baby nurses for comfort as much as for nutrition, so piling one big change on top of another can make things harder for both of you. You may also want to avoid weaning while your baby is sick. Babies and toddlers often nurse more when they do not feel well. That could have something to do with the antibodies in your milk, or simply because your baby finds nursing comforting. Ideally, you wean during a calm stretch, when your baby is healthy and your life is relatively steady.

The One Principle Behind All of This: Supply and Demand

Before we get into the how, there is one principle that everything else rests on. Your milk works on a demand and supply system. The more you breastfeed, the more milk you make. When you nurse less often, you are effectively telling your body to produce less. On top of that, once solid foods enter the picture, your baby naturally takes less milk. A six-month-old drinks far more milk, and more often, than a three-year-old. Your child’s age at weaning shapes the whole process, because weaning a three-year-old and weaning a six-month-old look very different.

This is also why it is generally recommended that you not quit cold turkey. Stopping gradually is easier on both your baby and your breasts. If you are nursing a six-month-old throughout the day and you stop all at once, your breasts are still making a lot of milk, which raises your risk of problems like plugged ducts and mastitis. Weaning gradually gives your supply time to wind down and keeps you more comfortable along the way.

Some organizations, like La Leche League, divide weaning into daytime and nighttime. Daytime can be easier, because you have distractions like food, activities, and other people to lean on. Nighttime is often harder, since in the moment you may want to do whatever gets your baby back to sleep fastest, and that is frequently nursing. KellyMom also has a helpful article on how to wean.

How to Wean, Step by Step

Let’s go through practical tips for weaning. Not all of them will apply to you, so take the ones that fit your baby’s age and your situation and leave the rest. The through-line for all of them is the same: drop feeds gradually, watch how your body responds, and give everyone time to adjust.

Supplementing With Formula for Babies Under One

If you stop before your baby is one year old, you will replace nursing sessions with formula. Start by swapping one nursing session for a bottle, then add more over time. This gradual approach lets your supply taper slowly and lowers your risk of plugged ducts and mastitis. A simple rhythm works well: drop one feeding, give yourself about three days to adjust, then drop another, wait three days, and so on. Morning and bedtime feedings are usually the last to go. Many moms find it easier to replace a mid-day feed with a bottle than to swap the breast for a bottle right before bed. If you are choosing a formula, our episode on choosing the right formula walks through how to compare your options.

Tips for Daytime Weaning

Tips for Nighttime Weaning

Talk Your Child Through It

Tell your child that nursing is coming to an end. This may feel silly with a young baby, but they understand far more than we give them credit for. With an older child, it genuinely helps to explain that a change is coming so they can start to accept it. You are not negotiating, just narrating what is about to happen.

When You Have to Wean Quickly

Everything above assumes you have the luxury of time. Sometimes you do not. A medication, a medical emergency, a hospitalization, or a sudden separation can force you to stop faster than you would choose. If you are in that situation, the goal shifts to protecting your comfort and lowering your risk of complications while your supply comes down as gently as it can.

The core move is to relieve pressure without fully draining your breasts, because draining them signals your body to make more milk. Express just enough to take the edge off, whether that is a couple of minutes of pumping or hand-expressing an ounce or two. Use cold packs and, if appropriate for you, an anti-inflammatory to manage swelling and discomfort. Watch closely for the warning signs of plugged ducts and mastitis that we cover next, since a fast wind-down carries more risk of both. If you have to stop abruptly for a medical reason, loop in your doctor, midwife, or a lactation consultant, who can help you manage the transition safely.

Weaning From Pumping

If you are exclusively pumping or pump alongside nursing, weaning follows the same supply-and-demand logic, just applied to your pump schedule. Every time you remove milk, whether by nursing or pumping, you signal your body to keep producing at that time. To wind down, gradually drop one pumping session at a time and lengthen the gaps between the sessions that remain. You can also trim each session slightly, taking a bit less milk than usual, so your body gets the message to make less. As with weaning at the breast, go slowly enough that you stay comfortable and do not end up engorged.

Troubleshooting Issues When Weaning

A few issues can come up while weaning. The point of learning about them is not to scare you, it is to help you recognize them early and know what to do. It is entirely possible to wean without any of these problems. A lactation consultant can be a great resource if you or your baby hit a rough patch, and this is a good moment to mention that lactation consultants help with far more than getting started. They are just as useful when you stop.

Engorgement

Engorgement during weaning happens when your breasts have not yet adjusted to making less milk. If milk is not removed for too long, your breasts can feel full, heavy, tender, hard, and even hot. If you get engorged, express just enough to feel comfortable. The trick is to not empty your breasts, because that tells your body to make more. There is no magic number here. You might pump for two minutes or hand-express a single ounce. A warm shower can make it easier to hand-express, but heat is not there to fix the engorgement. For the discomfort itself, cool compresses tend to work better than heat. For more, see this KellyMom article on engorgement.

Plugged Ducts and Mastitis, and Why the Advice Has Changed

Engorgement can raise your risk of a plugged duct or mastitis, and this is an area where the guidance has changed recently. For years, the standard advice was to attack a plugged duct with heat and firm massage and to empty the breast as completely and often as possible. If you were nursing a few years ago, that is probably what you were told.

In 2022, the Academy of Breastfeeding Medicine released a clinical Protocol, which reframed how we understand these problems. The big shift is conceptual. What we have long called a plugged duct is not really a solid plug that you need to squeeze out. It is inflammation and narrowing of the milk ducts, along with swelling in the surrounding tissue. Once you see it as inflammation rather than a blockage, the old fixes start to make less sense. Aggressive massage and heat can worsen the inflammation, and over-emptying the breast tells your body to make more milk, which fuels the cycle you are trying to break.

La Leche League has updated its guidance to match. In a notice explaining the change, LLL describes how the thinking shifted from removing a plug to calming inflammation. Under the current approach, a few things replace the old routine. Use cold rather than heat to ease swelling and pain. Skip deep or aggressive massage and any tools like electric toothbrushes or massagers, which can aggravate the tissue. If you do anything, use gentle lymphatic drainage. This uses a light sweeping of the skin toward your armpit, with about the pressure you would use to pet a cat. Keep feeding your baby on demand from the affected side. You should also resist the urge to add extra pumping sessions to “empty” your breast, since overstimulation makes things worse.

An anti-inflammatory like ibuprofen can help with pain, and you should check with your provider before taking any medication. If you want to look up whether a specific medication is compatible with breastfeeding, the LactMed database is a free, reliable resource that summarizes how drugs transfer into milk and affect your baby and your supply.

Here is how to tell a plugged duct and mastitis apart. With a plugged duct, you may notice a firm, tender lump that feels swollen and warm. Mastitis has similar but more intense symptoms, and it adds flu-like signs such as fever, aches, and chills. Mastitis may or may not involve an infection. Bacteria entering through a crack or point of damage on the nipple can turn inflammation into an infection. Some of the old advice still holds. If you have a fever or flu-like symptoms, contact your doctor or midwife, rest as much as you can, and ask about whether antibiotics are appropriate. Do not wait it out, because untreated mastitis can progress to an abscess, which is a serious health problem.

On a personal note, this happened to me, and I do not recommend it. I got a plugged duct that turned into mastitis and then snowballed into a days-long hospital stay for an abscess. I kept trying alternative methods to resolve it because at the time I wanted to avoid antibiotics. In hindsight, that was the wrong call. I share more of what I learned the hard way in my episode on lessons learned breastfeeding the second time around.

One more note on weaning. You are trying to slow milk production and eventually stop, but if a plugged duct or mastitis shows up, you may need to pause weaning briefly to resolve it. Getting the inflammation under control comes first. Once you are comfortable again, you can pick the process back up.

Decreasing and Drying Up Your Milk Supply

There are a few things you can do to actively decrease your supply. These are meant only for weaning or for extreme oversupply, and the evidence behind them is mixed. Use them only if you are genuinely trying to bring your supply down.

Do Not Bind Your Breasts

Please do not bind your breasts. This is outdated advice, and tightly wrapping your breasts can actually raise your risk of plugged ducts. A supportive bra is perfectly fine if it is comfortable, but do not bind or tightly wrap. It will not slow your milk production, and it can cause harm.

Cabbage Leaves

Cabbage leaves are a classic home remedy for engorgement and for drying up milk, but the evidence is underwhelming. A Cochrane review that looked at treatments for engorgement found that a cabbage-leaf-extract cream performed no better than a placebo cream, and the authors concluded there is not enough evidence to recommend cabbage leaves widely. It is also worth noting that the studies involved were small and focused on mothers who intended to keep breastfeeding, not to wean. If cool cabbage leaves feel soothing, they are unlikely to do any harm, but do not count on them to dry up your supply. There is one additional caution, and that is that raw cabbage can carry bacteria. If you use leaves against your skin, a clean cold pack does the same soothing job without that concern.

Sudafed

Sudafed, the brand name for the decongestant pseudoephedrine, is normally used for a stuffy nose and sinus pressure. It works by shrinking swollen nasal membranes, and it turns out it may also reduce milk production. In a small study of just eight women, a single 60 mg dose of pseudoephedrine reduced milk production by about 24% on average over the following 24 hours compared with a placebo. Keep in mind this was a very small study, and while researchers suspect the effect is related to a drop in prolactin, that change did not reach statistical significance. This is the main study people point to, so do not expect a large body of evidence behind it.

The LactMed entry for pseudoephedrine reflects the same picture, noting that a single dose decreases milk production acutely and that repeated use seems to interfere with lactation. It even mentions that pseudoephedrine has been used deliberately to bring down supply in mothers who make too much. It is not a guarantee, and it is worth discussing with your doctor or midwife before you try it.

Herbs

If you would rather try something more natural than an over-the-counter medication, a few herbs are thought to reduce supply. Sage and jasmine are the two most popular, and others like peppermint may help as well. For each of these, LactMed has a detailed entry covering how it transfers into milk and what it may do to your supply. KellyMom also has an in-depth article on herbs that can lower your milk supply. As with everything in this section, the evidence is limited, so treat these as gentle nudges rather than switches. Dose matters too. A dish seasoned with sage is unlikely to change anything, while something concentrated, like drinking sage tea regularly, is more likely to have an effect.

When Will You Actually Stop Making Milk?

After you stop breastfeeding, it takes time to stop producing milk completely. Most mothers see their milk dry up within a few weeks. You may keep making a small amount for weeks or even months longer, especially if you nursed for a long time or you keep stimulating your breasts by checking whether you can still express. You can occasionally check, but do not make it a habit, because every bit of stimulation tells your body to keep going a little longer.

The Emotional and Hormonal Side of Weaning

Weaning is not only physical. It can stir up a lot of emotion, sometimes even when you are more than ready to stop. Part of this is situational, the sense of closing a chapter, and part of it is hormonal. Breastfeeding runs on hormones like prolactin and oxytocin, and as you wean, those levels shift and fall. Just as a sharp drop in hormones after birth can affect your mood, the hormonal changes of weaning can leave some women feeling unexpectedly low, weepy, or irritable for a stretch.

There is research connecting the end of breastfeeding to mood, though it comes with an important nuance. A large Norwegian cohort study of more than 42,000 women found that stopping breastfeeding was associated with an increase in symptoms of anxiety and depression, and that the effect was strongest for women who already had high levels of anxiety or depression during pregnancy. Another study found the highest risk of postpartum depression among women who had planned to breastfeed but were not able to. Much of this research focuses on early or unplanned cessation rather than a smooth, chosen wind-down, so it does not prove that gradual weaning prevents low mood. Still, it lines up with what is widely recommended, which is easing off slowly, so your body adjusts more gradually, is a reasonable way to soften the transition.

For most women, this passes as your body settles into its new normal. However, if a low mood lingers, deepens, or starts to interfere with daily life, take it seriously rather than brushing it off as just hormones. Reach out to your doctor or midwife. Give yourself patience, a little grace, and some time to adjust to being a parent who no longer breastfeeds. This is a genuine life change, and there is no rule that says you should adapt to it instantly.

My Secret Weaning Hack

Here is the personal trick I promised, and it is a little ridiculous and slightly embarrassing. When I was panicking about how to stop breastfeeding my first child, I found this idea buried pages deep in some random online forum.

My secret is limes. I cut a slice of lime and squeezed the juice onto my nipples. The tip I found actually suggested lemons, but I only had limes on hand. I braced for it to sting, since nipples are sensitive, but thankfully it did not. What it did do was make my milk taste sour. I explained to my son, who was just over a year and a half at the time, that my milk was yucky. He did not believe me, so I let him try, and he discovered I was right. I did this a few times to prepare for the tantrum I expected when I stopped nursing, and that tantrum never came. It worked like a charm.

To be clear, it was not the limes alone. I was also using many of the techniques we talked about today. We had slowed the frequency of nursing way down, my partner was handling bedtime, and I would hop in a hot shower and express a little milk when I got engorged. A lot of pieces were in play, but I do think the limes helped. I tried it again with my daughter, and she nursed a couple of times with lime juice on my nipples. At one point I worried it might be backfiring and that she would like the sour taste, but she got over breastfeeding too. I am not saying it is magic. I am saying it might be worth a shot alongside the other tips in this episode.

Getting Additional Help

If you run into difficulty, or you just want someone to walk you through it, get a lactation consultant involved. We tend to think of lactation consultants only for the early days of breastfeeding, but they are just as helpful when it is time to wean. You can also talk with your midwife, your doctor, or your pediatrician, who can answer questions about your baby’s nutrition as you phase out breast milk.

Ending your breastfeeding relationship can bring up a mix of emotions. You may feel sad to close this phase. You may be thrilled to have more freedom and to be ready for what is next. Both are normal and healthy. Even if you hit a few snags along the way, I promise you will not breastfeed forever. Eventually your body will be your own again, your baby will be happily eating all kinds of solid foods, and you will be on to the next parenting adventure.

Talking to Your Doctor or Midwife

Weaning is mostly something you can navigate on your own, but your care team is there when you need them. Reach out if you develop a fever or flu-like symptoms that could signal mastitis, if a plugged duct or engorgement is not resolving, if you need to stop breastfeeding quickly for a medical reason, or if your mood dips and stays low as you wean. Your doctor, midwife, pediatrician, or a lactation consultant can help you manage the physical side safely and support you through the emotional side too. You do not have to figure it out alone.

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