What to Expect When You're Expecting

Now in its fifth edition, this comprehensive pregnancy guide by Heidi Murkoff and Sharon Mazel covers the full arc of pregnancy, from conception through postpartum recovery, organized as a month-by-month reference manual. The book originated from Murkoff's own first pregnancy, during which she found no single resource that addressed all her questions. Endorsed in a foreword by obstetrician Charles J. Lockwood, MD, who praises it as medically current and practically sound, the guide is structured around five parts that move chronologically through pregnancy while addressing specialized topics such as nutrition, complications, illness, and pregnancy loss. This edition includes updated content on medical advances, prenatal screening options, and fathers' concerns.

Part 1 establishes foundational knowledge. The opening chapter walks readers through early pregnancy signs, how home pregnancy tests detect the hormone human chorionic gonadotropin (hCG), and the standard method for calculating a due date: counting 40 weeks from the first day of the last menstrual period rather than from conception, since the precise moment of fertilization is difficult to pinpoint. The author provides detailed guidance on selecting a prenatal practitioner, comparing obstetricians, family physicians, and certified nurse-midwives, and outlining the advantages of various practice types. Birthing location options include hospitals, freestanding birthing centers, and home births.

The second chapter addresses the reader's individual pregnancy profile. It covers conception while using various forms of birth control, gynecological conditions such as fibroids and endometriosis, sexually transmitted infections and their management during pregnancy, and obstetrical history topics including pregnancies conceived through in vitro fertilization (IVF), closely spaced pregnancies, cervical insufficiency, and Rh incompatibility, a condition in which an Rh-negative mother's immune system may attack an Rh-positive baby's blood cells, preventable through RhoGAM, a pharmaceutical injection of Rh-immune globulin. The chapter surveys chronic conditions such as diabetes, hypertension, thyroid disease, and eating disorders, providing condition-specific guidance. A substantial section details prenatal screening and diagnostic testing, from noninvasive blood screenings and nuchal translucency ultrasound (an ultrasound measuring fluid at the back of the baby's neck to assess chromosomal abnormality risk) in the first trimester through amniocentesis (a procedure that withdraws amniotic fluid for chromosomal analysis) and chorionic villus sampling (a procedure that samples placental tissue to detect genetic abnormalities).

The third chapter addresses lifestyle considerations: exercise safety, caffeine limits (approximately 200 mg per day), alcohol (no amount proven safe), smoking risks, marijuana and other drug use, and household chemical hazards such as bisphenol A (BPA, a chemical found in some plastics and linings) and phthalates (chemicals used in plastics and personal care products). It also surveys complementary and alternative medicine modalities, including acupuncture, chiropractic care, massage, and herbal remedies, cautioning that many herbal supplements are unregulated and some are potentially dangerous during pregnancy.

The fourth chapter presents the Pregnancy Diet, a nutritional framework built on nine principles and a "Daily Dozen" system. Key recommendations include approximately 300 extra calories per day in the second trimester (rising to 500 in the third), with specific daily targets for protein, calcium, vitamin C, green leafy vegetables, whole grains, iron-rich foods, healthy fats (especially omega-3 fatty acids for fetal brain development), and adequate fluids. The chapter addresses food safety, including the risk of listeriosis (a foodborne bacterial infection dangerous during pregnancy) from unpasteurized dairy and deli meats, mercury in certain fish, and proper food handling.

Part 2 forms the bulk of the book, tracking pregnancy month by month. Each chapter follows a consistent structure: week-by-week fetal development, the mother's physical and emotional symptoms, what to expect at that month's checkup, answers to common questions, and a concluding feature on a major topic. The first month covers embryo implantation and early symptoms such as fatigue and breast tenderness. The second month covers rapid organ development alongside heartburn, food aversions, mood swings, and weight gain guidelines. The third month describes the transition from embryo to fetus and addresses constipation, headaches, and managing pregnancy while working, including workplace rights under the Pregnancy Discrimination Act and the Family and Medical Leave Act.

The fourth month covers dental care, breathlessness, and fetal movement, concluding with a prenatal exercise guide and Kegel instructions for pelvic floor strengthening. The fifth month addresses backache, skin changes such as linea nigra (a darkened line on the abdomen), the anatomy scan ultrasound, and sex during pregnancy. The sixth month covers insomnia, the glucose screening test for gestational diabetes, cord blood banking (the collection and storage of stem cell-rich umbilical cord blood for potential future medical treatment), and childbirth education classes. The seventh month addresses third-trimester fatigue, swelling, sciatica, the birth plan, the tetanus, diphtheria, and pertussis (Tdap) vaccine, and an overview of labor pain management, both medicated (epidural, spinal block, nitrous oxide) and unmedicated (hydrotherapy, hypnobirthing). The eighth month covers Braxton Hicks contractions (practice contractions that do not indicate the onset of labor), breech presentation and techniques for turning the baby, cesarean delivery, group B strep testing (screening for bacteria that can infect the baby during delivery), and breastfeeding preparation. The ninth month addresses the nesting instinct, overdue babies, and the signs distinguishing prelabor, false labor, and real labor.

Chapter 14 provides a detailed procedural account of labor and delivery organized by stage. Early labor involves cervical dilation to 4 to 6 centimeters with relatively mild contractions. Active labor brings stronger, more frequent contractions as dilation reaches 7 to 8 centimeters and may involve fetal monitoring, epidural administration, or Pitocin (a drug used to stimulate contractions) to address stalled progress. Transitional labor is the most intense but shortest phase, completing dilation to 10 centimeters. The pushing stage, lasting 30 minutes to over two hours, covers effective technique and various delivery positions. The chapter addresses episiotomy (a surgical cut to widen the vaginal opening, now performed in only about 10 percent of deliveries), vacuum extraction, forceps delivery, delayed cord clamping, and newborn procedures including Apgar scoring (a quick health assessment performed immediately after birth). Cesarean delivery is covered step by step, including the "gentle cesarean" approach.

Chapter 15 addresses multiple pregnancies, noting that nearly 4 percent of U.S. births are multiples. It covers amplified symptoms, increased nutritional needs, higher complication risks (including preterm delivery, twin-to-twin transfusion syndrome, an unequal blood-flow condition affecting twins who share one placenta, and preeclampsia, a pregnancy disorder characterized by high blood pressure), and delivery options based on the babies' positions.

Part 3 covers the postpartum period. The first-week chapter addresses lochia (postpartum vaginal bleeding), afterpains, perineal care, breast engorgement, bonding, cesarean recovery, and a breastfeeding guide covering latch technique, five nursing positions, and considerations for babies in the neonatal intensive care unit (NICU). The six-week chapter covers ongoing recovery, baby blues versus postpartum depression, additional postpartum mood disorders (anxiety, obsessive-compulsive disorder, psychosis, post-traumatic stress disorder), resuming sex, contraceptive options, and postpartum exercise guidelines.

Part 4 addresses illness during pregnancy, providing guidance on common infections (colds, influenza, urinary tract infections) and less common ones (cytomegalovirus, or CMV; Zika virus; Lyme disease). A medication safety reference categorizes commonly used drugs by their pregnancy and breastfeeding compatibility.

Part 5 covers complications and pregnancy loss. The complications chapter addresses gestational diabetes, preeclampsia, HELLP syndrome (a severe preeclampsia-related disorder affecting liver function and blood clotting), intrauterine growth restriction, placenta previa (a condition in which the placenta partially or completely covers the cervical opening), and placental abruption, among others. Childbirth complications such as fetal distress, cord prolapse, and postpartum hemorrhage are also covered, along with a detailed section on bed rest. The final chapter addresses pregnancy loss in all its forms: early miscarriage, molar pregnancy (an abnormal pregnancy in which placental tissue grows improperly), ectopic pregnancy (a pregnancy implanted outside the uterus, usually in a fallopian tube), late miscarriage, and stillbirth. Extensive guidance on the grieving process emphasizes that there is no single correct way to mourn, addresses fathers' grief specifically, and closes with the reassurance that the vast majority of women who experience a pregnancy loss go on to have a healthy pregnancy and baby.