Health and Human Services rea RE cea ee Color pictures representing the development of the child at two-week gestational increments: Pele cisYour pregnancy ry fon This booklet is designed to help you understand your options for pregnancy. Everyone needs access to good information in order to make important decisions about their pregnancy, their baby and their life. This booklet provides important information about the resources available to you before, during and after your pregnancy. During this time, itis important to know you are not alone and do not have to make any decisions by yourself. It is normal to feel anxious, confused and scared when faced with these decisions. Take whatever time you need to read this booklet and talk to other people you trust. You deserve the advice and support of those you trust {You might talk to a family member, a spirittal OF professional counselor, a close frieathver the father of your baby. Take whatever time you need to read this let and talk to other people you trust. ey, SoaksYour baby’s development ‘The next section shows the changes seen as a baby develops inside the mother’s body during pregnancy:' This period is called gestation and can be measured in two ways, both of which are noted in the following pages: «The number of weeks since the start of the last normal menstrual cycle (weeks of gestation) + The number of weeks since the estimated date of conception, around two weeks after the start of the last normal menstrual cycle. Usually, your baby’s due date is estimated to be 40 weeks after the start of your last normal menstrual cycle. Conception Your baby began developing at the moment of conception — when your unfertilized egg cell (ovum) met and fused with the sperm cell of the baby’s father. At that moment, your ovum provided half of the baby's genes (the inherited genetic material passed through DNA) and the father’s sperm cell provided the other half. Once combined together, this material provided aikof the genetic information needed to complet® your baby's development in your womb. Ja 2'full-term pregnancy, the cycle of development Begins with the fertilized egg and is complte about 38 weeks later when the baby is reag¥to be born. These illustrations show the changes taking place as thesbaby develops from the moment of conception onward. 4 Weeks of Gestation (2 weeks after conception) + Your baby is scientifically referred to as an embryo. + The cells that will become vital organs, such as the figure heart and brain, are developing, + The blood vessels begin to form + Your baby's weight is less than 1 ounce‘and length is less than 1/8 inch. 6 Weeks of Gesta’ + The brain Sig fhe spinal cord begin to form. +The lungs, liver, stomach and other major organs begin to form. +The arm and leg buds (the structures that will become the limbs) are present. + The eyes and ears begin to form. + Your baby is less than 1/4 inch long. enc n (4 weeks after conception) + Your baby'sheft Begins to form. The heart starts to beat.Poe ees 8 Weeks of Gestation (6 weeks after conception) + Your baby’s developing heart beats with a regular rhythm. + Facial features — the eyes, nose, lips and tongue — start to form. + All essential organs have begun to form + The spinal nerves begin to develop. + The brain continues to develop. +The arms and legs grow longer. +The fingers and toes are developing, + Sex organs are beginning to form. + Your baby is 1/2 inch long. 10 Weeks of Gestation (8 weeks after conception), + Your baby has his or her first spontaneous movements (movements that happen on their own). + Elbows are formed and fingernails appear. + The eyelids are more developed. + The external ears begin to take final shape. + Facial features continue to develop. + Cells that sense touch begin to form. + The nerves that will control your baby'sorgans are formed. + Activity in your baby's brain can belfecoftled. + After the end of this week, the Gaby is scientifically referred to as a fetus. + Your baby is about 1 % tL Jnches from head to bottom. 12 Weeks of.Gestation (10 weeks after conception) + Your baby méveSybut you cannot feel the movements. + All the bodylparts and organs are present and growing. + The heartbeat can be heard with electronic devices. + The body grows rapidly. = The body grows longer, and the neck lengthens. + The eyelids close and will not reopen until about the 28th week. + Fingernails appear. + Teeth buds begin to form. * Your! eighs about half an ounce and is about 2 1/2 inches longYour baby’s development 14 Weeks of Gestation (12 weeks after conception) + Taste buds are developing + Your baby's arms and legs begin to move. + Hiccup movements are present. + The external sex organs are developed and are clearly either male or female + Your baby can respond to skin contact. + Your baby is about 3% inches long from head to bottom and weighs about 1¥* ounces. 16 Weeks of Gestation (14 weeks after conception) + Your baby’s swallowing and chest movements are clearly present. +The mouth makes sucking motions. + Hand-to-face movements are common. + Your baby's eyes are beginning to move. + Your baby is about 4% inches long from head to bottom aridhwBighs less than 4 ounces. 18 Weeks of Gestation (16 week after conception) + You may feel the movements of your Baby's arms and legs. + The kidneys are functioning and flake urine. + Taste buds are present. + Your baby’s skin is wrinkled + Features further dev@lap = eyelids, ear and upper lip. + Your baby is abgtit§¥ inches long from head to bottom and weighs about 7 quits. See eeeSomes 20 Weeks of Gestation (18 weeks after conception) + Your baby is more active, moves about every minute, and you can feel the movements. + Breathing-like movements become regular and can be seen by ultrasound. + The structures of the ears are well-developed. Your baby can hear and respond to a growing range of sounds. + Hair begins to grow on the head. + All skin layers and structures are present, including hair follicles and glands. + Your baby can swallow at the end of this week. + Ovaries containing eggs are present in females and testes begin to descend in males. + Meconium (a greenish mixture of swallowed cells and secretions) begins to form in the intestinal tract. This will be your baby's first bowel movement. + Your baby weighs about 11 ounces and is about 6 inches from head to bottom. 22 Weeks of Gestation (20 weeks after conception) + Your baby sleeps and wakes regularly. Your baby canbe aWakened from sleep by noises and your movements. + The eyelids and eyebrows are formed. + The vocal cords are developing, + The nervous system continues to develgf? + Movernents become more coordinat + The heartbeat can be heard witha stethoscope. +The body is covered withfinethalr called lanugo. + Texas law prohibits.abortion after this stage, except in rare circumstances. + Your baby weighBabbut 1 pound and is about 7 to 7 ¥e inches in length from head te bottom. 24 Weeks of Gestation (22 weeks after conception) + Your baby will blink and startle (pull in arms and legs) if stimulated. + Skin is wrinkled and red. + The senses of smell and taste are developed. + Ababy born at this timewwill attempt to breathe, but the lungs are not fully developed. + Your baby about 1.4\pounds andiis about 8 inches from head toYour baby’s development 26 Weeks of Gestation (24 weeks after conception) + Your baby’s developing lungs are now fully formed but are not yet ready to function outside the womb. + The lines on the skin of the fingers (future fingerprints), toes, palms of the hands and soles of the feet are now formed. + Your baby weighs about 1.8 pounds and is about 9 inches from head to bottom. 28 Weeks of Gestation (26 weeks after conception) + Your baby’s brain and nervous system are formed and continue to develop + The lungs and digestive system are formed and continue to develop. + The eyes are partially open, and eyelashes are present. + Your baby weighs about 2.2 pounds and is almost 10 inches from hgad to bottom. 30 Weeks of Gestation (28 weeks aftér-conception) + Your baby kicks and stretches + Your baby makes grasping motions and resfiends to sound. + The nervous system controls some body fut tions. + Your baby weighs about 2.9 pounds and'is more than 10 ¥ inches from head to bottom. 32 Weeks of Gestation (30 weeks after conception) + Your baby(gaifts Weight, and the body fills out. + Toenails and Wngernails are growing. + The pupils wil react to light. + Your baby weighs about 4 pounds and is almost 11 inches from head to bottom. eee eSomer ee s 34 Weeks of Gestation (32 weeks after conception) + Your baby is active (moving) 60 percent or more of the time. + Bones harden, but the skull remains soft and flexible for delivery. + Your baby has rhythmic breathing movements and the lungs continue to develop. + Your baby weighs about 4.6 pounds and is almost 12 inches from head to bottom, 36 Weeks of Gestation (34 weeks after conception) + Your baby rapidly gains weight in preparation for birth. + The body and face fill out; the skin no longer appears wrinkled. + The fingernails reach the ends of the fingertips. + Large amounts of immune factors (substances in the blood that: protect against disease or infection) are passed from you ta faubaby during the last four gestational weeks. + Your baby weighs about 5.5 pounds and is about 12 ¥ inches from head to bottom. 38 Weeks of Gestation (36 weeks.after conception) + Your baby’s lungs and brain are develofing Fapidly. + Your baby can grasp firmly. + Your baby weighs about 6.4 pdlinds and is about 13 1/3 inches from head to bottom. 40 Weeks of Gestation (38 weeks after conception) + Your baby is fully developed and considered full-term. + The brain and nervous system will continue to develop after birth. + Your baby's toenails have reached the tips of the toes. + Small breast buds are present. = The fingernails extend beyond fingertips. + Your ut 7.5 pounds and is about 14 inches from head = reePregnancy and Childbirth Birth is a life-changing experience. Each birth brings a new and different set of experiences and feelings. Pregnancy and birth are usually safe and natural processes, although complications can occur. There are complications associated with I pregnancy and childbirth. The most common. complications of pregnancy include: + Tubal or ectopic pregnancy (where the baby grows outside of the uterus) 3 + High blood pressure + Complicated delivery a + Premature labor a + Depression ft + Infection i + Diabetes i + Hemorrhage (heavy bleeding) een You can reduce the risk for problems or complications in any pregnancy by: + Getting early and regular prenatal care, + Eating a well-balanced diet and getting regular exercise. + Avoiding tobacco, alcohol or drligs that your doctor hasn't prescribed foryou. During labor, the uterys cSitfacts and pushes to deliver the babyhe baby may be delivered through the woman's ¥agina or by a surgical procedure callédcBsarean section or c-section. VaginabDelivery Possibieiside effects and risks: “Injury to the bladder or rectum * Ahole (fistula) between the bladder and vagina or the rectum and vagina + Hemorrhage (heavy bleeding) + Infertility (the inability to have a baby) due to infection or complications + Emergency treatment for any of the above problems, including the possible need to treat with an operation, medicine or blood transfusions + Death (very rare — 1.7 in-hospital deaths occurring after delivery per 100,000 vaginal deliveries during 2000-2006") Cesarean Birth Possible side effects and risks: + Injury to the bowel or bladder + Infertility (the inability to have a baby) due to infection or complications+ Hemorrhage (heavy bleeding) + Injury to the tube (ureter) between the kidney and bladder + Apossible hysterectomy (removal of the uterus) due to complications or injuries + Complications from anesthesia such as respiratory problems, headaches or drug reactions + Emergency treatment for any of the above problems, including the possible need to treat with an operation, medicine or blood transfusions + Death (very rare —12.7 in-hospital maternal deaths per 100,000 cesarean deliveries occurring during 2000-2006 4 Postpartum Symptoms The feelings you experience after birth may be the most intense you have ever had: great surges of joy and happiness, or feelings of contentment and fulfillment. It is not uncommon for women to also experience fears, worries or sadness. Depression can occur after the birth of a baby, and many new mothers experience various degrees of it. While depression can occur,mat hi days after delivery, it can also appear gfadiually. ‘Sometimes it may begin during pregnant or up toa year after the birth, na anit oe ea Sip a Ese In most cases, mothers have mild symptoms that may last only a few days. However, some mothers experience severe symptoms that can include exhaustion, feelings such as worthlessness or hopelessness, and memory loss. In some circumstances, you may be diagnosed with postpartum depression (PPD). PPD can occur up to 1 year after delivery but is typically apparent during pregnancy (50 pereentghthe time) and about 1-3 weeks after childbirth» PPD is characterized by intense feelings of sadness, anxiety or despair that prevents the new mother from being able function normally ona daily basis. In rare circumstanceSpyati may have a fear of harming yourgélgoryour baby. You should call your doctor Fight away and discuss these symptoms: Ifyour doctor is not available, call 911. Dodgtots cah give you professional help and supaotte,during this time. ‘Woluen with a history of mental health problems re more likely to have mental health problems following birth. These women may need. additional support. Hf you have questions or concerns, be sure to talk with your doctor or other health care provider.Your decision You have several options to consider with your pregnancy and baby, including parenting, adoption or abortion. Parenting Parenting is a life-long commitment. As with all life-changing decisions, it requires your time and attention. Raising a child is both challenging and rewarding. Many teens become parents and are happy with their decision. You should talk toa family member, a spiritual or professional counselor, or a close friend when making this decision. ‘There are many private socialforganiations and government programs that carfhelp you during your pregnancy. Social Services, ‘Some exampléaf government programs include: + Medical serviges from Medicaid or the Children’s Health Insurance Program (CHIP) + Financial payments from Temporary Assistance for Needy Families (TANF) + Food vouchers and nutrition information from the Women, Infants and Children (WIC) program SEEM C You can find information on all of these programs by calling 2-1-1 or online at hhs.texas.gov or yourtexasbenefits.com. Child Support Under state law, your child's father mustpay to) support your child. The Texas Office ofthe Attorney General can assist you in@btaining this support. The Attorney GeneraMs Child Support Division can help locate missing fathers, determine who the child's father is, seek enforcement of childssuppOrt orders, and collect child support paygrents, If you need sérvites, call 800-252-8014 or visit texasattofne¥general.govics. If you are a surviyar,GPfemily violence, there are steps you can taketto pursue child support safely. Formore information, visit {getchildsupportsafely.org Adoption ‘Anather option to consider is adoption. Adoption means you, as the birth parent, are voluntarily transferring your rights as the parent of your baby to another family, Choosing adoption means you want your baby to have a good life, but right now may not be the best time for you to be a parent. Adoption is a brave, loving choice for your baby. When you place your baby for adoption, you are placing him or her with loving parents who can raise your baby to have the good life that you want for your baby. There are many resources available to help you decide whether adoption is the best choice for you and your baby. Each adoption is different, and help is available to make sure that the adoption process fits your and your baby's needs.If you choose adoption, you may be able to select and meet the family who will adopt your baby. There are two different types of adoptions that you can choose. An open adoption allows you to stay in contact with your baby as he or she grows up, perhaps through pictures, phone calls, or visits. A closed adoption means there will be no contact between you and the family adopting your baby once the adoption is finalized. The type of adoption you want is entirely your choice Talk with a family member, a spiritual or professional counselor, or a close friend to seek their advice on adoption. Since adoption is such a big step, you may want the support of those you trust when making this decision. itis never too late to choose adoption for your baby. You can make this choice anytime during your pregnancy or even after your baby has been born. You can find more information about adoption and organizations that offer adoption services at: dshs.texas.gov/wrtk. if you choose to have your baby and find yourself overwhelmed by the job of being a parent, Texas has the “Baby Moses/Safe Havent” law. The law allows you or the baby’s father to leave a baby who appears to be undeF60 days old in the care of a designated emérgency care provider, such as an emergency medical services station, fire station, licensed. chit@-placing agency or any hospital¥ou d8 not have to return for the baby, afd yal will not be charged with a crime if the'Babyis unharmed. Abortion, You can chodSe to end your pregnancy. This is ‘a big decision, and you should talk to a family member, your doctor, or a counselor before making,thlis choice. in Texas, you must have your parents"gofisent to have an abortion, with one mgj@r,eXception, known as judicial bypass. In some cases, you may not feel safe talking ‘to your parents and are unable to obtain your parents’ support on this decision. Texas law allows for a process called judicial bypass under such circumstances. Judicial Bypass Judicial bypass occurs when a judge gives you permission to have an abortion without your parents’ consent. First, you must file an application in a court of law in the county where you live. Your application is assigned to a judge. The judge will review your application and appoint an attorney to represent you [if you do not have an attorney), The judge will also appoint aa guardian ad litem for your case, meaning someone who advocates for and protects your best interests during this hearing. To learn more.about adoption programs and health services for women during pregnancy, childbirth and as the child is growing up, ead. AWoman’s Right to Know: Resource Directory at dshs.texas.gov/wrtkYour decision After you turn in your application, the judge has five business days to decide whether to grant you permission to have an abortion without parental consent, However, you may ask the judge to delay the decision and extend the timeline. if you do ask for an extension, you will need to notify the Judge when you are ready to proceed with the hearing. The judge will then have another five business days to make a decision. The judge will decide whether you should receive permission to have an abortion without your parents’ consent based on either: (1) whether you are adequately mature and informed to make the decision to have an abortion: or (2) if notifying your parents would not be in your best interest? ‘At your hearing, the judge will approve oRdeny your application. If the judge does net approve your request, you have two optiaf + You may file another application if you can prove your situdtionhas changed significantly, and yau May now qualify for a Judicial bypass, + You can affpedhthe court's decision to the civil court of appeals. Your information will remain confidential at all times before, during and after the appeals process. Three Types of Abortion ‘The types of abortion procedures include medical abortions and surgical abortions. Texas law states that abortion may not be performed after the eens post-fertilization age of 20 weeks or more, which is approximately 22 weeks or more of gestation, as gestation is defined in this booklet. Texas law allows for exceptions when the life of the mother is threatened, serious risk exists of irreversible impairment of a major bodily function (other than a psychological condition) or a severe fetal abnormality is present. ‘A woman will usually have cramping and vagihaf bleeding after any type of abortion procedure) ‘There are other symptoms or side effets that may ‘occur with any type of abortion prdcedure. These can include nausea (feeling sick'to your stomach) or vomiting, diarrhea, warrath Of éhills, headache, dizziness and fatigue (feelingvery tired), Medical (Nonsurgical) Abortion Medical abortidfises medicine to end a pregnancy instead of surgery and is used early in pregnancy 70 days(D weeks) or less from the first day of ‘younlgstimenstrual period, This method requires several sits to your doctor. The medicines used for Bredical abortion may cause bleeding, cramping, Your pregnancy history affects Your chances of getting breast cancak{iF¥du give birth to your baby, you are leSSiikBly to develop breast cancer in the futufe. Research indicates that having an ati@rtitn Will not provide you this increased profégtion against breast cancer. In addition, doctors and scientists are actively studying the complex biology of breast cancer to understand whether abortion may affect the risk of breast cancer. If you have a family history of breast cancer or breast disease, ask your doctor how your pregnancy will affect your risk of breast cancer. OSE ees After an Abortion ‘There are many risks and problems that may occur when having an abortion. The most likely risks are hemorrhaging (minor to severe bleeding) and infection. However, in rare instances, there may be complications that require surgery. Call the clinic or doctor that performed the abortion or go to the emergency rooméf; + Heavy bleeding occurs (two or moré'thiek pads per hour for two hours ing’taw} or if you are concerned about heavy'bleeding. + You have stomach pairyar distomfort, or feel sick (such as feelingweakcér having an upset stomach, nausea,yOfiting or diarrhea) with cor without feyetifoF more than 24 hours after a medical abortion. + You have SeveP{a temperature greater than 200% degrees Fahrenhe 38 gabrees Celsius). Sou Have difficulty breat! shortness of breath. 19 or have + You have chest pain. + Pain is severe or not controlled by pain medication. + You are disoriented. Your doctor will schedule one or more follow- up visits, usually beginning within two to three weeks after the procedure. Your doctor must schedule a follow-up visit within 14 days of a medical abortion. It is important that you keep all of your appointments. You should also consider seeking counseling if you are experiencing depression, thoughts of Suicide or other psychological distress following your abortion| Fete development references v "American Congres ofOsttrcons and Gecologts ACOG FAQ 156: How Your Baby Grows Dung Pregnancy. valabe taco org/=edaForsaaPaterts fi eden iate=2012052671157139676 Last ocessed 6/10/2016 American Congress of Obstetricians and Gneclogts Your Pregnancy ‘ond ChigbrMonth to Mane>—How Your Baby Grows (Webel. [rolabe pen urregroneyans ube comment gue pe Last acessed 05/10/2018. + Corson BM. Human Embryology and Developmental lay Sched Phledelphi, PX: Saunders. animpant of eve inc: 2014 = Cunningham F6 Leven Ki Som SL, etal Fetal growth nd evelopment in Cuelgham FG, Leveo ftom SL eta eds. lions Obstetrics 2860 New York NYS Meow 2014 chap 7. +Englnd MA Le Bfere Beh 2nd, Tovstock Square, Lando: Mosby= Wate: 1996 *Lasen's Huron Eméryology. Ah ed Phloelhio, P:Chrchil Ugstone on mgrit oF vies ne: 2008 “e + Moore K, Persaud TVN, Torco MG. Te Developing Huron: Cnty ‘reread Embryology Sth ed Phiodepia, PK Sounders, an imprint of + Navono! Museum of Heth ond Medine Huron Development Anotamy (Center Developmental Antony Developmental Anan (Came Stges ef Dewgpent) ep wn medcaimuseum minx. cntpscoectons hc onctomynde Las oxesied /ID/2016. “NH MLM Medine Ps. etal Developme. Mebste) Avokote ep! ‘erimntgovnedneplstngyorce/002398 am + oftce on Women’s Heh Pregnancy. Webste Avaable ety! ‘womensheatgovreprancyndex Mm Last ocesed 08/21/2016, + ORohily& Maller The Embryonic Human Bro: A Atos of Devopental tages. 1998, Seder, Longmans Medal Embrey. 2thed Baltinore MO: Lppincat Wits & Wain: 2011 1 lark, Bator MA, ORGY GA Hert MA, Mayers JA, Hokin GO. {2008} MorerolSeath in he 2c coves, preverton, ond rectorsip to cesarean der. Amnon Jurado Obstet ond Smee 1990). 3501-5 i Mec! borin: US Food and Org Adinsvation.Mfeprex Meiatan Gude 2038 ht/w cece gouge Soc lnbe/2016/020687s0206\ pa Las cccessed 9/10/2016. Texas Meal Diciosre ne! (2016) ListProcedures Reqiting Fl Diaoure of Spec Risks ond Hazard #13 (Sura abortion, and avetagetloten and evecato) and 14 Medial abaton/nan [uric Aloe rom: tp nnd exo ow force tscsurefowsrlessps Lost ocesed S/IGI2016. wv Suction euterage Texos Medal Dscosre Panel (2016) Lt Procedures feting Full Discsur of Specie ks and Hazards, #13 (Sycalaagporsdlton aye ColegeofObstetricions ond Groeolgsts (ROG) The car of women requesting Induced cba, Landon (England): Reyel (lege of Oise encans and Gyroecologis(RCOG} 2011 Nox 130. (Evidencebosed Cncl Gute o. 7 ip /fnmrcog org.uk womens eatin oceania een ae Sr Last American Congres of Obstetricians end Gmeclogs (2013, ‘eafimed 2015) ACDG Practice ulin Na 135: Secne-mester horton Obstetric & Gynecology, 121()1394-406 Tous Medial ‘iclosur Panel (2016) tA, Procedures Requiring Ful Disclosure of Spec Risks and Honrds, #13 (Surgical abortansllation and carettoge/ ‘oton and evecvton) ond 4 Macc! obortionnon sgl Avaiobe ‘rom hp wine dah eos goonies! asesureon ‘alesse Last acesed 8/10/2016 Roel ClegeofObsteicans and (Gnaeclogits (RCOG). The cae of women requesting induced abortion Landen (England) Rel Clege a Ostevisans and Gyroeclogsts (c0gy 2011 Now 130. (EaGence-bosed Cnc Gude: ep og ogame heathen quences waren requsing induced oberton Lost ecessed 6/5/2015. axa, Gaonga AA, Jamieson Ds Centers for isos Control and Prevention COC) (2015), Abortion Surveilnce- United Sates 2022 eterno! Mortoty Weel Review Srveiince Summaries 64(10;dnfB Arco: tpn de gow previontrarertiis64 083 mis edetéeion e Lot oresed 30/2016 Lege sole stuces of pub het records in Deamark endl which provi stote-hinded abortion, hove awn igh 7 of dea Reardon DG, Clem Pk. Stet end ong term rai otesesscioted wih st pregnancy outcame: Population ester Doe uty for Denar! 2004 (2012) Med Se Mon 2012100304 71-76 ese M, Berg Bowie Cae Mt, Bans ® Pregrancy-ossocited ‘morta afer bit spontaneous aber oF induced abortion i Friend 1587-2000 (2004) Am Ob Gyag HBP 427 reo concer cation Huong, Zhang Kes Wag of (2024).Ameto-onoas ofthe ‘sock betwger Igy abort ond breast cane kong Chinese frais Cana ouses Como 25:227 + Song A, ig Ding JH eo (2012 Abortions and beast concer “ish premenepeusal and pestenopexsol women hargau Pownce ‘oF Cina ton Pot.) Concer Prev, 13533 35 img Re 0 (2013). A stato ik fotrs of beast concer ameng ovres xendig the erty core spl Ui tr ndon J Lemur Med 38(2)95 95 + Michels KB Xue, Cole A, Witt WC (2007) ncuced ond ‘Spontaeacscbrton ond incidence of breast concer mang young omen o prospective coor stud Archives fea Meche ierepare-aeo. + Reves Gk Kan SW Key T, etl (2008) reat concer rik nreation to ‘horn rests ram the EPC Study. nternaonol ural of Cancer nigparari76s TEXAS Health and Human Services www.dshs.texas.goviwrtk Health and Human Services Commission Cg ee one teenie Dee eee ee