Oh, Baby! Information for Your Pregnancy

Preconception

Preconception Tips

  1. Get a preconception checkup. Your OB/GYN will help you know how best to stop your current birth control and will evaluate your overall well-being, including offering genetic counseling, to ensure that you have the healthiest pregnancy possible.
  2. Eat a healthy diet and maintain a healthy body weight. Eating foods rich in vitamins and minerals makes for a healthier mom and baby, and being over- or under-weight can also impair fertility.
  3. If you smoke, stop. Smoking not only inhibits fertility, it damages the unborn baby and is dangerous for newborns as well. Just quit now.
  4. Avoid alcohol. A good rule of thumb: If you wouldn’t give it directly to your baby, don’t put it in your body either!
  5. Take prenatal vitamins. Experts recommend taking prenatal vitamins three months before conception (and all during your pregnancy) to provide the extra folic acid your body needs to protect your unborn baby from some birth defects. There may be a cost benefit to getting a prescription for your prenatal vitamins, so check with your insurer and talk to your May-Grant provider.
  6. Stay active. Being physically active before and during pregnancy many benefits, including helping maintain a healthy weight and being fit for delivery. Talk to your provider about how to incorporate exercise if you are not currently active.
  7. Get to know your cycle. Knowing your menstrual cycle (what is “normal” for you) will aid in conception, and help you know right away when it may be time to take that pregnancy test! Clue is an app approved by the American College of Obstetrics and Gynecology and can help you track your period and fertility window each month.
  8. Know when you ovulate. If you monitor when you ovulate, you can time intercourse to maximize your chances of conception.
  9. Have sex right before you ovulate and wait 15 minutes after sex before getting up. But, certain sexual positions don’t increase your chances, so just do whatever is most comfortable!
  10. Try to keep stress level low. Trying to conceive can be stressful, but pregnancy is more likely to occur when couples are relaxed, and less likely during months when the couples felt tense or depressed. Taking time for yourself every day, exercising, journaling, getting massages, talking with your partner, and getting enough sleep can make it easier to unwind.

Asthma and Pregnancy

Asthma and Pregnancy

Now that you’re pregnant, you may be concerned about how asthma will affect your health and the health of your baby. But asthma doesn’t have to stop you from having a healthy pregnancy. Managing your asthma can keep you and your baby healthy.

Why managing asthma is important during pregnancy

When you’re pregnant and have an asthma flare-up, it affects both you and your baby. The baby gets oxygen from your blood to grow and develop normally. Severe asthma can cause problems getting oxygen to your baby. When asthma isn’t controlled, problems that can develop include:

  • Baby being born too early (prematurity)
  • Need to deliver by C-section
  • Baby being smaller than normal
  • High blood pressure and/or preeclampsia in the mother

Work with your healthcare providers to manage your asthma

You likely have a healthcare provider (HCP) who helps you manage your asthma. During your pregnancy, continue to see this HCP regularly. He or she can continue to monitor your asthma. And medicines can be adjusted as needed. Be sure that this HCP is in contact with the HCP who is caring for your pregnancy. Also be sure both providers know what asthma medicines you take. If you don’t have an HCP taking care of your asthma, tell the provider who cares for your pregnancy.

Prevent flare-ups

Here are tips to prevent flare-ups:

  • Continue using asthma medicines as prescribed.  Follow your HCP’s instructions about using asthma medicines. These will likely be inhaled medicines. These have little or no chance of harming you or your baby.
  • Monitor your lung function. Lung function tests help measure how well your lungs are working. The test results tell you and your providers whether you are getting enough oxygen. You may be tested at your provider’s office or at a hospital. You may also be instructed to monitor yourself at home. This is done using a peak flow meter. Your provider will tell you when and how often you need to use the meter.
  • Control asthma triggers. These are things that cause your airways to react and lead to an asthma attack (flare-up). Triggers can include smoke, scents, and chemicals. They also include allergies to things like pollen, pets, and dust mites. A flare-up can also be triggered by exercise and changes in the weather. Having a cold or the flu can also trigger a flare-up. To prevent the flu, get a flu shot. If you’ve been getting allergy shots, you should continue to do so. However, you should not get allergy shots for the first time when you’re pregnant.

Monitor the health of your baby

Your HCP will monitor your baby’s health closely during your pregnancy. If your asthma is not well controlled, this becomes even more important. So be sure to keep all your prenatal appointments. Monitoring includes:

  • Regular ultrasound tests. Ultrasound is a safe test that allows you and your HCP to see an image of your baby in the womb. The ultrasound shows your baby’s development, including whether the baby’s organs are growing normally.
  • Fetal nonstress test. This test may be done when you are around your third trimester. It checks if your baby is receiving enough oxygen by monitoring the baby’s heart rate. Normally, a baby’s heart rate goes up when the baby moves. If the baby’s activity is low, it may mean that the baby isn’t getting enough oxygen.
  • Fetal movement counting. Your HCP may tell you to track your baby’s movements by doing “fetal kick counts.” This is done by counting the number of movements (kicks) that the baby makes over a certain period. Your provider will let you know how often to count. You’ll also be told when you should call him or her. If the baby’s movement pattern changes or decreases, more tests will likely be done to check the baby’s health.

Know your plan for labor and delivery

Before your due date, talk with your HCP about your labor and delivery plan. You will likely continue taking your asthma medicines during this time. These prevent a flare-up. They can also help relieve a flare-up if you have one. Your provider will tell you more about this.

When to call your healthcare provider

Call your HCP right away if any of the following happen:

  • You have wheezing that does not go away after you take medicine.
  • Your asthma medicines stop working.
  • You cough up bloody, green, or yellow mucus (signs of a lung infection).
  • You develop a temperature above 100.4°F (38°C) with shortness of breath or a cough.
  • Your baby’s movement pattern changes or decreases.
INFORMATION FROM KRAMESONLINE

Obesity and Pregnancy

Being overweight is defined as having a body mass index (BMI) of 25–29.9. Obesity is defined as having a BMI of 30 or greater. Within the general category of obesity, there are three levels that reflect the increasing health risks that go along with increasing BMI:

Lowest risk is a BMI of 30–34.9.

Medium risk is a BMI of 35.0–39.9.

Highest risk is a BMI of 40 or greater.

You can calculate your BMI using the following formula: BMI = (Weight in Pounds / (Height in inches x Height in inches)) x 703 or using an online BMI calculator.

Does being obese during pregnancy put me at risk of any health problems?

Obesity during pregnancy puts you at risk of several serious health problems:

  • Gestational diabetes is diabetes that is first diagnosed during pregnancy. This condition can increase the risk of having a cesarean delivery. Women who have had gestational diabetes also have a higher risk of having diabetes in the future, as do their children. Obese women are screened for gestational diabetes early in pregnancy and also may be screened later in pregnancy as well.
  • Preeclampsia is a high blood pressure disorder that can occur during pregnancy or after pregnancy. It is a serious illness that affects a woman’s entire body. The kidneys and liver may fail. Preeclampsia can lead to seizures, a condition called eclampsia. In rare cases, stroke can occur. Severe cases need emergency treatment to avoid these complications. The baby may need to be delivered early.
  • Sleep apnea is a condition in which a person stops breathing for short periods during sleep. Sleep apnea is associated with obesity. During pregnancy, sleep apnea not only can cause fatigue but also increases the risk of high blood pressure, preeclampsia, eclampsia, and heart and lung disorders.

Does being obese during pregnancy put my baby at risk of any problems?

Obesity increases the risk of the following problems during pregnancy:

  • Pregnancy loss—Obese women have an increased risk of pregnancy loss (miscarriage) compared with women of normal weight.
  • Birth defects—Babies born to obese women have an increased risk of having birth defects, such as heart defects and neural tube defects.
  • Problems with diagnostic tests—Having too much body fat can make it difficult to see certain problems with the baby’s anatomy on an ultrasound exam. Checking the baby’s heart rate during labor also may be more difficult if you are obese.
  • Macrosomia—In this condition, the baby is larger than normal. This can increase the risk of the baby being injured during birth. For example, the baby’s shoulder can become stuck during delivery. Macrosomia also increases the risk of cesarean delivery. Infants born with too much body fat have a greater chance of being obese later in life.
  • Preterm birth—Problems associated with a woman’s obesity, such as preeclampsia, may lead to a medically indicated preterm birth. This means that the baby is delivered early for a medical reason. Preterm babies are not as fully developed as babies who are born after 39 weeks of pregnancy. As a result, they have an increased risk of short-term and long-term health problems.
  • Stillbirth—The higher the woman’s BMI, the greater the risk of stillbirth.

If I am overweight or obese, should I plan to lose weight before getting pregnant?

Losing weight before you become pregnant is the best way to decrease the risk of problems caused by obesity. Losing even a small amount of weight (5–7% of your current weight, or about 10–20 pounds) can improve your overall health and pave the way for a healthier pregnancy.

How can I lose weight safely?

To lose weight, you need to use up more calories than you take in. You can do this by getting regular exercise and eating healthy foods. Your obstetrician may refer you to a nutritionist to help you plan a healthy diet. Increasing your physical activity is important if you want to lose weight. Aim to be moderately active (for example, biking, brisk walking, and general gardening) for 60 minutes or vigorously active (jogging, swimming laps, or doing heavy yard work) for 30 minutes on most days of the week. You do not have to do this amount all at once. For instance, you can exercise for 20 minutes three times a day.

Can I still have a healthy pregnancy if I am obese?

Despite the risks, you can have a healthy pregnancy if you are obese. It takes careful management of your weight, attention to diet and exercise, regular prenatal care to monitor for complications, and special considerations for your labor and delivery. There may be additional tests and consultations that need to be performed to monitor you for complications.

How much should I exercise during pregnancy?

If you have never exercised before, pregnancy is a great time to start. Discuss your exercise plan with your obstetrician to make sure it is safe. Begin with as little as 5 minutes of exercise a day and add 5 minutes each week. Your goal is to stay active for 30 minutes on most—preferably all—days of the week. Walking is a good choice if you are new to exercise. Swimming is another good exercise for pregnant women. The water supports your weight so you can avoid injury and muscle strain. It also helps you stay cool.

How will my weight be monitored during pregnancy?

Your weight will be tracked at each prenatal visit. The growth of your baby also will be checked. If you are gaining less than the recommended guidelines, and if your baby is growing well, you do not have to increase your weight gain to catch up to the guidelines. If your baby is not growing well, changes may need to be made to your diet and exercise plan.

Recommended weight gain is based on your BMI:

  • BMI of 18-24.9: gain 25-35lbs total
  • BMI of 25-29.9: gain 15-25lbs total
  • BMI of 30 and greater: gain 10-20lbs total

How does obesity affect labor and delivery?

Overweight and obese women have longer labors than women of normal weight. It can be harder to monitor the baby during labor. Obesity during pregnancy increases the likelihood of having a cesarean delivery. If a cesarean delivery is needed, the risks of infection, bleeding, wound problems and other complications are greater for an obese woman than for a woman of normal weight. Obese women are also at increased risk for developing DVT (blood clots in their veins).

How can I manage my weight after my baby is born?

Once you are home with your new baby, stick to your healthy eating and exercise habits to reach a normal weight. Breastfeeding is recommended for the first year of a baby’s life. Not only is breastfeeding the best way to feed your baby, it also may help with postpartum weight loss. Overall, women who breastfeed their babies for at least a few months tend to lose pregnancy weight faster than women who do not breastfeed.

(ADAPTED FROM AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS; FAQ182, APRIL 2016)

Pregnancy after Bariatric Surgery

There are two categories of bariatric (weight loss or gastric bypass) surgery: restrictive and malabsorptive. Restrictive surgery limits the amount of food you can eat. Malabsorptive surgery changes the size of the intestine itself, which changes the way you digest food and absorb nutrients. There is also surgery that is a combination of restrictive and malabsorptive. If you become pregnant after bariatric surgery, you will have special nutritional needs that can affect the health of your pregnancy and your baby.

How Does Bariatric Surgery Change My Diet?

The portions of the stomach and intestine that are no longer used after bariatric surgery are where calcium, iron, folic acid, and vitamins B and D are absorbed into the body. You will need to take daily multivitamin supplements of these important nutrients to stay healthy.

You also need to learn to chew your food thoroughly and eat very slowly, because your stomach cannot hold large amounts of food. If you eat too much too quickly, you may feel nauseous (sick to your stomach) and vomit (throw up). You will also need to drink fluids often so you do not become dehydrated.

There is also a condition called ‘‘dumping syndrome’’ that occurs when you eat something too sugary, like candy. Dumping syndrome causes gas pain and diarrhea.

Can I Get Pregnant After Bariatric Surgery?

Yes. In fact, the weight loss after surgery can make it more likely for a woman to get pregnant than it was before she had this surgery. This is especially true if being overweight was part of why she could not get pregnant.

How Soon After Bariatric Surgery Can I Get Pregnant?

Experts recommend you wait at least 12 to 18 months after bariatric surgery before getting pregnant. By that time, your weight loss should have stopped or stabilized (evened out). If you have had bariatric surgery and you are planning to have a baby, it is very important to see a health care provider before you become pregnant.

 Things to Consider Before Becoming Pregnant

  • Am I meeting my nutritional needs?
  • Am I taking a multivitamin regularly before trying to get pregnant?   Do I have any psychosocial needs or medical conditions to address?

 Things to Discuss With Your Health Care Provider Before Becoming Pregnant

  •   What kind of bariatric surgery you had
  •   How much weight you have lost and how stable your weight is now
  •   Any problems you have had since surgery
  •   The adequacy of your storage of iron, calcium, and B vitamins, especially folate (folic acid)

How Will Bariatric Surgery Affect My Pregnancy?

Before you become pregnant, and a few times during your pregnancy, the following may occur:

  • Bloodworktocheckyouriron,folate,calcium,andvitaminstatus.Youmayneedotherbloodworkifyou have medical problems or take medications regularly.
  • Your health care provider will monitor your weight gain and might ask you to keep a food journal.
  • You may be offered additional ultrasound scans to make sure that your baby is developing and
  • growing well.
  • Because of dumping syndrome, you might need to use a different form of testing for gestational diabetes.

Symptoms of possible problems during pregnancy that are related to your surgery include feeling sick, throwing up, stomach pain, heartburn, or cramping. If you have these symptoms, be sure to tell your pro- vider and remind him/her that you have had bariatric surgery.

(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Smoking During Pregnancy

SMOKING DURING PREGNANCY 

KEY POINTS

  • Smoking during pregnancy can cause problems for your baby, like premature birth.
  • If you’re pregnant, don’t smoke and stay away from secondhand and thirdhand smoke.
  • If you need help to quit smoking, tell your health care provider.

WHY IS SMOKING DURING PREGNANCY HARMFUL?

Smoking during pregnancy is bad for you and your baby. Quitting smoking, even if you’re already pregnant, can make a big difference in your baby’s life. Smoking harms nearly every organ in the body and can cause serious health conditions, including cancer, heart disease, stroke, gum disease and eye diseases that can lead to blindness.

HOW CAN SMOKING AFFECT YOUR PREGNANCY?

If you smoke during pregnancy, you’re more likely than nonsmokers to have:

  • Preterm labor. This is labor than starts too early, before 37 weeks of pregnancy. Preterm labor can lead to premature birth.
  • Ectopic pregnancy. This is when a fertilized egg implants itself outside of the uterus (womb) and begins to grow. An ectopic pregnancy cannot result in the birth of a baby. It can cause serious, dangerous problems for the pregnant woman.
  • Bleeding from the vagina
  • Problems with the placenta, like placental abruption and placenta previa. The placenta grows in your uterus (womb) and supplies the baby with food and oxygen through the umbilical cord. Placental abruption is a serious condition in which the placenta separates from the wall of the uterus before birth. Placenta previa is when the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina.

HOW CAN SMOKING AFFECT YOUR BABY?

Tobacco is a plant whose leaves are used to make cigarettes and cigars. Tobacco contains a drug called nicotine. Nicotine is what makes you become addicted to smoking. When you smoke during pregnancy, chemicals like nicotine, carbon monoxide and tar pass through the placenta and umbilical cord into your baby’s bloodstream.

These chemicals are harmful to your baby. They can lessen the amount of oxygen that your baby gets. This can slow your baby’s growth before birth and can damage your baby’s heart, lungs and brain.

If you smoke during pregnancy, your baby is more likely to:

  • Be born prematurely. This means your baby is born too early, before 37 weeks of pregnancy. Premature babies are more likely than babies born on time to have health problems.
  • Have birth defects, including birth defects in a baby’s mouth called cleft lip or cleft palate. Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body. They can cause problems in overall health, in how the body develops or in how the body works.
  • Have low birthweight. This means your baby is born weighing less than 5 pounds, 8 ounces.
  • Die before birth. If you smoke during pregnancy, you’re more likely to have a miscarriage or a stillbirth. Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy. Stillbirth is when a baby dies in the womb after 20 weeks of pregnancy.
  • Die of sudden infant death syndrome (also called SIDS). This is the unexplained death of a baby younger than 1 year old.

WHAT IS SECONDHAND SMOKE?

Secondhand smoke is smoke you breathe in from someone else’s cigarette, cigar or pipe. Being around secondhand smoke during pregnancy can cause your baby to be born with low birthweight.

Secondhand smoke also is dangerous to your baby after birth. Babies who are around secondhand smoke are more likely than babies who aren’t to have health problems, like pneumonia, ear infections and breathing problems, like asthma, bronchitis and lung problems. They’re also more likely to die of SIDS.

WHAT IS THIRDHAND SMOKE?

Thirdhand smoke is what’s left behind from cigarette, cigar and pipe smoke. It can include lead, arsenic and carbon monoxide. It’s what you smell on things like clothes, furniture, carpet, walls and hair that’s been in or around smoke. Thirdhand smoke is why opening a window or smoking in another room isn’t enough to protect others when you smoke.

If you’re pregnant or a new mom, stay away from thirdhand smoke. Babies who breathe in thirdhand smoke may have serious health problems, like asthma and other breathing problems, learning problems and cancer.

IS IT SAFE TO USE E-CIGARETTES DURING PREGNANCY?

Electronic cigarettes (also called e-cigarettes or e-cigs) look like regular cigarettes. But instead of lighting them, they run on batteries. E-cigarettes contain liquid that includes nicotine, flavors (like cherry or bubble gum) and other chemicals. When you use an e-cigarette, you puff on a mouthpiece to heat up the liquid and create a mist (also called vapor) that you inhale. Using an e-cigarette is called vaping.

More research is needed to better understand how e-cigarettes may affect women and babies during pregnancy. Some studies show that e-cigarette vapor may contain some of the harmful chemicals that are found in regular cigarettes. Flavors and other chemicals used in e-cigarettes also may be harmful to a developing baby. If you’re pregnant and using e-cigarettes or thinking about using them, talk to your health care provider.

Just like regular cigarettes, you can become addicted to e-cigarettes. If you drink, sniff or touch the liquid in e-cigarettes, it can cause nicotine poisoning. Signs or symptoms of nicotine poison include feeling weak, having breathing problems, nausea (feeling sick to your stomach) and vomiting. Nicotine poisoning can be deadly. Liquid nicotine in e-cigarettes comes in different flavors and is sold in small tubes that may be bright and colorful. This may make e-cigarettes seem fun and appealing, especially to children.

CAN YOU JUST CUT DOWN ON SMOKING? OR DO YOU HAVE TO QUIT?

If you smoke, you may think that light or mild cigarettes are safer choices during pregnancy. This is not true. Or you may want to cut down rather than quit smoking altogether. It’s true that the less you smoke, the better for your baby. But quitting is best.

The sooner you quit smoking during pregnancy, the healthier you and your baby can be. It’s best to quit smoking before getting pregnant. But quitting any time during pregnancy can have a positive effect on your baby’s life.

Besides, when you quit smoking, you never again have to go outside and look for a place to smoke. You also may have:

  • Cleaner teeth
  • Fresher breath
  • Fewer stains on your fingers
  • Fewer skin wrinkles
  • A better sense of smell and taste
  • More strength and energy to be more active

WHAT ARE SOME TIPS TO HELP YOU QUIT SMOKING?

Try these tips to help you quit smoking:

  • Write down your reasons for quitting. Look at the list when you think about smoking.
  • Choose a quit day. On this day, throw away all your cigarettes or cigars, lighters and ashtrays.
  • Ask your partner or a friend to help you quit. Call that person when you feel like smoking. Stay away from places, activities or people that make you feel like smoking.
  • Keep yourself busy. Go for a walk to help keep your mind off smoking. Use a small stress ball or try some needlework to keep your hands busy. Snack on veggies or chew gum to keep something in your mouth.
  • Drink lots of water.
  • Ask your health care provider about things to help you quit, like patches, gum, nasal spray and medicines. Don’t start using these without your health care provider’s OK, especially if you’re pregnant.
  • Look for programs in your community or where you work that can help you stop smoking. These are called smoking cessation programs. Ask your health care provider about programs in your area. Ask your employer to see what services are covered by health insurance.

Don’t feel badly if you can’t quit right away. Keep trying! You’re doing what’s best for you and your baby.

INFORMATION FROM THE MARCH OF DIMES

Early Pregnancy

40 Weeks!

A PREGNANCY IS DIVIDED INTO THREE TRIMESTERS

Each trimester lasts approximately three months:

The unborn baby spends around 38 weeks in the uterus (womb), but the average length of gestation is calculated as 40 weeks. This is because pregnancy is counted from the first day of the woman’s last period, not the date of conception which generally occurs two weeks later. Since some women are unsure of the date of their last menstruation (perhaps due to period irregularities), a pregnancy is considered full-term if the birth falls between 37 to 42 weeks of estimated last menstrual period. A baby born prior to week 37 is considered premature, while a baby that still hasn’t been born by week 42 is said to be overdue. In many cases, labor will be induced in the case of an overdue baby.

The medical term for the “due date” is Estimated Date of Confinement (EDC):

However, only about 4% of women actually give birth on their EDC. There are many online pregnancy calculators that can tell you when your baby is due, if you type in the date of the first day of your last period.

A simple method to calculate the due date is to add seven days to the date of the first day of your last period, then add nine months. For example, if the first day of your last period was February 1, add seven days (February 8) then add nine months, for a due date of November 8.

Common Questions During Pregnancy

The doctors, midwives, and nurses at May-Grant Obstetrics and Gynecology will provide you with a great deal of information during the next several months. This information will help you to enjoy a healthy pregnancy. Many women do, however, encounter questions or concerns before the baby is born. Listed below are some common questions asked by women in early pregnancy. 

Are there any medications that are safe to take during pregnancy?

  • Tylenol (acetaminophen) for muscle aches or headaches
  • Antacids (Maalox, Mylanta, Tums, DiGel, Rolaids) for heartburn or nausea
  • Metamucil, Colace, or Citrusel for relief of constipation

AVOID Advil (Ibuprofen) and Aspirin and Aleve (Naproxen)

PLEASE CALL THE OFFICE BEFORE TAKING ANY OTHER MEDICATION

May I still have coffee in the morning?

Caffeine and Nutrasweet are okay in moderation. One or two cups of coffee or one of two diet drinks per day is okay.

Are there any specific things I should report to my doctor or nurse?

You should feel free to call the office anytime something concerns you. Important things to report include:

  • Persistent or severe vomiting
  • Cramps and/or bleeding
  • Signs of infection such as chills, fever, burning with urination
  • Blurred or double vision
  • Headaches which are unusual, severe, or continuous
  • Epigastric pain (severe upper stomachache)
  • Leakage of fluid from the vagina
  • Decrease in baby’s activity

May I change my activity level while I am pregnant?

Generally, you may continue your usual activities. Limit lifting to no more than 25 pounds. If you are unsure, please ask the nurse or provider. Avoid saunas, hot tubs, and jacuzzis.

May I continue to exercise?

Mild or moderate exercise is fine during pregnancy. Walking is especially beneficial.

If you exercise regularly, please follow these guidelines:

  • AVOID sports with a high potential for contact such as soccer, ice hockey, or basketball
  • AVOID activities requiring jumping, jarring, or rapid changes in direction
  • AVOID activities requiring balance and coordination such as skiing, surfing, racquetball, or horseback riding
  • Do NOT exercise while lying on your back after the fourth month
  • DO NOT scuba dive while pregnant
  • DO drink several glasses of water during and after exercise

Please consult your provider if you have any more specific questions about activity and exercise.

Will it hurt the baby to have sexual relations while I am pregnant?

It is okay to have sexual intercourse during pregnancy. There are certain times, however, when you should refrain from intercourse and consult your nurse or doctor. These include:

  • If you are spotting or bleeding
  • If you have leakage of fluid from the vagina
  • If your nurse or doctor has told you that you are at a high risk for preterm labor, or if you are taking medication to prevent preterm labor.

The nurses, midwives, and doctors at May-Grant Obstetrics and Gynecology want you to enjoy your pregnancy, as it is a unique and special time in each woman’s life. We believe that your concerns are important, and we encourage you to ask questions. Please do not hesitate to call the office at 717-397-8177.

Self Care in Pregnancy

If you are pregnant or thinking of becoming pregnant soon, you will want to pay special attention to your health.

What Should I Eat?

You do not have to eat a lot more food during pregnancy. But it is important to eat the right food—the most healthy food for you and your baby. Every day, make sure you have:

  • 6 to 8 large glasses of water.
  • 6 to 9 servings of whole grain foods like bread or pasta. By reading the label, you will know that you are getting ‘‘whole’’ grain and not just brown-colored bread or pasta (1 slice of bread or a half cup of cooked pasta is a serving).
  • 3 to 4 servings of fruit. Fresh, raw fruit is best (1 small apple or a half cup of chopped fruit is a serving).
  • 4 to 5 servings of vegetables (1 medium carrot or a half cup of chopped vegetables is a serving).
  • 2 to 3 servings of lean meat, fish, eggs, or nuts (A piece of meat the size of a pack of playing cards is 1 serving.)
  • 1 serving of vitamin C–rich food, like oranges, sweet peppers, or tomatoes (one half cup is a serving).
  • 2 to 3 servings of iron-rich foods, like black-eyed peas, sweet potatoes, greens, dried fruit, or meat.
  • 1 serving of a food rich in folic acid, like dark green, leafy vegetables (one half cup is a serving).

Are Some Foods Dangerous?

Most women can eat any food they want while they are pregnant. But there are some foods that can be dangerous to the health of your baby.

  • Fish—Fish is good food. And it is an important food for growing a smart baby. But some fish have lots of dangerous chemicals. To avoid these chemicals:
    •   Do not eat swordfish, shark, king mackerel, or tilefish.
    •   Eat salmon no more than 1 time per week.
    •   Eat only ‘‘light’’ tuna. Do not eat albacore tuna.
  • Milk and cheese—Dairy products are an important source of calcium, and calcium helps build strong bones and teeth. But some dairy products carry dangerous germs. To keep yourself and your baby safe, eat and drink only dairy products—such as milk, yogurt, and cheese—that are pasteurized.
  • Prepared foods—Any food that is spoiled or not cooked well can make you sick.
  • Do not eat any meat or fish that has not been cooked all the way through.
  • Do not eat any cooked food that has not been kept hot or chilled.
  • Wash knives, cutting boards, and your hands between handling raw meat and any other food—like fruits and vegetables—that you plan to eat raw.
  • Wash all fruits and vegetables with 1 tablespoon of vinegar in a pan of water to kill germs before you eat them.
  • Alcohol—We know that alcohol is dangerous for your baby if you drink a lot during your pregnancy. It is safest to avoid all alcohol.
  • Caffeine—The most recent studies say that 2 cups of caffeinated drink each day is safe during pregnancy. This means 2 small cups of coffee or tea or 1 can of caffeinated soda.

Do I Need to Take Vitamins?

Even if your diet is good, a daily multivitamin is a good idea. All prenatal vitamins are pretty much the same, so buy the cheapest kind. If you find that your vitamins upset your stomach, take a children’s chewable vitamin. Be sure you get at least 400 micrograms of folic acid every day in the vitamin you chose. The number of micrograms of folic acid is on the label of the bottle.

Is Exercise Important?

Yes! You are getting ready for an athletic event: labor! Daily exercise will help you stay fit, control your weight, and be prepared for labor. Every day, try to get at least 30 minutes of moderate exercise like walking or swimming. Do deep squats several times a day. This exercise will help control low back pain and help prepare your pelvis for delivery.

Are Some Exercises Dangerous?

You can continue to do pretty much any exercise you have been doing. It is important to avoid any danger of blows to your stomach. You should avoid scuba diving, and contact sports like rugby.

What if I Get Sick—Can I Take Medicine?

It is important to limit the medicines you take as much as possible. It is safe to take acetaminophen (Tylenol). Avoid ibuprofen (Motrin), naproxen (Aleve), and avoid aspirin.

  • Head cold—Drink lots of fluids, gargle with warm salt water, take warm baths or showers, take Tylenol for headache and sore throat, suck on throat lozenges
  • Headaches—Drink at least 6 big glasses of water every day, eat something healthy every 2 to 3 hours during the day, and take Tylenol
  • Constipation—Drink lots of water, eat lots of fruits and vegetables, including dried fruits like prunes, and use a fiber supplement like Metamucil

Are There Danger Signs That I Need to Watch Out For?

Call your health care provider if:

  • You start to bleed like a period
  • You are leaking fluid
  • Your baby is not moving (after 24 weeks into your pregnancy)
  • You are having very bad headaches or your vision is blurry or you see ‘‘spots’’   You are having very bad pain
  • You are feeling very frightened or sad
  • You are very worried about something
(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

First Trimester Body Changes

For you, the first trimester is a time of physical and emotional adjustments to being pregnant. The first trimester lasts from conception through 12-weeks, during which time your body will undergo considerable changes as it adjusts to your growing baby. Most of these changes are caused by a marked-shift in hormone production that begins almost immediately after conception. Many of the discomforts you may experience will be lessened or eliminated as your pregnancy progresses. You have probably already experienced some early signs and symptoms of pregnancy, such as missing your period.

Nausea & Vomiting

Commonly known as “morning sickness,” these symptoms can actually occur any time of day. This is caused by changing hormones, or hypoglycemia (low blood sugar). While it sometimes lasts longer, morning sickness should go away by the 12th-week of Pregnancy.

It is helpful to try nibbling on soda-crackers or dry toast before you even get out of bed in the morning, and trying to eat smaller meals all throughout the day. Chewing peppermint gum or drinking peppermint tea may also be helpful. Acupressure or motion-sickness bands provide relief for many. Ginger chews may also help.

Sore & Swollen Breasts

Due to the increased amount of the hormones Estrogen and Progesterone, mammary glands cause the breasts to feel full and become tender. It is helpful to wear a supportive bra, or change to a more supportive bra, at this time.

Frequent Urination

There is only so much room in your abdomen! As your uterus expands with your growing fetus, pressure is increased on your partially-full bladder. We recommend staying near restroom facilities at all times, avoiding long car trips, and relieving yourself as often as necessary.

Increased Fatigue

A sudden increase of Progesterone in a woman’s system may cause a feeling of sluggishness or sleepiness. While perfectly normal, it is important to get plenty of rest during this time.

That Bloated Feeling in Your Belly

Due to hormone changes on your digestive tract – which can slow down bowel function – you may experience increased gas & bloating. We recommend reducing consumption of foods that commonly cause gas, such as beans, cabbage, broccoli, asparagus & carbonated drinks. Eat smaller meals throughout the day, and exercise often if you can. A 10 to 15 minute walk can do wonders!

Increased Vaginal Secretions or Discharge

A major shift in hormones can cause an increase in vaginal secretions, so this is quite normal.

This discharge will increase steadily throughout all 3 trimesters. Wearing a mini or maxi-pad will help. However, if the discharge turns yellowish/greenish or becomes very thick, notify your doctor or midwife immediately.

Gaining Weight 

Below are some guidelines about weight gain during pregnancy. Talk to your health provider about your specific pregnancy weight gain goals.
If you began pregnancy at a normal weight, you should gain 25-35 pounds over the nine months. Assuming you gain between 1 and about 4.5 pounds in the first trimester, you should put on about one pound every week in the second and third trimesters.

If you began pregnancy underweight, you should probably gain a little more. That’s because underweight women are more likely to have small babies. A 28-40 pound gain is usually recommended. Assuming you gain between 1 and about 4.5 pounds in the first trimester, try to gain slightly over a pound a week in the second and third trimesters.

If you began pregnancy overweight, you should gain only 15-25 pounds over the nine months. Assuming you gain between 1 and about 4.5 pounds in the first trimester, you should put on slightly over 1/2 pound every week in the second and third trimesters. While you don’t want to gain too much weight, you should never try to lose weight during pregnancy because that could harm your baby.

If you were obese at the start of your pregnancy, you should gain only 11-20 pounds over the nine months. Assuming you gain between 1 and about 4.5 pounds in the first trimester, aim for gaining slightly under 1/2 pound every week in the second and third trimesters.

Where does it all go?

Approximate breakdown of a weight gain of 29 pounds:

Blood 3 pounds

Breasts 2 pounds

Womb 2 pounds

Baby 7.5 pounds

Placenta 1.5 pounds

Amniotic Fluid 2 pounds

Fat, protein & other nutrients 7 pounds

Retained Water 4 pounds

If you’re expecting twins and began pregnancy at a normal weight, you should probably gain between 37-54 pounds over the nine months. If you began pregnancy overweight, aim for gaining a total of 31-50 pounds. If you were obese at the start of your pregnancy, you should gain between 25-42 pounds over the nine months. That translates into about 1.5 pounds a week in the last two trimesters.

To find out if you were underweight or overweight before pregnancy, learn your Body Mass Index (BMI). BMI is a measure of body fat based on height and weight.

Putting on weight slowly and steadily is best. But don’t worry if you gain less than four pounds in the first trimester, and make up for it later, or vice versa. Also, many women have one or two “growth spurts” during which they gain several pounds in a short time period, and then level off. Again, this is not worrisome unless it becomes a pattern. The important thing is to keep an eye on your overall gain.

Feeling Hot & Sweaty

Near your 11th week of pregnancy, your basal metabolic-rate will have increased by 25%, and the amount of blood in your body will also have increased. This will cause feelings of warmth regardless of the temperature where you are, and perspiration helps to cool the body down. Start dressing in lighter colors (especially during summer months) and wear lighter-weight fabrics.

Headaches

During the first trimester, changes in circulation & hormonal activity can cause headaches. Resting for a short time may help as well. We recommend alternating hot & cold compresses to the aching area for 10 minutes a piece. Brisk walks may also be helpful.

Heartburn

A burning sensation which occurs just below the ribs (usually after eating), Heartburn is a common complaint during pregnancy.

Avoiding the following foods may help:

  • carbonated beverages
  • caffeinated beverages
  • citrus products
  • chocolate
  • vinegar
  • tomato-based foods
  • fatty-foods
  • oils

It is also helpful to abstain from eating within 2-3 hours of sleeping. If heartburn continues to occur, your doctor or midwife can recommend an antacid that is safe for you to use.

Sudden Mood Swings

Throughout the course of a pregnancy, emotional experience will vary from person-to-person. The initial reaction to a positive test for pregnancy will vary from excitement & heartfelt joy to fear or sadness, depending on the circumstances. It is perfectly normal for an expectant-mother to be surprised by how easily she cries. This is caused by hormonal changes in her body combined with physical factors such as fatigue, nausea, soreness and a constantly-changing physiology. Shifting from happiness to sadness – and back again – can be part of this experience.

Expected First Trimester Exams and Tests

VAGINAL EXAMINATION

These exams are performed for the following reasons during early pregnancy:

  • Confirming pregnancy
  • Correlating the size of the uterus with the date of the last menstrual period
  • Estimating the size and shape of the pelvis
  • Obtaining vaginal secretions to detect infection or cervical cancer (Pap smear)

Vaginal exams may be performed toward the end of pregnancy for the following reasons:

  • Assessing effacement and dilation of the cervix
  • Determining the station of the baby
  • Obtaining vaginal secretions to detect infections

At times, vaginal exams can be uncomfortable, and may cause a reddish or dark-brown vaginal discharge.

URINE TESTS

At each prenatal visit, it is necessary to test urine in order to:

  • Detect infection
  • Check for sugar and ketones, potential indicatoes of diabetes
  • Check for protein, which may indicate infection or pre-eclampsia.

BLOOD TESTS

Blood may be drawn during the 1st or 2nd prenatal appointment, for the purposes of:

  • Confirming pregnancy (1st visit)
  • Testing for anemia
  • Determining your blood type
  • Testing for antibodies to HIV and AIDS virus
  • Determining your Rh type
  • Testing for syphilis
  • Testing for German measles immunity
  • Testing for antibodies to Hepatitis-B virus

CHECKING BLOOD PRESSURE

In order to detect pre-eclampsia or pregnancy induced hypertension (PIH), your blood pressure will be checked at every office visit.

CHECKING YOUR WEIGHT

Sudden weight gains are potential indicators of pre-eclampsia, and checking your weight at every prenatal office visit is a method of monitoring general nutritional health.

ABDOMINAL EXAM

Your abdomen will be examined at each prenatal visit to measure the growth of the uterus which indicates fetal growth and gestational age. In the last weeks of pregnancy, it will also give your doctor or nurse-midwife important information about the size and position of the baby.

CHECKING FETAL HEART RATE

Utilizing a handheld ultrasound device called a Doppler, the baby’s heart-rate is checked during every prenatal office visit to assess the well-being of the baby.

BREAST EXAMINATION

Breasts are examined to detect any abnormalities that would warrant further examination. For example, nipples are checked to see if they are flat or inverted, to ensure successful breastfeeding later.

Internet Sites for Prenatal Information

Internet sites can provide a wealth of information on virtually any topic. It is often one of the first places women look to when they find out they are pregnant. This information, however, should never take the place of your healthcare provider.

The following sites were found to have appropriate and accurate information for pregnant women. The first group contains sites that are more “medically oriented,” with no advertising. The second group contains sites with more general information.

Group #l

  • www.amencanpregnancy.org
  • www.familydoctor.org
  • www.marchofdimes.com
  • www.webmd.com (type in “pregnancy”)
  • www.nlm.nih.gov/medlineplus/pregnancy.html
  • www.otispregnancy.org
  • www.mayoclinic.com (search “pregnancy week by week”)

Group #2

  • www.amazmgpregnancy.com
  • www.pregnancy-guide.net
  • www.surebaby.com
  • www.whattoexpect.com
  • www.visembryo.com
  • www.pregnancydiary.org
  • www.pregnancy.org

Enjoy your “surfing,” but please remember to call the office (717-397-8177) if you have any problems or questions. Also, be sure to check out www.maygrant.com!

First Trimester Baby Development

An average pregnancy lasts 40 weeks, and pregnancy is commonly divided into thirds, or trimesters, each lasting approximately 13 weeks. Your doctor or midwife will track pregnancy progress in terms of weeks, beginning with the first day of your last menstrual period. During the 10-weeks after the first day of your last menstrual period (12 -13 weeks after fertilization), your developing baby is called an embryo. All the major organs are formed during this period, but they are incompletely developed. It is during the first trimester when an embryo is most vulnerable to environmental toxins, and in which most miscarriages occur. Once the embryonic period is complete, your baby is now a Fetus.

Below are the highlights of key physiological developments you may expect, week-by-week:

WEEK 1

This is the week of Mom’s last menstrual period. Calculated later by her doctor, the first day of bleeding is considered to be the official date of pregnancy.

WEEK 2

The uterus is made up of a muscular “myometrium”, and a thin “endometrium” that lines the inside surface of the uterine cavity. During the usual menstrual cycle the endometrium grows into a velvety, blood-rich lining under the effects of progesterone. This thickened lining will provide a hospitable place into which the blastocyst can attach and implant. If the woman does not become pregnant the thickened endometrium is sloughed each month producing the typical menstrual flow. When the woman becomes pregnant, the endometruim into which the blastocyst implants first nourishes the blastocyst, and then later becomes part of the placenta, the organ that joins the fetus to the uterus. The endometrium that lines the uterine cavity that doesn’t become part of the placenta remains in the “premenstrual” state until the end of the pregnanacy and is sloughed during delivery (and for possibly many days afterward) just like it is during the woman’s menstrual period.

WEEK 3

  • On approximately the 14th day, one of the eggs travels into the fallopian tube, a process commonly known as ovulation.
  • During the next 24 hours, if one sperm (out of the 350 million in the average ejaculate) travels the entire distance (from Vagina through the uterus and into the fallopian tube) to penetrate the egg, fertilization has occurred.
  • In the uterus, the fertilized egg immediately begins cell division and floats down toward the uterine wall, where it embeds itself. At this stage the baby’s gender is determined by the genes of the father.

WEEK 4

  • Usually, a woman will miss her period by the end of this week.
  • At this phase of your pregnancy, your embryo consists of two layers of cells, the epiblast and the hypoblast. These will eventually develop into all of your baby’s organs and body parts. For the mother, the amnion and the yolk-sac develop at this time. The amnion (filled with amniotic fluid) surrounds and protects the growing embryo, while the yolk-sac helps to nourish until the placenta takes over that role.
  • Now, the baby has a home for the next 9 months! Here it is kept in safety, at a consistent temperature, and with plenty of room to grow without disturbing Mom’s vital organs.
  • Mom begins to experience physical signs and symptoms of pregnancy.

WEEK 5

  • The amazing placenta has the ability to reach out and tap the blood supply in order to bring necessary nourishment to the baby through a long, jelly-like rope called the umbilical cord. Utilizing three blood vessels, the umbilical cord is also used to take away the baby’s waste material. The umbilical cord has one artery delivering blood from the baby’s heart to the placenta and two veins returning blood from the placenta to the heart.
  • Mom has missed her period by now, and a home or laboratory test will verify her suspicions. Most women schedule their first appointment with their OB/GYN at this time.
  • The next 5 weeks are critical to the development of the embryo.

WEEK 6

  • The embryo is now about 0.5 inches in length, weighing less than a half-ounce.
  • Tiny limb-buds are growing into arms and legs, and the embryo now has a beating heart.
  • The neural tube, which becomes the brain and spinal cord, is forming.
  • The liver, kidneys and other major organs begin their development.
  • Surrounding the embryo is the amniotic sac, which contains fluid to cushion the baby against possible injury. Amniotic fluid is a viscous substance that is easy to move around in, and also helps to maintain just the right temperature.
  • Mom may begin to experience fatigue, soreness of breasts and nausea.

WEEK 7

  • Approximately the size of a raspberry, the embryo’s head is large, and dark spots have appeared which ultimately become the eyes and nose.
  • Eyelids, fingers, toes and muscles begin developing, and the neural tube has now closed.

WEEK 8

  • Your uterus is now about the size of a lemon.
  • The embryo now assumes its technical name, fetus. This Latin word translates to “young one”.
  • Ears are now forming, and webbed fingers and toes have developed.
  • The beginnings of all necessary internal and external structures are present.

WEEK 9

  • Still positioned low within the pelvis, the uterus is now about the size of a tennis ball. It presses against the bladder, causing the necessity to urinate more frequently.
  • Although you cannot feel it (yet), the fetus is constantly in motion. Mom may notice that her bras no longer fit.

WEEK 10

  • Utilizing Doppler Ultrasound, the heartbeat may be heard by now (or definitely by the 11th week).
  • The fetus now has a large head and small body, looking almost like a shrimp.
  • The genitals have begun to form.

WEEK 11

  • Vital organs are developing, and tiny fingernails and hairs are forming.
  • Although the fetus still weighs less than 1-ounce, the doctor should be able to hear a rapid heartbeat.

WEEK 12

  • Although Mom will not feel these movements for quite some time, the fetus now begins to bend and stretch, moving its arms and legs, making fists, opening hands and lifting its head.
  • The eyelids are completely developed, and tooth-bud are forming along with the vocal cords.
  • The kidneys have formed and the fetus begins to pass urine into the amniotic fluid.
  • The fetus is now up to 4 inches in length and weighs a little more than 1 ounce.
  • The chance of miscarriage has been greatly reduced.

Second Trimester Baby Development

By now, your baby is sucking his finger, moving his arms and legs, and floating up and down. He may hear and respond to your voice, other voices and even music. He may be startled by other noises in your environment. We encourage you to talk to the baby (older brothers and sisters included), and play music for him. As your baby’s movements become strong enough for you to feel, you’ll begin to learn your baby’s patterns.

DEVELOPMENT CHART

Week 14 Hair and eyebrows are growing. Heartbeat registers on ultrasound. Baby drinks amniotic fluid.
Week 15 Middle-ear bones harden and baby can hear for the first time.
Week 16 Fine hair (called “lanugo”), appears all over the body and face. External genetial organs are visible with ultrasound.
Week 17 Fingernails and toenails begin to appear. Baby hears sounds outside the mother’s body and may jump when startled. Baby may also begin thumb-sucking.
Week 18 Baby measures 8 inches long, and is moving much of the time now.
Week 19 Buds for permanent teeth begin to form. Baby may get hiccups.
Week 20 Baby’s movements can now be felt by mother. Baby weighs between 8 and 16 ounces.
Week 21 Tongue is fully developed, and skin is becoming opaque.
Week 22 A greasy, white substance (known as “Vernix”) is beginning to form on the baby’s skin to protect it. (Most of this vanishes by birth.)
Week 23 Heartbeat is detectable by stethoscope.
Week 24 Lungs are immature, but other vital organs are developed enough for baby to survive outside the womb.
Week 25 Bone centers begin to harden.
Week 26 Fat stores are beginning to form.

Prenatal Vitamins

When shopping for a vitamin, look for one that contains: 

  • Folic Acid — 800 mcg
  • Calcium — 250 mg
  • Iron — 30 mg
  • Vitamin C — 50 mg
  • Zinc — 15 mg 
  • Copper  — 2 mg
  • Vitamin B6 — 2 mg
  • Vitamin D — 400 IUs
  • DHA — 200 mg
    • make sure your DHA supplement is a non-fish source of DHA; fish sources may have too much mercury. Anything with the Life’s DHA logo is safe.

Here are a few good over-the-counter (or on Amazon, as the prices here compare) choices that all have DHA. If you cannot take a large prenatal vitamin and are just taking a multi-vitamin or two Flintstones Complete, please take a separate DHA supplement.

  • NatureMade Prenatal Multi + DHA
    • This has a large dose of DHA, which is a fatty acid crucial to fetal brain development.
    • about $15 for 90 day supply
  • One-A-Day Prenatal
    • This one has been monitored by an independent lab to ensure that it really has all the ingredients it claims. (Since supplements are not monitored by the FDA, you may not be getting everything they promise.)
    • about $28 for 90 day supply
  • Enfamil Expecta Prenatal Dietary Supplement
    • This is broken up into two pills, which may be easier on your stomach.
    • about $46 for a 90 day supply

If you are having trouble paying for your prenatal vitamin or if you are experiencing any discomfort such as nausea or constipation, please let us know. Some insurances may cover the cost of your prenatal vitamin (verify with your insurer to be sure), so we may also be able to write you a prescription.

Morning Sickness

Nausea and vomiting are two of the most common complaints of early pregnancy, affecting 50 to 80% of women. Because symptoms are usually worse upon arising, when your stomach is empty, it is often called “morning sickness.” It can, however, occur at any time of day. Nausea and/or vomiting may begin as early as 6 weeks after the start of the last menstrual period. Symptoms generally disappear 6 to 8 weeks later.

Please remember that morning sickness is a normal part of pregnancy. The following suggestions may help you deal with your symptoms, but time will be the only real cure. If after trying these suggestions you continue to be unable to tolerate food, or if you seem dehydrated, or if you are losing weight, please call one of the Obstetric Nurse Specialists at the office at 717-397-8177.

Dietary Changes

  • Eat small, frequent meals throughout the day. Nausea is often worse when your stomach is empty.
  • Eat easily-digested foods such as complex carbohydrates (such as breads, cereal, pasta, rice, potatoes, crackers) and low-fat protein foods (such as lean meat, poultry, cheese).
  • Have a snack before going to bed (crackers, cheese, yogurt), and keep something by the bedside for during the night should you arise.
  • Have a cracker or two before you get out of bed in the morning.
  • Drink fluids between meals, not with meals, which can contribute to nausea.
  • Avoid “trigger foods.” You will learn what these are for you. They usually include fried, spicy, and fatty foods. Sometimes even the smell of certain foods is enough to trigger nausea.
  • Caffeine may make nausea worse for some women.
  • Take your prenatal vitamin after dinner or at bedtime, not first thing in the morning.
  • Herbal teas (such as spearmint, peppermint raspberry, chamomile, or ginger) have been found to be helpful for nausea. Sip the tea throughout the day.

Other Remedies

If you have made changes to your diet and are still unable to get through the day, you can try one of the following suggestions. Remember to try these one at a time, and to try it for several days to see which will be most effective.

  • Ginger is often very useful for nausea. Ginger root tablets (200 or 300 mg) can be taken twice a day. Ginger root tea and ginger beer can also be helpful.
  • Milk of magnesia (magnesium hydroxide): chew 1 tablet 2-3 times per day in between meals.
  • Vitamin B6: 25 mg every 8 hours.
  • If Unisom makes you too drowsy during the day, use only at bedtime and consider adding Bonine or Dramamine Less Drowsy (meclizine) at 25 mg (1 tablet) every 8 hours.

Tips for Coping with Morning Sickness

Causes of Morning Sickness

Unfortunately, no one has been able to pinpoint exactly what causes morning sickness. However, pregnancy causes an increase in hormones, espeically estrogen, at a fast pace. The body has a difficult time adjsting to the sudden change. The rise in hormones gradually tapers off around the beginning of the fourth month and so should the nausea and vomiting. It may return a month or two later when hormones again increase. Some women suffer from it their entire pregnancies.

Symptoms of Morning Sickness

  • Nausea or vomiting
  • Decreased appetite
  • Sudden attacks or “waves” of nausea
  • Aversion to certain odors, even those previously pleasant
  • Fatigue and drowsiness
  • Possible weight loss
  • Can occur at any time of day, but it is usually worse in the morning

Tips for Coping

Emotional

  • Realize that this is not “just in your head.”
  • Remind ourself that this is a temporary condition.
  • Enlist the support and cooperation of your family, friends, and co-workers.
  • Learn a stress management technique.
  • Listen to your body. Your condition may not fit the sterotyped morning sickness.
  • Rest your body and mind. Fatigue and anxiety contribute to nausea and vomiting.
  • There will be good days and bad days. Try to be flexible with your plans.
  • You will feel a wide range of emotions, including anger and depression. If you have difficulty dealing with them, find a good friend or therapist who will listen to you vent your feelings. Don’t be afraid to ask for help.
  • A good cry never hurts. Don’t hide your feelings.

Physical

  • Try to find out what smells and foods are your “triggers” to nausea and vomiting.
  • Find out which foods you can eat and keep down. Food intake is essential to maintaining the energy your body needs to function.
  • Try to avoid areas that you have no control over, such as parking garages or bus stops.
  • Fluid intake is important to prevent dehydration and constipation.
  • Exercise, if it can bee tolerated and is permitted, helps especially if you already have a routine. Consult your healthcare provider for a safe plan during pregnancy.
  • Try to maintain some activity to prevent loss of muscle and bone mass.
  • Consult with your healthcare provider about acceptable weight gain and loss limits. Keep a weight chart of weekly weigh-ins, espcially if there has been a considerable amount of vomiting. Weight can vary by a pound or two daily, so compare weekly weight on the same day of each week and look for trends.
  • If you suffered with motion sickness before you became pregnant, it may be worse during pregnancy. Consult your healthcare provider before taking any medication for this condition.
  • Temperature extremes sometimes trigger nausea or vomiting. Find an area in your home or office where you can control the temperature to suit your comfort. It may mean using a fan or an electric blanket.
  • Maintain good oral hygiene. Poor nutrition and vomiting can cause bleeding gums and tooth decay. If toothpaste triggers nausea or vomiting, try plain water or water flavored with mint.
  • Shampoo and bathe regularly to prevent odors that may be a trigger. Use unscented soaps, shampoos, and lotions. Have your family do the same.
  • For some women, lying down may resolve a nausea attack. When getting up, rise slowly, in stages. Sit up on an elbow, then sit on the side of the bed before standing.
  • Low lighting may also help.

Nutritional

  • It is useless to eat healthy foods if you vomit them back up, so it usually comes down to eating what will stay down. The foods that will stay down will provide your calorie intake.
  • Many of the cravings for certain foods are healthy. Fruit is full of natural vitamins and satisfies thirst. Milk products provide a number of vitamins and minerals such as calcium.
  • Cravings can be viewed as nature’s way of protecting the mother’s health for the sake of the baby. Sometimes cravings for a particular food can break the cycle of vomiting.
  • Notify your healthcare provider if you crave something unusual such as dirt or metal.
  • Pay attention to the nutritional chart that gives the calorie, vitamin, mineral and protein content of foods. This can help you make good choices in the foods you may be craving.
  • Make a list of foods you can eat and classify them under sweet, salty, sour, spicy, crunchy, chewy, etc. Sometimes you may not know if it is the taste or the texture that will satisfy your craving.
  • It may be necessary for you to prepare and eat your meals separately from other family members. This way, you are not triggered from what they may be eating.
  • You should take your prenatal vitamin. If you cannot tolerate them, consult your provider.
  • There are over-the-counter and prescription medications that your healthcare provider can recommend in cases of extreme nausea and vomiting.

Get Help

Even though many symptoms of morning sickness are common and even exptected, you should not hesitate to contact your provider if you are experiencing symptoms that you consider more severe, such as:

  • You are unable to keep ANYTHING down, especially liquids.
  • You vomit blood.
  • You experience visual disturbances, dizziness, or fainting.
  • You have little urination, or dark, concentrated urine.
  • Your mouth is dry (no saliva).
  • Your mental concentration is decreased.
  • You feel extremely fatigued and have trouble getting enough air.

Nausea and Vomiting During Pregnancy

Do all women have nausea or vomiting during pregnancy?

About one in 4 pregnant women have only mild nausea. Three of every 10 pregnant women have nausea that is bad enough to interfere with their daily lives. Half of all pregnant women have both nausea and vomiting during the first months of pregnancy. Nausea and vomiting during pregnancy tends to be the worst at 8 to 10 weeks after your last menstrual period. It usually goes away by 12 to 16 weeks after your last period. Nausea and vomiting during pregnancy is often called “morning sickness” but can occur all day long or at any time in the day or night.

What causes nausea and vomiting during pregnancy?

The cause of nausea and vomiting during pregnancy is not known for sure. Changes in hormone levels may be involved. If your mother had morning sickness when she was pregnant, you may be more likely to have nausea and vomiting during pregnancy. A history of motion sickness or stomach problems before you got pregnant may be another risk factor. Nausea during pregnancy is worse if you are dehydrated (there is not enough fluid in your body) or if the level of sugar in your blood is low from not eating often enough.

Are nausea and vomiting during pregnancy dangerous?

Mild nausea and vomiting may make you feel awful, but it will not hurt you or your baby. You can talk to your health care provider about ways to make you feel better if nausea and or vomiting is making it hard for you to do your normal activities. Lots of vomiting that keeps you from keeping any food down is rare, but severe vomiting can cause health problems. You should call your health care provider if any of the following happen:

  • You are not able to keep any liquids or foods down for 24 hours
  • You are vomiting several times a day or after every meal
  • You have abdominal pain, difficulty urinating, or a fever
  • You do not urinate as often as usual and your urine is dark in color
  • You are weak, dizzy, or faint when you stand up
  • You do not gain weight or you lose weight in a week

How are nausea and vomiting treated?

Nausea or vomiting during pregnancy is treate in 3 steps:

1. Simple diet changes in what you eat and how often you eat may lessen nausea and help you avoid vomiting. This is all it takes for many women.

2. If diet changes are not enough, you can try eating ginger or using acupressure bands. Both have been shown to decrease nausea in research studies.

3. If the nausea and/or vomiting are making it hard to do your usual activities, your health care provider can prescribe medication.

Your health care provider can talk with you about how often you have nausea and are vomiting then help you decide which of the following ways to treat nausea and vomiting will be best for you.

Step One: Lifestyle and Diet Changes

  • Drink small amounts of fluids often all day long. Drinking a small amount at one time will also help the nausea lessen. Cold drinks may make you feel better than hot drinks will.
  • Eat small meals every 2 to 3 hours. Do not wait to be hungry or thirsty before you eat or drink.
  • Eat something plain like crackers, toast, or cereal in the morning. Some women find it helps to eat something before getting out of bed. Avoid eating foods that have strong odors.
  • Avoid foods that are greasy, fried, spicy, or very hot.
  • Try eating foods that are high in carbohydrates, such as potatoes, noodles, rice, or toast.

 Step Two: Treatments that Do Not Use Medications

  • Ginger

Ginger has been used for treating nausea since ancient times and can lessen nausea. Ginger root tea, ginger gum, ginger snaps, ginger syrup added to water, ginger ale, and all other forms of ginger are safe to use in pregnancy. You can also buy ginger capsules at a drug store. The dose of ginger that has been studied for nausea and vomiting in pregnancy is 1 gram per day. Some forms of ginger like tea or cookies do not list the dose. Ask your health care provider or pharmacist how often you should take ginger products that do not have the dose of ginger listed.

  • Acupressure Bands

Seabands are wristbands with a pressure point placed on the inside of your wrist. They are often used for motion sickness. Some women find them helpful for nausea during pregnancy, and they are safe.

Step Three: Medication

There are several different types of nausea medicines that work well and are safe for you and your baby. Because nausea and vomiting is caused by different “triggers” in your body, you and your health care provider can work together to find the medicine that is right for you. There are both over-the-counter and prescription medicines that can be used if your nausea and vomiting are severe.

  • Over-The-Counter Medication

Over-the-counter medications for motion sickness should not be taken during pregnancy unless recommended by your health care provider. Many women have found that vitamin B6 is helpful for making mild nausea better. Vitamin B6 does not help stop vomiting. Your health care provider can help you choose the dose and how often to take vitamin B6 if you want to try it.

  • Prescription Medication

If your nausea and vomiting continues after trying lifestyle and diet changes and over-the-counter medications or you are vomiting frequently, you may need a prescription medication. There are several different prescription medicines that have been studied and found to be safe for you and your baby. Your health care provider can talk with you about these medicines.

(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Bleeding During Early Pregnancy

Bleeding During Early Pregnancy

If you’ve had bleeding early in your pregnancy, you’re not alone. Many other pregnant women have had early bleeding, too. And in most cases, nothing is wrong. But your healthcare provider still needs to know about it. He or she may want to do tests to find out why you’re bleeding. Call your healthcare provider if you notice bleeding during pregnancy.What causes early bleeding?

The cause of bleeding early in pregnancy is often unknown. But many factors early on in pregnancy may lead to bleeding or spotting. These include sexual intercourse, which may cause bleeding in any trimester. Here are some other causes:

  • Implantation of the embryo on the uterine wall
  • Subchorionic hemorrhage (bleeding between the sac membrane and the uterus)
  • Miscarriage
  • Ectopic (tubal) pregnancy

If you notice spotting

Spotting (very light bleeding) is the most common type of bleeding in early pregnancy. If you notice it, call your healthcare provider. Chances are, he or she will tell you that you can care for yourself at home.

If tests are needed

Depending on how much you bleed, your healthcare provider may ask you to come in for some tests. A pelvic exam, for instance, can help see how far along your pregnancy is. You also may have an ultrasound or a Doppler test. These imaging tests use sound waves to check the health of your fetus. The ultrasound may be done on your belly or inside your vagina. Your healthcare provider also may order a special blood test. This test compares your hormone levels in blood samples taken 2 days apart. The results can help your healthcare provider learn more about the implantation of the embryo. Your blood type will also need to be checked to evaluate whether you will need to be treated for Rh sensitization.

Warning signs

If your bleeding doesn’t stop or if you notice any of the following, seek medical help right away:

  • Soaking a sanitary pad each hour
  • Bleeding like you’re having a period
  • Cramping or severe belly pain
  • Feeling dizzy or faint
  • Tissue passing through your vagina
  • Bleeding at any time after the first trimester

Questions you may be asked

Though not normal, bleeding early in pregnancy is common. If you’ve noticed any bleeding, you may be concerned. But keep in mind that bleeding alone doesn’t mean something is wrong. Call your healthcare provider right away, though. He or she may ask you questions like these to help find the cause of your bleeding:

  • When did your bleeding start?
  • Is your bleeding very light (spotting) or is it like a period?
  • Is the blood bright red or brownish?
  • Have you had sexual intercourse recently?
  • Have you had pain or cramping?
  • Have you felt dizzy or faint?

Monitoring your pregnancy

Bleeding will often stop as quickly as it began. Your pregnancy may go on a normal path again. You may need to make a few extra prenatal visits. But you and your baby will most likely be fine.

INFORMATION FROM KRAMESONLINE

Weight Gain During Pregnancy

How Much Weight Should I Gain During My Pregnancy?

How much weight you should gain depends on how much you weighed before you got pregnant. Women who weigh less need to gain more. Women who weigh more need to gain less. The amount of weight you need to gain ranges from 11 to 40 pounds depending on your prepregnancy weight. Talk with your health care provider about the right weight gain for you.

I Do Not Feel Hungry. Do I Have to Eat If I Do Not Feel Hungry?

Many women do not feel hungry early in pregnancy. This is because of hormone changes in the body. Later in pregnancy, it may be hard to eat because your stomach has less room between your baby and your lungs. You will feel better all through your pregnancy if you try to eat something every 1 to 2 hours. Eating a big meal may make you feel sick. Eating just a slice of apple, a carrot stick, or a bit of whole wheat bread will help you feel better if your stomach is upset. It is important to remember that what you put in your mouth goes to your baby. If you don’t eat, your baby gets nothing to eat.

People Tell Me I’m ‘‘Eating for Two.’’ Does This Mean I Have to Eat Twice As Much?

No. Most women only have to add about 200 calories every day to their diet. Many women can eat less and still be very healthy and grow a healthy baby. Your baby depends on you for all of its food, so you do have to eat well. Make healthy changes in your diet—eat at least 5 servings of fruit and vegetables a day, eat whole grain foods such as brown rice or whole wheat bread, include some protein whenever you eat, and cut down on fats. You don’t have to eat much more than you normally do.

What Happens If I Do Not Gain Enough Weight?

If you do not gain enough weight, your baby may be too small. Babies that are too small can have problems right after they are born. They may have trouble breathing or eating. Some babies who are too small at birth have trouble learning when they get older and go to school. Talk with your health care provider about how many pounds you should gain to make sure your baby is not too small.

What Happens If I Gain Too Much Weight?

If you gain too much, you will have more weight to lose after the baby is born. Women who gain a lot of extra weight have a higher chance of getting gestational diabetes and needing a cesarean birth.

Should I Gain the Same Amount Every Week?

The baby will gain most of its weight during the last 2 months of your pregnancy. You should try not to gain much weight at first. Plan to gain most of your weight in the last months of your pregnancy.

General Guidelines

PREPREGNANCY WEIGHT HEALTHY WEIGHT GAINDURING PREGNANCY
Underweight (BMI less than 18.5) 28 to 40 pounds
Normal (BMI between 18.5 and 24.9) 25 to 35 pounds
Overweight (BMI between 25 and 29.9) 15 to 25 pounds
Obese (BMI 30 or more) 11 to 20 pounds

Working During Pregnancy

AMA Guidelines for Working During Pregnancy

The American Medical Association (AMA) has issued guidelines in a report published by the Bureau of National Affairs on how long pregnant women can continue to work. In general, the guidelines say that a woman can work the entire 40 weeks of pregnancy if the physical demands of her job are limited to intermittent sitting and light tasks. The AMA advises stopping work when the following conditions apply:

  • At 32 weeks, when jobs require intermittent standing for a total of more than 30 minutes every hour.
  • At 30 weeks, if jobs involve intermittent lifting of items weighing more than 50 pounds.
  • At 28 weeks, if intermittent stooping and bending below knee level between two and ten times an hour, or climbing ladders and poles more than four times in an eight-hour shift is required.
  • At 24 weeks, if jobs require prolonged standing for more than four hours, or repetitive lifting of items weighing between 25 and 50 pounds.

Cold and Flu During Pregnancy

If you develop a head cold and need a decongestant, plain Sudafed (pseudoephedrine) may be taken. This medication is no longer available on the shelf, but it is available at the pharmacy department in drug stores. Sudafed PE is on the shelf, but should not be taken while pregnant. Guaifenesin (Mucinex 600, Robitussin) or dextromethorphan (Robitussin DM) may be used for coughing. It is advisable to use Tylenol (acetominophen) for a fever over 100.4 degrees. Tylenol will also be helpful for the aches and pains of the flu, and for headaches associated with sinus congestion.

Antihistamines are used for allergy symptoms, such as sneezing, itchy eyes, and runny nose. Diphenhydramine (Benadryl) and chlorpheniramine are useful, and are preferred in the first trimester, but Claritin (loratadine) or Zyrtec (certirizine) may be used, if necessary.

Normal saline nasal spray for nasal congestion and throat lozenges of any type are safe at any time in pregnancy, with the exception of zinc lozenges. These should not be used. If you have a fever over 100.4 degrees for more than 48 hours, a persistent cough or sore throat, or greenish-yellow nasal or oral discharge, please contact your family doctor. Do not use any other over-the-counter medication without contacting one of our Obstetric Nurse Specialists at the office (717-397-8177).

The Center for Disease Control (CDC) has recommended that all women who will be pregnant during influenza season should be vaccinated, regardless of their stage of pregnancy. Peak flu season is typically from late December through early March. The ideal time to obtain the flu vaccine is in October and November in order to receive protection during the peak season.

Talk to your provider today to schedule your vaccination.

Please let us know if you have any questions.

Medicine During Pregnancy

Most medicines are safe to take during pregnancy, but a few can harm a baby. Sometimes a woman needs to take a medicine because her illness could hurt her baby so taking the medicine is safest.

How can I tell if a medicine is safe to take during pregnancy?

For many years, the US Food and Drug Administration (FDA) had a letter system for medicines used during pregnancy. Medicines were placed into one of 5 groups: A, B, C, D, or X. The letter groups were based on known effects the medicine has on a developing baby during pregnancy. The safest groups were A and B, because studies showed these medicines were safe. Medicines in the D group might be harmful to a baby but might be needed because of how serious the illness was for the woman. Medicines in the X group were medicines that should never be used in pregnancy. Unfortunately, most medicines were in the C group, which was the letter used when there were not enough studies to know if a medicine was safe or not.

As of the end of 2018, no medicines will be put in a letter group. Instead, more information about the medicine is given out with the medicine. The new system includes a lot of information, and it uses the terms “safe” or “not safe” for new medicines. Medicines that are in the A, B, C, D, or X letter system will be moved to the new system over the next several years.

What medicines are not safe during pregnancy?

There are not many medicines that are harmful if taken when you are pregnant. Some of the medicines that are not safe to use include birth control pills, the acne medicine isotretinoin (Accutane), a few of the medicines called statins that are used for high cholesterol, and the antibiotics tetracycline (Teramycin) and doxycycline (Adoxa). In addition, ergotamine (Cafregot) which is used for migraine headaches and the ulcer medicine misoprostol (Cytotec) should not be used during pregnancy. Most vaccines are safe during pregnancy.

Are there some times during pregnancy when it is more dangerous to take medicines?

Your baby develops most rapidly in the first 12 weeks of your pregnancy. This is the time when you want to avoid exposing the baby to anything that could be harmful, such as alcohol. To be safe, check with your health care provider before taking any medicine when you are pregnant, including herbs and drugstore medicines. Before conception and during early pregnancy you should take folic acid to help protect your baby from some spinal birth defects.

I’ve been taking medicines that my health care provider gave me before I got pregnant. Are they still okay to take?

Tell your health care provider what medicines you are taking if you want to get pregnant or if you might be pregnant. Most medicines that you need to take regularly are safe. But some medicines can be changed to a lower dose or a different medicine to lower the risk to your baby.

Are medicines I can buy without a prescription (over-the-counter) safe to take in pregnancy?

Check with the pharmacist or your health care provider before you take any medicines during pregnancy, even ones you can buy without a prescription.

Here are some common ailments and safe things to try:

  • Colds and Coughs
    • Get plenty of rest.
    • Drink lots of fluids.
    • Wash your hands often.
    • Gargle with warm salt water and drink honey with lemon for a sore throat.
    • Rub Vicks on your chest and throat before you go to bed at night to clear your stuffy nose.
    • Stuffy nose: Take chlorpheniramine (Chlor-Trimeton) or pseudoephedrine (Sudafed).
      • An oxymetazoline (Afrin or Vicks Sinex) or phenylephrine (like Dristan) nasal spray may work well. If you use a medicated nasal spray, stop after 3 days. Using it for a longer time may cause your stuffy nose to get worse.
    • Cough: Take guaifenesin and dextromethorphan (Robitussin DM). Choose a cough syrup with the lowest amount of alcohol.
  • Headaches
    • Drink plenty of water, at least 6 big glasses a day.
    • Get someone to massage your neck and shoulders for you.
    • Acetaminophen (Tylenol) is safe during pregnancy.
    • Don’t take ibuprofen (Motrin), naproxen (Aleve), or aspirin.
  • Yeast Infections
    • Don’t use douches.
    • If you are sure you have a yeast infection, use a vaginal yeast treatment like clotrimazole (Gyne-Lotrimin) or miconazole (Monistat).
  • Allergies
    • First, do the things listed under colds and coughs.
    • Use an antihistamine like diphenhydramine (Benadryl) or loratadine (Claritin). Some antihistamines have alcohol included so check labels and avoid these.
  • Heartburn
    • Eat 5–6 small meals per day and do not lie down right after eating. Avoid foods that are acidic, like tomatoes, and fried foods.
    • Drink or eat something soothing like milk before you lie down. Chew gum after eating.
    • If you need an antacid, take a chewable tablet that has calcium (Tums) or magnesium (Maalox).
    • Don’t take antacids that have aspirin (Alka-Seltzer, Pepto-Bismol) or soda bicarbonate (baking soda).
  • Constipation
    • Drink plenty of fluids, at least 6 big glasses of water a day is best. Eat lots of fruit and vegetables for fiber.
    • Stool softeners like docusate sodium (Colace) and psyllium (Metamucil) are safe in pregnancy.
    • Don’t take mineral oil or senna (Senokot).
  • Diarrhea
    • Drink lots of clear liquids.
    • If you have diarrhea for more than one day, call your health care provider. Bismuth subsalicylate (Kaopectate) and loperamide (Imodium) are safe in pregnancy.
(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Vaccines During Pregnancy

Why are vaccines important?

Vaccines are a type of medicine that helps protect your body from some infections. They also help prevent the spread of infections to others who have not gotten the vaccine. Some infections can harm you or your baby if you get them when you are pregnant. When you get a vaccine in pregnancy, you become protected against getting the infection, and you pass this protection to your baby.

Should I receive vaccines while I am pregnant?

Some vaccines, like the flu and tetanus, diphtheria, and pertussis (Tdap) vaccine, are safe for you to get while you are pregnant. These vaccines are recommended for all pregnant women. Other vaccines are important, because they protect against infections that can hurt your baby, like rubella (German measles) and chickenpox. But they are not safe to receive while you are pregnant. It is better to get these vaccines at least a month before you get pregnant or after your baby is born. Other vaccines, like hepatitis A or B, can be safe to get while you are pregnant, but you should only get them if you at risk for that infection.

Will the vaccines hurt my baby?

Most vaccines will not hurt your baby if you get them during pregnancy. A small number of vaccines contain parts of live virus, which could hurt your baby. You should not get these vaccines while you are pregnant. See the next page for a list of these vaccines.

What if I am traveling to a foreign country while I am pregnant?

You may need extra vaccines for protection if you are traveling to a foreign country. You can find more information about which vaccines you may need depending on where you travel at www.cdc.gov/travel.

Which vaccines should I receive while I am pregnant?

YES!

  • Influenza (flu) inactivated injection vaccine
    • All pregnant women should get the yearly flu shot vaccine. Pregnant women who get the flu are more likely to be severely ill and may have a higher chance of problems like preterm labor. If you get the flu vaccine during pregnancy, your baby is protected from the flu for the first 6 months of life. The flu vaccine can be given at any time during pregnancy, but it must be the shot and not the nasal spray form of the vaccine.
  • Tetanus, Diphtheria and Pertussis (Tdap)
    • All pregnant women should get the vaccine to protect against pertussis (whooping cough) each time they are pregnant. This vaccine is given in a shot that also contains protection against tetanus and diphtheria. It is called the Tdap shot. Pertussis is a very serious infection of the lungs. Pertussis is more common now in adults, and it is a very harmful and deadly infection in newborns and young babies. Getting the pertussis vaccine in pregnancy can protect your baby from birth until 2 months of age when the first set of infant vaccines for pertussis are recommended. You should be vaccinated during each pregnancy between 27 and 36 weeks to give your baby the best protection. It does not matter if you received the tetanus vaccine before you were pregnant.

MAYBE

  • Hepatitis A
    • Hepatitis A vaccine is safe in pregnancy. You may need the vaccine if you are at risk for the infection. Risks include a family member infected with hepatitis A, travel to an area where hepatitis A is common, or exposure to dirty living conditions or unsafe water. The vaccine is given in 2 doses, 6 months apart.
  • Hepatitis B
    • Hepatitis B vaccine is safe in pregnancy. You may need the vaccine if you are at risk for the infection and are not already immune (protected from this infection). Risks include having more than one sexual partner in the last 6 months, recent treatment for a sexually transmitted infection, on dialysis, recent or current drug use, or if you have a sexual partner who has hepatitis B. The vaccine is given in 3 doses over a 6-month period.
  • Meningococcal
    • Meningococcal (MCV3, MCV4) vaccine is safe in pregnancy. It is important for persons who have certain health problems, such as an autoimmune disease. This vaccine is also recommended for persons who are living in a dormitory and aged 19 to 21 years or who were vaccinated before age 16 years.
  • Pneumococcal
    • Pneumococcal (PCV13, PPSV23) vaccine is safe in pregnancy. It is important for persons with certain health problems, like diabetes. Talk to your health care provider about whether you need this vaccine.

NO

  • Human Papillomavirus (HPV)
    • HPV vaccine is not recommended in pregnancy, but you should not be worried that it will harm you or your baby if you accidently get it while you are pregnant. HPV vaccine is recommended for women aged 26 years and younger before or after pregnancy. The vaccine is given in 3 doses over a 6-month period.
  • Measles, mumps, and rubella (MMR)
    • MMR vaccine is not recommended in pregnancy. If you become infected with rubella (German measles) during pregnancy, your baby can have serious birth defects. If you are not already immune to rubella, it is best to get this vaccine at least a month before you become pregnant. That will protect your baby from the disease. Most women are immune to rubella because they got the rubella vaccine when they were children. You will be tested during pregnancy to see if you are immune to rubella as part of the blood tests at your first prenatal visit. If you are not immune, you should not receive the vaccine until after your baby is born.
  • Varicella (chickenpox)
    • Varicella vaccine is not recommended for pregnant women. If you have not had the vaccine or chickenpox and are not immune to chickenpox, it is best for you and your baby to get the vaccine before you become pregnant. You can be tested during pregnancy to see if you are immune. Most women are immune to chickenpox even if they do not remember getting the disease or the infection. If you are not immune to the chickenpox, you should get the vaccine after the baby is born. The vaccine is given in 2 doses, 4 to 8 weeks apart.
  • Influenza (flu) live nasal vaccine
    • Pregnant women should not get the nasal flu vaccine because it contains parts of the live virus that could possibly cause the flu. You should get the flu shot vaccine.
(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Depression During Pregnancy

Depression During Pregnancy

Depression occurs in about 7 of every 100 people in the United States. Depression is more common in women than in men, especially in women who are ages 15 to 44 years. Pregnancy also happens during these ages. Depression can occur for the first time during pregnancy, or depression may become worse during pregnancy. Depression can also develop after the baby is born. There is no simple treatment for depression. Medications can help some women, especially those with severe depression. The most effective treatment for depression is a combination of medication and psychotherapy (talking with a therapist on a regular basis).

How do I know if I have depression?

These answers to these 2 questions will help you learn if you have depression:

1. Over the past 2 weeks, have you felt down, depressed, or hopeless?

2. Over the past 2 weeks, have you felt little interest or pleasure in doing things?

If you answer yes to both questions, contact your health care provider to discuss the possibility that you have depression. Your health care provider will ask you more questions to see if you have depression. People with depression often say that most days they feel sad, lifeless, trapped, or hopeless, and the pleasure and joy have gone out of life. If you spend time thinking about killing yourself or others, and especially if you develop a plan to do so, you need to seek care immediately. Severe depression is linked to suicide (killing yourself).

Why is it important to treat depression while I am pregnant?

Having depression during pregnancy can be harmful for both you and your baby. This is because the symptoms of depression, such as sadness, tiredness, and loss of appetite, can make it hard to do your normal activities. Depression may make it harder to take good care of yourself. You might skip a prenatal visit if you are too tired or don’t feel comfortable talking to other people. You also may not eat a healthy diet because you aren’t hungry. If you have depression, it is easier to make choices that are not good for your health, such as smoking, drinking, and doing drugs. These things can increase your chances of problems in pregnancy, such as miscarriage, preterm birth, and having a small baby. Treating depression helps you and your baby be healthier during and after you are pregnant. If you have depression during pregnancy, you have a higher chance of having postpartum depression. This can make it hard to take care of and enjoy your baby.

What can I do to help my depression while I am pregnant?

Psychotherapy along with self-care activities that help mental health may be enough treatment for your depression. Exercise, spending time outdoors, doing something you find relaxing, being with friends and family, mindfulness, meditation, and decreasing the stress in your life are forms of self-care that can all help you feel better. Sometimes depression can be managed without medication, but sometimes medication is needed.

What are SSRI medications?

Selective serotonin reuptake inhibitors, also called SSRIs, are the most commonly used antidepressants (medications for treating depression). If psychotherapy or self-care activities, such as exercise, do not relieve depression, an SSRI medication may be a good choice for you, even during pregnancy. Some common SSRIs are:

  • citalopram (Celexa)
  • escitalopram oxalate (Lexapro)
  • fluoxetine (Prozac)
  • fluvoxamine (Luvox)
  • paroxetine (Paxil)
  • sertraline (Zoloft)

How do SSRIS work?

SSRI medications increase the amount of a chemical called serotonin that is present in your brain and affects your general mood. Usually it takes a few weeks after you start taking the medication before you notice any changes in depression, even when the medication works well. Because SSRIs can take a few weeks to start working, you may still be depressed during that time. It is important to reach out to others for support, talk with your health care provider, and do self-care activities during the first few weeks after you start the medication.

Should I stop taking my antidepressant medication if I’m planning to get pregnant or if I am pregnant?

Always contact your health care provider before stopping your medication. Depression may become worse during pregnancy because the changes that happen to your body and emotions can make it more difficult to cope with depression. Some studies have found that women with depression have a higher chance of having a premature baby and postpartum depression if they do not take medication for depression during pregnancy. In addition, stopping some antidepressants too quickly can cause withdrawal symptoms. If you have mild depression and have had no symptoms in the last 6 months, you may be able to try stopping your medication. Talk about this with your health care provider.

Do SSRIS cause birth defects?

The chance that SSRIs will cause birth defects is very low. Because the chance of causing birth defects is so low, it is hard for scientists to study the question well, and we do not yet know the answer for sure. A few SSRI medications may increase the chance of your baby having a heart problem, but the chance of this happening is very low. If you are taking an SSRI medication when you get pregnant, call your health care provider to learn what is known about that medication. Do not stop the medication before talking with your health care provider.

Can SSRIS harm my baby after birth?

Some SSRIs may cause a mild withdrawal reaction in a baby after birth. If this happens, the baby can be fussy and have problems eating well during the first few days after birth. These symptoms go away after a few days. Remind the health care provider who is caring for your baby about any medications you took during pregnancy.

Are SSRIS safe to take if I’m breastfeeding?

It is safe to breastfeed if you are taking SSRIs after the baby is born. SSRIs get into your breast milk in very low amounts, so they do not affect the baby. Talk with your health care provider about the best medication to take while you are breastfeeding.

(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Exercise in Pregnancy

Is it safe for me to exercise while I’m pregnant?

Most exercise is safe for pregnant women. In fact, daily exercise during your pregnancy can help you and your baby be healthier and might decrease your chance of having some problems during pregnancy. If you had a medical problem before you became pregnant or have had complications during your pregnancy, you should talk about the safety of exercise with your health care provider before you start any activity.

How can exercising while I’m pregnant help me?

Exercise in pregnancy can help you in many ways. It can help you feel better and have less back pain, constipation, and tiredness. Exercise can also help you sleep better and improve your mood. Your body will be better prepared for labor. You may have a shorter labor with less chance of having a cesarean birth. You will gain less weight in pregnancy, which will help you get back to your prepregnancy weight more quickly after the baby comes. Exercise in pregnancy may also lower your chance of getting gestational diabetes or high blood pressure during pregnancy. Your baby is more likely to be born with a healthy birth weight. Exercise can also lower the chance of having postpartum depression.

How much exercise should I do while I’m pregnant?

You should try to do moderate exercise for at least 30 minutes most days of the week. Moderate exercise means you should start to sweat and your heart rate increases a bit, but you are still able to talk while you are exercising. If you exercised before pregnancy, you can probably continue the same physical activities. If you are not currently exercising, pregnancy is a good time to start. You want to start slow and gradually increase your exercise.

What exercises are safe for me to do while I’m pregnant?

Walking is a good exercise to start with. You will get moving and have less strain on your joints. Swimming, biking, yoga, and low-impact aerobics are also good choices. Light weight training is okay too. Being creative with your exercise will help you stay motivated. Hiking, dancing, and rowing can be fun activities to try. You do not need to pay money for an exercise class or activity. Walking up and down stairs or doing exercises at home are all good, free activities.

Are there other things I should consider when I’m exercising while I’m pregnant?

Be sure to stretch your muscles first and warm up and cool down each time you exercise. Drink water throughout your exercise so you can stay well hydrated. Make sure you do not get too hot, and do not overdo your exercise, especially on a hot day. During pregnancy, your balance changes as the baby grows, so it is important to move carefully and always make sure you are not in danger of falling. Avoid lying flat on your back. You can put a pillow or towel underneath one hip so that you can still participate in exercises that may require this position. Listen to your body for warning signs.

What exercises are not recommended while I’m pregnant?

You should not do exercises that put you at risk for getting hit or kicked in the stomach or falling. Do not do erxercises that involve contact with other persons or heavy lifting. Exercises to avoid are:

  • Hockey
  • Soccer
  • Basketball
  • Skiing
  • Gymnastics
  • Horseback riding
  • High-intensity racquet sports
  • Heavy weight lifting (over 50 pounds)
  • Scuba diving
  • Exercise at high altitudes

Use common sense. If you are not sure about an exercise, you should talk to your health care provider first.

(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Pregnancy and Sex

Is it safe to have sex while I am pregnant?

Yes, it is safe for most women to have vaginal, oral, manual (using your hands), and anal sex throughout pregnancy. Unless your health care provider has told you not to have sex for a medical reason, you can safely enjoy sex in all 3 trimesters of pregnancy. The baby is protected during sex by your cervix (opening to your uterus), the amniotic sac (bag of waters), and the amniotic fluid inside your uterus (womb).

When should sex be avoided?

You should not have sex if you have:

  • Leaking amniotic fluid
  • Preterm labor
  • Vaginal bleeding heavier than spotting
  • Placenta previa (placenta that covers all or part of your cervical opening)

You should avoid touching herpes lesions (sores) on your partner’s mouth or genitals. If you or your partner have new partners while you are pregnant, you need to protect yourself from sexually transmitted infections by using a condom or dental dam. If you have other health concerns about the safety of sex in your pregnancy, talk with your health care provider.

Will my desire for sex change in pregnancy?

Your body goes through many changes during pregnancy, both physically and emotionally. It is common for your sexual desires to be different now that you are pregnant. Some women have more interest in sex during pregnancy, and others have less interest.

Here are some specific changes during pregnancy that can affect how you feel about sex:

  • Many women experience fatigue, nausea, and/or vomiting, which can lead to less desire to have sex.
  • You have more blood flow to your pelvis. This can cause you to be more sensitive to sexual touch, which can make sex more enjoyable for you. Being more sensitive can also cause you to feel either more interested or more uncomfortable during sex.
  • Your breasts become larger and more sensitive. It may be uncomfortable to have them touched during sex.
  • As your pregnancy continues, your uterus (womb) and abdomen (belly) become larger, which may make it difficult to find a comfortable position during sex. Your changing body may affect you or your partner’s desire to have sex.
  • How can I have vaginal sex comfortably while I am pregnant?

There are several ways to make vaginal sex (penis, fingers, or vibrator into the vagina) more comfortable during prregnancy:

  • Make sure your vagina is well lubricated: You may need to use a water-based lubricant.
  • Try different positions: Being on your back with your partner on top of you (missionary position) may not be the most comfortable position for you, especially as your uterus gets bigger. You may find it more comfortable to be on top of your partner, lying on your side, standing, or on your hands and knees. If you are on top of your partner, you can face forward or backward.
  • Talk with your partner: Let your partner know what feels good and what doesn’t. If vaginal sex is painful for you, try changing positions and/or using more lubricant.

What about oral sex, anal sex, and using vibrators during pregnancy?

Oral sex is safe in pregnancy as long as you and your partner don’t have any herpes lesions. Your partner should not blow air into your vagina. Anal sex is also safe during pregnancy. You should be careful not to spread bacteria from the rectum to the vagina. If you’re going to have vaginal sex after anal sex, wash the body part or vibrator that was in your anus before putting it into your vagina. If you have hemorrhoids, you may not want to have anal sex, as it may cause pain or bleeding. You can use a vibrator while you are pregnant. Make sure the vibrator is clean to prevent infection.

Will sex cause me to go into labor?

Sex during pregnancy, especially in the third trimester, may cause you to have some cramps or contractions right after sex and during orgasm. Your orgasm releases a hormone called oxytocin, which can cause your uterus to contract. Male semen contains prostaglandins, which are other hormones that also may cause contractions. Contractions from sex will typically go away over 1 to 2 hours. If they continue or become stronger, contact your health care provider. You may have a small amount of vaginal bleeding or spotting after vaginal sex. This is because there are many small blood vessels in your cervix that can leak when they are touched. Mild spotting for 24 to 48 hours is normal. If your bleeding is heavy, like a period, or continues past 48 hours, contact your health care provider.

What if I don’t want to have sex while I am pregnant?

It is important to talk to your partner. Tell your partner how you feel about sex during pregnancy. Encourage your partner to talk with you about how both of you feel about sex in pregnancy. If sex is not something that is desired or possible, there are many other ways to be intimate including massage, touching and stimulating each other nonsexually, cuddling, or simply spending quality time together. These are ways to be close to your partner without having sex.

How soon after my baby is born can I have sex?

Before you start having vaginal sex again, your postpartum bleeding should have stopped and any tears should be healed. Every woman is different. Some women may feel ready at 4 weeks, while other women may need 10 weeks. Talk openly with your partner, and use other ways to be intimate with each other. When you have sex again, take it slow and use plenty of lubrication. You may want to put a finger into your vagina first before larger objects such as a penis or vibrator. Be sure to talk with your health care provider about birth control if you want to prevent pregnancy.

(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Dental Care in Pregnancy

Why is dental care in pregnancy important?

During pregnancy, you are more likely to have problems with your teeth or gums. If you have an infection in your teeth or gums, the chance of your baby being premature (born early) or having low birth weight may be slightly higher than if your teeth and gums are healthy

What is periodontal disease?

Periodontal disease is an infection in the mouth caused by bacteria. The bacteria use the sugar you eat to make acid. That acid can destroy the enamel (protective) coating on your teeth, which can cause tooth decay (cavities) or even tooth loss. Periodontal disease can begin with gum swelling and bleeding, called gingivitis. If it is not treated, gingivitis can spread from the gums to the bones that support the teeth and to other parts of the mouth. However, your dentist can treat periodontal disease even when you are pregnant.

Why are pregnant women more at risk for periodontal disease?

There are 2 major reasons women can have dental problems during pregnancy:

Pregnancy gingivitis—During pregnancy, changes in hormone levels allow bacteria to grow in the mouth and gums more easily. This makes periodontal disease more common when you are pregnant.

Nausea and vomiting—Pregnant women may have nausea and vomiting or “morning sickness,” especially in the first trimester. The stomach acids from vomiting can also break down the enamel coating of the teeth.

Is it safe to visit your dentist in pregnancy?

Dental care is safe during pregnancy and important for the health of you and your baby. Your dentist can help you improve the health of your mouth during pregnancy. Your dentist can also find and treat problems with your teeth and gums.

What should you know before you see the dentist?

Make sure your dentist knows that you are pregnant. If medications for infection or for pain are needed, your dentist can prescribe ones that are safe for you and your baby. Tell your dentist about any changes you have noticed since you became pregnant and about any medications or supplements you are taking.Routine x-rays should be avoided in pregnancy, but it may be necessary if there is a problem or an emergency. Your body should be covered with a lead apron to protect you and your baby. Dental work can be done safely at any point in pregnancy. If possible, it is best to delay treatments and procedures until after the first trimester.

(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Smoking During Pregnancy

SMOKING DURING PREGNANCY 

KEY POINTS

  • Smoking during pregnancy can cause problems for your baby, like premature birth.
  • If you’re pregnant, don’t smoke and stay away from secondhand and thirdhand smoke.
  • If you need help to quit smoking, tell your health care provider.

WHY IS SMOKING DURING PREGNANCY HARMFUL?

Smoking during pregnancy is bad for you and your baby. Quitting smoking, even if you’re already pregnant, can make a big difference in your baby’s life. Smoking harms nearly every organ in the body and can cause serious health conditions, including cancer, heart disease, stroke, gum disease and eye diseases that can lead to blindness.

HOW CAN SMOKING AFFECT YOUR PREGNANCY?

If you smoke during pregnancy, you’re more likely than nonsmokers to have:

  • Preterm labor. This is labor than starts too early, before 37 weeks of pregnancy. Preterm labor can lead to premature birth.
  • Ectopic pregnancy. This is when a fertilized egg implants itself outside of the uterus (womb) and begins to grow. An ectopic pregnancy cannot result in the birth of a baby. It can cause serious, dangerous problems for the pregnant woman.
  • Bleeding from the vagina
  • Problems with the placenta, like placental abruption and placenta previa. The placenta grows in your uterus (womb) and supplies the baby with food and oxygen through the umbilical cord. Placental abruption is a serious condition in which the placenta separates from the wall of the uterus before birth. Placenta previa is when the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina.

HOW CAN SMOKING AFFECT YOUR BABY?

Tobacco is a plant whose leaves are used to make cigarettes and cigars. Tobacco contains a drug called nicotine. Nicotine is what makes you become addicted to smoking. When you smoke during pregnancy, chemicals like nicotine, carbon monoxide and tar pass through the placenta and umbilical cord into your baby’s bloodstream.

These chemicals are harmful to your baby. They can lessen the amount of oxygen that your baby gets. This can slow your baby’s growth before birth and can damage your baby’s heart, lungs and brain.

If you smoke during pregnancy, your baby is more likely to:

  • Be born prematurely. This means your baby is born too early, before 37 weeks of pregnancy. Premature babies are more likely than babies born on time to have health problems.
  • Have birth defects, including birth defects in a baby’s mouth called cleft lip or cleft palate. Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body. They can cause problems in overall health, in how the body develops or in how the body works.
  • Have low birthweight. This means your baby is born weighing less than 5 pounds, 8 ounces.
  • Die before birth. If you smoke during pregnancy, you’re more likely to have a miscarriage or a stillbirth. Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy. Stillbirth is when a baby dies in the womb after 20 weeks of pregnancy.
  • Die of sudden infant death syndrome (also called SIDS). This is the unexplained death of a baby younger than 1 year old.

WHAT IS SECONDHAND SMOKE?

Secondhand smoke is smoke you breathe in from someone else’s cigarette, cigar or pipe. Being around secondhand smoke during pregnancy can cause your baby to be born with low birthweight.

Secondhand smoke also is dangerous to your baby after birth. Babies who are around secondhand smoke are more likely than babies who aren’t to have health problems, like pneumonia, ear infections and breathing problems, like asthma, bronchitis and lung problems. They’re also more likely to die of SIDS.

WHAT IS THIRDHAND SMOKE?

Thirdhand smoke is what’s left behind from cigarette, cigar and pipe smoke. It can include lead, arsenic and carbon monoxide. It’s what you smell on things like clothes, furniture, carpet, walls and hair that’s been in or around smoke. Thirdhand smoke is why opening a window or smoking in another room isn’t enough to protect others when you smoke.

If you’re pregnant or a new mom, stay away from thirdhand smoke. Babies who breathe in thirdhand smoke may have serious health problems, like asthma and other breathing problems, learning problems and cancer.

IS IT SAFE TO USE E-CIGARETTES DURING PREGNANCY?

Electronic cigarettes (also called e-cigarettes or e-cigs) look like regular cigarettes. But instead of lighting them, they run on batteries. E-cigarettes contain liquid that includes nicotine, flavors (like cherry or bubble gum) and other chemicals. When you use an e-cigarette, you puff on a mouthpiece to heat up the liquid and create a mist (also called vapor) that you inhale. Using an e-cigarette is called vaping.

More research is needed to better understand how e-cigarettes may affect women and babies during pregnancy. Some studies show that e-cigarette vapor may contain some of the harmful chemicals that are found in regular cigarettes. Flavors and other chemicals used in e-cigarettes also may be harmful to a developing baby. If you’re pregnant and using e-cigarettes or thinking about using them, talk to your health care provider.

Just like regular cigarettes, you can become addicted to e-cigarettes. If you drink, sniff or touch the liquid in e-cigarettes, it can cause nicotine poisoning. Signs or symptoms of nicotine poison include feeling weak, having breathing problems, nausea (feeling sick to your stomach) and vomiting. Nicotine poisoning can be deadly. Liquid nicotine in e-cigarettes comes in different flavors and is sold in small tubes that may be bright and colorful. This may make e-cigarettes seem fun and appealing, especially to children.

CAN YOU JUST CUT DOWN ON SMOKING? OR DO YOU HAVE TO QUIT?

If you smoke, you may think that light or mild cigarettes are safer choices during pregnancy. This is not true. Or you may want to cut down rather than quit smoking altogether. It’s true that the less you smoke, the better for your baby. But quitting is best.

The sooner you quit smoking during pregnancy, the healthier you and your baby can be. It’s best to quit smoking before getting pregnant. But quitting any time during pregnancy can have a positive effect on your baby’s life.

Besides, when you quit smoking, you never again have to go outside and look for a place to smoke. You also may have:

  • Cleaner teeth
  • Fresher breath
  • Fewer stains on your fingers
  • Fewer skin wrinkles
  • A better sense of smell and taste
  • More strength and energy to be more active

WHAT ARE SOME TIPS TO HELP YOU QUIT SMOKING?

Try these tips to help you quit smoking:

  • Write down your reasons for quitting. Look at the list when you think about smoking.
  • Choose a quit day. On this day, throw away all your cigarettes or cigars, lighters and ashtrays.
  • Ask your partner or a friend to help you quit. Call that person when you feel like smoking. Stay away from places, activities or people that make you feel like smoking.
  • Keep yourself busy. Go for a walk to help keep your mind off smoking. Use a small stress ball or try some needlework to keep your hands busy. Snack on veggies or chew gum to keep something in your mouth.
  • Drink lots of water.
  • Ask your health care provider about things to help you quit, like patches, gum, nasal spray and medicines. Don’t start using these without your health care provider’s OK, especially if you’re pregnant.
  • Look for programs in your community or where you work that can help you stop smoking. These are called smoking cessation programs. Ask your health care provider about programs in your area. Ask your employer to see what services are covered by health insurance.

Don’t feel badly if you can’t quit right away. Keep trying! You’re doing what’s best for you and your baby.

INFORMATION FROM THE MARCH OF DIMES

Eating Safely in Pregnancy

During pregnancy, you can eat the same things that you normally ate when you were not pregnant. But especially in the first few months of your pregnancy, your baby can be hurt by toxins (poisons) or bacteria (germs). For this reason, you need to be aware of these food dangers and learn how to choose and prepare your food safely.

What Foods Might Be Harmful to My Baby During Pregnancy?

The foods of most concern are certain fish, meat, milk, cheese, and raw foods. Because these are important parts of most diets, you will want to learn to choose the right foods.

What’s the Problem With Fish?

Fish that are large, eat other fish, and live a long time have mercury in them. Too much mercury can cause problems with the development of your baby’s brain and nerves. Some fish may also have dioxins and polychlorinated biphenyls (PCBs). Too much of these toxins may cause problems with the development of your baby’s brain and may cause cancer.

So Should I Just Stop Eating Fish?

No! Fish is a wonderful food. It has lots of good protein and omega-3 fatty acids (omega-3s). Omega-3s are important to your baby’s brain and eye development. You should not eat some types of fish, but should eat two meals of low mercury fish every week to give you the benefits of omega-3s. Raw fish should not be eaten as it may contain parasites (germs) that could harm you or your baby. Fish that are considered safe to eat during pregnancy are listed on the back of this page.

What Meat Is Dangerous?

In the United States, most of our meat is safe to eat. However, meat that has not been kept cold or that has not been prepared properly may have bacteria or parasites. Raw meat may contain toxoplasmosis. Toxoplasmosis is a parasite that can damage your growing baby’s eyes, brain, and hearing.

What Do I Need to Know About Milk and Cheese?

Some cheese may contain bacteria called Listeria. These bacteria can cause a disease called listeriosis which may cause miscarriage, stillbirth, or serious health problems for your baby. To avoid listeriosis, you should not eat soft cheeses like Mexican-style queso blanco, queso fresco, feta, Camembert, blue cheeses, or Brie if the cheese is made with unpasteurized milk. Read the label and do not eat the cheese if the label says it is made with raw milk or unpasteurized milk. If it is made with pasteurized milk and kept in the refrigerator at 40 F or less, it is safe to eat.

What Do I Need to Know About Raw Foods?

Uncooked meats and fish may contain toxoplasmosis and listeriosis and other bacteria that can be harmful during pregnancy. Raw fish like that found in sushi, and raw shellfish like clams and oysters should not be eaten during pregnancy. Raw alfalfa and bean sprouts and unpasteurized fruit and vegetable juices have lots of vitamins but can also contain disease-causing bacteria. Pregnant women should drink only pasteurized juices. Raw and undercooked eggs may have bacteria that can cause food poisoning. Do not eat food with raw eggs like Hollandaise sauce and homemade Caesar salad dressing.

 How Do I Prepare Food Safely?

  • Wash your hands and cooking surfaces often
  • Keep raw meat away from fruit and vegetables and cooked meat
  • Cook your food until it is steaming hot
  • Cook meats until no pink remains
  • Keep uneaten food cold or frozen
  • Keep your refrigerator at 40 F or less
  • Keep your freezer at 0 F or less
  • Throw away food that is left at room temperature for 2 hours or more
  • Do not eat foods if they are past the expiration date on the label
(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Caffeine Contents

Daily caffeine intake should be limited to 200 milligrams (mg), the equivalent of about two cups of coffee.

Milligrams of Caffeine

Coffee (5 fluid ounces), automatic drip

137

Coffee (5 fluid ounces), nonautomatic drip

124

Coffee (5 fluid ounces), automatic percolated

117

Coffee (5 fluid ounces), nonautomatic percolated

108

Coffee (5 fluid ounces), regular instant

60

Coffee (5 fluid ounces), decaffeinated instant

3

Tea (brewed 5 minutes), Black, imported 6 oz

65

Tea (brewed 5 minutes), Black, US 5 oz

46

Tea (brewed 5 minutes), Green, 5 oz

31

Tea (brewed 5 minutes), Decaffeinated

1

Mountain Dew (12 oz)

54

Coca-Cola (12 oz)

45

Pepsi (12 oz)

38

RC Cola (12 oz)

36

Chocolate, Baker’s Brand baking, 1 oz

25

Chocolate, sweet dark chocolate candy, 1 oz

20

Chocolate, milk chocolate candy, 1 oz

6

Chocolate milk, 8 oz

5

Hot Coca, 6 oz

5

Iron Needs in Pregnancy

Iron is a mineral needed to make hemoglobin. This protein in red blood cells carries oxygen to your organs, tissues, and your baby. Large amounts of iron are essential for your own increasing blood volume, and for your baby’s developing blood supply. Because it can be difficult to get the recommended amount of iron daily during pregnancy from diet along, your prenatal vitamin will contain 27-90 mg of this mineral. Your hemoglobin level will be checked early in pregnancy, and again at 26-28 weeks. If iron-deficiency anemia is present, you will need to supplement with an additional iron tablet.

You can increase your iron intake through your diet. Vitamin C will help your body absorb iron. Antacids, calcium, and caffeine, however, can block iron absorption, so avoid taking it with milk, tea, or coffee.

Primary sources of dietary iron are meats, eggs, vegetables, and iron-fortified cereals. 

Other food sources of iron include:

  • Spinach
  • Almonds, cashews, walnuts
  • Soybeans
  • Blackstrap molasses
  • Raisins
  • Liver
  • Chili
  • All-Bran cereal
  • Cream of Wheat
  • Beans: black, pinto, lima
  • Prune juice
  • Peas
  • Beef
  • Pork
  • Shrimp
  • Oatmeal
  • Chex cereal
  • Total cereal

Iron Supplementation for Prenatal Anemia

An iron deficiency called anemia is a common occurrence among pregnant women. Especially in severe cases, such a deficiency will lead to negative effects, which include infant mortality, maternal mortality, and premature birth. Pregnant women will also feel lousy, dizzy, light-headed, and tired when the iron is at a low level. Iron also helps in maintaining your immune system, which is important to have defense from a number of illnesses that can commonly happen during pregnancy. It is also important in the production of enzymes and collagen, a protein that is present in the connective tissues.

How Much Iron Do You Need?

For women who are not pregnant, 18 milligrams of iron is the recommended daily dosage. When you are pregnant, however, you need to have at least 27 milligrams of iron. This is because iron is not only needed by the pregnant woman, but by the baby in the placenta as well. As the iron requirement increases in the second half of pregnancy, you may want to aim for 30-50 mg of iron.

Iron supplements should be taken 1-2 hours before or after meals and with a small glass of orange juice to increase absorption. Do not take it with your prenatal vitamin or with dairy products as the calcium will decrease absorption of the iron.

Can You Have Too Much Iron?

Iron toxicity is only an issue among adults who consume more than 1,000 mg of iron daily. It can lead to diarrhea and constipation.If you go beyond the 27mg of iron that is recommended daily, as long as it is not too much above, the only thing that can happen is that the iron will no longer be absorbed by the body.

How to Choose an Iron Supplement for Pregnancy

There are many options available. As you shop:

  • Look at the dosage of the iron supplement. Remember, you will need to have 27 mg of iron in a day.  However, take note that you will not only get it from the supplement, but also from food intake. This is why even lower doses for a supplement will be fine, as long as you take food rich in iron as well.
  • Be familiar with the different forms of iron supplements that are available, such as capsules, tablet, and liquid. Look at the label and look for one that can be easily absorbed by the body. A slow-release form will also be a great choice.
  • As much as possible, look for a supplement that contains multiple vitamins that will support a healthy pregnancy, not just iron. Vitamin C is one of the most important, since it will help in the improvement of iron absorption.
  • Before you decide which to buy, you also need to be familiar with the different forms of iron that are present in the supplement, such as elemental iron, ferrous sulfate, and ferrous fumarate, among others. Your provider can help you decide which will be best to try for your body’s needs.
    • The equivalent of 60 mg of elemental iron is 300 mg ferrous sulfate heptahydrate, 180 mg ferrous fumarate or 500 mg of ferrous gluconate

Here are some brand names to compare and try:

  • SlowFe. With this supplement, you will get 45 mg of elemental iron, which is equal to 142 mg of ferrous sulfate. This supplement has great potency and is also easy to swallow. It has a controlled-release system, which means it will be able to deliver iron slowly, minimizing possible side effects.
  • FerroSequels High Potency. This supplement provides 65 mg of iron and includes Vitamin C, which will provide a boost for your immune system. It also is timed-release to deliver iron slowly to maximize absorption and minimize upset stomach. It is low in sodium and gluten-free.
  • Floradix. This supplement comes in both liquid and tablet form, so you can decide which your body will tolerate better.
  • Nature’s Plus chewable. If you prefer a supplement you can chew, this one provides potent iron as well as Vitamin C.

Calcium Needs in Pregnancy

FOOD ITEM

SERVING SIZE

CALCIUM CONTENT (mg)

CALORIES

Milk

  • Whole
  • Skim
  • 1%
  • 2%
1 Cup1 Cup

1 Cup

1 Cup

291302

300

297

15085

102

120

Silk Brand Nut Milks(Unsweetened)

  • Almond
  • Cashew
  • Coconut
1 Cup

1 Cup

1 Cup

450450

450

3025

45

Yogurt

  • Plain, low-fat
  • Fruit, low-fat
1 Cup1 Cup 415343 145230
Cheese

  • Mozzarella, part-skim
  • Cheddar
1 oz1 oz 207204 80115
Cheese Pizza, 1/8 of 15” 1 Slice 220 290
Macaroni and Cheese 1 Cup 200 230
Oatmeal, Instant 1 Packet 160 105
Pancakes, from mix 1 4” round 30 60
Wheat Bread 1 Slice 30 65
Tomato Soup (with milk) 1 Cup 160 160
Pork and Beans 1 Cup 140 310
Salmon, canned with bones 3 oz 167 120
Broccoli, raw 1 Spear 72 40
Broccoli, Cooked 1 Cup 354 45

Calcium Supplementation in Pregnancy

All calcium supplements are not equal; some kinds are absorbed better by the body than others. Calcium Carbonate, the most widely used form of calcium, may not dissolve as easily in the stomach as calcium citrate or calcium gluconate, especially in the elderly. However, calcium citrate and gluconate are less concentrated than calcium carbonate. This means that you may have to take more of some kinds of calcium supplements than others to get an equivalent amount of this important mineral.

PRODUCT MG. OF AVAILABLE CALCIUM
Caltrate 600 Carbonate (600 mg)
Caltrate 600 + Vit. D Carbonate (600 mg)
Tums Carbonate (limestone) (200 mg)
Tums E-X Carbonate (limestone) (300 mg)
Tums 500 Carbonate (limestone) (500 mg)
Citracal Citrate (200 mg)
Citracal + D Citrate (315 mg)
Viactiv (chewable) Carbonate (500 mg)
Os-Cal 500or Os-Cal 500 +D Carbonate (oyster shell); This type may contain trace amounts of lead and should be avoided in pregnancy.

Triple/Quad Screens

TRIPLE/QUAD SCREENS

What is it?

The Triple/Quad Screen is a blood test you may choose to have done between 16 and 20 weeks of pregnancy. It is a screening test used to identify pregnancies that are a higher risk to have open neural tube defects, Down Syndrome, or Trisomy 18. The test measures the amounts of three or four substances in your blood: alpha-fetoprotein (AFP); human chorionic gonadropin (hCG); unconjugated estriol (uE3); and Inhibin-A (quad screen only).

Neural Tube Defects

Neural tube defects (NTDs) are abnormalities that occur in the spinal cord or brain of the developing baby. They are seen in about 1 in 1,000 live births. The two major kinds of NTDs are spina bifida and anencephaly. Spina bifida is a defect of the spinal column. There may be little or no physical handicap, or there may be some lower-limb paralysis. Anencephaly is much more severe and far less common. Infants born with this condition usually do not live long after birth.

Small amounts of AFP are normally found in the amniotic fluid and in the mother’s blood. If the baby has an NTD, however, the level of AFP is greatly increased.

Down Syndrome

Down Syndrome is a condition which affects about 1 in 800 newborns. It is the result of a chromosomal abnormality, usually an extra chromosome #21. The risk for delivering a baby at term with Down Syndrome increases with maternal age, especially after 35. At age 24, the risk is about 1 in 1,300; at 35, the risk is 1 in 365; and at 40, the risk is 1 in 109. Babies with Down Syndrome have a distinct appearance, some degree of cognitive disability, and may have defects of the heart.

In the presence of a baby with Down Syndrome, the level of AFP in the mother’s blood is often low, as is the uE3. The hCG and Inhibin-A levels have been found to be higher than normal. The blood levels of each of these substances, in addition to your age, weight, race, and gestational age, are used in the Triple/Quad Screen to determine your risk for having a child with Down Syndrome.

Accuracy of The Test

You must remember that maternal serum screening tests are not diagnostic. They do not give you a “yes” or “no” answer. There are many other kinds of birth defects that cannot be detected by Triple/Quad Screens. The tests will, however, identify those women who may be at a higher risk for NTDs, Down Syndrome, and Trisomy 18. The AFP will detect about 90% of all pregnancies with an NTD.

The combination of AFP, hCG, and uE3 (Triple Screen) will detect about 60-65% of all pregnancies with a baby with Down Syndrome. There is, however, about a 5% false positive rate for Down Syndrome in women under age 35. This means that the results indicate an increased risk for the condition, but the baby does not have abnormalities. The Quad Screen has a Down Syndrome detection rate of 70-75% with a 5% false-postive rate. 

Can Other Conditions Be Detected?

Defects of the baby’s abdominal wall may also be associated with abnormal Triple Screen results, with an increase in the AFP level. Another chromosomal abnormality, Trisomy 18, is associated with low levels of AFP, uE3, and hCG. The Triple/Quad Screen will detect about 60% of fetuses with this condition, which is usually lethal and occurs in about 1 in 8,000 births.

What Does It Mean If Results Are Normal?

Normal levels of AFP, hCG, uE3, and Inhibin-A means your baby probably does not have Down Syndrome, Trisomy 18, or a neural tube defect. It does not, however, guarantee a healthy baby.

What if Results Are Abnormal?

There are several reasons why your Triple/Quad Screen test may be abnormal. The two most common are: you are not as far along in your pregnancy as we believed; or, you are carrying more than one baby. An ultrasound will be done, and if that does not provide an explanation, then you will be offered genetic counseling and amniocentesis. If your risk for Down Syndrome is high (generally greater than 1 in 270), the only way to know with certainty whether or not your baby is affected is by having an amniocentesis. While the risks to the baby are extremely low with amniocentesis, there is a miscarriage rate of about 0.3% (1 in 300).

Should I Have the Test?

Your decision on whether or not to have the Triple/Quad Screen is a personal one. Discuss it with your partner, and bring your questions to your next OB visit. We will be happy to discuss your concerns about the test and the information it provides.

Are Maternal Serum Screens Covered By Insurance?

Nearly all insurance companies cover the Triple Screen test. Because it is newer, coverage for the Quad Screen varies with insurance company. Because it is a more sensitive test, it is the one we recommend. Please verify coverage with your company prior to having any tests.

Cystic Fibrosis Screening

Cystic Fibrosis Carrier Screening

Cystic Fibrosis is an inherited disease affecting about 1 in 3300 Caucasians per year in the United States. The disorder causes problems with breathing and digestion, and the severity of symptoms can vary. The body produces thick mucous in these areas, leading to pneumonia, diarrhea, and poor growth. Some people are only mildly affected, but others have a more severe form of the disease that can lead to an early death. Affected individuals require lifelong medical care. Although there is no cure for CF, a great deal of research is being done on new treatments.

The American College of Obstetrics and Gynecology (ACOG) has recommended that CF carrier testing be offered to “individuals with a family history of CF; reproductive partners of people affected with CF; couples in whom one or both partners is Caucasian and are currently planning a pregnancy or seeking pregnancy care. It is further recommended that screening be made available to couples in other racial and ethnic groups who are at a lower risk and for whom the test may be less sensitive.”

To be affected by the disease, an individual must inherit the CF gene from each parent, thus carrier testing is done on adults. If both parents are carriers, each of their children has a 1 in 4 chance of having CF. Carrier testing is done with a blood sample, and the risk of being a carrier is much higher in Caucasians than other racial or ethnic groups. If there is no one in your family with CF, your risk of being a carrier is shown in the following table:

Racial Group and Risk:

Caucasian     Risk is 1 in 29

Hispanic       Risk is 1 in 46

African American     Risk is 1 in 65

Asian American        Risk is 1 in 90

CF carrier testing is recommended for all women planning a pregnancy or who are currently pregnant. If she tests positive, her partner should also be tested to determine the risk to their children. If both parents test positive as CF carriers, genetic testing is advised for evaluation of the unborn child. If a woman is found to be positiv

e and her partner negative, both may be referred for genetic counseling. The risk for having a child with CF, however, is low.

Although CF testing is recommended by ACOG and the National Institutes of Health (NIH), not all patients desire genetic testing for themselves or their children. You may wish to discuss your questions about CF carrier testing with your provider before making your decision on how to proceed. Early diagnosis of CF is available for your newborn through the Newborn Supplemental Screening Test, which is mandatory for all newborns before discharge from the hospital.

We urge you to contact your insurance company regarding coverage for CF carrier testing. You should also investigate whether the lab with which your insurance company participates can perform the test, and if they do not, what options are available to you. The cost of CF carrier testing varies from $275 to $575 per person.

Miscarriage

A miscarriage is the early loss of a pregnancy. Sometimes health care providers call a miscarriage a spontaneous abortion or SAB. Miscarriage can happen any time between your last period and 20 weeks of pregnancy. After 20 weeks, a pregnancy loss is called a stillbirth. Most miscarriages happen in the first trimester (first 13 weeks of pregnancy).

How common is miscarriage?

Miscarriage is more common than most women think. Miscarriage occurs in 10% to 15% of pregnancies that have been diagnosed. Some miscarriages happen before a woman even knows that she is pregnant.

What causes miscarriage?

Sometimes there are clear reasons, and other times there are no clear reasons. About half of all miscarriages are caused by problems with the genetic makeup of the fetus. Miscarriage is more common in older women and women who have had a miscarriage before. Chronic medical conditions like uncontrolled diabetes and thyroid disease increase the chance a woman will have a miscarriage. Smoking and alcohol use also increase the chance of miscarriage.

What are the signs and symptoms of miscarriage?

The most common signs of miscarriage are vaginal spotting or bleeding, cramping, abdominal pain, or lower backache.  These symptoms do not always mean a woman will have a miscarriage. Sometimes a miscarriage can occur without any symptoms at all.

How is a miscarriage diagnosed?

Usually a miscarriage is diagnosed by an ultrasound.  The ultrasound will show that your baby does not have a heart beat when a heart beat should be seen. Blood tests to check your levels of the pregnancy hormone HCG may also be done if your health care provider thinks you are having a miscarriage.

What is the treatment for a miscarriage?

 There are several treatment options after miscarriage.  The best option for you depends on how far along you were in the pregnancy, your current medical condition, your preferences, and your health care provider’s advice.

Some of the different treatments may include:

• Observation/expectant management

Some women may choose to allow the miscarriage to happen naturally. Usually, the miscarriage will pass within 2 weeks. It is important to tell your health care provider if you have signs of infection (fever, chills, feeling sick) or heavy bleeding (soaking more than 1 maxi-pad in an hour). Sometimes you are unable to pass all of the pregnancy on your own and will need surgery.

• Medication

Women may choose or be advised to take medication to help the body pass the miscarriage.  The medication is either taken by mouth or put in the vagina and usually works within 24 to 48 hours. You may have heavy bleeding and cramping when you pass the pregnancy. Sometimes you are unable to pass all of the pregnancy with medication and will need surgery.

• Surgery

Sometimes surgery is the treatment for a miscarriage.  This may be because a patient prefers it, her health care provider recommends it, or one of the other methods of treatment did not work.  The usual surgery is a D&C (dilatation and curettage). A small suction device is placed in the uterus (womb), and the pregnancy is removed. When this surgery is done, there is a very small chance that the lining of your uterus can be damaged, and you might have trouble getting pregnant again.

• Induction of labor

If the pregnancy was greater than 16 weeks, your health care provider may admit you to the hospital to induce labor.  This is often a long process that may involve the use of several different medicines.

What will happen after I have a miscarriage?

• How long will I have bleeding?

Women may have bleeding like a heavy period for about 1 week after a miscarriage. Don’t put tampons into your vagina or have sex until at least 2 weeks after the miscarriage and only when the bleeding has completely stopped.

• How do I know if the miscarriage was complete?

Sometimes women will have a follow-up ultrasound to make sure the miscarriage passed completely. Other times, an ultrasound is not needed. Sometimes the level of pregnancy hormone HCG in your blood will be monitored until your levels are back to normal. If you bleed through more than 1 maxi- pad in an hour, you should contact your health care provider.

• What if my blood type is negative?

Women who have an Rh-negative blood type will need a shot of RhoGAM after a miscarriage. Usually the shot is given when the miscarriage is diagnosed.

• What feelings will I have?

Women can have different feelings about miscarriage. Having a miscarriage is like losing a baby for many women. Grief is very normal. Other women feel less sad and may even be relieved if they were not planning to be pregnant.  There is no right or wrong way to feel. Ask your health care provider about pregnancy loss support groups and tell your provider if you are feeling depressed.

• When can I start birth control?

Most types of birth control can be started immediately after a miscarriage. Ask your health care provider about specific methods.

• When can I try to get pregnant again?

Most women who had regular periods before miscarriage will return to their normal cycles within 6 weeks after miscarriage. Most women can try to get pregnant again when their periods return and they feel ready emotionally. Talk to your health care provider about your pregnancy plans.

• What is my risk of having another miscarriage?

This depends on many factors including how far along you were, how many miscarriages you have had, and your age. Your health care provider can give you more information about your specific chance of having another miscarriage.

(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Twins!

AM I HAVING TWINS?

Twins naturally occur once in every 41 births, and can be identical (formed from the same egg) or fraternal (formed from two separate eggs). Fraternal twins are more common than identical twins.

Your doctor or midwife can detect whether or not you are carrying “multiples” (twins, triplets or more) fairly early-on in your pregnancy. A quickly growing uterus, or more than one fetal heartbeat (detectable by ultrasound or stethoscope) are signs that you may be pregnant with more than one baby.

Mothers of multiples need to see their doctor or midwife more frequently, may require more prenatal tests, and may need additional time on bedrest. They also require more calories (2,700) each day, and their doctor or nurse-midwife may prescribe extra vitamins and minerals to help their babies grow. A woman pregnant with twins should gain a total of 35-45 pounds.

Important Note: About half of all multiples are born before 37 weeks, so be certain to look for signs of preterm labor.

PARENTING IN THE NICU: CARING FOR MULTIPLES

If you have more than one baby, you have the added challenge of getting to know each infant’s needs and personality. Even in the NICU, your babies can show differences in their medical needs, preferences, how they respond to their surroundings and what they need from you. For instance, one baby might prefer a light touch, while the other prefers a firm hold. One baby might sleep calmly through sudden noises, while the other startles and cries. As you get to know your babies and their unique preferences, you can fit your responses to meet each child’s needs.

Getting to know each child as an individual can be especially challenging at first, because you may feel there is not enough of you to go around. You may feel torn between babies, not knowing who needs you more.

  • Trust yourself to give each infant what he or she needs on any given day, or even hour by hour.
  • If there is a day when you feel especially drawn to one of your babies, spend more time there. Encourage your partner to focus on the other(s).
  • You can enlist the help of family members to spend time with your babies.
  • Let yourself appreciate and rely on the attention given by your babies’ nurses. They are there to help you take care of your little ones.
  • Have confidence that your babies will do just fine, even if your attention is split some time. You can be flexible and so can they. By doing your best, you are given them enough to thrive.

FEEDING

When you have more than one baby, feeding decisions regarding the breast or bottle, breastmilk or formula, can seem complicated. You may be able to breastfeed them all, or one baby may feed better from a bottle. One baby may do better on breastmilk, and another on formula. Or you may try to pump milk for all your babies, and substitute formula when needed.

If breastfeeding them all is your ultimate goal, flexibility is key. Whatever the situation, take your time to figure out what works best for you and your babies. And expect to adjust your plans as your babies grow.

Multiple Gestation

BEING PREGNANT WITH TWINS, TRIPLETS AND OTHER MULTIPLES

KEY POINTS

  • If you’re pregnant with multiples, you and your babies are more likely to have health complications than if you’re pregnant with one baby.
  • You may need to go to extra prenatal care checkups so your health care provider can check you and your babies closely during pregnancy.
  • The most common complication of being pregnant with multiples is premature birth (before 37 weeks of pregnancy).

WHAT CAUSES YOU TO GET PREGNANT WITH MULTIPLES?

A multiple pregnancy (being pregnant with multiples) means you’re pregnant with more than one baby. If you’re pregnant with higher-order multiples, it means you’re pregnant with three or more babies.

Multiple pregnancy usually happens when more than one egg is fertilized by a man’s sperm. But it also can happen when one egg is fertilized and then splits into two or more embryos that grow into two or more babies.

Twins are called identical when one fertilized egg splits into two. Identical twins look almost exactly alike and share the exact same genes. Twins are fraternal when two separate eggs are fertilized by two separate sperm. Fraternal twins don’t share the same genes and are no more alike than any brothers and sisters from different pregnancies with the same mother and father.

Most babies are singleton babies. This means you’re pregnant with just one baby. But more women are getting pregnant with multiples now than in the past. This is mostly because more women are having babies later in life, and you’re more likely to have multiples if you’re older than 30. Also, more women are using fertility treatment to get pregnant. Fertility treatment is medical treatment to help women get pregnant.

HOW DO YOU KNOW IF YOU’RE PREGNANT WITH MULTIPLES?

You may be pregnant with multiples if:

  • Your breasts are very sore.
  • You’re very hungry or you gain weight quickly in the first trimester.
  • You feel movement in different parts of your belly at the same time.
  • You have severe morning sickness. Morning sickness is nausea (feeling sick to your stomach) and vomiting that happens in the first few months of pregnancy, usually in the first few months. It’s sometimes called nausea and vomiting of pregnancy or NVP.
  • Your health care provider hears more than one heartbeat or finds that your uterus (womb) is larger than usual. The uterus is the place inside you where your baby grows.
  • You have high levels of a hormone called human chorionic gonadotrophin (also called hCG) or a protein called alpha-fetoprotein in your blood. HCG is a hormone your body makes during pregnancy. Alpha-fetoprotein is a protein that a developing baby makes during pregnancy.

Your provider uses ultrasound to find out for sure if you’re pregnant with multiples. Ultrasound uses sound waves and a computer screen to show a picture of a baby in the womb.

WHAT KIND OF PRENATAL CARE DO YOU NEED IF YOU’RE PREGNANT WITH MULTIPLES?

If you’re pregnant with multiples, you may need extra medical care during pregnancy, labor and birth. You may need to go to extra prenatal care checkups so your provider can watch you and your babies for problems. You also may need more prenatal tests (like ultrasounds) to check on your growing babies throughout your pregnancy.

If you’ve had pregnancy complications in the past or if you have health conditions that put you at risk for pregnancy complications, your provider may refer you to a maternal-fetal medicine specialist. This is a doctor with education and training to take care of women who have high-risk pregnancies. High-risk means you’re more likely than most pregnant women to have problems with your pregnancy. If you’re referred to this kind of doctor, it doesn’t mean you’ll have problems during pregnancy. It just means he can check you and your babies closely to help prevent or treat any conditions that may happen.

HOW CAN A MULTIPLE PREGNANCY AFFECT YOUR HEALTH?

If you’re pregnant with multiples, you’re more likely than if you were pregnant with one baby to have complications, including:

  • Preterm labor. This is labor that happens too early, before 37 weeks of pregnancy. Preterm labor can lead to premature birth (birth before 37 weeks of pregnancy).
  • Anemia. Anemia is when you don’t have enough healthy red blood cells to carry oxygen to the rest of your body. You may have anemia if your body isn’t getting enough iron. A condition called iron-deficiency anemia is common in multiple pregnancies and can increase your chances of premature birth. Your provider may prescribe an iron supplement for you to make sure you’re getting enough iron.
  • Gestational diabetes. This is a kind of diabetes that only pregnant women can get. If untreated, it can cause serious health problems for you and your babies. Diabetes is when you have too much sugar (called blood sugar or glucose) in your blood.
  • Gestational hypertension or preeclampsia. These are types of high blood pressure that only pregnant women can get. High blood pressure is when the force of blood against the walls of your blood vessels is too high. It can cause problems during pregnancy. Preeclampsia is a condition that can happen after the 20th week of pregnancy or right after pregnancy. It’s when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly.
  • Hyperemesis gravidarum. This is a severe kind of morning sickness or nausea and vomiting of pregnancy (also called NVP).
  • Intrahepatic cholestasis of pregnancy (also called ICP). ICP is a liver condition that slows the normal flow of bile, causing bile to build up in the liver. Bile is a fluid that helps your body break down fats and helps the liver get rid of toxins (poisonous substances). This buildup can cause chemicals called bile acids to spill into your blood and tissues, leading to severe itching.
  • Polyhydramnios. This is when you have too much amniotic fluid. Amniotic fluid is the fluid that surrounds your baby in your uterus (womb).
  • Miscarriage or stillbirth. Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy. Stillbirth is when a baby dies in the womb after 20 weeks of pregnancy. Some women who are pregnant with multiples have a condition called vanishing twin syndrome. This is when one or more babies die in the womb, but one baby survives.

If you’re having multiples, you’re more likely to have these complications after giving birth:

  • Postpartum depression (also called PPD). This is a kind of depression that some women get after having a baby. PPD is strong feelings of sadness that last for a long time. These feelings can make it hard for you to take care of your baby.
  • Postpartum hemorrhage. This is heavy bleeding after giving birth. It’s a serious but rare condition.

HOW CAN BEING PREGNANT WITH MULTIPLES AFFECT YOUR BABIES’ HEALTH?

If you’re pregnant with multiples, your babies are more likely to have health complications, including:

  • Premature birth. Premature babies (born before 37 weeks of pregnancy) may have more health problems or need to stay in the hospital longer than babies born later. Some may spend time in a hospital’s newborn intensive care unit (also called NICU). This is the part of a hospital that takes care of sick babies. Premature babies also may have long-term health problems that can affect their whole lives. More than half of twins and nearly all triplets and other higher-order multiples are born prematurely. The earlier in pregnancy your babies are born, the more likely they are to have health problems.
  • Birth defects. Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body. Birth defects can cause problems in overall health, how the body develops or how the body works. Multiples are about twice as likely as singleton babies to have birth defects, including neural tube defects (like spina bifida), cerebral palsy, congenital heart defects and birth defects that affect the digestive system. The digestive system helps your baby’s body process food.
  • Growth problems. Multiples are usually smaller than singleton babies. Your provider can use ultrasound to check your babies’ growth at prenatal care checkups. When one twin is much smaller than the other, they’re called discordant twins. Discordant twins are more likely to have health problems during pregnancy and after birth.
  • Low birthweight (also called LBW). This is when your baby is born weighing less than 5 pounds, 8 ounces. Babies with LBW are more likely than babies born at a normal weight to have certain health problems, like retinopathy of prematurity. They’re also more likely to have health problems later in life, like high blood pressure. More than half of twins and nearly all higher order multiples are born with LBW.
  • Twin-twin transfusion syndrome (also called TTTS). This condition happens when identical twins share a placenta and one baby gets too much blood flow, while the other baby doesn’t get enough. The placenta grows in your uterus (womb) and supplies your babies with food and oxygen through the umbilical cord. TTTS can be treated with laser surgery to seal off the connection between the babies’ blood vessels and amniocentesis (also called amnio) to drain off extra fluid.
  • Neonatal death. This is when a baby dies in the first 28 days of life. Premature birth is the most common cause of neonatal death.

ARE YOU MORE LIKELY THAN OTHER WOMEN TO GET PREGNANT WITH MULTIPLES?

You may be more likely than other women to get pregnant with more than one baby if:

  • You have fertility treatment. If you’re having fertility treatment, it’s important to try to get pregnant with just one baby. For example, if you’re having a treatment called in vitro fertilization (also called IVF), you can have just one embryo placed in your uterus. This is called single embryo transfer (also called SET). In IVF, an egg and sperm are combined in a lab to create an embryo (fertilized egg) which is then put into your uterus. If you’re having any kind of fertility treatment, talk to your provider about ways to help lower your chances of getting pregnant with multiples.
  • You’re in your 30s, especially your late 30s. If you’re 30 or older, you’re more likely than younger women to release more than one egg during a menstrual cycle (also called your period).
  • You have a family history of multiples. Family history is a record of health conditions and treatments that you, your partner and everyone in your families has had. If you or other women in your family have had fraternal twins, you may be more likely to have twins, too. You’re also more likely to have multiples if you’ve been pregnant before, especially if you’ve been pregnant with multiples.
  • You’re obese. If you’re obese, you have an excess amount of body fat and your body mass index (also called BMI) is 30 or higher.
  • You’re black or Caucasian. Black women are more likely to have twins than other women. Caucasian women, especially those older than 35 years old, are most likely to have higher-order multiples.

HOW ARE MULTIPLES BORN?

If you’re pregnant with multiples, you’re more likely to have a cesarean birth (also called c-section) than if you’re pregnant with one baby. A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus. Most triplets and higher-order multiples are born by c-section.

If you’re pregnant with twins, you may need a c-section if neither baby is in the head-down position or if you have other complications. You may be able to have a vaginal birth if:

  • Both babies are in the head-down position and you have no other complications
  • The lower twin is in the head-down position but the higher twin isn’t.

Vaginal birth is the way most babies are born. During vaginal birth, the uterus (womb) contracts to help push the baby out through the vagina.

DO YOU NEED TO EAT SPECIAL FOODS IF YOU’RE PREGNANT WITH MULTIPLES?

No. But you do need more of certain nutrients, like folic acid, protein, iron and calcium. You can get the right amount of these nutrients by eating healthy foods and taking your prenatal vitamin every day. Prenatal vitamins are multivitamins made just for pregnant women. Compared to a regular multivitamin, they have more of some nutrients that you need during pregnancy. Your provider can prescribe a prenatal vitamin for you at your first prenatal care checkup. Even when you’re pregnant with multiples, you only need to take one prenatal vitamin each day.

HOW MUCH WEIGHT SHOULD YOU GAIN IF YOU’RE PREGNANT WITH MULTIPLES?

If you’re pregnant with multiples, you need to gain more weight than if you were pregnant one baby. The amount of weight to gain depends on your weight before pregnancy and how many babies you have. Talk to your provider about how much weight to gain.

Here’s what you should know about gaining weight if you’re pregnant with twins:

  • If you were at a healthy weight before pregnancy, you want to gain about 37 to 54 pounds during pregnancy.
  • If you were overweight before pregnancy, you want to gain about 31 to 50 pounds during pregnancy.
  • If you were obese before pregnancy, you want to gain about 25 to 42 pounds during pregnancy.

DO YOU NEED TO LIMIT PHYSICAL ACTIVITY IF YOU’RE PREGNANT WITH MULTIPLES?

Talk to your provider about what kind of activities are safe for you to do. You may need to cut out any high-impact activities, like aerobics or jogging, that make you jump or put stress on your joints. But you may be able to do some activities, like swimming, prenatal yoga or walking.

You may need to limit physical activity later in pregnancy, including travel and work. Many women pregnant with multiples go on bed rest. Bed rest means reducing your activities while you’re pregnant. Bed rest may mean staying in bed all day or just resting a few times each day.

Image result for multiple pregnancy images
INFORMATION FROM THE MARCH OF DIMES

Later Pregnancy

Common Questions in Later Pregnancy

What kind of physical changes can I expect during this part of my pregnancy?

The following are common changes that pregnant women experience during their second and third trimesters. Each pregnancy is unique, and you may experience several of these, or none at all.

  • Skin changes: including a darkening around eyes; stretch marks on abdomen, breasts, or upper thighs
  • Varicose veins of the legs, vulva, and anal area (hemorrhoids)
  • Round ligament pain may occur as the enlarging uterus stretches ligaments that help support it, causing sharp pain in the abdomen tat may last only seconds, or several minutes
  • Palpitations (heart pounding) are common for some women during pregnancy. If they are frequent or continuous, please let us know.
  • Joint pain, backache, and hip discomfort
  • Heartburn and indigestion 

My belly gets very tight every once in a while. Are these contractions? Are they normal?

It is normal for the uterus to contract throughout pregnancy. These are called Braxton-Hicks contractions. They may become noticeable to you after about 20 weeks of pregnancy. They are irregular and erratic. If the contractions become regular, coming every 10-15 minutes, you may be experiences preterm labor. Preterm labor is true labor that occurs between 20 and 37 weeks of pregnancy. The following are signs that often occur with preterm labor, although some are a normal part of a healthy pregnancy:

  • Regular contractions (tightenings) every 10-15 minutes. These are often painless.
  • Lower backache, either constant or rhythmic
  • Menstrual-like cramps
  • Increase or change in vaginal discharge
  • Pelvic pressure

If you are experiencing “tightenings” every 10-15 minutes, empty your bladder, then lie down on your left side and drink 3-4 glasses of liquid. If you are still contracting after one hour, please call the office immediately.

How often should my baby move?

You will learn your baby’s own activity pattern. Generally, after 28 weeks, you should feel at least 10 fetal kicks in an hour after a meal. Please call the office any time you are concerned about your baby’s activity.

Are there other things I should report?

Please call any time something concerns you. The following should always be reported:

  • Blurred or double vision
  • Headaches that are unusual or severe
  • Leaking fluid from the vagina
  • A decrease, or lessening, of baby’s activity

What about childbirth classes?

Childbirth classes are strongly recommended for couples having their first child Refresher classes are available for women who have already given birth but need to review breathing techniques for labor. Full classes last five weeks and the refresher is one week.

Because we are concerned about the health and safety of both you and your unborn child, please wear your seat belt. Lap belts must be kept under your growing belly. Shoulder belts can be safely used as normal.

Please feel free to call the office any time you have a question or concern. The Clinical Nurse Specialists (CNS) are available weekdays until about 4:30. A physician or Certified Nurse Midwife (CNM) is on call at all other times and can be reached by calling the office number 717-397-8177.

Second Trimester Baby Development

By now, your baby is sucking his finger, moving his arms and legs, and floating up and down. He may hear and respond to your voice, other voices and even music. He may be startled by other noises in your environment. We encourage you to talk to the baby (older brothers and sisters included), and play music for him. As your baby’s movements become strong enough for you to feel, you’ll begin to learn your baby’s patterns.

DEVELOPMENT CHART

Week 14 Hair and eyebrows are growing. Heartbeat registers on ultrasound. Baby drinks amniotic fluid.
Week 15 Middle-ear bones harden and baby can hear for the first time.
Week 16 Fine hair (called “lanugo”), appears all over the body and face. External genetial organs are visible with ultrasound.
Week 17 Fingernails and toenails begin to appear. Baby hears sounds outside the mother’s body and may jump when startled. Baby may also begin thumb-sucking.
Week 18 Baby measures 8 inches long, and is moving much of the time now.
Week 19 Buds for permanent teeth begin to form. Baby may get hiccups.
Week 20 Baby’s movements can now be felt by mother. Baby weighs between 8 and 16 ounces.
Week 21 Tongue is fully developed, and skin is becoming opaque.
Week 22 A greasy, white substance (known as “Vernix”) is beginning to form on the baby’s skin to protect it. (Most of this vanishes by birth.)
Week 23 Heartbeat is detectable by stethoscope.
Week 24 Lungs are immature, but other vital organs are developed enough for baby to survive outside the womb.
Week 25 Bone centers begin to harden.
Week 26 Fat stores are beginning to form.

Back Pain in Pregnancy

Most women have back pain at some point during pregnancy. The pain can be mild or severe, but it can usually be treated. In some cases, it can be prevented.

Why Do Pregnant Women Have Back Pain?

Pregnancy hormones loosen all of your joints. Your growing abdomen changes your posture. These changes can increase the normal curves that are in your back which can cause back pain. Later in pregnancy the looser joints in the pelvis move more from the growing weight of your baby and this can cause general pain in your lower back and sometimes shooting pain in your buttock or upper legs.

What Makes the Pain Worse?

Lying on your back, sitting upright in a chair, rolling over at night or getting out of bed or out of a chair can cause back pain to be worse.

How Can I Avoid and Reduce Back Pain?

● Avoid siting for long periods of time. Change positions and move frequently.

● Avoid bending; arching, and twisting motions, you will feel less discomfort.

● When lifting heavy things, keep your back straight and use your leg muscles instead of your back when

picking things up.

● Whenever you are sitting, put your feet up on a stool or box so your hips tilt forward and the curve in

your lower back flattens out.

● Many women get pain relief from using moist heat or cold packs, getting a massage, or sitting in a warm bath.

● Some women find wearing supportive, low-heeled shoes or an abdominal support binder can also help.

Gentle exercise, along with walking 20 minutes most days, can relieve or lessen back pain. Exercise helps

strengthen the back muscles, decrease muscle tightness and spasm, and keep the joints in good position.

● Sleeping on your side with a body pillow in your arms and between your knees may help as well.

What is Sciatica?

The sciatic nerve is a large nerve that runs down the back across the buttocks and down the back of your legs. Sciatica is pain in the sciatic nerve which is caused by pressure on the nerve. The symptoms of sciatica that are different from normal back pain in pregnancy are: pain down the buttock and back of your leg past your knee, tingling, numbness, or if you have trouble moving your leg. The treatment for sciatica is the same as the treatment for back pain but your health care provider may also suggest bedrest, and physical therapy. Sciatic pain usually goes away in 1 to 2 weeks.

(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Gestational Diabetes Screen (Glucose Test)

Most women are screened for gestational diabetes between the 24th and 28th week of pregnancy. Women who are considered at high risk (including women who have had gestational diabetes in a previous pregnancy) often are screened at an early prenatal visit. If test results are normal, they are screened again at 24 to 28 weeks.

The test involves drinking a liquid that contains 50 grams of glucose (a form of sugar). One hour later, the health care provider takes a blood sample. The sample is sent to the lab to measure the amount of glucose in the blood.

If the screening test shows that a woman has high levels of glucose in her blood, she needs to take a similar, though longer, test called the glucose tolerance test. It involves drawing blood samples while fasting and at 1, 2 and 3 hours after drinking 100 grams of glucose.

Most women diagnosed with gestational diabetes can control their blood-sugar levels with diet and exercise.

Fetal Movement Counts

FETAL MOVEMENT COUNTS

Your Baby’s Movements

At about 5 months (19-24 weeks), you will begin to feel your baby move, kick, twist, or turn. Usually by 24-26 weeks the baby is moving regularly.

After 28 weeks, a healthy baby moves 10 times or more within 2 hours after you have had something to eat or drink. Remember, babies take naps and will sleep anywhere from 20 to 45 minutes at a time.

How to do a Movement Count

Start when you are 28 weeks pregnant. You should feel your baby move between meals every day. But do the formal movement counting once a day during your baby’s most active time. For many women, this is in the evening, or after a meal.

  • Write down the time you start on the attached chart.
  • Place a check in the box each time your baby kicks, twists, or turns.
  • After your baby has moved 10 times, write down the time again. It may take up to two full hours. 

If your baby has not moved:

  • Eat and drink something such as orange juice, peanut butter crackers, a sandwich, or a glass of milk.
    • Wait about 5 minutes.
    • Rest on your left side, if possible, and try again.

Do movement counts every day after 28 weeks of pregnancy, and fill in the chart.

Please bring the chart with you to your prenatal appointments.

If you do not feel 10 movements in 2 hours during your baby’s most active time, please call the May-Grant office at 717-397-8177 and ask to speak with an obstetric nurse specialist, nurse care coordinator, or provider.

Group B Strep in Pregnancy

What is group B strep (GBS)?

GBS is one of many common bacteria that live in the human body without causing harm in healthy people. GBS can be found in the intestine, rectum, and vagina in about 2 of every 10 pregnant women near the time of birth. GBS is not a sexually transmitted infection and does not cause any vaginal symptoms.

When does GBS cause infection?

GBS can cause your baby to get pneumonia or a blood infection if your baby gets GBS from your vagina during birth. Full-term babies whose mothers carry GBS in the vagina at the time of birth have a 1 in 200 chance of getting sick from GBS during the first few days after birth. Women who have GBS in their vagina during labor can get an infection in their uterus.

How do I know if I carry GBS?

Some women have GBS all the time. In many women, it grows in the vagina at times then goes away and comes back again later. During a prenatal visit when you are between 35 and 37 weeks pregnant, you or your health care provider will collect a sample by touching the outer part of your vagina and just inside the anus with a sterile Q-tip. If GBS grows from that sample, you will be told that you carry GBS and this will be recorded in your chart.

How can newborn infection from GBS be prevented?

If your culture is positive for GBS within 5 weeks of giving birth, it is very likely that you will still have GBS in your vagina when you go into labor. Your health care provider will recommend that you receive the antibiotic penicillin during labor. GBS is very sensitive to penicillin and is easily removed from the vagina. A few IV doses of penicillin given up to 4 hours before birth almost always prevents your baby from picking up GBS during birth.

Do I have to wait for labor to take penicillin?

GBS is usually not harmful to you or your baby before you are in labor. GBS is easy to remove from the vagina, but it is not easy to remove from the intestine. If you take penicillin before you are in labor, GBS will return to the vagina as soon as you stop taking the medication, which does not get rid of GBS in your intestine. It is best to take penicillin during labor when it can get rid of the GBS in your vagina quickly and best prevent your baby from getting sick. The one exception is that GBS can occasionally cause a urinary tract infection during pregnancy. If you get a urinary tract infection, you should be treated with antibiotics at that time. You should also receive penicillin again when you are in labor.

What if I don’t have time to get penicillin while I’m in labor?

If you carry GBS in your vagina at the time of birth and are not able to receive penicillin before your baby is born, your baby will be watched closely for signs of GBS infection. Almost all babies who develop GBS infection will show signs within 24 hours of being born.

How do I know if my baby has a GBS infection?

If your baby gets a GBS infection, symptoms include difficulty breathing (including grunting or being pale), problems with temperature (too cold or too hot), difficulty breastfeeding with more spitting up than usual, or extreme sleepiness that interferes with breastfeeding.

 What is the treatment if my baby has a GBS infection?

If the infection is caught early and your baby is full-term, most babies will completely recover with IV antibiotic treatment. Of the babies who get sick, about 1 in 6 can have serious complications. Some babies who are very sick will die. In most cases, if you carry GBS in the vagina at the time of birth and are given IV penicillin in labor, the risk of your baby getting sick is very rare (about 1 in 4,000).

What if I’m allergic to penicillin?

Penicillin is the best antibiotic for preventing GBS infection. However, women who are allergic to penicillin can receive different antibiotics during labor. Tell your health care provider if you are allergic to penicillin and what symptoms you had when you had that allergic reaction.

(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Rh Negative Blood and Pregnancy

What is blood type?

Your blood type tells you about markers on the surface of your red blood cells. The red cells in your blood can be A, B, AB, or O. The red blood cells also have a protein that is called Rh on the surface of the cell. Your blood can be Rh positive, which means that you have the Rh protein, or Rh negative, which means that you do not have the Rh protein. The letter of your blood group plus the Rh makes your blood type. You can be O+, O−, A+, A−, B+, B−, AB+, or AB−. A test that tells you your blood type is done at your first prenatal visit and usually when you are admitted to the hospital for labor if you are planning a hospital birth.

Why is my blood type important?

If you ever need a blood transfusion, you should be given blood that is your same blood type. You can become very sick if you are given blood that is a different blood type unless it is O blood, which will not cause harm to people who have other blood types.

I am Rh negative. What does this mean for my pregnancy?

Being Rh negative means that you do not have Rh proteins on your red blood cells. If your baby is Rh positive and you get a small amount of your baby’s blood into your circulation (bloodstream) when you are pregnant or when you give birth, your body can make antibodies that hurt and kill red blood cells that are Rh positive.

The most likely time that you would be exposed to your baby’s blood is when you give birth. This is why being Rh negative will not harm your baby during your first pregnancy. But in your next pregnancy, the antibodies that you made when you were exposed to Rh-positive blood at your first birth can cross the placenta and attack the Rh-positive red blood cells, if your next baby has Rh-positive blood. This is called Rh sensitization. Rh sensitization can cause fetal anemia (low iron in the blood), miscarriage, stillbirth, or a serious illness in the baby that is called hemolytic disease of the newborn. Fortunately, Rh sensitization is very rare because women who are Rh negative can get a shot that stops their body from making antibodies to Rh-positive blood.

What is RhoGAM?

RhoGAM is a medicine that stops your blood from making antibodies that attack Rh-positive blood cells. RhoGAM is a sterilized solution made from human blood that contains a very small amount of Rh-positive proteins. These proteins keep your immune system from making permanent antibodies to Rh-positive blood. They do not hurt your baby. RhoGAM is given as an injection (shot).

When do I get RhoGAM?

Although the chance of your blood and the baby’s blood mixing is highest at the time that you give birth, which rarely happens, it can also happen during the last trimester of your pregnancy, when your placenta is growing and the membranes that separate your blood from your baby’s blood are very thin. For this reason, RhoGAM is given at 28 weeks of pregnancy to protect you for the rest of your pregnancy. RhoGAM works for about 13 weeks.

Soon after you give birth, your baby’s blood will be tested for Rh. If your baby has Rh-positive blood, you will get another dose of RhoGAM within 72 hours after you give birth. If your baby’s blood is Rh negative, you will not need the second RhoGAM shot.

Are there any other times that I might need RhoGAM?

Rr hoGAM is also given anytime that your blood could come into contact with Rh-positive blood cells, such as:

  • Any vaginal bleeding during pregnancy
  • Miscarriage
  • abortion

If you are Rh negative and any of these things happen to you, you should contact your health care provider right away. You should get a RhoGAM shot within 72 hours of the possible exposure to Rh-positive blood for the shot to work best.

How safe is RhoGAM?

RhoGAM is very safe. It is recommended for all pregnant women with Rh-negative blood type and has been used for about 50 years. Although RhoGAM is made from human blood, only the very small Rh piece is used. There is a very rare chance that you could get an infection such as HIV or hepatitis from RhoGAM, but this is so rare that there are no reports of it happening. There is also a very rare chance that you will have an allergic reaction to the RhoGAM that causes fever and chills or shortness of breath. It is more common to have a small reaction like redness or swelling where the RhoGAM was injected, usually your upper arm or buttocks.

It is important to know that the risk of developing Rh sensitization is much higher than the risk of problems from the RhoGAM shot. Once that happens, all future pregnancies are at risk for the baby being very sick or dying if the baby is Rh positive. Therefore, not taking RhoGAM is much more dangerous than taking RhoGAM.

Are there women who should not get RhoGAM?

If you have hemolytic anemia, or you have had an allergic reaction to a shot of immune globulin, or you already have Rh sensitization, you should not get the RhoGAM shot.

Is there anything else I need to know about RhoGAM?

It is best not to get some vaccines within 3 months of having the RhoGAM shot. This is not usually a problem because the vaccines that do not work well after getting a RhoGAM shot are never given to pregnant women. This is something to think about if you are planning to travel out of the country within 3 months after giving birth to an area where you need a vaccine called a “live-virus” vaccine. If you are in this situation, talk to your health care provider before you are given the RhoGAM shot. Also, if you have any religious or cultural concerns about taking a blood product, you should talk to your health care provider or religious leader about the risks and benefits.

What if I do not choose to get RhoGAM?

About one in 5 women who do not get RhoGAM will get Rh sensitization, which cannot be fixed once it happens. If you do not get RhoGAM during pregnancy, you should get your blood drawn regularly in the last trimester to see if you have become Rh sensitized. If you do become sensitized, tests to see how your baby is handling the problem will be offered. If the baby has a serious problem, you may need to be induced to give birth early.

(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Third Trimester Body Changes

During the third trimester, you may notice your baby responding to the heat and bright light of being outdoors. As your baby grows, your uterus stretches along with your baby she can’t really run out of room. But now that she is nearly ready to be born, your baby takes up more room in your uterus than she used to. You may notice your baby settling into a favorite position, and you may begin to easily identify where those little kicking feet and tiny stretching arms are. As the third trimester progresses, babies often settle into a head-down position and move lower into the pelvis. After that time, your baby may be more cramped for space and the movements you feel will be different.

CHANGES IN YOUR BODY

  • Hemorrhoids
  • Stretch marks
  • Increased vaginal discharge (call your health care provider if discharge is watery, bloody or has a bad odor)
  • An uncomfortable, itchy rash on your abdomen that may spread to your legs or arms

You may:

  • Feel dizzy and lightheaded. The weight of your baby and uterus on major blood vessels can decrease the blood return to your heart, causing low blood pressure which can make you feel dizzy. Change positions slowly, drink 8 to 10 glasses of water a day, and avoid lying on your back.
  • Feel uncomfortably bloated or swollen. Increased blood supply to the vagina is normal, but it can cause swelling. The pressure of your growing baby and uterus can also cause a feeling of pressure in your groin.

TIPS FOR ALLEVIATING GROIN PRESSURE

  • To improve the flow of blood to your heart, rest with your hips elevated on pillows.
  • Do your Kegel exercise to improve circulation.
  • Place an ice pack on your bottom to numb the tissue and temporarily decrease the amount of blood flow to the area.
  • Put your feet up for several rest periods during the day.
  • Go for a swim.

CONSTIPATION

Constipation is perfectly natural during this point in your pregnancy.

Here are some tips to help avoid it:

  • Drink warm water.
  • Increase your fiber by eating whole grains, beans or lentils and plenty of fruits and vegetables.
  • Drink at least 8 to 10 glasses of fluids a day.
  • Try to exercise more.
  • Ask your health care provider if a stool softener or other measures might help.

HEARTBURN

Your growing uterus is taking up more abdominal space. This, combined with increases in the hormone progesterone, can create the backflow of stomach acid into the esophagus.

Here’s how to minimize it:

  • Avoid greasy, spicy foods and large meals, especially before bedtime.
  • Sleep with your head elevated to decrease the flow of secretions up into your esophagus.
  • Drink milk.
  • If you plan to take an antacid, check with your health care provider.

HOW YOU MAY FEEL EMOTIONALLY

You may feel anxious about labor. You may be increasingly aware of your dependence on your partner. You may be impatient for your baby to arrive. You may be worried that you’ll never see your feet again. This part of your pregnancy you may feel like you are on an emotional roller-coaster.

Share your feelings with other mothers-to-be in your childbirth classes may help relieve your anxiety. Remember to communicate to your partner how you are feeling.

Third Trimester Baby Development

DEVELOPMENT CHART

Week 27 Baby’s hair is longer. Eyelashes and eyebrows are noticeable.
Week 28 Eyes are open and sensitive to light. Baby is approximately 15 inches long and weighs around 3 pounds.
Week 29 Baby gains about 7 ounces a week.
Week 30 Taste buds develop. All of baby’s senses are developed.
Week 31 Vernix (a creamy coating on the skin) and lanugo (fine hairs) begin to disappear. Baby’s head is more in proportion to the body.
Week 32 Skin is less wrinkled, but baby is still thin. Baby is approximately 18 inches long and weighs about 5 pounds.
Week 33 Baby’s movements can be seen on the outside of the mother’s abdomen.
Week 34 Skin is becoming pinker. Baby begins to blink.
Week 35 Fingernails and toenails have grown to the end of baby’s fingers and toes.
Week 36 All organs are mature at this point. Skin is red and smooth. Baby is approximately 19 inches long and weighs about 6 pounds.
Week 37 Deposits of fat continue to form. Baby is considered full-term.
Week 38 Baby gains approximately 1 ounce a day. Baby may begin to move down into pelvic area.
Week 39 Fine hair remains only on arms and shoulders. Fingernails are now beyond the ends of fingertips.
Week 40 Baby is fully developed. Baby is approximately 20 inches long and weighs 7 to 8 pounds.

Pre-Mature Rupture of Membranes (PROM)

Premature Rupture of the Membranes (PROM)

During pregnancy, the baby is surrounded in the uterus by the amniotic sac. The sac is also called the “bag of waters.” It protects and cushions the baby. Premature rupture of the membranes (PROM) is when the amniotic sac breaks before you go into labor. Normally, the sac breaks after labor begins and contractions have started. If PROM happens at 37 weeks or earlier in pregnancy, it is called preterm PROM.

Cross section of pregnant woman's pelvis showing baby developing in amniotic sac in uterus. Placenta is attached to inside of uterus. Placenta is attached to baby by umbilical cord. Closeup detail shows tear in amniotic sac.

Are you at risk for PROM?

Healthcare providers aren’t sure what causes PROM. But certain things seem to make PROM more likely. These are called risk factors. Risk factors for PROM include:

  • Lack of prenatal care
  • Smoking during pregnancy
  • Low body weight
  • Bleeding from the vagina during the 2nd or 3rd trimester
  • Having had a sexually transmitted disease (STD), or an infection in the bag of waters
  • Being pregnant with more than one baby
  • Having had certain medical procedures, such as amniocentesis (a test that takes fluid from the amniotic sac) or cerclage (sewing the cervix closed during pregnancy)

The dangers of PROM

PROM can result in the following serious problems:

  • Germs can travel from the vagina into the uterus and cause a dangerous infection.
  • The umbilical cord can be squeezed, reducing blood flow to the baby.
  • The placenta can separate from the wall of the uterus (placental abruption). This can lead to severe bleeding.
  • The baby can be born too early. This can cause breathing and nervous system problems.

Symptoms of PROM

The main symptom of PROM is fluid leaking or gushing from the vagina. Even though there is loss of fluid, it keeps leaking because the baby is making more. The fluid can be clear or light yellow. Other symptoms include bleeding from the vagina, pain in the lower abdomen or in the low back. If you have any of these symptoms, call your healthcare provider right away.

Evaluating PROM

Your healthcare provider will ask about your symptoms. Mention if you have recently had contractions, bleeding from the vagina, sexual intercourse, or a fever. He or she will then likely do the following:

  • Examine your vagina and cervix.
  • Take a swab of fluid from the vagina. This is examined for the presence of amniotic fluid.
  • Do an ultrasound test to measure amniotic fluid in the uterus.
  • Check your baby’s heart rate.

Treating PROM

PROM is treated based on where you are in your pregnancy:

  • If you are 34 weeks or earlier, you’ll likely be admitted to the hospital. There, you’ll be given antibiotics to prevent infection and to prolong the pregnancy. You may also be given medicine (steroids) to help the baby’s lungs mature. You and the baby will then be carefully monitored for signs of infection. If there is enough amniotic fluid to test, it will be analyzed to check how well the baby’s lungs are developing. The baby’s lungs will also be checked for how they’re developing.
  • If you are between 34 and 37 weeks, labor will likely be induced.
  • If you are at 37 weeks or later, if you don’t go into labor on your own, your provider will recommend induction of labor.

Follow-up care

Work with your healthcare provider. Together, you can take steps to avoid PROM complications. This will ensure your health and the health of your baby.

INFORMAITON FROM KRAMESONLINE

Travel Guidelines

Traveling in later pregnancy is usually fine, but keep a few things in mind:

  • Check the regulations on your specific airline before you travel; many have restrictions on flying in pregnancy.
  • DO NOT FLY after 36 weeks.
  • Take a copy of your prenatal medical file along with you (just in case!).
  • Increase your fluids.
  • For every hour of travel (either in a plane or by car), make sure you move or walk around for 5-10 minutes. This will help prevent swelling and blood clots.
  • Also, if you must remain seated, flexing and extending your calf muscles can help decrease the likelihood of  blood clots in your legs.
  • Make sure to discuss your travel plans with your provider so he or she can give you more specific guidance tailored to your situation.

Placenta Previa

Placenta Previa

Placenta blocking the cervix.Placenta previa is a condition that may happen during the second or third trimester of pregnancy. It’s one of the most common causes of vaginal bleeding during these trimesters. It happens when the placenta implants in the lower part of the uterus. This causes the placenta to block part or all of the opening of the cervix to the vagina (birth canal). It can lead to problems for both the mother and baby, including blood loss and premature labor.

Some factors that make placenta previa more likely

Factors include the following:

  • Multiple pregnancy (carrying more than one baby)
  • Previous pregnancies and deliveries
  • Previous myomectomy (removal of uterine fibroids through an incision in the uterus)
  • Previous cesarean section (if the scar is low and close to the vaginal cervix)
  • Smoking cigarettes

Diagnosing the problem

Placenta previa can cause painless bleeding during the second or third trimester. If this happens, an ultrasound test can confirm the problem. But the problem can be present without bleeding. So your healthcare provider will check the position of the placenta during routine ultrasound exams.

Treating the problem

Depending on the amount of bleeding, the type of placenta previa, and the stage of the pregnancy, the following treatments may be recommended:

  • Partial or complete bed rest for the mother
  • Blood transfusions to replace maternal blood loss
  • Medicines to help mature the baby’s lungs or prevent premature labor
  • Cesarean delivery (this may be done immediately if bleeding cannot be stopped)

During treatment

Even if you are not on bed rest, your healthcare provider may ask you to restrict your activity. You will likely be told to:

  • Avoid intercourse
  • Limit traveling
  • Avoid pelvic exams
INFORMATION FROM KRAMESONLINE

Preeclampsia

The Dangers of High Blood Pressure and Pregnancy: When the pressure of the blood inside your arteries is at a higher level than normal during pregnancy, it could be a sign of serious complications, such as hypertension, preeclampsia and other related disorders.

WHAT IS PREECLAMPSIA?

Preeclampsia is one of the most common complications of pregnancy, occurring in five to eight percent of pregnancies. It is as common in the USA as breast cancer, complicating over 200,000 pregnancies in this country alone. It is characterized by high blood pressure and protein in the urine, but other signs can occur as well. Most cases are very mild and occur near term with healthy outcomes. It can, however, be very dangerous for mother and baby, progressing quite rapidly in some instances. Early diagnosis and proper management by a qualified health care provider is crucial to keeping you and your baby safe.

WHAT ARE THE SYMPTOMS OR SIGNS OF PREECLAMPSIA?

Always trust your instincts if something feels wrong and report any of the following symptoms to your health care provider as soon as possible:

  • Swelling in the hands, feet or face.
  • Headaches that won’t go away, even with medication.
  • Changes in vision, double vision, blurriness, flashing lights or auras.
  • Nausea or upper abdominal pain (often mistaken for “indigestion”, “gallbladder pain”, or the “flu.”
    Nausea late in pregnancy is not normal.)
  • Sudden weight gain of 2 pounds or more in one week.

In addition,

  • High Blood pressure
  • Protein in your urine

Those warning signs are more difficult to recognize without proper instruments such as a blood pressure cuff or dipsticks to measure the protein in your urine. If you are unsure, seek out free blood pressure screening devices at your local pharmacy. Although they are often inaccurate, they will give you some idea if you have high blood pressure.

WHO GETS PREECLAMPSIA?

As many as one in every twelve pregnant women develop preeclampsia, including many who have no known risk factors. Some risk factors have been identified by medical professionals as increasing your chance of developing preeclampsia.

Family history of:

  • Preeclampsia on mother’s OR father’s side of the family
  • High blood pressure or heart disease
  • Diabetes

WHEN DOES PREECLAMPSIA BEGIN?

Usually preeclampsia begins after 20 weeks, during the 2nd or 3rd trimester. For most women, preeclampsia begins to go away as soon as the baby is delivered. Nonetheless, serious complications can occur up to six weeks postpartum and women and their doctors need to be vigilant should signs of preeclampsia occur after delivery. If your blood pressure has not returned to normal after six weeks, you may be referred to a specialist for chronic hypertension.

WHAT IS THE TREATMENT?

The only “cure” for preeclampsia is delivery of the baby. It may still be possible to have a vaginal delivery, but in some situations a cesarean birth might be necessary. Most babies do best if delivery can wait until at least 37 weeks. Bed rest, medication and even hospitalization may prolong your pregnancy. Often, women with preeclampsia will stay in the hospital because the symptoms may suddenly worsen and close monitoring is necessary.

WHAT IS HELLP SYNDROME?

HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome is rare, but one of the most severe forms of preeclampsia. It can occur before you exhibit the classic signs of preeclampsia and is often mistaken for the flu or gallbladder pain. Early diagnosis is critical to aiding pregnant women with HELLP syndrome, as they may have uncontrollable bleeding, liver and blood pressure problems that can result in an adverse outcome for both the mother and the baby, including serious illness or death.

ARE ANY MEDICATIONS USED FOR TREATMENT?

If blood pressure is too high, there are medications that may be used to help bring it down. These medications rarely cause any side effects in the mother and if prescribed, it probably means your blood pressure is high enough to be a greater risk to you or your baby than the medications. One of the rare but possible risks of preeclampsia is seizure. Magnesium sulfate, given in an IV, is recommended for women with preeclampsia during labor or after delivery to prevent seizures. It is safe for the baby, but may cause hot flashes, sweating, increased thirst, vision change, sleepiness, mild confusion, muscle weakness, and shortness of breath in the mother. These side effects will all disappear when the medication stopped.

(INFORMATION FROM THE PREECLAMPSIA FOUNDATION)

Perineum and Perineal Massage in Pregnancy

What Is My “Perineum”?

Your perineum is the area between your vaginal opening and your rectum. This area stretches a lot during childbirth, and sometimes it tears. If your health care provider cuts an episiotomy during birth, it is this area that is cut. You may need stitches after your baby is born if you have a tear or have an episiotomy.

I’m Concerned About Perineal Tears—How Often Do They Occur?

40% to 85% of all women who give birth vaginally will tear. About two thirds of these women will need stitches.

I’m Also Concerned About Episiotomies—Are They Necessary?

An episiotomy is not necessary for most women. Although they were common before the 1990s, they are rarely done today. However, sometimes your health care provider may recommend an episiotomy just as your baby is being born. For example, an episiotomy can help if your baby needs to be born very quickly. You can ask your health care provider to talk with you about episiotomy during a prenatal visit

Can My Health Care Provider Do Anything to Help Me Avoid a Tear?

There are many ways that your health care provider can help to reduce your chance of tearing. For example, your provider may:

  • Apply a warm compress to the perineum just before the baby comes out
  • Recommend specific positions for you to be in as you push
  • Provide gentle downward pressure on the baby’s head as your baby is coming out
  • Ask that you push your baby out between contractions
  • Avoid the use of forceps or a vacuum to help your baby be born

Can I Do Anything Before The Birth To Help Me Avoid a Tear?

Preventing a perineal tear that occurs during birth has been the subject of many research studies. Several studies have found that perineal massage during the last weeks of pregnancy can reduce tearing at birth for women giving birth for the first time. This massage—using 2 fingers to stretch your perineal tissues—is performed by you, in your home, once or twice a week, for the last 4 to 6 weeks of your pregnancy. For every 15 women who do perineal massage, one woman will avoid an episiotomy and perineal tearing that needs stitches. While you massage, you can practice relaxing the muscles in your perineum. This can help you prepare for the stretching, burning feeling you may have when your baby’s head is born. Relaxing this area during birth can help prevent tearing.

Does Perineal Massage in Pregnancy Help All Women?

Massage seems to work better for some women than others. Women having their first baby, women 30 years or older, and women who have had episiotomies before have fewer tears and less severe tears when perineal massage is done during the last weeks of pregnancy.

Can My Partner Help?

Yes! Many women find that it is easier to have their partners do this massage.

Are There Any Risks to Perineal Massage During Pregnancy?

Not that we know of. It is free. It doesn’t hurt. It is easy to do. And most women don’t mind doing it. However, you should check with your health care provider before beginning perineal massage. And, if you believe your bag of waters is leaking, check with your health care provider before putting anything in your vagina.

Instructions for Perineal Massage During Pregnancy

  1. Wash your hands well, and make sure your fingernails are short. Relax in a private place where you can rest with your legs open and your knees bent. Some women like to lean on pillows for back support.
  2. Lubricate your thumbs and the perineal tissues. Use a lubricant such as vitamin E oil, coconut oil, almond oil, or any vegetable oil used for cooking—like olive oil. You may also try a water‐soluble jelly, such as K‐Y jelly, or your body’s natural vaginal lubricant. Do not use baby oil, mineral oil, or petroleum jelly (Vaseline).
  3. Place your thumbs about 1 to 1.5 inches inside your vagina. Press down (toward the anus) and to the sides until you feel a slight burning, stretching sensation.
  4. Hold that stretched position for 1 or 2 minutes.
  5. With your thumbs, slowly massage the lower half of the vagina using a U‐shaped movement for 2 to 3 minutes at most. Concentrate on relaxing your muscles. This is a good time to practice slow, deep breathing techniques.
  6. Partners: If your partner is doing the perineal massage, follow the same basic instructions above. However, your partner should use his or her index fingers to do the massage (instead of thumbs). The same side‐to‐side, U‐shaped, downward pressure method should be used. Good communication is important—be sure to tell your partner if you have too much pain or burning!

   

(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Epidural Anesthesia in Labor

EPIDURAL ANESTHESIA FOR LABOR AND DELIVERY

• Defined as the placement of local anesthetics and/or narcotics into the epidural space for the purpose of pain relief during labor and birth.

• Typically, the catheter is placed when first-time moms are 4-5 cm. dilated. It may be placed earlier in those who have delivered before and are in active labor, or if pitocin augmentation is used.

• Relief is gradual in onset, reaching a maximum at 15-20 minutes. The anesthetic mixture is administered via a continuous infusion to maintain a steady level of relief.

• Laborpatternsmaychangeduringtheinitialanestheticexposure,butoftenreturnto their baseline in 15-20 minutes; pitocin may be required to maintain a good labor pattern.

• Patients will experience some mild numbness of their legs, but motor function is largely retained. The anesthetic will be tailored to your specific needs, with the goal being complete pain relief, a continued awareness of your labor, and no loss of pushing power.

• Side effects are uncommon._ Occasionally a headache may result, which may be sever and require treatment. The incidence is less than 1%. The risk of reaction to the medication is very rare, making it safe for both mother and baby.

• Most insurance companies cover the fee for this procedure in its entirety after deductibles are met. It is recommended that you contact your carrier if you have-any questions.

ANESTHESIA ASSOCIATES OF LANCASTER

My Baby is Overdue!

OVERDUE BABIES

Imagine that you have passed your due date by a week or more. Your family and friends are calling to ask you if you have had the baby (as if you would have forgotten to tell them!) or, worse, why you haven’t yet had the baby. You are more than ready for labor to begin!

You might need to have an induction if your pregnancy has gone two weeks or more past your due date. In this case, your baby may be quite large, your placenta may no longer be functioning adequately, or both.

A physician can induce labor by “stripping” or tearing, the membranes; by placing a synthetic prostaglandin in the cervix; by inflating a small balloon in the cervix; or by administering oxytocin intravenously.

Stripping of the membranes: Your practitioner may insert a finger through your cervix and manually separate your amniotic membranes (water bag) from the lower part of your uterus. This causes the release of prostaglandins that can sometimes initiate labor. Stripping of the membranes is often the first induction method tried.

Artificial rupture of membranes: If your cervix is “ripe” (soft and effacing) and dilated a bit, your body is quite ready for labor and perhaps just needs a jump-start. In this case, your practitioner can use a small hook to snag and break the water bag, which releases the amniotic fluid. This procedure is generally painless. Prostaglandins released in the amniotic fluid can stimulate the start of labor. Your baby’s heart rate and your uterine contractions will be monitored for a period after the procedure. If contractions do not start within several hours, you may receive oxytocin.

Cervical ripening: To stimulate the softening and effacing of the cervix, physicians often use misoprostol, a synthetic prostaglandin used off-label for labor induction. A small tablet is inserted into the vagina, sometimes more than once. Often used before oxytocin, misoprostol occasionally initiates contractions by itself.

The primary danger of misoprostol is that it can cause contractions that come too frequently or last too long. For this reason, the baby’s heart rate and the mother’s uterine contractions are monitored carefully after the drug is administered.

Foley catheter: The practitioner may insert into your cervix a catheter with a very small, uninflated balloon at the end. The balloon is then filled with a small amount of water. This puts pressure on the cervix, and the pressure stimulates the release of prostaglandins. As the cervix dilates, the balloon falls out, and the catheter is removed.

Oxytocin Injection (such as Pitocin): The administration of a synthetic form of the natural hormone oxytocin is the most common method of inducing labor. Causing uterine contractions, this is administered in intravenous fluid in very small doses at first. Over the course of several hours or a day, the amount is gradually increased, just as a woman’s production of natural oxytocin increases as labor begins. Besides causing contractions, this synthetic hormone stimulates the body to produce its own oxytocin.

The chance of a successful induction is much higher if the cervix is soft and partly effaced before an oxytocin injection is given. This is why a synthetic prostaglandin is often administered first. If labor does not begin after a full day of oxytocin injection, the drip may be stopped and restarted the following day. Most inductions are successful by the end of the second day.

[ADAPTED FROM THE JOY OF PREGNANCY)

Signs of Labor

Possible signs: Without other signs, these are not enough to signify labor. They may be due to something else, such as indigestion, fatigue, or physical overexertion.

  • Vague nagging backache causing restlessness and a need to keep changing positions
    • different from “normal” backache felt during pregnancy; may be associated with early contractions
  • Several soft bowel movements, sometimes accompanied by flu-like “sick” feelings
    • probably associated with increases in prostaglandin levels, which ripens and effaces the cervix
  • Intermittent or continuous cramps, similar to menstrual cramps; discomfort may extend to thighs
    • may be associated with prostaglandin action and early labor contractions
  • Unusual burst of energy resulting in great activity; the “nesting instinct”
    • ensures that the mother will have strength and energy to handle labor, so try to avoid overexertion

Preliminary signs:  These are more important than the “possible signs,” but it could still be hours or even days before labor is really underway.

  • Blood-tinged mucous discharge (“bloody show” or mucous plug)
    • associated with thinning and softening of the cervix
    • may occur days before other signs, or not until after progressing contractions have begun
    • a discharge, mistaken for show, may appear after a pelvic exam; this tends to be brownish, whereas show is pink or red
  • Bag of water leaks, resulting in a trickle of fluid from the vagina, but no contractions occur
    • ALWAYS call the office, even if no contractions present
    • not necessarily associated with labor
    • occurs before labor only about 10-12% of the time
  • Continuing, non progressive contractions; they do NOT become longer, stronger, and closer over time. Sometimes called “false” labor, pre labor, or Braxton-Hicks
    • accomplishes softening and thinning of cervix, allowing cervix to begin dilating; should not be perceived as unproductive

Positive signs:  These are the only certain signs that the mother is progressing or in true labor.

  • Progressive contractions, meaning that they become longer, stronger, and closer together over time.
    • It is a clear sign that the cervix is opening if contractions are 5 or fewer minutes apart, and they feel painful, usually in lower abdomen and/or back
    • May be accompanied by bloody show
    • mother cannot be distracted from these contractions
  • Spontaneous rupture of membranes (“water breaks”) with a gush of fluid; may feel a “pop”; along with progressive contractions
    • often associated with rapid cervical dilation
    • usually happens in late labor

Stages of Labor

STAGES OF LABOR GUIDE

STAGE 1: LATENT PHASE OF LABOR

Duration: about 6 hours for 1st baby, 2-4 hours for subsequent babies

Contractions: about 5-10 minutes apart, lasting about 30-60 seconds 

Cervix: dilates to about 3-4 cm, begins to efface (thin)

What you might feel:

  • Backache 
  • Nausea
  • Diarrhea or    constipation 
  • “Nesting” instinct 
  • Excitement, anticipation 
  • Abdominal cramps 
  • Bloody show
  • Regular contractions 

What you can do:

  • Clear liquids; stay hydrated 
  • Controlled relaxation
  • Slow deep breathing with contractlons—begin with any sign of tension
  • Call the office when contractions are 4-5 min. apart or if water breaks 

What your partner can do:

  • Offer encouragement 
  • Help time contractions
  • Help patient with breathing and relaxation

ACTIVE PHASE OF LABOR

Duration: about 4 hours, or 1cm/hr. for 1st baby; 2-4 hours, 2 cm/hr. for subsequent babies

Contractions: about 2-4 min. apart, lasting 45-60 seconds; much stronger 

Cervix: dilates to 8 cm., effacement 100%

What you might feel:

  • Contractions are much stronger, more frequent, usually felt in lower abdomen 
  • Backache
  • Significant mood change: less talkative, more focused on work, introverted 
  • Needs more support from partner/nurse
  • May ask for pain medication/anesthesia (epidural)

What you can do:

  • Continue slow deep breathing 
  • Concentrate on one contraction at a time 
  • Walk, if permitted, or sit in chair
  • Empty bladder frequently

What your partner can do: 

  • Act as go-between you and nursing staff/midwives/doctors
  • Verbally coach 
  • Watch for tension
  • Help change positions 
  • Chapstick (your lips may feel dry from the breathing)
  • Rub back
  • Cool washcloth to face 
  • Encourage and praise!

For Back Labor:

  • Pressure on, or massage, lower back Ice or heat to back
  • Lie on Left side
  • Hands and knees position every 20 minutes

TRANSITION PHASE OF LABOR

Duration: Shortest, most difficult phase; 1.5 min. to 3 hours 

Contractions: May seem continuous, very intense, lasting up to 90 sec. 

Cervix: Dilates to 10 cm (full dilatation)

What you might feel:

  • Contractions feel almost continuous
  • May feel Increasing pressure In lower back and/or rectum 
  • May feel hot and sweaty one minute, then cold and chilled the next
  • Usually feel that you cannot continue anymore
  • May feel an involuntary urge to push 

What you can do:

  • Keep your eyes open and focus on partner/nurse
  • Change to pant/blow breathing to keep from pushing before it is time 
  • Remember, it’s almost over!

What your partner can do:

  • Keep her attention and help her breathe through each contraction 
  • Verbal praise!!!!
  • Remind her that labor is almost over 
  • Cool cloths to forehead
  • Note:  some  women  become  almost   “out of control”  at  this  point,  so  partners should not take anything said or done personally!

  STAGE 2: DELIVERY

Duration: may take up to 2-3 hours for 1.st baby, especially if you have an epidural; may be just a few minutes if you’ve had a child before

Contractions: expulsive in nature; may space out a bit 

What you can do:

  • Push!!
  • Take deep, full breath then bear down as if having a bowel movement 
  • Release tension in your face
  • Open your eyes when told to do so to see your baby being born!

What your partner can do:

  • Help your partner maintain the most comfortable position for pushing
  • Give verbal encouragement 
  • Cool washcloth to face

STAGE 3: DELIVERY OF PLACENTA

Duration: within about 5-10 minutes after birth, but may take up to 30 minutes

Contractions: you may notice some cramping as the uterus contracts to expel the placenta, but you do not have to push

How you might feel:

  • Relieved!
  • You might have  “the shakes” 
  • Crampy
  • Excited
  • Sense of accomplishment!

What you can do:

  • Relax!
  • Focus on baby!

Breathing Techniques for Labor

BREATHING TECHNIQUES FOR THE FIRST STAGES OF LABOR

WHY THE BREATHING WORKS:

Your brain will respond to the strongest stimuli it receives. If you are having a contraction, the main impulse to the brain is pain. If, however, the brain is receiving other strong stimuli (controlled relaxation, concentration, breathing), it will be distracted and your perception of the pain during the contraction will be greatly decreased.Rhythmic Breathing promotes relaxation by reducing muscle tension and anxiety. The breathing techniques also provide a distraction for the woman to focus on other than the discomfort of the contraction.

The Cleansing Breath

  • Done at the beginning and end of every contraction
  • Take a deep breath in through your nose then exhale through your mouth
  • Serves as a signal for mom to relax and focus
  • Lets partner know when con.traction has begun and ended

Slow Relaxed Breathing

  • Inhale slowly through your nose; let your belly expand first, then your chest
  • Exhale slowly through your mouth, with your lips pursed
  • Breathing should be slow and relaxed, about 8-10 per minute
  • Keep a good rhythm, and concentrate on a focal point, with eyes open
  • Rate should be about 1 inhale and 1 exhale every 8 seconds
  • This Is the easiest breathlng technique and requires the least amount of energy; USE IT AS LONG AS POSSIBLE!

Pant-Blow Breathing (Hee-Puff Technique)

  • To be used durlng transition phase of labor, when contractions much stronger
  • Requires mom to focus her concentration on breathing; rather than on the intensity of contractions
  • Aids in controlling the urge to push when not fully dilated
  • Combine panting (“hee”) with regularly occurring “blows” (“puffs”)
  • Blows usually occur after every 3 pants,  but fewer or more “hees’ can be used if necessary
  • If desire to push is felt during a contraction, just “blow” during that time, then return to pattern
  • Remember to begin and end each contraction with cleansing breath

   Hyperventilation

  • Occurs when there is an imbalance of oxygen and carbon dioxide
  • Symptoms:
  • numbness and tingling of lips, fingers
  • lips or fingernails turn blue
  • dizziness
  • Treatment:
  • hold your breath between contractions (with ending cleansing breath)
  • cup your hands over your face and breathe into them
  • breathe into a paper bag

VOLUNTARY EXPULSIVE EFFORTS DURING

SECOND STAGE OF LABOR

WHAT HAPPENS

Uterine contractions during labor will cause the cervix to dilate and the baby to descend somewhat into the vaginal canal. These forces are usually not enough to push the baby out (unless one has given birth previously, or has very small infant). The mother must  aid  the  contractions with her own voluntary expulsive efforts.

The lungs are filled with air, with the chest tilted forward and shoulders slightly rounded, and the abdominal muscles are powerfully contracted to exert pressure.

Pelvic floor muscles (perineal and anal muscles) must remain relaxed during pushing. There is a tendency to tighten these muscles, so you must teach yourself control of these muscle groups by doing Kegel Exercises.

Helpful Hints

  • It helps to think in direction you are pushing, i.e. “down” or “out”
  • Don’t hurry when beginning to push; let the contraction reach a peak, then push with it
  • The longer you can push, the more progress the baby will make down the birth canal
  • Relax thighs, rectum, vagina!
  • Partners: help hold her legs, or support her shoulders, give encouragement and praise

DO NOT PRACTICE PUSHING AT HOME OR IN LABOR UNTIL INSTRUCTED TO DO SO!

When to Call the Office

WHEN TO CALL THE OFFICE

Please call the office (717-397-8177) anytime you experience any of the following conditions:

  • Your contractions are 4 to 5 minutes apart
  • Your membranes rupture (bag of water breaks)
  • You experience bright red bleeding
  • Your experience decreased fetal movement

Time your contractions from the beginning of one contraction to the beginning of the next. They may feel like Braxton-Hicks contractions, when your abdomen becomes very firm, but there will usually be some discomfort with them. Most women feel them as strong menstrual cramps, others have backache or presure, some feel it in the upper thighs. True labor contractions have three characteristics: they get longer, stronger, and closer together over time.

Your  membranes may rupture at any time. You do not have to be having contractions. There may be a sudden gush of fluid, or you may experience a slow leak. Amniotic fluid is usually clear. Always call if you suspect that your water has broken.

You do not need to call if you have a “bloody show” or if you pass a “mucus plug.” As the cervix “ripens” it becomes soft and it thins out (effacement). This may cause you to have a “mucousy” discharge. It may be yellowish, whitish, or blood-tinged, and it does not mean that you are in labor or that you must call the office.

Anytime you are not sure about when your baby last moved, eat and drink something, then lie down on your left side and count the number of kicks in an hour. There should be at least 6 to 10; if not, call the office immediately.

When you call the office, give your name, what number baby this is for you, your contraction pattern, and your due date. Other things to include, especially if this is after office hours, are:

  • broken bag of water and color of fluid
  • breech presentation
  • scheduled for C-section, or previous C-section
  • twins
  • previous rapid labor
  • travel time to hospital

Cord Blood Preservation FAQs

CORD BLOOD PRESERVATION: FREQUENTLY ASKED QUESTIONS

What is cord blood?

Cord blood, or umbilical cord blood, is the blood remaining in your baby’s umbilical cord following birth. It is a rich, non-controversial source of stem cells that must be collected at the time of birth.

What are stem cells?

Stem cells are the building blocks of our blood and immune systems. They are found throughout the body including in bone marrow, cord blood, and peripheral blood. They are particularly powerful because they have the ability to treat, repair, and/or replace damaged cells in the body.

Why do families choose to collect and store their baby’s cord blood?

Today, cord blood stem cells have been used successfully in the treatment of over 70 diseases. For many families, banking their baby’s cord blood offers peace of mind that their family’s stem cells are readily available should they need them. Others save cord blood because of its emerging use in treating Type I Diabetes and Cerebral Palsy, which requires a child’s own cord blood. Stem cells from a related source are the preferred option for all treatment, and transplants using cord blood from a family member are twice as successful as transplants using cord blood from a non-relative (i.e. public source).

How is cord blood collected?

The collection process is safe, easy, and painless for both mother and baby and does not interfere with the delivery. After the baby is born, but before the placenta is delivered, a medical professional will clean a 4 to 8 ince area of the umbilical cord with antiseptic solution and insert a needle collected to a blood bag into the umbilical vein. The blood flows into the bag by gravity until the umbilical vein is emptied. The blood bag is clamped, sealed, labeled, and shipped by courier to a processing lab. The collection itself typically takes about 2 to 4 minutes.

Who can use my newborn’s cord blood stem cells?

Your newborn’s cord blood stem cells have the potential to be used by the child, and, if there is an adequate match, by siblings, and sometimes parents. An adequate match using related cord blood is defined as a 3 of 6 HLA Match. When two people share the same HLAs they are said to be a “match,” which means their tissues are immunologically compatible. With your newborn’s cord blood, there is a 100% probability of an adequate match for the child and a 75% probability for siblings.

How long do cord blood stem cells last?

It is well-established that stem cells are still viable after 15 years of storage. Although there is no definitive data on how long cord blood stem cells last, the New York State Health Department Guidelines for cord blood banking state, “there is no evidence at present that cells stored at -196o C in an undisturbed manner lose either in-vitro determined viability or biologic activity.”

What are the odds of having a stem cell transplant?

The latest statistics suggest there is a 1 in 217 chance for any given individual to undergo a stem cell transplant by age 70.

How much does it cost to preserve cord blood with a Family Bank?

Generally, the cost for blood stem cell preservation as a one time charge of about $2200 and an annual storage fee of about $125. Many companies offer extended payment plans as low as $64 per month.

More information can be found by calling 1-877-CORD FACTS (1-877-267-3322)

Postpartum

Postpartum Recovery Tips

POST-PARTUM RECOVERY TIPS

Below is a list of suggestions that may ease the sting of your symptoms throughout the course of your recovery. Keep in mind that you may not feel well enough to do some of the things listed here. They are reminders that you continue to hold more power than you think you do over the way you feel while you are healing.

The most important thing for you to do right now is to follow your doctor’s treatment plan, continue to take your medication if it has been prescribed for you, and keep in touch with those close to you, letting them know how you are feeling. After that, do what you are able, no more and no less. Take small steps, and try not to be too hard on yourself, taking things one day at a time.

  • Rest when your baby sleeps.
  • Let your partner know how you are feeling.
  • Make your needs a priority.
  • Let others know what they can do to help.
  • Avoid strict or rigid schedules.
  • Give yourself permission to have negative feelings.
  • Screen phone calls.
  • Do not expect too much from yourself right now.
  • Allow yourself a moment to laugh.
  • Avoid overdoing anything.
  • Be careful asking too many people for advice.
  • Trust your instincts.
  • Set limits with your guests.
  • Avoid people who make you feel bad.
  • Set boundaries with people you cannot avoid.
  • Eat well.
  • Avoid caffeine and alcohol.
  • Take a walk.
  • Set small goals for yourself.
  • Stay on all medications you have been instructed to take.
  • Do not be afraid to ask for help.
  • Get out of the house.
  • Do not feel guilty, it wastes energy.
  • Play.
  • Expect some good days and some bad days.
  • Prioritize what needs to be done and what can wait.
  • Thank your partner for helping you.
  • Don’t compare yourself to others.
  • Be very specific about what you need from your partner.
  • Do not blame yourself.
  • Delegate household duties.
  • Do the best you can. If it doesn’t feel like enough, it is enough for now.
  • Encourage your partner to seek support from friends and outside activities.
  • Confide in someone that you trust.
  • Remind yourself that all adjustments take time.

Caring for your Perineum After Birth

After you give birth, your perineum (the area between your vaginal opening and your anus) can feel sore and tender for a couple of weeks.  This is especially true if you had stitches. Even without stitches, your perineum may be swollen and sore. Most women feel much better about 3 weeks after birth. Here are some tips to help you feel better sooner and prevent any problems or complications.

How can I help my perineum heal?

• Sitz Baths — Fill your tub with about 6 inches of warm water and sit in the tub for 10 to 15 minutes at least 2 to 3 times each day. The warm water increases the flow of blood to the perineum, which helps the area heal.

• Rosemary Tea — Make a tea with dried rosemary leaves by pouring very hot water over about 3 table- spoons of the leaves. You can buy these leaves in bulk at many grocery stores. Add the strained tea to the water when you take your sitz bath. Rosemary may help women heal faster, and it smells very nice.

• Kegels — Do Kegel exercises (tightening the muscles of your perineum as if you were trying to stop urinating) often during the day. Kegel exercises also increase the flow of blood to the perineum.

• Numbing Spray—You may have been given a small can of numbing spray for your perineum.You can spray it on your perineum to help with the pain. If you did not get the spray, call your provider and ask for a prescription for numbing spray (lidocaine).

• Arnica — Arnica is a homeopathic treatment. It may help with swelling and bruising. You can buy Arnica pills at most health food stores. Place 2 to 3 of the tiny pills under your tongue 3 to 4 times a day and let them dissolve.  They are safe to use when breastfeeding.

• Fresh Air—When you are lying down to rest or breastfeed, take your underwear off so the perineum is exposed to fresh air.  The area will heal faster if it is dry and warm, which is hard to do when wearing a pad to collect any vaginal bleeding or discharge.

I am constipated. What should I do?

• Water — You need to drink at least 6 big glasses of water a day to keep from getting constipated.  This is especially true if you are breastfeeding.

• High-fiber diet — Eating lots of fruits and vegetables, salads, brown rice, dried fruits (like prunes and figs), and yogurt will help you avoid constipation.

• Stool softener — You may be given a stool softener medication by your provider. You can buy more in any pharmacy without a prescription. Look for docusate (Colace), and take 1 to 2 each day until your stools are so.

 The first bowel movement— The first bowel movement is not going to hurt as much as you think it will. Don’t wait or avoid it, because holding the stool in will make it harder and more difficult to push out. When you feel like you can have a bowel movement, go into the bathroom and make a big ball of toilet paper. While you bear down to have a bowel movement, push up against your perineum in front of the anus with the toilet paper.  is will support the area that hurts and any stitches so they don’t pull. You might urinate on your hand, but you will have a bowel movement without putting painful pressure on your perineum!

It really stings when I urinate. Is that normal?

If you have stitches or even small tears, you can have burning and stinging when you urinate. Get a plastic bottle with a spray top and fill it with warm water before you urinate. Spray the warm water on your perineum while you urinate.  This will dilute your urine and make urinating more comfortable. If you feel pain inside your body or need to urinate more often or can only urinate small amounts, be sure to call your provider. You might have an infection.

I think I have hemorrhoids. What can I do?

• Avoid constipation.

• Use over-the-counter ointments such as Preparation H or Anusol.

• Use witch hazel (Tucks) pads. Witch hazel pads can be found in the drugstore.  They are great to wipe with after you have a bowel movement. You can make your own pads by soaking cotton balls in regular witch hazel (very cheap and available in all drugstores). Witch hazel helps swollen tissue get back to normal.

• Your hemorrhoids will shrink and stop being painful, but they will not ever go away completely.

When should I call my health care provider?

• Fever — If you get a fever of more than 100°F, call your provider.

• Increasing pain—You should be feeling a little better everyday. If you have a big increase in pain in your vagina or perineum or rectum, call your provider.

• Bleeding—You can expect your bleeding to be bright red for 3 or 4 days after giving birth. You may passa few clots in the first 3 to 4 days, especially when getting up or after breastfeeding.  Then the bleeding will become more yellowish and light red and may be very strong smelling for about 10 days.  Then it will become light red or pink spotting for several weeks. You may have a burst of bright red bleeding 10 to 14 days after giving birth when the placenta site heals. As long as it lasts for less than a day and tapers off, that is okay. If you have bright red blood that soaks more than 2 pads an hour and continues for more than 2 hours or if you pass several clots, call your provider.

• Odor — Your discharge will smell pretty strong for several weeks.  This is normal. If the smell gets stronger rather than less strong or starts to smell like fish, call your provider.

Remember, this is going to get better!

Postpartum Depression

Postpartum Depression and the ‘Baby Blues’

Are mood changes common after childbirth?

After having a baby, many women have mood swings. One minute they feel happy, the next minute they start to cry. They may feel a little depressed, have a hard time concentrating, lose their appetite, or find that they can’t sleep well even when the baby is asleep. These symptoms usually start about 3 to 4 days after delivery and may last several days.

If you’re a new mother and have any of these symptoms, you have what are called the “baby blues.”  The “blues” are considered a normal part of early motherhood and usually go away within 10 days after delivery. However, some women have worse symptoms or symptoms that last longer. This is called “postpartum depression.”

What is postpartum depression?

Postpartum depression is an illness, like diabetes or heart disease. It can be treated with therapy, support networks and medicines such as antidepressants. Here are some symptoms of postpartum depression:

  • Loss of interest or pleasure in life
  • Loss of appetite
  • Less energy and motivation to do things
  • A hard time falling asleep or staying asleep
  • Sleeping more than usual
  • Increased crying or tearfulness
  • Feeling worthless, hopeless or overly guilty
  • Feeling restless, irritable or anxious
  • Unexplained weight loss or gain
  • Feeling like life isn’t worth living
  • Having thoughts about hurting yourself
  • Worrying about hurting your baby

Although many women get depressed right after childbirth, some women don’t feel “down” until several weeks or months later. Depression that occurs within 6 months of childbirth maybe postpartum depression.

Who gets postpartum depression?

Postpartum depression is more likely if you had any of the following:

  • Previous postpartum depression
  • Depression not related to pregnancy
  • Severe premenstrual syndrome (PMS)
  • A difficult marriage
  • Few family members or friends to talk to or depend on
  • Stressful life events during the pregnancy or after the childbirth

Why do women get postpartum depression?

The exact cause is not known. Hormone levels change during pregnancy and right after childbirth. Those hormone changes may produce chemical changes in the brain that play a part in causing depression.

How long does postpartum depression last?

It is hard to say. Some women feel better within a few weeks, but others feel depressed or “not themselves” for many months. Women who have more severe symptoms of depression or who have had depression in the past may take longer to get well. Just remember that help is available and that you can get better.

(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Breastfeeding: What to Expect in the Early Days

Is it Important to Breastfeed My Baby?

Breastfeeding is a wonderful way to care for your baby. Breast milk is perfect food for babies. It has all the right nutrients in just the right amounts. The World Health Organization (WHO) says that feeding your baby only breast milk for the first 6 months its life is the best way to keep your baby healthy. WHO suggests continuing breastfeeding along with other foods for the second 6 months.

How Can I Tell if I’m Making Enough Milk?

Right after your baby’s birth, you will have a special type of breast milk called “colostrum” which is very rich. Colostrum is all the food your new baby needs. If you are breastfeeding your baby often during the first 2 days, about 3 to 4 days after your baby’s birth your regular breast milk will “come in.” Your breasts will feel fuller at this time.

One of the best ways to tell that you have enough milk is how often your baby has a bowel movement. After your milk comes in, your baby should have more than 4 bowel movements every day.

Weight gain is another good way to tell that your baby is getting enough milk. It is normal for babies to lose weight in the first few days after birth. But your baby should gain weight after your milk comes in.

My Milk Looks Thin and Watery—Almost Blue. Is That Normal?

Yes. Human breast milk is not like cow’s milk. Your breast milk has a better mix of fat and proteins, which is perfect for human babies!

Is There Anything I Can Do to Make Lots of Milk?

The more you breastfeed, the more milk you will have. At first, you will probably need to breastfeed your baby 10 or 12 times every 24 hours. This will give your body the message to make lots of milk.

How Will I Know if My Baby is Hungry?

Watch your baby to learn the signals that say, “Feed me.” When you see your baby do these things, offer your baby your breast:

  • Moving her hands near her mouth
  • Clenching his fists
  • Making sucking motions with her mouth
  • Rooting (turning his head and mouth toward something that strokes his face)
  • Do not wait until the baby cries to start a feeding. A great time to offer your baby the breast is just as the baby is waking up.

What if Breastfeeding is Uncomfortable?

If you are having pain or any other problems with breastfeeding, get help right away. Some sources of help include:

  • Your health care provider or the baby’s health care provider
  • A lactation specialist. Many hospitals have these special care providers on staff.
  • Your local chapter of La Leche League. These groups of women help each other with breastfeeding.

What to Expect Right After Birth

Holding your baby skin-to-skin is the best way to start breastfeeding. Skin-to-skin contact helps smooth out the baby’s heartbeat and breathing rate. Your baby should be wearing nothing but a hat and a diaper.

Many babies will begin to look for the breast within the first hour after birth. Move your baby close to the breast to help him or her latch on.

Breastfeeding should not be painful. If the first feeding causes pain, ask for help.

Just after birth, it is very common for babies and mothers to be wide awake for a few hours, and then to have a long, restful sleep. This sleep helps you and the baby to recover.

The First Few Days

Many babies are very sleepy in the first few days. You may need to wake your baby to feed. Your baby should be awakened to breastfeed if he sleeps more than 4 hours.

Your milk will probably “come in” about 3 to 4 days after your baby’s birth. Your breasts will fill with milk, and you may even leak milk through your clothes. You may also feel a bit weepy at this time: these are normal changes after birth!

The First 4 to 6 Weeks

After your milk comes in, your baby will probably want to feed 10 to 12 times in 24 hours.

Every baby is different. Some babies may need to feed more often. Others may be able to go longer between feedings.

Lots of women feel like all they do in the first weeks is breastfeed. It takes a while for moms and babies to get nursing down. However, if feedings take a long time, seek help.

Try to make your life a bit easier during this time. Carrying your baby in a sling or pouch, and keeping the baby’s bed near your own will allow you to move around and sleep more easily. Ask family and friends to help with food and house chores. Get help so you can focus on your baby and not worry about anything else.

By 6 to 8 weeks, you will find that you and your baby have gotten into a rhythm. Your baby will usually be able to go longer between feedings. You will begin to get more sleep. And your baby will begin to smile!

(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Preventing Breast Engorgement

For the first few days after giving birth, breasts remain soft and produce colostrum – the first milk. The amounts may seem small, but colostrum is available in just the right amount for the size of your baby’s stomach. Colostrum is rich in nutrients and immune factors which feed your newborn baby and protect him from diseases.

Within 72-96 hours, you will notice changes in your breasts. They will become full, firm, warm, and perhaps tender as milk production increases and colostrum begins to change to mature milk. Breast fullness and mild to moderate swelling is normal. It is caused by milk and extra blood and fluid in the breasts. Your body will use the extra fluids to make milk for your baby. This breast fullness and swelling may last a day or two.

Your breasts will adjust over time, making the exact amount of milk that your baby needs. In cases of extreme or prolonged, painful engorgement, get help from a lactation consultant or healthcare professional. Your baby helps you manage engorgement by removing milk frequently. This means you should breastfeed at least 8-12 times each 24 hours. If your baby is not latching properly or feeding frequently, you may use a breastpump to keep your breasts from becoming overly full. Engorgement reduces the elasticity of the breasts and nipples, leading to more latch problems and sore nipples.

If breast fullness or swelling becomes severe, your breasts may redden and become very painful. If the excessive milk is not removed from the breast, chemical signals are released which can decrease milk production. Unrelieved, prolonged engorgement leads to a lowered milk supply.

A temperature over 100.4 oF or 38 oC may be a sign of an infection. Call your healthcare professional.

Prevention

  • Begin breastfeeding as soon as possible after birth and frequently thereafter to prevent painful engorgement.
  • Avoid early use of bottles and pacifiers while baby is learning to breastfeed.
  • Avoid unnecessary supplements, as this can lower milk supply.
  • Breastfeeding at least 8-12 times in 24 hours is the most important thing you can do to prevent engorgement.
  • Be sure that your baby is latching well. Improper latch can reduce the amount of milk your baby removes from your breasts which can lead to engorgement.
  • Let baby nurse until he finishes each breast. Do not limit baby’s time at the breast.
  • Gently massage and compress the breast when your baby pauses between sucks. This can help drain the milk from the breast.
  • Ask for help from your nurse, lactation consultant or healthcare professional so that latch problems are resolved as soon as possible.
  • If you must miss a feeding or if baby is not nursing well, use hand expression or a breastpump to remove the milk.
  • Seek help if:
    • Engorgement becomes severe or you are in pain.
    • If you develop a temperature over 100.4 F or 38 C.
    • Your baby has trouble latching on.

 Treatment for Engorgement

  • Use relaxation techniques and gentle breast massage to help improve milk flow and reduce engorgement.
  • To start milk flow, use warm moist heat on the breasts for a few minutes, or take a brief warm shower before breastfeeding. Note: Using heat for extended periods of time (over 5 minutes) may make swelling worse.
  • Hand expression or brief use of a breastpump will soften the nipple and areolar tissue, making it easier for baby to latch well and deeply.
  • Pumping once to completely drain the breasts after baby nurses can resolve engorgement for some women. Then return to frequent breastfeeding to manage breast fullness.
  • Gently massage and compress the breast when your baby pauses between sucks. This helps drain the breast, leaving less milk behind.
  • Although research data is scarce, cabbage leaf compresses have been used for generations to reduce pain and swelling from breast engorgement. Apply clean, whole leaves of cabbage to breasts for approximately 20 minutes between feedings 3 to 4 times a day until engorgement subsides.
  • A bag of frozen vegetables wrapped in a thin towel works well as a cold compress. Some women find a cold compress before nursing reduces swelling and helps relieve pain.
  • If your breasts are uncomfortably full, express a little milk by either hand expressing or pumping with a quality breastpump on a low setting. Express just enough until you are comfortable; avoid over stimulating. Use manual expression or a quality breastpump on a low setting.
  • Ask your healthcare professional about medications such as ibuprofen to reduce pain and inflammation.
  • A well-fitted, supportive nursing bra makes some women feel better. Others prefer to go braless during engorgement.
  • Fever higher than 100.4 oF or severe pain may signal a breast infection. Call your healthcare professional if this occurs.
(INFORMATION FROM MEDELA)

Breast and Nipple Care in Breastfeeding

Breastfeeding is meant to be a comfortable and pleasant experience. When you are first getting started with breastfeeding, you may feel awkward – that is common. It will take some practice and patience to get relaxed. Remember, both you and your baby are learning a new skill.

Breastfeeding is not supposed to hurt, but many new mothers find that in the first week or two of nursing, they may experience nipple tenderness and soreness. This is normal and will improve as the baby gets better at nursing.

The key to comfortable breastfeeding is getting the baby attached (or latched) to the breast correctly with your nipple deep into his mouth. The way your baby latches and the positions in which you nurse can help prevent sore nipples. If your nipples are already sore, a proper latch and good positioning will help them heal a little bit faster. It is also helpful to contact a lactation consultant or healthcare professional to assist you in comfortable breastfeeding techniques.

Positioning and Latch Technique

  • You and your baby should be in a comfortable position.
  • You may find it helpful to use some pillows to support your arm.
  • Hold your baby so he is facing you and your breast. His ear, shoulder and neck should be in a straight line.
  • Hold your breast with your thumb on top of your breast and fingers below, well away from the areola (darker part surrounding the nipple).
  • Pointing the nipple upward, tickle his lip until he opens his mouth wide. Be patient, sometimes this takes a minute or two.
  • Bring baby’s chin into your breast and pull him close so he takes in a big mouthful of breast.
  • Keep baby’s body pressed close to yours. This allows the nipple to stay deep in the baby’s mouth. It’s OK if baby’s nose touches the breast.
  • After the first few sucks, you should feel a tug at the breast, but no pain. (In the first few days the latch itself may hurt a bit, but the discomfort should ease over time.)

Signs of a Good Latch

  • Baby sucks actively at the breast.
  • Mouth is opened wide.
  • Lips are flanged outward (like a rosebud).
  • You may hear swallowing.
  • Baby’s chin is touching your breast (nose may also be touching).
  • Baby’s ear, shoulder and hip are in a straight line and baby’s body is facing you.
  • You should feel a tugging at the breast but no “toe-curling” pain after the first few sucks. 

  If your Nipples are Already Sore

  • You may want to begin the feeding on the side that hurts less.
  • Massage your breast for a minute or two before breastfeeding to stimulate the milk flow before baby latches on.
  • If your breasts are full or firm, express some milk to soften the breast and make it easier for the baby to get the breast and nipple far back into his mouth.
  • Make sure the baby is positioned properly with a wide open mouth and has hold of a large mouthful of breast. If baby is sucking on the nipple only, this can be extremely painful and your nipple may become damaged.
  • For pain relief, you can apply a lanolin cream on your nipples and areola after feeding to soothe the tender skin.
  • If your nipples are very sore or there is a break in the skin, a moist environment is recommended for optimal healing. A cooling pad can provide immediate cool and soothing pain relief and promote tissue healing. The pads are placed over the nipple and worn inside the bra between feedings. Lanolin can also be used with the pads if needed.
  • Pads for sore nipples can be worn inside your bra between feedings to allow air to circulate and protect the tender nipples from rubbing on the fabric.
  • If you have tried these comfort measures for a few days and nipple pain increases or you see bleeding or cracks, call a lactation consultant or healthcare professional for assistance.

Helpful Hints

  • When removing baby from the breast, remember to first break the suction by inserting a clean finger into the baby’s mouth between the gums and holding it there while pulling him away.
  • Breastfeed frequently (8-12 times in 24 hours). Watch for early feeding cues such as gentle stirring, being awake and alert, putting his hand to his mouth, etc. It is a good idea to try to breastfeed when baby is calm and alert, before he is crying and upset.
  • Wait until breastfeeding is well established before introducing bottles and pacifiers.
  • Keep bras and bra pads clean and dry.
(INFORMATION FROM MEDELA)

Breastfeeding and Back to Work

The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months. Women everywhere are returning to work and successfully continuing to breastfeed. Advanced planning, family and workplace support, and a high quality breastpump help create success for working moms. The longer babies are breastfed, the greater the health benefits for both mom and baby. Breastfeeding is good for your employer too – it reduces employees’ absence from work for baby’s illnesses.

Breastfeed often in the evenings and learn how to breastfeed lying down while you rest. Nighttime breastfeeding boosts your supply! Remember, pumping takes practice. If you only get a small amount of milk the first few times you pump, don’t worry. With practice and patience you’ll soon be pumping more milk.

Benefits of Breastfeeding

For Baby

  • Breastfed infants have fewer and shorter episodes of illness.
  • Nutrition provided by breastmilk benefits your baby’s IQ.
  • Helps the baby’s immune system mature.
  • Increases effectiveness of immunizations.
  • Fewer allergies.
  • Perfect nutrition.
  • Reduces the risk of obesity and hypertension.
  • Protects against developing chronic diseases.

For Mom

  • Just the right temperature, and it is the healthiest choice at the least cost.
  • Convenient and always ready for baby.
  • Decreases risk of breast and ovarian cancers.
  • Increases the rate of weight loss in most mothers.
  • Breastfed babies are healthier, and mothers miss less work and spend less time and money on pediatric care.
  • Reduces risk of diabetes, heart attack, high blood pressure and stroke.
  • Decreases risk of osteoporosis.

…there are many other benefits to breastfeeding.

Tips for Continued Successful Breastfeeding

  • First Week of Work

Going back to work can be overwhelming. Start slowly, if possible, by returning to work for only a half-day, or mid-week. It is normal to feel tired at first. On days off, nap with your baby, enjoy your time together, and breastfeed often. Protect your milk supply by pumping often while away and breastfeeding when you are with your baby. Avoid having your breasts become overly full, as engorgement sends a signal to your body to slow down milk production.

  • Pumping at Work

The milk you pump at work one day may or can be used the next day to feed your baby. After pumping, cool your milk in a refrigerator or cooler. Store your milk in Medela’s BPA-free breastmilk collection bottles or storage bags specifically designed for breastmilk, such as Medela Pump & SaveTM bags. Freeze milk in 2-4 ounce containers and thaw when needed to use as back-up supply. Use a cooler carrier with frozen ice packs to transport your milk from work or to your daycare provider.

(INFORMATION FROM MEDELA)

Breastfeeding and Birth Control

How do I decide what birth control method is best for me while I am breastfeeding?

Choosing a method of birth control is very personal. First, answer the following questions:

• Do you want to have more children?

• How much spacing between births do you want for your children?

• Do you smoke or have you had any health problems, such as liver disease or a blood clot?

Talk about the answers to each of these questions with your health care provider to help you choose the best method for you.

Can I use breastfeeding as my birth control?

Using breastfeeding as your birth control (the lactational amenorrhea method) can be a good way to keep from getting pregnant in the first months after the baby is born. Each time your baby nurses, your body releases a hormone called prolactin, which stops your body from making the hormones that cause you to ovulate (release an egg). If you are not ovulating, you cannot get pregnant.

 The lactational amenorrhea method works only if:

• you have not started your period yet.

• you are breastfeeding only and not giving your baby any other food or drink.

• you are breastfeeding at least every 4 hours during the day and every 6 hours at night.

• your baby is less than 6 months old.

When any 1 of these 4 things is not happening, you no longer have good protection from getting pregnant, and you should use another form of birth control.

What birth control methods are safe for me to use while I breastfeed?

Methods without hormones

Methods without hormones do not affect you, your baby, or your breastfeeding.

Methods without hormones that are the most effective

  The copper intrauterine contraceptive device (IUD) (ParaGard) is a small, T-shaped device that is in- serted into your uterus (womb) through the vagina and cervix.  The copper IUD lasts for 10 years.

• Sterilization (getting your tubes tied or your partner having a vasectomy) is very effective, but it is per- manent. You should choose sterilization only if you do not want to have more children.

A method without hormones that is effective

  The lactational amenorrhea method described above is effective for the first 6 months.

Methods without hormones that are less effective

• Natural family planning is monitoring your body for signs of ovulation and not having sex when you think you are ovulating.  This method is reliable only if you are having regular periods every month.

• Barrier methods (condoms, diaphragms, sponges, and spermicides) are used at the time you have sex.  These methods are effective only if you use them correctly every time.

Methods with hormones

Birth control methods that use hormones can be used while you are breastfeeding.  They may have a small effect on lowering the amount of milk you make. All hormones will get into your breast milk in very small amounts, but there is no known harm to your baby from this small amount of hormone in breast milk.

Progestin-only methods

 These methods use only 1 hormone, called progestin. You can start them right after your baby is born or wait 4 to 6 weeks to make sure your milk supply is good.

• Progestin-only pills (“minipills”): If you like to take pills every day, you can use the minipill. In order for this pill to work well, you have to take 1 at the same time each day. When you stop breastfeeding, you should start pills that have both estrogen and progestin because they are better at keeping you from getting pregnant.

• Progestin IUD (Mirena):  The progestin IUD is shaped and inserted into the uterus like the copper IUD. It works for up to 5 years. Both IUDs are usually inserted 4 to 6 weeks after the baby is born.

• Progestin implant (Implanon or Nexplanon):  e progestin implant is a small matchstick-sized  exible rod. It is placed into the fatty tissue in the back of your arm. It works for up to 3 years.

• Progestin shot (Depo-Provera):  The progestin shot is given every 3 months.

Combined estrogen and progestin methods

These methods use 2 hormones, called estrogen and progestin.  These methods increase your risk of a blood clot, which is already higher than normal after you have a baby. You should not use them until your baby is at least 6 weeks old.  The combined methods are not recommended as the first choice for women who are breastfeeding. If a combined method is the one that you feel will be best for you to prevent getting pregnant, these methods are okay to use while breastfeeding.

• Combined birth control pills: You take a pill each day.

• Vaginal ring (NuvaRing):  The ring is worn in the vagina for 3 weeks then left out for 1 week before you put in a new ring.

• Patch (Ortho Evra): The patch is placed on your skin and changed every week for 3 weeks then left off  for a week before putting a new patch on a different area of your skin.

(INFORMATION FROM THE JOURNAL OF MIDWIFERY)

Yeast on Nipples

If you have yeast on your nipples:

  • Wash hands often (before and after nursing, after using the bathroom, and before or after changing the baby’s diaper). Use hot, soapy water and paper towels.
  • Nurse frequently for shorter amounts of time. Start nursing on the least sore side. Numb the nipple with ice wrapped in a washcloth before beginning to nurse. Take Advil (unless you are allergic to it) around the clock. If it becomes too painful to nurse, you may want to pump your milk temporarily and feed it to your baby by cup or bottle until the pain lessens.
  • Try drinking green tea 3 or 4 times a day. It may help cleanse your system of excess yeast, and all evidence points to its benefits, so it certainly won’t hurt to try.
  • After nursing, rinse the nipples with a solution of one cup water plus one tablespoon of vinegar. Air dry well. Apply antifungal creams like Lotramin AF or Gyne-Lotramin (containing clotrimazole) or Monistat (containing miconazole). These are available without a prescription. Your doctor may also prescribe an antifungal cream like Nizoral (containing ketoconazole).
  • If pain is severe, apply the cream sparingly after each feeding (6-8 times per day) for 24 hours. Then apply 3-4 times daily. The cream is absorbed quickly, and does not have to be removed before baby nurses. If you feel that some of the ointment remains on your nipple, you may want to gently press a damp warm washcloth on the nipple and areola before nursing. Avoid wearing nursing pads, but if you have to use them be sure to change them at every feeding. Keep the nipples as dry as possible.
  • Decrease consumption of foods containing high amounts of sugar and/or yeast (such as beer, wine, sodas, bread, desserts, etc).
  • Dietary supplements that may be helpful include:
    • Lactobacillus acidophilus (helps promote the growth of “friendly bacteria”). Usual dose 1\4 to 1\2 tsp of powder or 1-2 capsules, 1-4 times per day.
    • Bifadophillus also works well, and does not contact apple pectin, which may limit the supplement’s effectiveness.
    • Acidophilus supplements of up to 24 tablets a day are not harmful, and may be helpful in severe or chronic cases.

Mastitis

MASTITIS

Mastitis is an inflammation of the breast that is often associated with fever (which might be masked by pain medications), muscle and breast pain, and redness. Mastitis can happen at any time during lactation, but it is most common during the first six weeks after delivery. Muscle aches, chills, malaise, or flu-like symptoms are very common.

If you do have an infection, your healthcare provider will probably put you on antibiotics. Here are some things you can do to manage mastitis:

  • Take your antibiotics exactly as directed. If you don’t start to feel better within two to three days of starting antibiotics, please call. You may need a different antibiotic or may have a different problem.
  • Continue breastfeeding, even while you are being treated, and work on your feeding technique, so that your breasts empty well and you avoid nipple cracks. You may need to pump after a feeding to be sure that the breast is empty.
  • Take a mild pain reliever, such as acetaminophen (sample brand name Tylenol) or ibuprofen (sample brand names: Advil, Motrin), if you think it could help.
  • Apply cold compresses or ice packs. Apply warm compresses before breast feeding or pumping to help prevent blocked ducts and to help ensure that the breast is getting completely empty.

To help prevent mastitis: make sure the baby is latching well (see below) to avoid nipple damage/cracks, make sure you avoid engorgement (when the breasts are too full of milk), and avoid blocked/plugged ducts.

The prevent engorgement and blocked ducts you can use warm compresses and massage prior to feeding or pumping to be sure that the breasts are emptying. You should manually massage your breast from the outer part of your breast toward the nipple.

LATCH ON — Latching on refers to the baby’s formation of a tight seal around the nipple and most of the areola with his or her mouth. A correct latch-on allows the infant to obtain an adequate amount of milk and helps to prevent nipple soreness and trauma.

Signs of a good latch-on include:

  • The top and bottom lips should be open to at least 120°
  • The lower lip (and, to a lesser extent, the upper lip) should be turned outward against the breastThe chin should be touching the breast, while the nose should be close to the breast
  • The cheeks should be full
  • The tongue should extend over the lower lip during latch-on and remain below the areola during nursing (visible if the lower lip is pulled away)

When a baby is latched correctly, you may feel discomfort for the first 30 to 60 seconds, which should then decrease. Continued discomfort may be a sign of a poor latch-on. To prevent further pain or nipple trauma, you should insert her clean finger into the infant’s mouth to break the seal and then reposition the infant and assist with latch-on again.)

Signs of poor latch-on include:

  • The upper and lower lip are touching at the corners of the mouth
  • The cheeks are sunken
  • Clicking sounds are heard, corresponding to breaking suction
  • The tongue is not visible below the nipple (if the lower lip is pulled down)
  • The nipple is creased after nursing

Gestational Diabetes: What Happens After Birth?

What is Gestational Diabetes?

Gestational diabetes happens when your pregnancy hormones stop insulin (the hormone that lowers blood sugar) from doing its job of moving sugar out of the blood and into your cells.  This can cause your blood sugar levels to get too high. If you have gestational diabetes, you will change your diet to help your blood sugar levels stay normal and test your blood sugar levels. Sometimes women with gestational diabetes need insulin shots during pregnancy.

What happens to gestational diabetes after my baby is born?

For most women, their blood sugar levels go back to normal quickly after the baby is born. Sometimes women with gestational diabetes will have type 1 or type 2 diabetes after the baby is born. If this is the case, you will need to continue taking medicine to keep your blood sugars in a healthy range.

What is type 2 diabetes?

Type 2 diabetes happens when your blood sugar levels are high because your body does not allow insulin to work well.  This type of diabetes can usually be controlled with exercise and diet. Some people with type 2 diabetes will need to take medicine to keep their blood sugar levels normal.

How can I know if my gestational diabetes is gone?

Your blood sugar should be tested 6 to 12 weeks after your baby is born to make sure you do not have type 2 diabetes.  The best test is a 2-hour glucose tolerance test. You will have a first blood sample taken while you are fasting (have not eaten or had anything to drink except water for at least 6 hours). Then you will drink a sugary drink. Your blood sugar is then tested twice more: 1 hour and 2 hours after you have the sugary drink.  The results of this test will tell your health care provider if you have type 1 or type 2 diabetes, if you have prediabetes, or if your blood sugar is normal.

What if I want to become pregnant again?

Two of every 3 women who have had gestational diabetes before will have it again during their next pregnancy. If your blood sugar was normal 6 weeks after your baby was born and you are not taking any diabetes medication, you should have your blood sugar tested at least 3 months before you start trying to get pregnant. This lets your health care provider know if you have developed blood sugar problems before the pregnancy. This information is important to having a health pregnancy. If you have blood sugar problems, it is important to get your blood sugar levels normal before you have another baby.

What are my chances of getting type 2 diabetes later in life?

Women who have gestational diabetes are more likely to get type 2 diabetes compared to women who do not have gestational diabetes. Of all the women who have gestational diabetes, as many as 7 in 10 will get type 2 diabetes within 10 years. You should have your blood sugar tested for type 2 diabetes at least every 3 years. If you have other risk factors for diabetes such as obesity or a family history of diabetes, you may need to have your blood sugar tested more often. Talk to your health care provider about how often you should have a blood sugar test after your pregnancy.

How can I keep myself healthy and prevent having diabetes in the future?

There are several lifestyle changes you can make to help your body use insulin better.  These changes may help keep you from getting gestational diabetes with your next pregnancy. A healthy lifestyle can also prevent or delay getting type 2 diabetes.

Eat Well: Eat healthy well-balanced meals. It is best to eat 3 small- to medium-sized meals, with snacks in between. Be careful about how much you eat at each meal. Use a smaller plate and split a meal when you eat out. Fill at least half your plate with fruits and vegetables of different colors. Eat 2 to 3 servings of low-fat or fat-free dairy a day. At least half of your grains should be whole grains. Be careful about how much fat you are eating. Drink water or unsweetened drinks instead of sugary drinks like soda and juice, which have lots of sugar and calories.

Stay Active: Exercise at least 30 minutes most days of the week. Your goal is to get your heart rate up and to sweat. Find activities you enjoy. Walk, swim, bike, or dance. You can stay motivated by changing what activities you do. Also, find a friend who will exercise with you. Exercising with a friend or in a class will help you keep exercising regularly.

Lose Weight if You Need to: Losing just a small amount of weight can be very helpful for your health. You can lower your chance of getting type 2 diabetes and heart disease by losing as little as 10 or 20 pounds. Losing weight will also help you feel better about yourself and give you more energy. You can also have a healthier pregnancy next time you have a baby. Set goals and come up with a realistic plan to lose weight. Making changes in what you eat and exercising most days can help you achieve your goals. Any weight you lose and keep off is worth it.

Keep an Eye on Your Blood Sugar Levels: Having diabetes and not knowing it can really affect your health.  This is especially true if you plan to become pregnant again soon. You have a much higher chance of miscarriage (losing the baby early in the pregnancy) and congenital abnormalities (problems with the development of your baby’s organs while the baby is growing in your womb). You should have a glucose tolerance test every 2 to 3 years if your blood sugar was normal after your baby was born. If the results of the blood test you had 6 to 12 weeks after your baby was born showed that you have prediabetes, you need to have a glucose tolerance test every year. Knowing your blood sugar status will help you stay as healthy as possible during your life.

(INFORMATION FROM THE JOURNAL OF MIDWIFERY)