Pregnancy Health Topics

Exercise:
Watch out for activities where you might hit your stomach (ie. Waterskiing, snowskiing, rock climbing) Keep your pulse less than 140. If it is greater than 140, then decrease the intensity of your workout. Don’t exercise to exhaustion. As pregnancy progresses, balance may become more of a problem. Your center of gravity has now shifted, so beware of the potential for falling, particularly with certain types of activity.

Diet:
A well-balanced diet is important in pregnancy. Take a prenatal vitamin every day, make sure to get 1200 mg of calcium daily and drink plenty of water (at least 64 oz/day). Calorie requirements in pregnancy are only 300 calories more than when not pregnant; therefore, be careful not to overindulge. You will need three meals and 2-3 snacks daily.

Intercourse: Intercourse is OK in pregnancy unless you are told otherwise by your physician. Certain positions may be more comfortable than others. As pregnancy progresses, you may notice cramping and low back pain after intercourse. This usually resolves within a few hours.

Travel: Stay close to home after 36 weeks gestation. If you travel after 20 weeks of pregnancy, make sure that you stop the car every 1-2 hours and walk around it; or walk the aisles of the airplane. This will help prevent blood clots in the legs which occur more commonly in pregnancy.

Pets: If you have a cat, please do not change the litter box. This now becomes the job of your significant other. This is to prevent the transmission of toxoplasmosis to your baby. Toxoplasmosis may be excreted in cat feces and can become airborne when changing the litter, which then may be inhaled by you. It is fine to hold and cuddle with your pets, however.

Bleeding: Spotting after an exam or after intercourse may occur and is normal. If bleeding is more significant, expecially if it is associated with pain, please call your doctor.

The following over-the-counter medications may be taken during your pregnancy:

1. Tylenol (including extra-strength and generic acetaminophen) for headaches, aches, & pains
2. Tums, Pepcid, or Zantac for heartburn
3. Sudafed &/or Robitussin for colds (Robitussin DM is fine if you have a cough)
4. Benadryl for allergies and trouble sleeping
5. Monistat, Vagisil or Gynelotrimin for yeast infections
6. Imodium for diarrhea
7. Hydrocortisone cream for itchy skin and rashes
8. Colace, Senokot, or Miralax for constipation
9. Claritin or Claritin D for colds, allergies and congestion

Avoid the following unless recommended by your physician:
1. aspirin, Motrin, Advil, Aleve
2. Pepto-Bismol

If there is anything else you are considering taking that is not on this list, please consult with your physician first.

“Morning sickness” is a common complaint of pregnancy. It usually begins around the sixth week of pregnancy and improves by 12 – 14 weeks. No longer is it something you just need to put up with. There are many tricks to dealing with this condition that can alleviate the symptoms so you can enjoy this part of your pregnancy.

FIRST: Eat small meals & snacks frequently.
Keep a tolerable, bland food by your bedside, such as crackers, and eat a few when you first get up in the morning, even before you get out of bed. Then get up slowly and eat a few more crackers while you sit on the side of your bed. After showering, etc, you may have a small bland breakfast. Food tastes different at this stage of your pregnancy, so just eat what is palatable to you & don’t worry about much variety in your diet. You will need to keep food with you at all times, such as crackers or granola bars. Eat a few bites every hour during the day. Try to avoid drinking from straws, ice, and really hot/cold foods all of which tend to exacerbate nausea.

SECOND: Medications
1. Take vitamin B6 50 mg and ½ Unisom together at bedtime. You can obtain these over-the-counter at any drugstore. They may also be taken before meals, if you find you need extra help; but remember, the Unisom is a sleep aid and may make you sleepy. These have been found to be safe in pregnancy.
2. Ginger supplements have been reported to help with nausea of pregnancy.
3. Wearing “sea bands” – You can find these at the drugstore. They are wrist bands marketed for motion sickness.
4. Prescription anti-nausea medication may be obtained from your doctor, if the above methods fail.

If severe nausea & vomiting continues despite these methods, you must let your doctor know. You may require hydration with IV fluids or home health care or possibly hospitalization.

During your pregnancy, you may find that you are suffering from yeast or vaginal infections, cold or flu, upset stomach, or other complaints. In order to help you take care of these problems or alleviate these symptoms, we provide you with the following information. It is not in any way meant to replace advice from your physician. If you have questions, please discuss them with your doctor.

Yeast infection: if you have had a yeast infection in the past, you are familiar with the white curd-like discharge, itching, and redness of the vagina and vulva. It is safe to use over-the-counter medications (such as Monistat) during pregnancy. Please follow the package directions and use caution when inserting the applicator. Your symptoms should improve in several days, if it does not, it will be necessary for you to schedule an appointment for evaluation.

Common cold: it is safe to take Tylenol, no aspirin or ibuprofen products should be taken during pregnancy. Sudafed or Actifed are also safe to take for congestion. Plain Robitussin or Triaminic without alcohol are also safe. In the event you are experiencing coughing at night that is keeping you from sleeping, Benadryl may be taken. For these medication, please follow the instructions on the package. If you experience a fever of more than 101 degrees, productive cough or discolored sputum, shortness of breath or difficulty in catching your breath, or changes in fetal movement, please contact your doctor immediately.

Heartburn: heartburn is a common complaint during pregnancy. Avoid laying down after eating, and some over-the-counter medications are safe to take during pregnancy. Those are Tums, Maalox, and Di-Gel. Pepto-Bismol is NOT recommended because it is metabolized with aspirin. If your heartburn is accompanied by upper abdominal pain, hypertension, or high blood pressure, swelling and headache, this may be a sign of a pregnancy complication called "HELLP Syndrome." Please contact your physician for further evaluation.

Most women deliver their babies vaginally. However, approximately 24-29% of pregnant women in the United States deliver by cesarean section, so it is important to be prepared for each route.

When you are admitted to the hospital for labor, your contractions and the baby’s heart rate are monitored. A small device is attached to your belly by an elastic waistband, which is then connected to a bedside machine by a long cord. You are able to move around and if the baby is looking good, you can even come off the machine for short periods of time. If you would like pain medication, you have the choice of either IV medication or an epidural. IV medicine will not completely take the pain away but decreases the intensity and will also make you sleepy. It does not last very long, so may need to be re-administered. It also should not be given too close to time of delivery. An epidural is medicine placed through a catheter that goes into your back. This is the most popular choice for pain relief. The pain medicine can be continuously infused so it will last throughout labor, delivery and for any repair that is necessary after the baby is born. The most common side effect of an epidural is a spinal headache that occurs less than 1% of the time and usually resolves within 24 hours.

Once your cervix has completely dilated, you are now ready to begin pushing. If this is your first baby, it is not uncommon for the pushing to take 1-2 hours, sometimes even three. It’s not as simple as it is on TV. Your doctor may decide that an episiotomy (cut in the vagina to allow more room) may be necessary. This is not done routinely, however, and the physicians at Oasis try to avoid an episiotomy.

When the baby has completely delivered, the cord will be clamped and may be cut by the father of the baby. If the baby is doing well, he or she will be placed on your abdomen. If you have any tears or an episiotomy that needs to be repaired, it is then performed while you are examining your new baby.

Problems may occur during labor which may require a cesarean section. This is performed for many reasons, such as: previous c-section, failure of the cervix to dilate fully, arrest of descent of the baby’s head, malpresentation of the baby (e.g. Breech), or compromise of the mother or baby (e.g. decelerations of the baby’s heart rate). Usually, the c-section is performed while you are awake, under epidural or spinal anesthesia. A catheter will also be placed in your bladder to keep it empty so it does not get in the way of the operating field. Usually a bikini incision is made in your abdomen. The baby is then delivered within minutes. You will be able to see the baby right away. After surgery, you may consume solid foods, as long as you are not nauseated. The catheter in your bladder will be removed the day after surgery. You will be kept comfortable with pain medication as needed. Most women go home from the hospital after two days. Now is when the difficult part begins – raising your beautiful child for the next 18 years. Congratulations!

If you are going to be age 35 or greater at the time of delivery, you are given a diagnosis called AMA, or Advanced Maternal Age. While this may not seem like a flattering term (we at Oasis OB/Gyn think this age is downright young), there is a reason behind the diagnosis. Women at this age are at increased risk of having a baby with a genetic abnormality when compared to younger women. The most common abnormality women think of is Down Syndrome. The risk increases throughout your childbearing years but on a much steeper slope after age 35. For example, the risk of Down Syndrome at age 35 is 1 in 270, at age 40 it is 1 in 100 and at age 45 it is 1 in 40 vs. approximately 1 in 2-3000 for women in their twenties. The risk for all abnormalities is further increased. However, please keep in mind that your chance of having a healthy baby is still greater and most women go on to have very successful pregnancies. Because of the increased risk, we do offer genetic testing early in your pregnancy. This can be accomplished by a screening test or a definitive test, such as amniocentesis or chorionic villus sampling.

Amniocentesis is performed typically between 14-16 weeks by inserting a needle through your abdomen into the uterine cavity to withdraw fluid from around the baby. This fluid is then sent for a chromosome (genetic makeup of the baby) analysis. The complication rate is approximately 0.5%. Chorionic villus sampling, or CVS, can be performed earlier, 10-12 weeks, with a slightly higher complication rate of 1%. This is accomplished by passing an instrument through the cervix to remove a very small piece of placenta, which is then sent for a genetic analysis.

Screening tests are becoming popular options for all ages of women, as they do not increase risk to the fetus. The ultrascreen is performed near the end of the first trimester. It involves a fingerstick for blood and an ultrasound to measure the back of the baby’s neck. A risk assessment is then given to determine if you are at increased risk of having a baby with certain genetic disorders, such as Down Syndrome. If so, an amniocentesis may be recommended. Many times, the risk is found to be less than your age related risk, in which case women of advanced maternal age may avoid a more invasive procedure.

Another screening test may be performed during the second trimester, if you decline the first trimester screening. It involves drawing blood to analyze certain proteins in your blood, which then gives a risk assessment for disorders, such as Down Syndrome and spina bifida. If the risk is elevated, an amniocentesis may be recommended.

For many women, it is difficult deciding whether or not to have genetic testing. All these tests are optional. Some women choose testing, as they may terminate the pregnancy if their baby has a genetic abnormality. Some abnormalities found are incompatible with life. Other women may not terminate, but want as much preparation time as possible should there be an abnormality. Still others may worry about the possibility of an abnormality so much that testing is a way of putting their mind at ease. Whatever your decision, it is a personal one. We respect & support your decision

Congratulations, you are having twins! Does this mean two times the fun or two times the work? - Probably a little of both. No doubt you are a bit apprehensive about the upcoming onslaught of diapers, bottles and noise at your house.

The first challenge is surviving the twin pregnancy and we know you can do it well. There are some things you will need to know. First of all, you do not need to eat much more than if you had only one baby. Eat a well-balanced diet in moderation. You will need three meals a day and two to three snacks a day. Exercise is fine, as long as you are not having contractions. The intensity of exercise, however, will need to be decreased. Swimming and brisk walking are excellent forms of exercise, but leave the marathons for after pregnancy.

Many moms of twins experience more severe morning sickness. This is normal, but uncomfortable and there are many remedies. Please see our handout on Nausea & Vomiting of Pregnancy for many tips on controlling the morning sickness.

Your doctor will see you more frequently than if you were having an uncomplicated singleton pregnancy. Monthly ultrasounds for growth are performed beginning at 20 weeks gestation. Sometimes one baby will grow much more than the other so your doctor will want to know if this is happening. Non-stress testing will begin at 30-32 weeks gestation. This is a test that monitors the babies’ heart rates over 20-30 minutes time and is a measure of their well being. It will be performed twice weekly and is an excellent opportunity for you to sit-back & relax.

There are certain complications that occur more frequently in twin pregnancies that you need to be watching. Preterm labor, contractions with cervical dilatation that occurs prior to term, is not uncommon with twin pregnancies. If you are having 4-6 contractions in an hour, please rest and if they do not go away or they get stronger or more frequent, go to labor and delivery immediately. Other conditions such as elevated blood pressure, preeclampsia, diabetes and stillbirth are also more frequent, so your doctor will be watching you closely for any of these problems at each visit. If you notice severe headaches that don’t go away with rest or Tylenol, blind spots in your vision, constant nagging upper abdominal pain, decreased movement of the babies, or a sudden increase in swelling; please call your doctor.

Oftentimes, twin pregnancies do deliver sooner than if you were having only one baby. However, many pregnancies can make it to term (37 weeks & beyond). Depending on the position of the babies at the time of delivery, a cesarean section may be recommended.

Remember, this is a special time and we at Oasis OB/Gyn wish you the best. We will strive to help you in any way we can. We also recommend Mothers of Multiples support group and you may find more information about this group at www.nomotc.org. Another great website is www.twinstuff.com.

Between 26-28 weeks gestation, your doctor will ask you to take a screening test for diabetes in pregnancy. Many of the hormones produced by the placenta during pregnancy actually antagonize, or fight, the effects of insulin, which may cause a diabetic state. This results in abnormal sugar metabolism, which will usually resolve after delivery. However, women with gestational diabetes are more at risk of developing type II diabetes mellitus in the future.

The test requires that you consume a sugary drink provided by our office. One hour after consuming the beverage, your blood is drawn and the glucose (sugar) level is assessed. If your glucose level is elevated, you will then be asked to take a more definitive test called the three-hour glucose tolerance test. This requires consumption of another sugary beverage, but your blood is drawn prior to the drink; then one, two & three hours after consumption.

If the three-hour test is abnormal, you are given the diagnosis of gestational diabetes. It is important to control your blood sugar level during pregnancy. An out-of-control level can cause the baby to grow too big and the baby can have problems controlling his own blood sugar after delivery. Therefore, your doctor will recommend diabetic education and the implementation of a diabetic diet. You will be asked to check your blood sugar 2-4 times a day and report the values to your doctor on a regular basis. Most of the time, the disease can be kept under control by diet alone. Sometimes, however, medications may need to be instituted.

After delivery, you may go back on your usual non-pregnant diet. At your 6-week post-partum visit, your doctor will order a two-hour glucose test to make sure that you do not have any residual diabetes.

Preterm labor is the presence of contractions with cervical dilatation occurring prior to 37 weeks of pregnancy. However, when this occurs prior to 34 weeks, your doctor may be more aggressive at stopping labor. You may need to be hospitalized and placed on medications to help relax your uterus. You may also be given a steroid injection to help speed the baby’s lung development and help prevent bleeding into the baby’s brain, should the baby deliver early. Sometimes antibiotics are given, as infection may be a precipitating factor in preterm labor. When released from the hospital, you will be placed on bedrest until the baby is delivered, or until you reach term status.

It is not uncommon for contractions to occur irregularly and mildly throughout pregnancy. You may notice more uterine activity in the evenings, when your bladder is full, and when participating in rigorous activities. If you are experiencing 4-6 contractions in an hour, please rest and drink plenty of water. If they do not go away rather quickly, or they worsen, go to labor and delivery at the hospital so that we may check your cervix and monitor uterine activity. You do not need to call first, as the nurses will call your physician when you arrive. Also, if you think your water has broken, even if you are not experiencing contractions, please go to the hospital.

Preeclampsia is a disease of pregnancy that results in “leaky” blood vessels and inadequate blood supply to your body. This can cause decreased blood flow to the baby, which may result in low amniotic fluid around the baby and growth restriction of the baby. In its most severe form, eclampsia, seizures occur. This can compromise both the mother and the baby. Rarely; stroke, organ failure, mental retardation and death to both the mother & baby may occur. Due to these rare, but serious consequences, your doctor will watch you closely at every visit for signs of this disease.

The disease typically occurs late in the second trimester or beyond. First pregnancies are more at risk. You are also more at risk if you have had the disease before. Oftentimes, your blood pressure will increase and you may spill protein into your urine. Other symptoms to watch for include severe headaches that don’t resolve with Tylenol or rest, blind spots in your vision, upper abdominal pain, or sudden increases in swelling.

If you develop mild preeclampsia and are preterm, your doctor may advise close observation and bedrest. Depending on the severity of the disease and how far along you are in your pregnancy, delivery might be recommended. Delivery is the cure for preeclampsia, but the benefits of delivery need to be weighed against the risk of early delivery. This is your doctor’s job and she will discuss her recommendations and reasons with you and your family.

A kick count is an informal test for well being of your baby that you can perform in the privacy of your own home. This can reliably be performed beginning at 28 weeks gestation. At this time, normal movement of the baby is at least two time periods of movements during 24 hours and during these active times, approximately 5-10 movements in an hour. If you are not noticing this, then performing kick counts is recommended.

First, go to a quiet, dark room where you are free of distractions. Then lie on your side, put your hand on your belly, watch the clock and begin counting movements. Hiccups do not count as movement. If you do not get a total of 10 movements after one hour, count an additional hour. If you still do not get 10 movements in the entire two-hours, proceed to labor and delivery at the hospital. You do not need to call first. It also may help to drink some juice or water prior to performing the test.

Now that you are nearing delivery, you may have concerns about when is the appropriate time to go to the hospital. If you are at least 37 weeks pregnant, you can wait to go to the hospital until your contractions are about every five minutes for at least an hour. This is a general rule of thumb, however, so if your contractions are less frequent but quite intense, you may need to go sooner. Also, if you have a history of fast labors or live far from the hospital, leaving sooner may be a good idea. You do not need to call first, as the nurses will call your physician when you arrive at the hospital.

The first part of labor is typically noticed as mild to moderate menstrual type cramps and may be experienced at home. Eventually, however, the contractions become more definite and intense. Many first time mothers are nervous that they won’t make it to the hospital on time. Don’t worry, as it is rare for first time labor to go very quickly.

Other reasons to present to labor and delivery would be leakage of fluid (water breaking) whether or not you are having contractions, decreased fetal movement, or bleeding like a period. It is normal to have spotting or blood-tinged mucous discharge. This is to help serve as a guideline. However, if anything seems questionable or not normal to you, please call.