Congratulations on Your Pregnancy Women’s Specialists I

Congratulations on
Your Pregnancy
Women’s Specialists
I
Pregnancy—What to expect
Pregnancy is a very special time in a woman’s life, and we look forward
to sharing this experience with you. During your pregnancy, one of our
staff members will schedule monthly visits for you with your doctor for
the first seven months, then every two weeks until about a month before
your due date. During the last month of your pregnancy, your visits will
be weekly. You are encouraged to bring the father of your baby to the
visits so that he may meet us, be involved and ask questions.
Childbirth classes are available in the community and generally start in
the seventh month of your pregnancy.
Following your discharge from the hospital, you will need to schedule an
appointment for a six-week postpartum check, or earlier, according to
your doctor. Please call the office to schedule your appointment after you
return home from the hospital.
This booklet has many helpful tips for having a healthy pregnancy, along
with answers to common questions. If you require further information
related to your healthcare, please call 414-5150 during regular business
hours (8:00 am – 4:30 pm).
Should you have a medical emergency when the office is closed, please
call the hospital at 414-5000 and they will page the doctor on call.
When paged the doctor only gets your phone number, so when the
doctor returns your call, please tell her your name, your doctor’s name,
the approximate number of weeks you are pregnant/post-partum and
then ask your question.
CONGRATULATIONS AGAIN AND OUR BEST
WISHES FOR A HEALTHY PREGNANCY!
Table of Contents
Prenatal Care.........................................................................1
Prenatal Testing....................................................................3
Work and lifestyle................................................................5
Health and Nutrition During Pregnancy....................11
Melissa E. Casper, MD, FACOG
Jami Chisdak, MD, FACOG
Drugs and Pregnancy........................................................19
Exercise in Pregnancy........................................................27
Managing Body Changes..................................................31
Choosing a Pediatrician....................................................39
Common Pregnancy Terms...............................................41
Shaun J. Gillis, MD, FACOG
Shauna Werth Kronfuss, MD
Melissa Wolf, MD
Prenatal Care
Thorough prenatal care, beginning in early pregnancy, is vital to the
birth of a healthy baby. An expectant mother usually starts seeking
care during the first trimester of pregnancy. During your prenatal visits,
certain examinations and tests are performed. Some are done once,
while others are performed periodically throughout the pregnancy.
The following are usually performed once:
•
Complete health history and physical examination
•
Gynecologic examination and testing
•
Pelvic examination to estimate the size and shape of the pelvis
•
Vaginal examination (and again at the end of the pregnancy)
•
Pap smear
•
Assessment of the state of the cervix
•
Vaginal cultures, if indicated
•
Blood type and Rh factor
•
Complete blood count (CBC)
•
Rapid plasma reagin (RPR) testing for syphilis
•
Rubella
•
Urinalysis
•
One-hour glucola test; Screens for gestational diabetes and is
done at about 28 weeks gestation, along with a repeat of your
hematocrit to check for anemia.
•
Hepatitis B
•
HIV
Performed at each checkup (monthly, biweekly, then weekly):
•
Weight
•
Blood pressure
•
Urine tests to check for the presence of sugar and protein
•
Abdominal exam, which measures the growth of the uterus and
estimates the size and position of the fetus
•
Fetal heart check
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Please call the office (414-5150, during regular office hours) or Bozeman
Deaconess Hospital (414-5000, after regular office hours) if you
experience any of the following warning signs during pregnancy:
•
Any vaginal bleeding
•
Rupture of membranes—leaking or gush of fluid from the vagina
•
Sudden puffiness or swelling of the hands, feet, or face
•
Severe, persistent headache
•
Disturbance of vision (spots, flashes, or blind spots)
•
Painful or burning sensation on urination
•
Irritating vaginal discharge
•
Abdominal pain
•
Dizziness
•
Persistent nausea or vomiting
•
Oral temperature over 100° F
•
Uterine contractions — more than 4-5 per hour, not relieved by
rest and fluids
Prenatal Testing
Several tests may be offered or recommended during your pregnancy.
If you have any questions concerning the reasons for the tests, or about
the tests themselves, feel free to ask. Asking questions can alleviate
anxiety and concern about the examination. During your prenatal visits,
take the opportunity to ask any questions you have concerning your
pregnancy, your birth experience or the upcoming postpartum period.
Genetic Counseling
A referral may be made by your physician to Genetic Counseling. The
most common reasons for a referral are:
1. Maternal age of 35 or greater at the expected time of delivery
2. Family history of genetic problems
Kick Counts
If you have been asked to note your baby’s kick counts, your doctor
will tell you how often to do it and when to call her. One method is to
write down how long it takes the baby to make 10 movements. To do
this, choose a time when the fetus usually is active. Often, a good time
is after a meal. Each baby has its own level of activity, and most have a
sleep cycle of 20-40 minutes. Alert your doctor if there is a change in
the normal pattern or number of movements. The baby should move
10 times in two hours or less. If you feel no movement in the first 60
minutes, please call your doctor.
Ultrasound
An outline of the baby,
the placenta, and other
structures can be seen
when sound waves scan
the mother’s abdomen and
transmit a picture to a video
screen. Information on fetal
development and gestational
age can be determined by
measuring the size of the
baby’s head, abdomen,
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and thigh bone with
ultrasound. The position
of the placenta can
also be determined, as
well as the possibility of
multiple births. There is
no radiation involved in
this test.
Work and Lifestyle
Lifestyle Changes and Considerations
Pregnancy can affect your lifestyle, both in terms of your own health
and comfort, but also the health and well being of your baby. Some
commonly asked questions are addressed below.
Your Questions Answered
How long can I continue to work?
Non-Stress Test (NST)
Fetal well-being can be determined by measuring the fetal heart rate
response to the baby’s activity. The examiner measures changes in the
baby’s heart rate in association with the baby’s movement.
Biophysical Profile (BPP)
An assessment of fetal status which consists of combined scoring to assess:
fetal breathing movements, gross body movements, fetal tone, amniotic
fluid, and NST. This test can take up to 20-30 minutes and is done by
ultrasound.
Cystic Fibrosis (CF) Carrier Testing
As of October 2001, the American College of Obstetrics and Gynecology
requires that all pregnant patients be offered screening for CF by means
of a blood test. If the mother tests positive as a carrier of CF, the father
will also be offered testing. Both parents must be carriers for baby to
have CF.
In general, you can continue to work until your due date (or two weeks
before). If you have a medical problem before this time, such as high
blood pressure or preterm labor, your physician may recommend that
you stop work earlier.
Will I have any restrictions at work?
This depends on your job. In general, you need to avoid very heavy
lifting, especially in the last trimester. If you are exposed to chemicals,
fumes, or other potential hazards, this should be discussed with your
physician and your supervisor or personnel department at work. If you
have concerns regarding the safety of any of your work duties, please
discuss this with your physician.
Should I wear seat belt during my pregnancy?
Group B Streptococcus (GBS) is a type of bacteria that can be found in
up to 40% of pregnant women. A woman who is a carrier (someone
who has the bacteria in the vaginal or rectal area, but doesn’t have
an infection) for GBS can pass it to her fetus during delivery. Most
babies who get GBS from their mothers do not develop any problems.
However, it can cause a serious infection.
Pregnant women often question the safety of using seat belts. Fear of
hurting the fetus and affecting the pregnancy are common. A study by
the American College of Obstetrics and Gynecology shows that the use
of seat belts does not increase the chance of
injury to the fetus or mother in a collision,
no matter how severe. According to the
study, the fetus is extremely well protected
inside the mother. The fetus grows in a fluidfilled sac in a very elastic uterus. The bowel,
bladder, and abdominal wall can soften a
blow from the front; strong back muscles and
the spine protect the uterus from the back.
To prevent a baby from becoming sick, the mother is treated with
antibiotics during labor if she has a positive GBS test or if she goes into
labor before 36 weeks.
In a crash, the pressure of the seat belt may
squeeze the fetus in the amniotic fluid; this
usually happens for a short time, and the
Group B Streptococcus
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fetus recovers quickly. It is unlikely that the fetus would be killed from the
belt pressure alone. This type of injury occurs in less than one in 10,000
fetuses involved in car accidents. Although the use of seat belts can’t
guarantee against fetal loss or injury, risks are increased for mothers who
do not wear them. The leading cause of fetal death in a car accident
is the death of the mother. Fetal injury is closely related to the amount
of injury to the mother. Since mothers who wear seat belts suffer fewer
injuries and death than those who do not wear seat belts, doctors
strongly recommend the use of seat belts during pregnancy.
Recommendations regarding the use of seat belts during pregnancy:
•
Seat belts should be worn as low on the pelvis as possible, not
over the abdomen.
•
When possible, a pregnant woman should choose to wear a
three-point, lap-shoulder belt.
•
Heavy outer garments should be pulled aside so that the lap belt
lies snugly across the hips.
IT IS RECOMMENDED THAT PREGNANT
WOMEN SHOULD WEAR SEAT BELTS.
Please call the office if you are involved in
a motor vehicle accident while pregnant.
Is it safe to travel during pregnancy?
If you will be traveling a long distance (greater than one and one-half to
two hours away), discuss this with your doctor at your routine visit prior
to leaving. It is important to drink plenty of fluids and take breaks to
walk around every one and one-half hours. Airplane travel after 36 weeks
gestation is not advised.
Is it safe to continue having intercourse?
If there are no medical problems prohibiting intercourse (your doctor
will inform you if there are), you and your partner may continue to have
intercourse throughout your pregnancy. If vaginal lubrication decreases,
water based lubricants such as K-Y Jelly, may be used. Avoid oil-based
lubricants. Oral stimulation is safe but do not let partner blow air into
vagina.
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Can I safely paint a room in my house?
Latex or water-based paints used in a well-ventilated room are fine.
Are household cleaning products safe to use?
Rubber gloves are generally advised when using strong soaps or caustic
products, and it is advisable to have adequate ventilation while cleaning.
Can I still color and/or perm my hair?
Hair color and perms are considered to be low risk. It is generally
recommended that exposure to these chemicals be avoided in the first
trimester. Your hairdresser should use the most natural products available
and provide a well-ventilated area for you. Because your hair may
temporarily change in pregnancy, you should know that you may not
achieve the desired result.
Can I take care of my pet?
If you have a cat, avoid changing the litter box to reduce the risk of
toxoplasmosis, a parasitic infection which is found in cat feces. Because
cat feces can also be found in gardens and sandboxes, careful hand
washing and the use of rubber gloves is recommended.
What Do I Need To Know About Maternity Clothing?
Bras
It is advisable to reassess your bra size as your pregnancy progresses
so that you can continue to have a properly fitting and supportive bra.
Some women experience discomfort with underwire bras and need to
switch to bras without underwires. If you plan on breastfeeding, you
may want to begin wearing nursing bras during your last trimester, a
time when you will need to increase your bra size. Some women find
that they are more comfortable if they wear a bra to bed at night.
Underpants
100% cotton underpants will help avoid vaginal irritation during
pregnancy, a time when vaginal secretions are increased.
Shoes
Avoid high-heeled shoes and go for comfort (as well as safety) with flat
shoes. Use proper athletic shoes when exercising.
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If you spend a lot of time on your feet, you may benefit from support
pantyhose. There is no need (for most women) to invest in “maternity”
hose, just go up one size in your regular brand.
pregnancy by joining her in any changes that she makes, she is much
more likely to be successful. Recent studies on secondhand smoke
indicate that both mother and baby can be adversely affected; therefore,
it is best to limit your exposure to people who are smoking or to smokefilled areas without adequate ventilation.
Information Regarding Environmental Agents and
Potential Hazards
Tanning booths and sun exposure
Stockings
Herbicides and Insecticides
Household chemicals including bathroom cleaners, glass cleaners,
bleach, insecticides, and some herbicides may pose a threat to pets
and humans. Rubber gloves should be used when working with these
products and be used in a well ventilated area. Pesticide applications
should be left to a licensed professional to ensure that they are used
safely. Avoid direct contact with all chemicals during pregnancy.
Your skin is more sensitive because of the hormones present during
pregnancy. Use 15 SPF or greater sunscreen during sun exposures.
Tanning booths are not recommended.
Radiation
X-rays for medical diagnosis and working in areas where radiation levels
may be high, ought to be avoided—especially during the first trimester.
Most x-rays can be avoided or postponed until after the birth. After the
first trimester, shields should be used to minimize fetal x-ray exposure in
the event x-rays are needed for diagnosis or treatment.
Electric blankets, saunas and hot tubs
There is now some evidence that prolonged exposure to extreme heat
may raise the mother’s body temperature to levels that present a danger
to the fetus. For this reason, saunas, hot tubs or whirlpools may be okay
if the water temperature does not elevate body temperatures above
98.8° F. Keep electric blanket and waterbed temperatures low.
Drugs, environmental hazards and the father
At this time, there is little scientific information available on the effects
of tobacco smoke, marijuana, alcohol, caffeine, or medicines on the
reproductive system of the man. Whether these agents alter the genetic
component contributed by the male is a matter for further research.
Although the father’s direct contribution to his infant’s health is poorly
understood, the indirect contribution is of great significance. A woman
is much more likely to control her use of tobacco, alcohol, or other
questionable substances if her partner also controls the use of these
agents. If he supports her in her concern for a positive outcome of the
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Health and Nutrition During Pregnancy
Dental Health
Your oral health directly affects
your baby’s oral and general
health. Obtain a dental exam
and any needed dental treatment
before your baby is born. Dental
treatment, including dental
radiographs, are safe for pregnant
women. Floss and brush your teeth daily with fluoridated toothpaste.
Visual Health
Your vision may change during pregnancy. In general, it’s not a good
idea to get a new prescription for lenses or contacts during pregnancy
because your vision may change again after pregnancy. If you are having
any problems with your vision, talk to your physician.
Good nutrition is essential throughout your lifetime and especially
important while you are pregnant. Studies have proven that mothers
with the poorest prenatal diets are most likely to develop complications
of pregnancy. It is extremely important for both yourself and for your
baby that you eat well throughout your pregnancy. In order to help you
do just that, we have gathered the following information for you. By
observing a few simple, common sense rules, you can do a great deal
to promote a healthy pregnancy for yourself and a healthy start for your
baby.
A nutritious diet is needed:
•
To furnish building material for a strong body.
•
To assure development of teeth resistant to decay.
•
To safeguard your own health and to make birth easier with fewer
complications.
•
To prepare for nursing your baby.
Weight Gain
It is now felt that the ideal weight gain for a normal pregnancy is 25
to 35 pounds. This weight gain is accounted for by the weight of the
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baby, the increased size of the uterus, the placenta, amniotic fluid,
breast tissue, expanding blood volume, and extra reserves of nitrogen
and fat. Your weight will be checked at each visit so that we will be able
to advise you regarding any weight problems along the way. Excess
weight gain can cause problems including: abnormal labor, increased
risk of Caesarian Section (C-Section) and difficulty losing weight after
pregnancy.
Meats and beans
Diet for Pregnancy
Milk and Calcium
Daily food choices
A 50% increase in calcium is required during pregnancy for the
formation of the baby’s bones and teeth. Calcium also aids in reducing
muscle cramps in pregnant women. The need for calcium increases
as the pregnancy progresses. By the last trimester, a woman should
consume 1200 mg/day with 3 servings from milk, cheese, yogurt,
custard or pudding. One-half cup cottage cheese, 1 cup of milk or
yogurt, 1 1/2 ounces of natural cheese or 2 ounces of processed cheese
can be considered as 1 cup from the milk group. Dark green vegetables
that are high in calcium include: broccoli, spinach, kale and mustard
greens. Those who find milk upsetting, or who simply do not like milk,
may have a problem getting enough calcium. Cultured forms of milk (for
example, acidophilus or yogurt) are often well tolerated by people who
cannot use other dairy products. Calcium can also be found in sardines,
certain types of salmon, spinach and fortified orange juice. Calcium
supplements may be desirable for those who are not meeting the needs
of their diets. Consult with one of the physicians or nurses if you feel this
may be a problem for you.
Pregnant women need to eat an additional 100–300 calories per day.
This is not a lot of food. 300 calories is equal to a small snack. An
example is one-half of a peanut butter and jellly sandwich with one cup
of low fat milk.
For more information log onto www.mypyramid.gov and check on the
section “for moms.”
Every day you should eat the following:
Grains and Carbohydrates
Eat 5–6 ounces daily. One ounce = 1 slice of bread, 1/2 cup of
potatoes/rice/noodles/macaroni or 3/4 cup of dry cereal.
Vegetables
Eat 2 1/2 cups daily. Try to include a variety of vegetables in your diet.
We also recommend that you eat one serving of a raw vegetable (lettuce,
celery, cucumber, cabbage, etc.) daily. These are low in calories and they
supply essential vitamins and bulk to the diet. One cup of raw or cooked
vegetables or vegetable juice, or 2 cups of raw leafy greens is considered
one cup from the vegetable group.
Fruits
Eat 1 1/2 – 2 1/2 cups daily. Be sure
to include one serving of a citrus fruit
(such as orange, grapefruit, or tomato
juice) daily for Vitamin C. One cup of
fruit or 1/2 cup of 100% fruit juice or
dried fruit can be considered as 1 cup
from the fruit group.
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You should eat 5 – 5 1/2 ounce servings daily. Examples of foods rich in
protein: eggs (1 egg = 1 oz. of meat), meat, fish, poultry, cheese, milk,
yogurt, peanut butter (2 tbsp = 1 oz.), cooked beans (lentils, kidney
beans, soybeans), tofu and cottage cheese. Be sure to refer to the
guidelines under Safety of Foods and Safe Preparation for information on
specific fish, meats, and cheeses to avoid during pregnancy.
Fats
Eat no more than 1-2 tablespoons daily. This includes butter, margarine
and mayonnaise.
Liquids
Drink 6-8 glasses of liquid daily. Liquids are used to maintain the
increased amount of body fluids and to prevent constipation. Rely
primarily on water,
fruit juices or milk. Calorie-reduced soda should be minimized.
Vitamins
Vitamin and mineral needs increase during pregnancy. If you are unsure
about your vitamin intake, look first at your diet. Then, with your
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physician, evaluate your needs. An over-the-counter prenatal vitamin
may be adequate or prescription prenatal vitamin may be given. If your
prenatal vitamin causes nausea, try taking it at night before bed.
Iron
Supplements are commonly prescribed because of the increase in the
mother’s blood supply and the demands of the baby. The blood testing
done at your first visit and at 28 weeks can help determine if you need
supplements. Foods rich in iron include dried fruits, iron-fortified cereals,
red/yellow/orange/deep green vegetables and most meats.
Folic Acid
Folic acid is a vitamin that is essential to normal fetal development.
The current recommendation is that all pregnant women get at least
400 micrograms (0.4 mg) of folic acid daily, either from food or
supplements.
Do not skip meals! If you cannot tolerate a full dinner at night, rearrange
your calories and eat the bigger meal at breakfast or lunch. Or, you may
feel best eating light nutritious snacks during the day. The idea is to get
the right quality of food in the appropriate amounts.
Special Conditions and Nutritional Considerations
During Pregnancy
Allergies
A woman with significant food allergies may need the help of a
nutritionist in planning a healthful diet for pregnancy. Without careful
guidance, the elimination of problem foods can lead to a diet insufficient
for pregnancy.
Constipation
Increase the fluids (especially water) and fiber in your diet. Daily exercise
is also helpful, especially walking. If necessary, you may use Metamucil or
Citrucel as directed.
Food Additives
You are advised to minimize food additives and other substances
(caffeine, artificial sweeteners and colors) during pregnancy even though
none of these substances have been specifically linked to birth defects.
Heartburn or gas
Eat regularly, chew thoroughly, eat slowly, try smaller meals, avoid
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greasy/highly seasoned/very sweet foods. In addition to a healthy diet,
exercise and rest are important.
Limited food budget
Sometimes during pregnancy a woman will not be able to eat correctly
because she cannot afford to buy the food she needs. If this is a problem
for you, we can refer you to the Women, Infants and Children program
(WIC), which has been established just for this purpose. Remember, what
you eat during pregnancy will have an important effect on your baby.
“Morning Sickness” (which may occur at any time of the day)
Try saltine crackers, pretzels or dry toast (Melba toast) before getting out
of bed in the morning. Wait 10 minutes after eating before getting up.
Overweight
Although obesity represents an added risk in pregnancy, it is generally
agreed that this is not the time to reduce. Instead, we recommend an
emphasis on a consistent rate of weight gain during pregnancy and that
weight loss be postponed until after delivery. The maximum weight gain
should be 10-15 pounds.
Safety of Foods and Safe Preparation
Avoiding under cooked meats can help reduce the risk of trichinosis. To
reduce the risk of salmonella, it is recommended that you wash your
hands and food preparation surfaces thoroughly after handling raw
poultry and eggs. Always wash hands, utensils and surfaces exposed to
raw meat. It is also wise to thoroughly wash fruits and vegetables prior to
eating. Keep your refrigerator clean and throw out leftovers if you have
any doubts about freshness.
The risk of a potential infection, listeriosis (which can be serious for
fetuses and infants), can be reduced by avoiding the following foods,
which may harbor the listeria bacteria: soft Mexican-style cheeses,
feta, camembert, brie, bleu and other soft cheeses, unpasteurized milk
products, smoked fish and ready-to-eat meats (including cold cuts and
pate). Cook hot dogs and leftovers until they are steaming hot.
Because of the risk of potentially high concentrations of mercury (a
nervous system toxin) in certain types of fish, the FDA recommends
that pregnant women, nursing mothers, and children under the age of
6 avoid the following kinds of fish: swordfish, shark, king mackerel and
tilefish. Sushi is generally not recommended. Limit canned light tuna to
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less than 12 ounces per week and tuna steaks or albacore tuna to less
than 6 ounces per week.
Teenage pregnancy
If you are a pregnant teenager, you have even greater nutritional
requirements because you are still growing yourself. In order to meet
your needs as well as those of the baby, you need increased supplies of
calories, protein, calcium and phosphorous. When following the diet
outlined on the previous page, you should add 2 cups of milk or its
equivalent.
Vegetarians
With knowledge and careful planning, vegetarians can nourish
themselves and their unborn babies adequately, especially if they include
milk and eggs. The major concerns are the need to get sufficient calories;
the possible need to supplement vitamin B 12, found mostly in animal
products including milk, eggs, and meats; and the need to combine
protein foods to obtain complete proteins.
Use of Other Products in Pregnancy:
Alcohol
No safe levels have been determined. Pregnant women are advised to
give up drinking alcohol altogether. Alcohol crosses the placenta rapidly
and small amounts have been shown to affect the baby’s activity within
the uterus. Drinking alcohol during the critical period of development of
the embryo may harm formation of the baby’s organs. Binge drinking
and alcoholism are acknowledged hazards to both mother and the
developing baby. Chronic daily use of alcohol has been linked with
mental retardation and other birth defects. At this time, it is unknown
how much alcohol might be safe and how much is harmful. Therefore,
the safest recommendation is that alcohol should be avoided during
pregnancy.
Cigarette Smoking
This activity during pregnancy reduces the baby’s growth, increases
the risk of miscarriage, and can be a factor in serious complications
of pregnancy and delivery. If you smoke, you should STOP! You
may work with your doctor regarding smoking cessation aides and
recommendations.
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Caffeine
Cola beverages, coffee, tea, chocolate, and some over-the-counter
medications contain caffeine. Although some studies suggest drinking
three or more cups of coffee per day may increase the risk of miscarriage,
there is no proof that caffeine causes miscarriages. With the information
now available, it seems wise to limit caffeine intake to 1 cup per day.
Herbal teas
There are hundreds of herbs commercially available in herbal teas.
They are said to have various curative or restorative properties. It is not
possible to comment on the safety or value of herbal teas for the fetus
since there has been little scientific scrutiny and little is known about the
active ingredients which produce the benefits; therefore, one should be
cautious in using them. For more information about the use of herbs in
pregnancy, refer to the section “Herbs in Pregnancy“ under Drugs and
Pregnancy.
Pregnancy is a temporary condition that does require some special selfcare and some extra sacrifice to ensure the best outcome. If you have
questions or problems, please let us know and we will try to help.
What’s Your Body Mass Index (BMI)?
What’s so important about BMI? Being too thin (a body mass index of
less than 18.5) or overweight (a body mass index of 25 or more) can
affect your fertility and your baby’s health.
Use the online tool to calculate your pre-pregnancy body mass index.
This will give you a starting point for recommended weight gain.
Women in the average body mass index range should gain somewhere
between 25-35 pounds during pregnancy, while women with a lower
body mass index should gain more, and women with a higher body
mass index should gain less, with their doctor’s guidance.
Visit www.fitpregnancy.com/bmi and use the calculation tool.
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Drugs and Pregnancy
Medications During Pregnancy
Medications in Complicated Pregnancy
A number of medications are sometimes necessary to treat either medical
diseases that are present at the time of pregnancy (such as epilepsy,
diabetes or high blood pressure) or actual complications of pregnancy
(such as toxemia or premature labor). In these circumstances, the risks
of using a particular medication must be carefully weighed with its
benefits. Your physician will discuss the need for (and the effect of) these
medications as necessary, along with any alternatives to drug therapy
that might be available. At your next visit, you should notify any other
physician or healthcare provider who may be prescribing medication for
you that you are pregnant.
Non-prescription Drugs During Pregnancy
A non-prescription drug is any medication that you might pick up overthe counter at a drug store without a prescription, such as Tylenol® or
antacids. Many “cold medications” consist of a combination of drugs,
some of which may be harmful in pregnancy.
Colds or respiratory infections are the most common reasons pregnant
women require medications. The following medications are considered
safe in the first trimester (up to 14 weeks from the last menstrual period):
•
Cough drops (with the exception of zinc)
•
Saline nasal spray
•
Nasal steroid spray
•
Vicks® Vaporub
•
Tylenol® (acetaminophen)
After 14 weeks of pregnancy, you may also use the following
medications:
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•
Sudafed (pseudoephedrine) 30mg every 4-6 hours, as needed
•
Robitussin cough syrup, as directed/needed
•
Over-the-counter antihistamines, as directed (Benadryl®,
ChlorTrimeton®, Chlorpheniramine Maleate®, Diphenhydramine®,
Brompheniramine®, Zyrtec®).
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Iron
Cranberry
Iron, such as ferrous gluconate or ferrous sulfate, may be prescribed to
provide the increased amount of iron necessary for you and your baby to
produce red blood cells. Taking iron may cause constipation; however,
this can usually be relieved with a high fiber diet and plenty of fluids.
Reported safe in recommended doses. Large doses of cranberry juice
may cause mild diarrhea, gastric upset and excessive sugar intake.
Herbs in Pregnancy
If you choose to use herbal medication during pregnancy, there are
several things to keep in mind:
•
Many substances are harmless at low doses but toxic at higher
doses. Do not exceed the recommended dosing!
•
Many herbs are not adequately studied to determine their safety in
pregnancy.
•
Do not use herbs preventively—remember, herbs are medications.
•
Avoid herbal combinations.
•
Many current herbal products are more potent than those
historically used.
Specific herbs (Not intended to be a complete review of contraindicated
herbs in pregnancy):
Echinacea
Echinaguard/Nature’s Way is the most studied product. Reported safe
in pregnancy in recommended doses. Not for use in patients with
chronic immunosuppression or progressive systemic diseases. Avoid in
female and male infertility. May cause allergic symptoms in patients with
predisposition for allergies and/or eczema.
Ephedra
Unsafe in pregnancy. Found in herbal products, especially weight loss
products.
Evening Primrose
Possibly unsafe in pregnancy.
Feverfew
Contraindicated in pregnancy due to potential uterine stimulation,
possibly causing bleeding.
Garlic
Black Cohosh
Do not use in doses exceeding amounts typically found in food.
Contraindicated in pregnancy due to potential uterine stimulation or
possibly causing bleeding.
Ginger
May help with morning sickness. Maximum dose 250 mg capsule 4
Blue Cohosh
Contraindicated in pregnancy due to uterine stimulation; has reportedly
caused profound neonatal congestive heart failure in one documented
case.
Chamomile
A mild sedative considered to be safe for use in pregnancy. Usual dosage:
1-2 cups at bedtime. Steep 1 Tbsp of herb in 8oz. of boiling water for 10
minutes.
Chaste Tree Berry
Contraindicated in pregnancy due to potential uterine stimulation or
possibly causing bleeding.
20
21
times per day. May use ginger ale and ginger tea (commercial).
Ginkgo
Avoid in pregnancy as there is insufficient data on the effects. Avoid in
female and male infertility.
Ginseng
Contraindicated in pregnancy, due to potential uterine stimulation.
Kava Kava
Contraindicated in pregnancy.
Raspberry Leaf
given before birth) are very important. This is why those providing your
care may suggest one medication at one point in labor and another at a
different point.
The most common medications that might be used during labor and/
or delivery are listed below. This list includes medications used for relief
of pain (analgesics), for relief of anxiety (tranquilizers), and those which
cause either partial or complete loss of sensations (anesthesia). Also listed
is the medication oxytocin, which may be needed during labor under
certain circumstances.
Demerol or Fentanyl
Avoid during pregnancy.
Demerol or Fentanyl may be used in active labor for pain relief without
excessive side effects to either mother or baby. Effect for mother is to
“take the edge off” the sharpness of the labor pain. It may cause some
drowsiness, but cannot relieve pain completely in dosages that are safe
for the infant. Since Demerol and Fentanyl does cross the placenta, the
baby may be affected—resulting in temporary depression of respiration
and changes in behavior. (For example, the infant may initially appear
“sleepy” and may not respond very actively to stimuli.) If temporary
depression should occur and is significant at birth, it may be reversed by
use of a drug called Naloxone (Narcan). No long-term developmental
problems have been associated with the use of Demerol or Fentynol for
labor analgesia.
Medications During Labor and Delivery
Nubain
Many women find relief from the discomfort of labor with the support
of family and/or friends and by using breathing relaxation techniques.
These techniques can be learned in prepared childbirth classes. When
a woman in labor does request pain medication, our goal is to provide
reasonable relief. This can be achieved by use of properly and carefully
selected medications, while keeping side effects for the infant to a
minimum. Those medications used for pain relief may have some shortterm effect on the ability of the baby to maintain its temperature, to
suck strongly or to begin breathing immediately on its own. There may
also be an effect on the mother’s muscle tone. Therefore, the lowest
dose to achieve pain relief should be given when indicated. In order
to avoid depression of the baby, the amount of medication, route of
administration and timing (in reference to how long the medication is
Nubain is an analgesic similar to Demerol in pain relief properties. There
is somewhat less respiratory depression in infants of mothers medicated
with Nubain than with Demerol.
Has been used in pregnancy commonly for morning sickness, to
decrease cramping and to aid in childbirth. It has documented use for
1,000 years without adverse effect historically or in the literature. Little
research has been done to evaluate efficacy. Usual dose: Tea, 1-2 cups
at bedtime. Steep 1 Tbsp. of herb in 8 ounces of boiling water for 10
minutes.
St. John’s Wort
Caution in pregnancy due to potential increase of miscarriage
Valerian
22
Morphine
Morphine is used in questionable or early labor when the mother
needs some rest before active labor. It is very helpful for the mother
who is extremely tired due to prolonged, irregular and uncomfortable
contractions. This medication will usually allow the mother to sleep
for approximately four hours before awaking in active labor or without
contractions because the labor is false. As with Demerol, Morphine could
cause depression in the infant if the mother were to suddenly go into
the active phase of labor after receiving the medication. This depression,
if significant, can also be reversed by the drug Naloxone. Although
23
conclusive studies are lacking, low doses of Morphine administered
during labor have not associated with any long-term development in
newborns.
Tylenol #3 (with Codeine):
This can have a similar effect as Morphine but to a lesser degree.
Ambien
Ambien is used to help encourage sleep before active labor begins.
Phenergan
This medication is either used for relief of nausea associated with labor
or for anxiety. Phenergan may also be combined with Demerol or
Morphine, for a better analgesic effect. Phenergan is known to cross the
placenta, but short term use of Phenergan during labor appears to be
safe.
Local Anesthesia
Used at the time of the delivery, the local anesthesia agent Xylocaine
(or similar agent) is injected directly into the tissue where an episiotomy
may be cut or where a tear needs to be repaired. This anesthesia appears
to be safe for the baby.
Pudendal Block
Used at the time of delivery, Xylocaine (or similar agent) is injected
within the vagina to block the pudendal nerve which controls sensations
of the vagina, labia and perineum (the area between the vagina and
rectum). This type of anesthesia is often useful if forceps are needed.
Pudendal anesthesia appears safe for the baby. An excessive dose, allergy
or accidental injection of the medication into the blood stream of the
mother could cause the mother to have a seizure.
Regional Anesthesia
Epidurals and spinals are regional anesthesia. These are administered by
an anesthesiologist.
Epidural
This type of anesthesia may be used for labor when Demerol is not
recommended or has been ineffective, when a long or difficult labor is
anticipated, or for a non-emergency Cesarean birth. In order to be able
24
to continuously administer as needed throughout labor, a small plastic
tube is inserted into the epidural space of the lower spinal column of
the mother’s back. (This type of anesthesia does not mix with the spinal
fluid.) An epidural usually will not be chosen until the mother is felt to
be well into the active phase of labor (greater than four centimeters
dilated). If given too early, it may slow the labor process. With a good
nerve block, there will be relief of labor pain within about 20 minutes.
Occasionally, the epidural will not give complete relief. The major side
effect of an epidural may be a drop in the mother’s blood pressure which
can in turn affect the baby’s system. This drop, if it should occur, can
be counteracted with a change in the mother’s position and an increase
in IV fluids; hence, an IV is required. Another significant side effect is
possible lack of sensation to push when it is time. This may increase
the need to use forceps or vacuum to assist the delivery. However, by
waiting, the medication may wear off enough for the mother to actively
push her baby out. Without a drop in the mother’s blood pressure, the
only other significant side effect on the newborn is a possible decrease in
muscle tone and general activity.
Spinal
This anesthesia is used for a difficult vaginal delivery or a non-emergency
Cesarean birth where the mother desires to be awake. The anesthetic is
injected directly into the spinal fluid surrounding the lower spinal cord
so as to cause loss of sensation to the lower half of the body. As with an
epidural anesthesia, a drop in blood pressure can also occur with spinal
anesthesia. Increasing IV fluids and changing the mother’s position
usually counteract this. There is also the possibility of postpartum
headaches. The headaches, if they occur, usually disappear in time
without further problems.
General Anesthesia
This anesthesia is most often used for an emergency Cesarean section or
any Cesarean birth where the mother does not want to be awake for the
surgery. Occasionally, general anesthesia may be used for an anticipated
vaginal delivery or for removal of a retained or “stuck” placenta. Since
the medications and gases used to produce general anesthesia cross
the placenta, this anesthesia will not be given until all the preparation
for the delivery or surgery are complete and the actual delivery or
25
surgery is ready to begin. By waiting, transfer of the anesthetics to the
baby is decreased, and the likelihood of depression of the newborn is
lessened. Staff members are always prepared when general anesthesia is
used to deal with any depression of the newborn that might occur. An
empty stomach is important for the mother, as this will prevent possible
vomiting and aspirating while asleep which could lead to pneumonia
after surgery. Also, a tube is usually passed into the windpipe of the
mother after she is asleep to prevent this problem from occurring.
Occasionally, the mother may notice a “sore throat” after general
anesthesia because of the use of this tube.
Oxytocin
This medication is used to either induce or improve labor when the
situation warrants it. Those providing your care will discuss with you any
circumstances of your pregnancy or labor that may require the use of
Oxytocin. The dosage of this medication is controlled by the use of an
intravenous pump; therefore, those who need Oxytocin will also need an
IV. In addition, a fetal monitor will be used to assure that the medication
received is developing adequate contractions without causing adverse
effects on either the mother or the baby. Without careful observation
with a monitor, possible side effects could include contractions that fail
to relax, possibly leading to stress for the baby and even rupture of the
uterus.
26
Exercise In Pregnancy
Pregnancy does not mean that exercise or recreational activities should
be discontinued; in fact, the many benefits of exercise still apply in
pregnancy. Pregnant women who are fit are better prepared for the
physical challenge of labor and delivery. However, as in other aspects of
your health, some modifications may be needed.
Conditions where exercise is NOT permitted in pregnancy:
•
Heart disease
•
Vaginal bleeding
•
High blood pressure
•
Placenta previa
•
Lung disease
•
History of current or preterm labor
•
Incompetent or weakened cervix
•
Ruptured membranes (“water broke”)
•
Multiple gestations (twins or more)
Conditions where exercise MAY be permitted but which require
discussion with your physician FIRST:
•
Anemia
•
History of being sedentary
•
Breech fetal position in the third trimester
•
History of poor fetal growth
•
History of preterm labor
•
Heart palpitations or irregular heartbeat
•
Seizure disorder
•
Thyroid disease
•
Chronic bronchitis
•
History of three or more miscarriages
•
Diabetes
•
Obesity or extreme underweight
•
Vaginal bleeding during pregnancy
27
Once you have determined that it is safe to proceed with exercise, there
are some special considerations. During pregnancy changes occur in
your body that may affect you and your baby during and after exercise.
These include:
Pregnancy Related Chances
Exercise Consideration
Your blood volume is increased by
30% and your heart rate, even at
rest, is increased. This will affect
your endurance.
•Do not exercise until exhaustion.
Maximum heart rate should be
140 beats per minute for no
more than 15 minutes. Check
your pulse regularly.
Your joints are loosening in
preparation for childbirth due to
the hormone relaxin. This makes
you more susceptible to injury.
•Avoid heavy lifting. Avoid deep
flexion or extension of joints.
Avoid activities that require
jumping, jarring, or rapid
changes in direction.
•Avoid exercises that involve lying
Your growing abdomen affects
flat on your back after the fourth
your center of gravity, places stress
month of pregnancy. Take care
on your lumbar spine, and the
to rise gradually from the floor
growing baby can place stress on
to avoid lightheadedness.
major blood vessels.
Near the end of pregnancy, the
diaphragm is displaced, resulting
in a feeling of shortness of breath
and mild hyperventilation.
•Avoid high intensity exercise for
prolonged periods.
Your baby may be affected by an
extreme rise in body temperature.
•Avoid vigorous physical activity
for prolonged periods as this
can raise your core body
temperature. Avoid exercise
in hot, humid environments.
Do not use saunas or hot tubs.
Maintain good fluid intake to
avoid dehydration.
Pregnancy Related Chances
Exercise Consideration
Nutritional requirements increase •Exercise in pregnancy should
by 300 calories per day to help
NOT be weight loss. Be certain
support the fetus. It is easier to
to maintain an adequate caloric
become dehydrated in pregnancy.
intake. Drink plenty of fluids
Exercise, especially if prolonged
to avoid dehydration. Eat a
and strenuous, can produce
light carbohydrate snack (fruit,
hypoglycemia (low blood sugar),
crackers or vegetables) prior
and since glucose is the baby’s
to exercise to help prevent low
main “fuel source,” care needs
blood sugar.
to be taken to have adequate
carbohydrate intake.
To help put these considerations into effect, the following suggestions
for various activities may provide you with some guidelines:
Aerobics
Make sure it is a good program with a scientific basis. Avoid
overextension and exercises performed lying on your back. Avoid
exercising on hard surfaces and limit repetitious movements to ten.
Warm up and cool down gradually.
Biking
A stationary cycle is safer due to changes in your balance later in
pregnancy. Avoid biking in high temperature.
Jogging
It is not a good idea to START this activity during pregnancy but it is fine
to continue if done prior to pregnancy. Your ability to run long distances
will be reduced, and it has been recommended not to run more than
two miles per day. Be careful to avoid hyperthermia (overheating) and
dehydration. Do not run on humid days.
Scuba Diving
This activity should NOT be done in pregnancy.
Swimming
28
Your swimming endurance may be less later in pregnancy due to
breathing capacity changes. This is an excellent activity because it is not
weight bearing, and therefore is a little easier in pregnancy. Be aware of
water temperature and try to avoid water that is too hot or too cold.
29
Managing Body Changes
Sports
Softball, volleyball and racquet sports are fine as long as common
sense is applied to avoid injury. Contact sports should be avoided (e.g.
basketball). Cross-country skiing is preferable to downhill skiing. It is best
to avoid ice skating, water skiing and horseback riding.
Weight Lifting
Light weight training can be continued during pregnancy but NOT
heavy resistance on weight machines. Avoid heavy free weights.
Yoga
Prenatal yoga classes are often very restorative; choose a course that is
specifically taught for pregnancy and avoid certain poses or prolonged
time on your back.
The following are some of the body changes that may accompany
a normal pregnancy. They are alphabetized for your convenience.
Suggestions for coping comfortably with these changes are included.
Remember that no two pregnancies are alike, and just because a
particular change is listed does not mean that it will happen in your
pregnancy. Few women will experience all of the discomforts mentioned,
and you may avoid most of them.
Symptom
Causes:
Care:
Backache
•Relaxation of pelvic
joints
•Moderate daily exercise/pelvic
rock
•Poor posture
•Stretching, yoga
•Increasing weight and
position of the baby
•Proper posture/limited
bending
•Improper shoes (heels
too high)
•Straight backed chair/feet
elevated for sitting
•Ligaments attached
to lower spine stretch
and lose tone
•Firm mattress
•Improper lifting
•Avoid fatigue
•Comfortable shoes
•Avoid lifting heavy objects
•Avoid lifting with your back
•Maternity belt/panty girdle
(ask office where to find)
Bleeding
Gums
•Fragile capillaries in
mouth
•Use soft bristle brush/floss
daily
•Hormonal changes
•Adequate vitamin C intake
•Regular dental care
throughout pregnancy,
including local anesthetic
use (Novocaine without
epinephrine is fine)
30
31
Symptom
Care:
Symptom
Causes:
Care:
Braxton•Dehydration
hicks contractions
(intermittent,
irregular
“practice”
contractions
of the
uterus)
•Rest
Contact
lens
problems
•Corneal changes
due to hormones
•Stop wearing contact lenses
or wear for fewer hours (wear
glasses)
Breast
•Hormonal
changes
(including
increased
size, darkening of
the nipple
and areola, and
leaking
of colostrums)
•Wear a well-fitting cotton bra for
support
Constipation
Causes:
•Notify your physician if
contractions become regular
and/or greater than 4-5 per hour
and you are less than 36 weeks
pregnant
•Check with OB and
ophthalmologist
Diarrhea
•Increase fluids
•Uterine pressure
on bowels
•Soft diet/less fiber
•If persistent, report
•Decreased tone of
bowel muscles
•Start wearing a nursing bra during
second to third trimester of
pregnancy
•Uterine pressure
on bowels
•Increase bulk (fiber) in diet by
increasing fruits and vegetables
•Irregular bowel
habits
•Drink 8-10 glasses of fluid per day
•Hormonal
•Moderate daily exercise
•Decreased tone of
bowel muscles
•AVOID laxatives and enemas
unless advised by physician
•Maintain regular bowel habits
•Stool softener (Colace) once a day
•Fiber supplements (Metamucil or
Citrucel)
Emotional •Hormonal changes •Recognize as normal
ups and
•Ambivalence
•Communicate with father of baby,
downs
about and
friends, and care providers
adjustment to
pregnancy
Faintness/ •Sudden changes
dizziness
of position
•Rest periods each morning and
afternoon
•Decreased muscle
tone in blood
vessels
•Dietary changes and/or
supplements
•Room too warm
•Low blood sugar
•Small, frequent meals with higher
protein content
•Anemia
•Dress comfortably (in layers)
•Change positions slowly
•Low blood
pressure
Fatigue
(tiredness)
•Increased
metabolism/
increased weight
to carry
•Decreased muscle
tone
•Increased rest/avoid becoming
overtired
•Proper diet
•Moderate daily exercise
•Iron supplement
•Anemia
•Hormonal changes
32
33
Symptom
Causes:
Care:
Symptom
Causes:
Care:
Headaches
•Emotional strain
•Eye exams as necessary
•Relaxation exercises
•Intestinal muscles
lost tone
•Daily bowel movement
•Eyestrain
Intestinal
gas
•Nasal congestion
•Fatigue
•Hormonal changes
•Vascular changes
Heartburn •Regurgitation of
(indigesstomach contents
tion)
due to pressure of
enlarging uterus
•Slowed digestion
•Heating pad applied to base of
neck or cold compresses applied
to forehead
•Gassy foods
•Moderate daily
exercise
•Tylenol, 1-2 tablets occasionally
•Any severe or persistent headache
not relieved by Tylenol should be
reported to physician or nurse
•Avoid highly seasoned, oily, or
fried foods
•Eat slowly and chew food well
•Sit and sleep with head elevated
•Eating and
drinking too fast
Muscle
•Pressure on
cramps
nerves or pelvic
(especially
veins from fluid
in the
retention
legs)
•Fatigue in the legs
•Overstretching of
leg muscles
•Tums or Mylanta (antacids) may
be effective
•Straining with
bowel movement
•Prevent constipation and straining
at stool
•Increased blood
volume
•Apply witch hazel compresses,
Tucks, or Anusol
•Pressure from
enlarging uterus
•Sitz bath
•Very hard bowel
movements
•Metamucil/Citrucel (fiber
supplements) 1-2 per day
•Prevent diarrhea
•Diarrhea
Insomnia
•Metabolic changes •Regular bedtime
•Discuss concerns on your mind
•Tension and
emotional changes •Avoid stimulation before bedtime
•Physiologic
•Relaxing bath at bedtime
(urinary frequency,
•Regular exercise during the day
backache)
34
•Rest
•Elevate legs at times during the
day
•Avoid lying on back; lie on left
side
•Gentle massage
•If cramp occurs, straighten leg
•Inadequate
and flatten foot on floor
potassium/calcium
•Calcium supplement (try taking in
intake
the evening)
•Consult with physician or nurse if
symptoms persist
Hemorrhoids
(varicose
veins
in and
around
the rectum)
•Avoid gassy foods
•Slowed digestion
•Warm bath at bedtime
•Eat a banana daily
Nausea and
vomiting
(“morning
sickness”
but may
occur any
time of
the day)
•Unclear, but may
include hormonal,
emotional
•Digestive changes
or unmet
nutritional needs
•Rest/relaxation
•Small, frequent meals
•Fresh air/daily exercise
•Reduce liquids consumed on an
empty stomach
•Keep crackers at bedside to eat
upon waking
•Increase dietary fiber
•Sea bands
•Reduce intake of fats and fried
foods
35
Symptom
Causes:
Care:
Symptom
Nosebleeds/
•Fragile capillaries
in the nose
•Increase humidity in the home
Skin
•Hormonal
changes
(increased
pigmentation of
face or
nasal con- •Physiologic
gestion
changes including
increased fluid
volume
•Adequate vitamin C intake
•Vaseline applied to nostrils at
bedtime
•Lie down with head elevated on
pillows higher than heart; apply
cold compress to bridge of nose
•Avoid vigorous nose blowing
•Sudafed 30mg is acceptable in the
second trimester
•Saline nasal spray (over-thecounter)
Pelvic or
abdominal pain
Causes:
Care:
•Avoid prolonged exposure to the
sun
•Always use sunscreen when in the
sun
abdomen)
Swelling
•Impaired
circulation from
increased pressure
while sitting or
standing
•Lie or sit with feet elevated
•Moderate daily exercise
(swimming is particularly helpful)
•Adequate fluid intake
•Long ligaments
pulling as uterus
grows, especially
with sudden
position changes
•Rest
•Varicose veins
•Support hose
•Warm (not hot) bath
•Hormonal
effect on veins
causing increased
relaxation
•Avoid excessive salt in diet
•Pressure of
enlarging uterus
•Avoid lifting heavy objects
•Gas or bowel
cramping
•Heating pad
•Change positions slowly
•Notify physician or nurse if
persistent
•Adequate protein in diet
•Remove rings if fingers swell
*Notify physician is the swelling in
•Inadequate protein
one leg is greater than the other,
intake or excessive
if there is redness or tenderness,
salt intake
or if there is a marked change
involving the hands or face
•Uterine
contractions
(Braxton-Hicks)
Shortness
of breath
•Elevated
diaphragm from
enlarging uterus
•Increased weight,
so body works
harder to breathe
36
•Deep breathing
•Lie on left side
•Sleep supported with pillows at
upper back
37
Symptom
Causes:
Urinary
•Diminished
bladder capacity
frequency
due to pressure
of the growing
uterus
Vaginal
discharge
•Limit fluid after evening meal
•If pain or burning on urination,
notify physician
•Hormones
causing increasing
secretions
•Cleanliness, but do not scrub
excessively. Rinse well and dry
completely when washing around
the vagina.
•Changes in vaginal
acidity
•Wear cotton underwear, and if
wearing pantyhose, make sure
•Infection
they have a cotton panel
•Avoid tight-fitting pants
•Do not wear underpants to bed
•Do not use deodorant sprays/
pads/soaps. Use either Dove,
Purpose, Emulave, Neutrogena
soaps
•Avoid douches
•Notify physician or nurse if
discharge burns, itches, has a foul
odor, or is bloody
Varicose
veins
•Poor circulation
and blood return
causes valves in
veins to become
weak
•Poor muscle tone
•Inactivity
Choosing a doctor for your new baby is an
important task for expectant parents. There are
several factors to consider. Ask your friends or
relatives for their recommendations. Select two
or three doctors and call their offices. Ask if the
doctor will see you for an interview. Remember,
you are the one doing the interviewing. Some
doctors will charge a fee, and some may not
be accepting new patients. Check with your
insurance carrier regarding coverage for prenatal
interviews. Before going to the interview,
consider your feelings about important child care issues such as: daycare,
breastfeeding, infant nutrition, and/or toilet training. You will want to
ask about these issues in order to find out how the doctor’s philosophy
meshes with your own.
You may also want to consider:
•
If you have insurance that covers “well-baby” office visits, does the
doctor you have selected participate in that coverage?
•
Is the office easily accessible to you? (Remember, initially you will
be making frequent visits for well-baby care.)
•
Will you see your child’s primary physician at each visit or will you
see other members of the practice regularly?
•
Is the doctor accessible by telephone? Do they have specific calling
hours for general concerns as well as for emergency calls?
•
Does the office have weekend or holiday hours?
•Moderate daily exercise
•Support hose
•Elastic hose which should be put
on before getting out of bed
(once veins have swollen, it’s too
late) *Rest with legs elevated
•Weight gain
•Do not stand still or sit with legs
down for long periods
•Genetic tendency
•Cross legs only at the ankles
•Notify physician or nurse if
one vein becomes tender and
suddenly more swollen
38
Choosing A Pediatrician For Your Baby
Care:
After all of your questions have been answered and all of the factors
have been weighed, make your choice. Choose the doctor or group who
will best meet your needs and those of your child, is supportive of your
decisions about child care, and is acceptable to both you and the baby’s
father as informed parents. You should begin your search for a baby
doctor early in pregnancy.
39
Common Pregnancy Terms
Afterpains
Pains resulting from contractions
of the uterine muscle after birth.
Afterpains are more common
in women who have had
two or more babies. They are
usually more noticeable with
breastfeeding.
Amniocentesis
Sampling of the fluid from the
amniotic sac for various genetic
tests.
Amniotic fluid
Water-like fluid surrounding the
baby inside the uterus. It serves
to help support the baby, permit
movement and growth of the
baby, prevent heat loss and
absorbs shocks.
Analgesic
A drug which lessens the
perception of pain.
Anesthetic
A drug which produces partial or
complete loss of sensation, with or
without loss of consciousness. Part
or all of the body becomes numb;
therefore, insensitive to pain.
APGAR score
Numerical rating of an infant’s
condition taken at one and five
minutes after birth. This is based
on a heart rate, respiratory effect,
muscle tone, reflex irritability, and
color. Scores range from 0 to 10.
40
Augmentation
Use of pitocin to increase strength
and/or frequency of contractions.
Bilirubin
A normal product in the
bloodstream of newborns which
comes from the red blood
cells. This can cause jaundice (a
yellowish coloring of the skin) if
the level is high.
Bilirubin lights (phototherapy)
Special fluorescent lights which
shine on the baby’s skin to help
break down potentially harmful
levels of bilirubin in the newborn’s
blood. The lights are placed over
the baby’s crib after covering the
eyes and removing the clothing.
Bloody show (or “show”)
The pinkish or reddish-colored
mucus which sometimes precedes
the onset of labor or is gradually
discharged during labor. It
represents the sloughing off of the
protective mucus plug which seals
over the cervix during pregnancy.
Caput
Swelling of the fetal scalp tissue;
often occurs with long labor and/
or pushing.
Centimeters
Unit of measurement used to
describe the dilation (opening) of
the cervix. Complete dilation of
the cervix is 10 centimeters.
41
Cesarean delivery
Delivery of the baby through
an incision in the abdomen and
uterus.
Chorionic villus sampling
Sampling of placental tissue for
genetic testing.
Episiotomy
Performed infrequently,
episiotomy is a cut in the
perineum (between the vaginal
opening and the rectum) prior to
the delivery to allow more room
for the baby to pass
Dilation
Opening of the cervix during
labor. Dilation is said to be
complete when the opening is
about 10 centimeters in diameter.
The doctor or nurse estimates the
degree of dilation by inserting two
gloved fingers into the vagina and
feeling the cervical opening.
Fetal Heart Rate (FHR or FH)
Normal range for the fetal heart
rate is 120-160 beats per minute.
Duration (of a contraction)
Time from the beginning of a
contraction to the end of that
contraction. It is usually stated in
seconds.
Frequency (of contractions)
Time from the beginning of one
contraction to the beginning of
the next one, usually stated in
minutes.
Effacement
Gradual thinning and shortening
of the cervix. Measured in
percentages, 100% being totally
effaced (paper thin).
Fundus
The rounded upper portion of the
uterus.
Engagement
Means the presenting part of the
baby has secured itself into the
upper opening (inlet) of the pelvis
and is in its beginning position for
passage through this circular bony
structure. The baby is sometimes
said to have “dropped,” may
be noticed by the mother as
“lightening.” Breathing is usually
easier after engagement occurs.
42Urinary frequency increases.
Fontanels
Soft spots on the head of all
newborns which allow for the
necessary molding of the skull
bones during birth. (Also see
molding.)
Gestational age
The age of the baby in weeks
since the last menstrual period.
The gestational age of a full term
baby is 37-41 weeks. A pre-term
baby is one born before 37-weeks,
and a post-term baby is one born
after 41 weeks.
Hyperventilation
Excessive loss of carbon dioxide
(CO2) by deep and/or fast
breathing. Beginning symptoms
include tingling of the fingers &
toes and numbness of the face. It
may be reversed by taking slow,
shallow breaths.
with freedom of movement and
constant temperature (see also
amniotic fluid).
Induction
Labor started by artificial
methods; for example, enema
(artificially rupturing the
membranes) or the administration
of synthetic oxytocin (Pitocin)
and/or prostaglandin.
Molding
The shaping of the baby’s head
during childbirth to adjust itself
to the size and contours of the
mother’s pelvis and birth canal.
Intravenous (IV)
Fluid administered into a vein
for the purpose of nutrition,
hydration, and medication.
Labor
Periodic, rhythmic contractions
of the uterine muscles which thin
and open the cervix and allow the
delivery of the baby, placenta, and
membranes.
Lochia
The discharge of blood, mucus,
and tissue from the uterus and
vagina during the postpartum
period. The discharge lasts several
weeks.
Mucus plug
The bloody mucus which block
the cervical opening during
pregnancy to prevent entrance of
bacteria into the uterus, it is not
holding the baby in the uterus.
Loss of the mucus plug is not
concerning and usually indicates
that the cervix is beginning to
prepare for the labor process.
Multipara (multip)
A woman who is giving birth to
her second (or later) child.
Perineum
The area between the vagina and
rectum.
Meconium
The first bowel movement of
newborns. It is thick and black or
dark
green in color.
Pitocin
Synthetic oxytocin, a hormone
given intravenously and used to
start or improve contractions.
Also, given after delivery to
decrease blood loss by keeping
the uterus contracted.
Membranes (bag of water)
The principle purpose is to
hold the amniotic fluid which
protects the fetus from trauma or
infection and provides the baby
Placenta (afterbirth)
The sponge-like organ attached
to the uterine wall and the baby’s
umbilicus by way of the umbilical
cord. It is the means by which the
43
baby received nourishment and
eliminates waste products.
Postpartum
The period of time after giving
birth.
Ultrascreen
Ultrasound and maternal blood
test for genetic screening.
Primipara (primip)
A woman who is giving birth to
her first child.
Ultrasound
Sound waves used to project
image on a screen. Allows
visualization of fetal structures and
assessment of fetal well-being.
Prostaglandin
Medication inserted in the vagina
to soften and thin the cervix in
preparation for labor (examples
include misoprostal and cervidil).
Uterus (womb)
Muscular pear-shaped organ
in which the baby grows and
develops. It consists of the fundus,
the body, and the cervix.
Rupture of membranes
Leakage of amniotic fluid.
Spontaneous rupture of
membranes occurs naturally.
Artificial rupture of membranes
occurs when the doctor uses a
soft-tipped hook to break the
“bag of water” to allow the
amniotic to leak. Premature
rupture of membranes occurs
when there is spontaneous
leakage of amniotic fluid at least
one hour before the onset of
labor.
Vagina
The birth canal.
Station
Relationship of baby’s head to
mom’s pelvic structures (measured
from -3 to +5).
Triple Screen/Quad Screen
Blood test at 16 weeks for genetic
screening.
44
Vernix caseosa
Protective material covering the
skin of the newborn. It is white
in color and thick, cream-like in
consistency.
Vertex
Leading part of the baby’s head.
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