WHAT TO EXPECT NOW THAT YOU'RE PREGNANT
Pregnancy should be a pleasant time for you, but some body changes may appear. If you know about them, they are less likely to worry you. The changes are usually due to the hormones of pregnancy or physical body adaptation to the pregnancy.
WHAT ARE THE NORMAL BODY CHANGES THAT I MAY FEEL WHILE PREGNANT?
Your breasts will get larger and firmer. The areola or dark areas around your nipples will get darker and may develop bumps in them. Veins in the breast may become more noticeable. At around months 4 and 5 of your pregnancy, your nipples may start giving off a clear or cloudy liquid.
You may experience nausea/vomiting, and heartburn during pregnancy. These discomforts can be helped by eating smaller meals and eating more often. For example, rather than eating three regular meals a day, try six small meals each day. Also, try to snack on plain crackers or toast (without butter) especially early in the morning before getting out of bed. For heartburn, try not to lie down for at least one hour after eating.
Your moods may change. It is not unusual for a pregnant woman to feel happy one minute then sad soon after without an apparent reason.
You may get tired more easily.
You may notice pulling pains in your lower belly and hip areas. These are usually caused by the growth of your uterus, your belly will get larger as your baby grows inside you. You will start "showing" usually after the second half of the pregnancy but could be sooner depending on your body size and prior pregnancies.
You may notice skin changes such as stretch marks or striae (pinkish lines on your breasts or belly) later in the pregnancy and some brown blotches on your face (chloasma). Creams, lotions, or oils do not always prevent these changes. However, after pregnancy, the marks tend to fade and are less noticeable.
You may get constipated and have to strain to have a bowel movement. Hemorrhoids (large blood vessels near the opening in your rectum) may develop. Constipation is best prevented or relieved by including more fiber in your diet. Foods such as fresh fruits, fresh vegetables, and bran cereal are often helpful. Also, increasing the amount of fluid you take will soften the stool and relieve constipation and ease discomfort from hemorrhoids. Avoid sifting on the toilet for a prolonged time and avoid straining this worsens hemorrhoids.
You may experience changes in your legs such as cramps, swelling, and possibly develop enlarged blood vessels (varicose veins).
WARNING SIGNS IN EARLY MISCARRIAGE
FOR WHAT PROBLEMS SHOULD I CALL THE OFFICE RIGHT AWAY, EVEN AT NIGHT OR WEEKENDS?
If you have heavy bleeding (more than a period), heavy cramping, or significant abdominal pain contact the office immediately. Some spotting or bleeding 1s not uncommon in the first trimester, but you are welcome to call the office with your concerns.
WHAT ARE THE DANGERS OF CIGARETTES, ALCOHOL, CAFFEINE AND DRUGS?
These things can harm your unborn baby. It is best not to smoke or drink alcoholic beverages while you are pregnant. It is wise to check with your doctor about the safety of any medication before taking it. But, if you are taking medication necessary to your health, do not stop the medication without discussing it with your doctor.
IS IT TRUE THAT CATS MAY CARRY A DISEASE THAT COULD AFFECT MY BABY WHILE I AM PREGNANT?
Cats may carry a disease that is called Toxoplasmosis. Even though it 1s rare, it has been known to cause very serious problems in newborn babies including mental retardation, growth failure, blindness, and deafness. To prevent it, avoid changing the cats litter box as the disease is usually spread to humans by cat litter/feces.
Raw or poorly cooked meat (especially beef) is another cause of this disease. Cook all meat until it 1s well done. It is important to wash your hands after handling raw meat.
IF IT AM IN AN ACCIDENT, WHAT SHOULD I DO?
In anything more than a simple fender-bender, you should get checked by your doctor as soon as possible. This is true even if you are not hurting as your baby could be affected. You may need some simple tests to be sure your baby 1s doing well. If any vaginal bleeding or contractions occur, call us immediately.
EXERCISE IN PREGNANCY
Regular exercise during pregnancy is a good idea. It makes you feel good and keeps you healthy. What is comfortable, and safe, depends on the level of fitness you have achieved before you became pregnant. This is NOT the time to take on a new sport or increase your fitness level. Exercise three times a week, whether you are pregnant or not, is far better than exercising in spurts. But there are some special changes your body experiences during pregnancy you need to be aware of which will affect any exercise you do. Be sure you set up a safe exercise program because pregnancy changes your body, which could affect the way you exercise.
For example, your ligaments become easier to stretch. That is why you feel a little wobbly just walking. It is easier to sprain something, like an ankle or to pull a muscle. As your baby grows, your weight distribution is different; your center of gravity changes which can make it easier for you to lose your balance. Your ability to catch your breath (get enough oxygen) 1s decreased during exercise.
Because of these changes in your breathing and circulation systems, you may occasionally experience dizziness or weakness. Now, when you exercise, you will notice you don't have the aerobic capacity you did before. Your heart rate when you are at rest is higher than it was before you became pregnant and will rise more rapidly when you exercise. With some adjustments you can continue to enjoy exercising and return slowly, to your desired program after your baby 1s born. If you are in doubt about what kind of exercise or sport you can do, consult your doctor.
ARE THERE TIMES WHEN I SHOULD NOT EXERCISE AT ALL?
Yes, you may have to modify your exercise routine if you:
1. Have problems with early labor
2. Are excessively underweight
3. Have blood pressure, heart, lung, or thyroid problems
4. Have experienced vaginal bleeding during the pregnancy
5. Are having problems with your baby's growth
6. Are severely anemic
7. Having leaking form your bag of water
8. Have experienced #1, 3, or 5 on the above list during a different pregnancy
HOW ABOUT SOME GUIDELINES FOR SAFE EXERCISING THAT I CAN USE DURING
1. Drink enough before exercising, even in the winter.
2. Warm up slowly, at least 5 minutes before starting.
3. Stretch, but not to your limit so as not to injure your ligaments. Remember they are looser now.
4. Avoid exercises with jerky or bouncing motions.
5. Use a stable floor. Avoid loose rugs that may slide.
6. Exercise regularly (every other day), not just once in a while.
7. No competitive exercises.
8. Do not exercise during hot humid weather or if you have a fever.
9. Your body temperature should not go above 38 degree C. (101 degrees F.). Avoid the use of hot tubs and saunas.
10. Exercise should be followed by a cool down period to help heart rate return to normal and cool your body off
11. After the first trimester do not exercise lying down on your back for a prolonged period of time.
12. No weight lifting or anything where you hold your breath and strain.
13. During pregnancy caloric intake is to be over and above your usual need. Adjust it to your level of activity.
14. Avoid strenuous exercise at altitude.
15. Slow down every 20 minutes for 5 minutes to lower heart rate and cool your body.
Choose exercise shoes that feel secure and help your balance. Support hose can help your legs feel better during and after exercise. If you need to increase your bra size you might go right into a nursing bras if you plan to nurse, or your may need an athletic bra for more support during your workouts.
It is NOT a good idea to take up a new sport while pregnant. But you can begin something that will give you a head start after your baby is born. Some good sports are, Yoga (without breath holding), swimming, pregnancy classes, stationary bicycling (gently), easy stretching (but not to your limit), and don't forget about daily walking 1n fresh air.
WALKING: 15-30 minutes of brisk walking is the perfect exercise even if you weren't a walker before you became pregnant. Start out at a slow but steady pace for at least five minutes. Walk up to 15-30 minutes at a brisk pace. Then slow down for 5-10 minutes.
AEROBICS: In general, low impact aerobic exercise is usually safe. It's important to avoid any high- impact exercise and to avoid jerky movements. Wear shoes that give you good footing and reduce any jarring shock to the body.
SWIMMING: If you are used to swimming, by all means continue. Swimming is an excellent exercise because it uses so many muscle groups while the water is supporting your weight. Diving, however, should be avoided due to increased chance of injury.
BIKING: Generally, biking is fine. Start up in moderation and avoid unusual fatigue. Remember to protect your head with a bike helmet and avoid busy, dangerous roads, both of which are important any time you're biking but especially when you're pregnant. Biking in the third trimester is better on a stationary bike due to increased risk of falling with the change in your center of gravity.
Begin very slowly with low intensity. Remember, even if you are in great shape, you will not be able to do what you did. Pregnancy is a special time and requires adjustments to help you and your growing fetus feel happy and stay well.
WHEN SHOULD ISTOP EXERCISING IMMEDIATELY AND CALL MY DOCTOR?
If any of the following happens to you, stop what you are doing and call your doctor
1. Regular contractions that don't resolve with rest
2. Vaginal bleeding or leaking of fluid
3. Blacking out or fainting
4. Shortness of breath
5. Persistent Pain
6. Unusually fast heart beating that doesn't seem to pass
7. Anything else that concerns you
Avoid sports where you might get hit in the belly. Otherwise you can continue the same activities as before pregnancy. Try not to push yourself to the point of becoming over tired. You may find that you have less strength and energy than before you became pregnant, but exercise 1s still good for you unless you pregnancy is considered High Risk.
HOW FAR ALONG IS MY BABY?
By the end of the third month your baby has formed all of its vital organs such as the heart, lungs, and kidneys. Also formed are the arms, legs, and the head. The baby weighs about one ounce and 1s three inches long.
In addition the placenta has formed. This is attached to the inside wall of the uterus (womb) on one side and to the umbilical cord on the other. The umbilical cord then goes on to attach to what will be the baby's belly button. Food or nutrition from your blood stream travels through the placenta into the blood stream in the umbilical cord and nourishes your baby.
HOW MUCH WEIGHT SHOULD I GAIN DURING MY PREGNANCY?
The best amount to gain depends on how much you weighed right before you became pregnant. The doctor or staff will let you know if this weight 1s considered overweight, normal, or underweight.
IMPORTANT: DO NOT TRY TO LOSE WEIGHT WHILE YOU ARE PREGNANT.
WHAT PROBLEMS CAN BE CAUSED BY GAINING TOO MUCH WEIGHT?
The extra pounds will put more strain on your back and legs. The extra weight may stay with you after you deliver your baby. Being overweight can lead to serious medical problems for you such as high blood pressure and diabetes. Also, your baby may become too big for you to have a vaginal delivery.
WHAT IS A GOOD DIET TO FOLLOW DURING MY PREGNANCY?
Your body needs a good balance of foods to keep you healthy and build a healthy baby.
Try to eat regularly and not skip meals. Important parts of your daily diet should include:
1. Protein at each meal from meat, chicken, fish, eggs, beans, milk, or cheese.
2. Calcium, Vitamins A and D from a few glasses of milk each day (low fat 1s best).
3. B Vitamins from whole cereals, breads, or noodles.
4. Vitamin C from the fruit or juice of oranges or grapefruits.
Other healthy additions to your diet are fresh fruits and vegetables. Butter, margarine, or vegetable oils should only be used in moderation (these are empty calories). It is best to avoid "junk food" (candy, sodas, chips, desserts), as they are very high in calories but have few nutrients or vitamins.
To keep from becoming constipated, it might be helpful to have high fiber foods like bran, bran cereals, breads, as well as fresh fruits and vegetables including salads.
FOOD BORN RISKS IN PREGNANCY
Certain soft cheeses, ready-to-eat meats (including packaged luncheon meats and deli meats) and unpasteurized milk (and products made from it) can cause a form of food poisoning called listeriosis. Listeriosis is caused by a bacterium and can be especially dangerous during pregnancy. Pregnant women should follow these guidelines from the
Do not eat hot dogs or luncheon meats (including deli meats such as ham, turkey, salami, and bologna) unless they are reheated until steaming hot.
Avoid soft cheeses such as feta, brie, Camembert, Roquefort, blue-veined, queso blanco, queso fresco or Panela unless it 1s labeled as made with pasteurized milk. Hard cheeses, processed cheeses, cream and cottage cheeses are safe.
Do not eat refrigerated pates or meat spreads. (Listeria thrives at refrigerator temperatures. ) Canned and shelf-stable versions are safe.
Avoid refrigerated smoked seafood unless it has been cooked (as in a casserole). Canned and shelf-stable versions can be eaten safely.
Do not consume unpasteurized juices, milk, or foods made from it.
A pregnant woman who eats liver regularly may consume enough vitamin A to pose a risk to her baby. Though it is not proven that eating liver cause's birth defects, the safest approach is for pregnant women to minimize their consumption of liver.
Always wash vegetables and fruits before eating and refrigerate unused cooked foods promptly. Advice on Mercury in Fish & Shellfish (FDA & EPA)
Fish and shellfish contain high-quality protein and other essential nutrients, are low in saturated fat, and contain omega-3 fatty acids. A well-balanced diet that includes a variety of fish and shellfish can contribute to heart health and children's proper growth and development. Yet, some fish and shellfish contain higher levels of mercury that may harm an unborn baby or young child's developing nervous system.
The risks from mercury in fish and shellfish depend on the amount of fish and shellfish eaten and the levels of mercury in the fish and shellfish. By following these recommendations for selecting and eating fish or shellfish, women and young children will receive the benefits of eating fish and shellfish and be confident that they have reduced their exposure to the harmful effects of mercury.
DO NOT eat Shark/Swordfish/King Mackerel/Tilefish because they contain high levels of mercury.
DO eat up to 12 ounces (2 average meals) a week of a variety of fish & shellfish that are lower in mercury.
Five of the most commonly eaten fish that are low in mercury are shrimp, canned light tuna, salmon, pollock & catfish.
Another commonly eaten fish, albacore ("white") tuna, has more mercury than canned light tuna. So, when choosing your two meals of fish and shellfish, you may eat up to 6 ounces (one average meal) of albacore tuna per week.
Check local advisories about the safety of fish caught by family and friends in your local lakes, rivers & coastal areas. If no advice is available, cat up to 6 ounces (one average meal) per week of fish you catch from local waters, but don't consume any other fish during that week.
Follow these same recommendations when feeding fish and shellfish to your young child, but serve smaller portions.
WHAT ABOUT TAKING VITAMINS AND IRON PILLS?
If you eat a balanced diet, the only extra things you may need are some iron and multi-vitamins with folic acid. Later in your pregnancy we may suggest you take an iron pill up to 3 times each day. Taking additional vitamins and supplements available over the counter may be harmful to your developing baby. Please check with us before taking other vitamins or medications.
IF I HAVE A JOB, WHEN SHOULD I STOP WORKING?
Generally, you can work right up until the end of your pregnancy if you feel up to it. The only types of jobs that might be a problem are those where you work around certain chemicals or x-rays. If you have any questions ask us.
CAN I CONTINUE REGULAR SEXUAL RELATIONS?
Yes, as long as it is not causing you to have pain or bleeding. For certain problems, you may be told to avoid sex. Some women find that sex is more comfortable during pregnancy if they are on top or lying side to side. Feel free to ask us any questions about sexual relations during any of your prenatal visits.
CAN I TRAVEL DURING PREGNANCY?
Yes. There are generally no problems with riding in a plane or taking auto trips. It is best that you get up for ten minutes or so and move around every two hours. Also, you can do legs and feet exercises while seated. This reduces the risk of blood clots and swelling in the legs. Avoid travel we encourage wearing support hose in addition to the above for long trips. It 1s advised to not travel after 35 weeks of your pregnancy.
WHAT ABOUT DENTAL CARE?
Keep getting your regular dental checkups. Take good care of your teeth. Let your dentist know that you are pregnant before any x-rays are taken or any medicines are given to you. If x rays are optional, delay them until postpartum.
WHAT ABOUT CLOTHING?
Wear comfortable clothes that are not tight on your belly. Flat heeled or broad heeled shoes are recommended. Use a bra that gives good support to your breasts.
Quadruple Screening AKA QUAD
Spina Bifida and Down Syndrome Testing
WHY SHOULD I CONSIDER HAVING THIS TEST DONE?
This test is usually done between 15 and 18 weeks of pregnancy. It is used to identify babies with a spine defect or with Down's syndrome or Trisomy 18. Spine defects occur when the baby 1s growing inside the womb and doesn't form a complete covering around the major parts of the nervous system (brain and spinal cord). The defect is usually called spina bifida. It may lead to various physical problems ranging from needing braces to walk to severe handicaps including the inability to walk, as well as mental problems and even death. The test is routinely offered to all women who are pregnant. The decision to have the test done 1s up to the patient.
HOW IS THE TEST DONE?
Blood 1s taken from an arm after 15 weeks of pregnancy. More testing is needed if the levels of the quad markers are abnormal. If there is a history (either in the family, a previous pregnancy, or parents) of a spine defect, genetic amniocentesis is a more appropriate test than the blood test.
The Quad Screen Test consists of measuring Alpha Feta Protein (AFP) combined with three other markers made by the fetus, the placenta and by the pregnancy.
DOES AN ABNORMAL TEST ALWAYS MEAN THAT THE BABY HAS A SPINE
No. There are some normal conditions which cause an abnormal test including twins, not being as far pregnant as you thought you were, or bleeding early in pregnancy. An abnormal test will require further testing to see if your baby has a defect. After you have read this material, you should discuss any questions with your doctor or medical staff.
DOES THE TEST ALWAYS DETECT BABIES WITH THESE ABNORMALITIES?
No test is absolutely foolproof rarely, this test can be normal even though you may be carrying a baby with a birth defect. Fortunately, this test is very good. Just by itself, it can detect many birth defects. But remember, a normal result on this test does not guarantee a normal baby. It detects approximately 80% of cases of Down's syndrome, spina bifida, and Trisomy 18.
BREAST AND BOTTLE FEEDING
Even though your delivery is months away, this is a good time to think about how you're going to feed your baby during the early months. Will you use breast milk or formula?
WHAT ARE THE ADVANTAGES OF BREAST FEEDING?
Breast feeding or nursing is unquestionably an excellent way to feed your baby. It can give you much pleasure to have you child in close contact with you during feedings, and, of course, this contact gives much pleasure to your little one.
Breast milk is the most easily digestible food that a baby can consume. In other words, it is very agreeable and is unlikely to cause spitting-up or any stomach problems. No special preparation is needed such as measuring and sterilizing and it's definitely cheaper than formulas.
If asthma or allergies run in the family, it seems that breast feeding can cut down the chances of these happening in the baby. Breast milk contains antibodies that protect young babies against infections. They are made in your body and passed to your child in the breast milk.
Breast-feeding helps your body get back to its normal size and shape. The baby's sucking stimulates the muscles of your uterus (which got stretched out during pregnancy) to return to normal. Breast-feeding can help prevent overfeeding. Breast fed infants usually get just what they need during each feeding. There is sometimes a problem of bottle fed babies getting too many calories and gaining too much weight. Overweight babies often grow up to have weight problems.
WHAT ARE THE PROBLEMS WITH BREAST FEEDING?
Almost any mother can breast feed her baby. Women with certain disease or those taking certain medicines may be told that they should not nurse. Your doctor will discuss this with you.
One of the greatest problems of breast-feeding 1s a mother's fear that she can't do it. This is common, but with a little help and instruction these fears can be removed. Some mothers think their breast size is too small. The part of the breast that makes milk has little to do with the breast size.
Women with any size breasts of nipples should be able to nurse their children.
Some mothers fear that breast-feeding limits their freedom. Many women have gone back to full time jobs after having a baby and continued to nurse when at home. There are ways to save breast milk so it can be put into a bottle for use when the mother 1s not home. If you think you want to breast feed, a lactation consultant from Seton Medical Center will be happy to help you and give you information on how to prepare for it and how to handle problems than can come up during nursing.
HOW CAN I PREPARE MY BREASTS FOR NURSING?
Your body will prepare your breast for breast-feeding. Keep the skin around you nipples healthy. Avoid excess rubbing or stimulation since this might damage the skin. It's best to avoid using lotions or alcohol on your breasts. You can do normal cleaning of the breasts when bathing or showering. If you have inverted nipples (nipples that are turned inward) ask about what you may need to do when breast-feeding. Try to attend a breast-feeding class and read some pamphlets of books on breast- feeding. Ask your doctor or nurse for more information.
SHOULD MY DIET BE ANY DIFFERENT?
You will need to take in about 500 extra calories cach day to help you produce good breast milk. Otherwise your dict should be like the diet recommended during pregnancy. To be sure you are not getting too many calories, watch you weight. You should not gain weight at this time.
WHAT ABOUT MEDICINES, DRUGS, AND ALCOHOL?
These can get into your breast milk. Don't use anything, even nonprescription medicine for the drug store unless you first check with your doctor. It's best to avoid alcohol and smoking while you are pregnant and even late, when breast-feeding.
HOW CAN I TELL IF THE BABY IS GETTING ENOUGH MILK?
Watch that the baby is swallowing while nursing.
The baby should be content for one or more hours after feeding.
The baby has 5-6 wet diapers a day (the baby may have less the first few days after birth)
The baby is having stools (bowel movements) at least every day or two.
Ultimately, the pediatrician will tell you if the baby is gaining adequate weight.
WHAT CAN I DOIF I HAVE PROBLEMS NURSING?
If you have any problems at all, don't get discouraged and think it would be easier to switch to a bottle. First, talk to your doctor or the nursing staff and let them help you. You can call the hospital nursery (anytime day and night). There are support groups and breast-feeding centers in many states. Ask the doctor, the hospital nursery or check you phone book. One suggestion would be the La Leche League.
WHAT IF I HAVE TO STOP NURSING FOR SOME REASON?
If breast-feeding is delayed after birth, stopped for a while, or if you and baby are separated, you will want to use a breast pump or hand expression to keep up your milk supply and empty your breasts.
Ideally, if the baby is not nursing 6 hours after birth, you should begin to stimulate your milk supply by stimulating your breasts. Ask the hospital personnel for assistance with this.
WHAT ABOUT BOTTLE FEEDING?
Some women may choose not to nurse their baby and, instead, desire to give them formula. If you choose to bottle feed, it is important to remember a few things:
1. Keep bottles and nipples clean so germs don't get into the baby's milk
2. Try to hold the baby close to you while giving the formula. This can help you and the baby build a close relationship. Propping a bottle on a blanket, so the baby lies alone and drinks is not a good habit and can be dangerous. Babies need and like close contact.
3. Always use formula for the entire first year of your baby's life. Using regular or low fat
homogenized milk before your baby is a year old is not recommended and can lead to
anemia or a low blood count in the baby.
PREPARING FOR THE HOSPITAL
Your baby will be delivered at North Austin Medical Center. It’s a good idea to make a practice trip to the hospital at some time before actually going into labor. This way you can make sure you know the correct roads and how long the drive takes. Better yet, take a tour of labor and delivery area. A nurse will be happy to show you around.
If you have other children, you might want to make arrangements ahead of time for someone to watch them when you go to the hospital for the delivery. Sometime during the month before your due date you might want to pack a suitcase of things to take with you to the hospital.
Some of the things you may want to bring are:
Bathrobe, Toothbrush, Loose fitting outfit to wear home, Slippers, Toothpaste, Cosmetics,
2-3 nightgowns, Hairbrush, Nursing bras (if plan to breast feed or two other support bras).
About all you'll need for the baby are a baby blanket, a sleeper or nightshirt, and two diapers. If you are expecting cold weather, then make sure these items are heavy enough to keep the baby warm on the way home.