What are the most common early symptoms of pregnancy? 

Missing a period is usually the first sign of a new pregnancy, although women with irregular periods may not initially recognize a missed period as pregnancy. During the first few weeks of pregnancy, many women experience a need to urinate frequently, extreme fatigue, nausea and/or vomiting, and increased breast tenderness. All of these symptoms can be normal and are expected in the beginning of new pregnancy.   

 

How many months is a normal pregnancy?

Pregnancy is 280 days (40 weeks or 10 “lunar” months) from the first day of your last menstrual period. 10 lunar (4 week months) months which a 40 weeks. A lunar month is 29.5 days.

The 40 weeks is further broken down into 3 trimesters.

When does the first trimester start and end?

The first trimester is from week 1 to the end of week 12.

 

Why am I so exhausted during the first trimester?

Feeling exhausted is a classic symptom of an early pregnancy.  In fact, it is often the very first symptom women notice when pregnant.  Women experience overwhelming fatigue and find they cannot get enough sleep.  These symptoms of feeling exhausted occur as a result of the hormonal changes caused by progesterone.

 

Is gas a common sign of an early pregnancy?

 

Very early in pregnancy, complete chaos with bowel function occurs.  Hormonal changes and prenatal vitamins create bowel pandemonium causing bloating, gas and constipation.

 

How common is cramping seen during the first trimester of pregnancy?

Cramping is a common symptom early in pregnancy as the uterus begins to grow.  The cramping should feel similar to the mild cramping you may experience with your period.  If the cramping becomes more intense and associated with other symptoms such as vaginal bleeding, nausea, vomiting or fever you should contact your health care provider.

 

How common is vaginal spotting seen during the first trimester of pregnancy?

 

Any bleeding during pregnancy is scary. When the embryo implants itself in the uterine lining there can be normal bleeding or spotting described as implantation bleeding.  Implantation bleeding is common occurring in 30% of pregnant women.  

The type of bleeding is classically light red, brown or pinkish. Implantation bleeding typically lasts for 2-7 days.

The main difference between normal implantation bleeding and an abnormal pregnancy is the amount of bleeding you experience and severity of uterine cramping.  Implantation bleeding is light or “scanty” in appearance with mild uterine cramping.  An abnormal pregnancy is associated with heavy, bright red bleeding with clots and severe uterine cramping.

 

I just found out I am 6 weeks pregnant, why am I feeling so anxious?

 

Early hormonal changes in pregnancy can make you feel more emotionally fragile and sensitive.  Anxiety, depression and feeling emotionally vulnerable may be your first sign of pregnancy. 

 

Can you get a period if you are pregnant? 

 

Just around the time you are due for your next period is the same time the embryo implants into the lining of the uterus causing spotting or light bleeding lasting 1-2 days and mild uterine cramping.  Implantation bleeding occurs in about 30% of pregnancies and is often the first sign of pregnancy. Implantation bleeding is not a period.

What should you do if you suspect you’re pregnant?

Ideally you want accurate and reliable results when determining if you are pregnant or not. Delay pregnancy testing as close to your expected period as possible. The most accurate results will be if you miss a period and get a blood test to confirm pregnancy.  Getting a blood test where you measure the HCG (Human Chorionic Gonadotropin) levels will give you the most reliable results but this would be done at your health care providers’ office.  HCG is a hormone only produced by fetal cells confirming pregnancy.

When do I go see my once I find out I am pregnant or miss a period?

Typically, you will be seen by your obstetrician or healthcare provider sometime between 6 to 12 weeks from your last menstrual period (LMP).

What happens during my first OB visit?

During your first prenatal visit, your obstetrician or healthcare provider, will perform a physical exam, including a breast and pelvic exam. Vaginal cultures and a Pap smear will be taken along with an OB panel of blood that includes a genetic panel.

What kind of genetic screening can I do for the baby in the first trimester?

Genetic screening tests can be invasive or noninvasive. A safe and noninvasive way to find out the chromosomes of the baby is a blood test called noninvasive prenatal testing (NIPT). NIPT involves taking maternal blood between 10-14 weeks to determine if the baby has abnormal chromosomes including Down’s (trisomy 21), Edward’s (trisomy 18) and Patau (trisomy 13).  NIPT can also test for gender. The NIPT is cost effective, no risk to the baby and has a 98% to 99% accuracy rate. 

 

What about Chorionic Villi Testing (CVS) for genetic testing?

CVS is an invasive test to learn the chromosomes or gender of the baby. Chorionic villi testing is traditionally offered to pregnant women over 35year or who are high risk for chromosomal abnormalities.

Chorionic Villi Testing (CVS) is done between11-14 weeks and involves a needle that is inserted through the vagina or uterus under ultrasound guidance to collect cells from the placenta.   The placental tissue removed is tested for chromosomal analysis.  JS

 

Why do you feel dizzy when you’re pregnant?

 

Feeling dizzy is a common and normal symptom of pregnancy, especially in the first trimester.  It happens as a result of all the hormonal, blood volume, structural and blood sugar fluctuations throughout pregnancy.  Some of these changes ultimately affect your blood pressure which can reduce blood flow to the brain and cause bouts of dizziness. When lying on your back after 20 weeks the uterus will put unwanted pressure on the large vessels carrying blood to the heart reducing the flow to and out from the heart causing dizziness.  When you have not eaten regularly your blood sugar levels drop and can also cause dizziness. In the third trimester it’s common to feel dizziness as a result of abrupt movement due to all the blood volume changes.

 

Is dizziness dangerous for you or the baby?

It can only be dangerous for the baby if it occurs frequently enough where it leads to fainting, falling or not eating enough calories which would have a potential negative affect.

 

How can you prevent or reduce dizziness from happening during pregnancy?

 

You can prevent dizziness by making sure to follow some of these suggestions:

• Eat every 2 to 3 hours and avoid long periods of time between meals.
• Avoid hot baths, showers or Jacuzzi’s.
• Avoid lying on your back after 20 weeks for more than 20 minutes.
• Avoid getting up or going down too quickly. 
• Avoid standing on your feet for long periods of time.  
• Wear Ted Hose stocking to help the blood circulation in your lower legs when standing for long periods of time.

Can I drink caffeine during pregnancy?

Caffeine can be consumed in a safe way in pregnancy.  It was thought that moderate caffeine consumption > 200mg/day (12oz cup of brewed coffee) was thought to be a contributing factor in miscarriages and preterm labor. The good news for coffee drinkers is the studies currently do not show that drinking a 12 oz cup of coffee will lead to an increase miscarriage rate or affect your pregnant in the slightest way.   It’s recommended to limit your caffeine intake to 1 cup of coffee or 2 cups of tea/day during pregnancy.  Also know how much caffeine is contained in the foods and beverages you eat so you can keep the quantity under 200mg/day which is considered a safe amount before and during pregnancy. 

 

The bottom line is all the medical research suggests that having a 12-oz cup of coffee or 2 cups of tea a day is safe for your growing baby.

What foods should I avoid during pregnancy?

 Food concerns during pregnancy include raw vegetables, unpasteurized juices, liver, and undercooked meat, poultry, or eggs. Food poisoning can occur when eating raw vegetables, unpasteurized juices, and undercooked meat, poultry, or eggs that can be linked with Salmonella and Escherichia coli bacteria.  Cooking properly and thoroughly kills bacteria in the majority of foods.   Eating raw fish, such as sushi, has not been recommended in pregnancy since it can carry certain bacteria and parasites.  Mercury is very toxic and can cause problems to the fetus and to the newborn nursing infant.  Fish, such as shark, grouper, Chilean sea bass, halibut, swordfish, king mackerel, tuna and tilefish have increased mercury levels and cause the most concern for consumption by pregnant women. 

 

A pregnant woman can safely eat 12 ounces per week of varieties of fish thought to be low in mercury if they eat a variety of cooked, smaller fish. The safest fish that are low in mercury are shrimp, canned light tuna, scallops, oysters, squid and salmon.

What is the miscarriage rate for pregnancy?

Every pregnant woman has a 25% chance of having a miscarriage.  When the bleeding starts to look like a heavy period with blood clots and severe menstrual-like cramping then it’s time to be concerned that you are experiencing a miscarriage.  If heavy bleeding and cramping is associated with fatigue or dizziness it’s important to contact your health care provider to have a pelvic US, blood count and beta HCG (human chorionic gonadotropin) to make the correct diagnosis. 

When is a pregnancy considered safe? 

The majority of miscarriages happen during the first trimester.  Over 85% of miscarriages will happen by 6-8 weeks of pregnancy.   If you are not having any abnormal signs of pregnancy and have an US that shows cardiac motion after 12 weeks chances, are you have a healthy pregnancy. There are many complications of pregnancy that can occur in the second and third trimester that are based on maternal age and other preexisting medical conditions that can happen unexpectedly.

What is morning sickness?

Nausea is considered as one of the classic symptoms of pregnancy. It popularly known as ‘morning sickness’, although it can occur during the morning, noon, or night and affects about 80% of all pregnant women. 

In 2% of pregnancies, persistent nausea and vomiting can become so severe pregnant women can lose weight, become malnourished, and dehydrated where hospitalization is necessary.   

If you are unable to keep down liquids or solid foods for more than 24 hours you should contact your healthcare provider.

What causes morning sickness?

The actual causes of nausea and vomiting of pregnancy remains a mystery but theories include hormonal changes, imbalance in blood sugar levels and psychological factor

 

Why do some women have morning sickness, yet some don’t at all? 

The actual causes of nausea and vomiting of pregnancy remains a mystery but theories include hormonal changes, imbalance in blood sugar levels and psychological factors.

 

How long does morning sickness last?

Morning sickness can begin as early as 2 weeks into pregnancy and

continue until 12 weeks.  

Is morning sickness a sign of a healthy baby/healthy mother?

What is interesting is women with mild nausea and vomiting during pregnancy experience fewer miscarriages and stillbirths than women without these symptoms.  So, for me, when a woman is really nauseous and has occasional vomiting, I know she is probably carrying a healthy pregnancy! 

How long does morning sickness last?

It is popularly known as ‘morning sickness’, although it can occur during the morning, noon, or night and affects about 80% of all pregnant women. 

What foods combat morning sickness?

The best way to avoid nausea during pregnancy is to eat frequently and often.  Don’t wait to feel hungry to eat. Ideally eat foods high in carbohydrates and low in fat.  Avoid foods that are spicy, salty or high in protein.  The BRAT diet is always helpful and consists of Bananas, Rice, Applesauce and Toast. Drink cold, clear and carbonated beverages in small amounts and as often as possible. 

Saltine crackers are also quite helpful!

What medications can women take to combat morning sickness?

The safest medication to take in pregnancy is called Diclegis.  It’s basically a combination of Benadryl and Vitamin B6. Zofran has been used in the past but is not as safe to take in pregnancy.

What are some natural remedies to combat morning sickness? 31

Vitamin B6 25mg taken 3 times a day has been effective for nausea and vomiting pregnancy.  It’s not clear how it works but has a great track record.

Ginger in different forms-ginger root boiled in water, ginger root tea, ginger lozenges, ginger nonalcoholic beer, gum or capsules works well. Ginger ale and ginger snaps are less effective but also do help with symptoms. It’s thought that ginger helps relax gastrointestinal muscles relieving symptoms associated with morning sickness.

Acupuncture and acupressure are easy and safe alternatives to help the woes of morning sickness. Acupuncture and acupressure use the PC6 pressure points to relieve mild nausea and vomiting.

How can pregnant women prevent morning sickness? 

There is really no way to prevent morning sickness.  You can do your best to manipulate the way you eat and drink to help you get through it. Morning sickness is a normal sign of a healthy pregnancy…a rite of passage so to speak. It suggests the pregnancy hormones are rising appropriately and your body is responding normally to the changes. Feeling miserable the first 12 weeks can be a soft sign to your health care provider that all systems are working normally. Reassuring women who don’t see a light at the end of the tunnel is important so they understand morning sickness is common, it’s short lasting and it suggests your pregnancy is off to a healthy start.

  

When should morning sickness be a cause for concern? 

 In 2% of pregnancies, persistent nausea and vomiting can become so severe pregnant women can lose weight, become malnourished, and dehydrated where hospitalization is necessary. Losing 10% of your normal body weight would be a concern for you and your baby.  This condition is called Hyperemesis Gravidarum.  Where expected morning sickness of pregnancy typically improves around 10 weeks, Hyperemesis Gravidarum continues up until 20 weeks of pregnancy. Hyperemesis tends to improve in the last half of pregnancy, but may persist until delivery.

Does stress increase morning sickness symptoms?

Many factors play a role in morning sickness for pregnant women. Normal hormonal changes cause a slowing of the digestive tract and relaxation of the intestinal muscles which all contribute to nausea and morning sickness during pregnancy.  Stress can also trigger and exacerbate morning sickness. 

What should someone do to reduce stress while pregnant?

Stress is inevitable, it’s how we deal with it that ultimately makes us more resilient and equipped to handle it and minimize morning sickness during pregnant.  I suggest creating daily rituals involving healthy habits which will help reduce unwanted stress. Regular exercise including yoga, meditation, biofeedback, practicing mindfulness, guided imagery, Tai Chi, massage, acupuncture and psychotherapy along with eating a healthy diet, drinking 8 to 10 -12 oz-glasses of water and sleeping at least 7 hours a night is helpful. Taking probiotics can also be helpful in minimizing gastrointestinal upset and improve digestive health. 

The BRAT diet is always helpful and consists of Bananas, Rice, Applesauce and Toast. Drink cold, clear and carbonated beverages, like 7-Up and Ginger ale, in small amounts and as often as possible. Cold foods, fruits, vegetable, Jell-O, popsicles, saltine crackers and pretzels should be added to your diet.

Find your stress-relieving activity and diet that works best for you!

What are the signs that something is wrong with an early pregnancy?

The classic signs of an abnormal pregnancy or impending miscarriage are vaginal bleeding, pelvic pain and uterine cramping.  If any of these symptoms are persistent it may represent an abnormal pregnancy. Following up with your health care provider will help you know if this is a healthy pregnancy or not.

What are the most important things to do or keep track of during the first trimester? 

Pay attention to how you are feeling and be aware of any potential warning signs of an abnormal pregnancy. Always bring your concerns and questions to the attention of your healthcare provider if you have any questions.

Continue taking your prenatal vitamin, eat a well-balanced diet, get plenty of rest and discuss any prescription medication with your health care provider before taking them.

How can you calculate how many weeks pregnant you are?

Your pregnancy will first be dated by your first day of your last menstrual period (LMP). Since there is variation and irregularities with LMP’s, a transvaginal ultrasound (US) may be a more accurate way to establish dating of a pregnancy. A transvaginal US is typically done in the first trimester to evaluate an early pregnancy and establish accurate dating of the pregnancy.

When is an Ultrasound (US) done during pregnancy? 

A pelvic or abdominal ultrasound take pictures of the baby using sound waves throughout pregnancy. If an US is done prior to 12 weeks, it may be done using a vaginal probe, also known, as a transvaginal US. If performed on your belly it would be an abdominal US. Typically, the best time to do an US to evaluate the health of a growing baby is between 18 and 22 weeks.  You may get other US’s during the pregnancy if there is a concern with the baby’s growth or well-being.

Is Ultrasound safe during pregnancy?

I am frequently asked if Ultrasound (US) during pregnancy is safe.  Pregnant women can take a sigh of relief knowing that there is no evidence showing that US is harmful to a growing baby at any time during pregnancy. The US performed during pregnancy uses high frequency sound waves to evaluate a pregnancy.  There is no harmful radiation used during an US. 

What can the US see during pregnancy?

Ultrasound can check many aspects of the health of the baby including:

• the number of babies
• the size of the baby
  • how well the baby’s heart works
  • how well other organs (such as the spine, brain and kidneys) are growing
  • the anticipated date of birth
  • whether there are problems with the mother’s uterus, fallopian tubes or ovaries
• to see what position the baby is in
  • to check the placenta (afterbirth)
  • to view how much fluid is around the baby
  • to check the baby’s growth and well-being
  • to check for signs of a possible genetic problem

Could a sudden cold be an early sign of pregnancy?  

Early symptoms of pregnancy can include a headache, a metallic taste in the mouth, fatigue, feeling lethargic and a stuffy nose which could be confusing signs of the common cold. Since early pregnancy signs typically include missing a period, nausea, breast tenderness and other longer lasting symptoms, this can help in differentiating between pregnancy and the common cold.

How does a pregnancy-symptom cold differ from a regular cold?  

Missing a period is usually the first sign of a new pregnancy, although women with irregular periods may not initially recognize a missed period as pregnancy. During the first few weeks of pregnancy, many women experience a need to urinate frequently, extreme fatigue, constipation, heartburn, nausea and/or vomiting, fluid retention, mood swings, headaches, back pain, increased breast tenderness and milky white vaginal discharge. All of these symptoms can be normal and are expected in the beginning of new pregnancy as a result of normal hormonal changes.  

The common cold is usually more short term and doesn’t include the majority of early pregnancy symptoms. The common cold symptoms are typically a runny or stuffy nose, cough, congestion, body aches, sneezing, low grade fever and sore throat. These symptoms are classic for the common cold and not for pregnancy.

What are other reasons for cold like symptoms? 

Other medical conditions that can appear like the common cold include COVID-19, allergies, an ear infection, pneumonia, asthma, sinusitis, and the flu. If symptoms persist longer than 7 days, you should contact your health care provider.

When does the second trimester start and end?

The second trimester is from week 13 to 26 week.

During the second trimester, the baby will grow from about 2.9 inches (7.5cm) in length, and weighing 1oz (30g) in week 13, to about 9 inches (23cm) in length and 28 oz (820g) at week 26.

What are the most common symptoms during the second trimester?

The second trimester also referred to as the “honeymoon period” is when you will feel the most energetic and less bothered by first trimester symptoms.  Your belly, breasts and waistline will continue to grow. Feeling more nasal congestion, dizziness, headaches, leg cramps, milky white vaginal discharge, painless Braxton Hicks contracts and brown skin changes—also known as melasma– on your body including your face, breasts and abdomen are common during the second trimester.

When should you start to feel movement during pregnancy?

 Most women feel the beginnings of “fetal movement” before 21 weeks gestation. In a first pregnancy, this can occur around 18-21 weeks gestation, and in following pregnancies it can occur as early as 15-16 weeks gestation. Early fetal movement is felt most commonly when the woman is sitting or lying quietly and concentrating on her body. She may also feel fetal movement after eating or drinking a sugary beverage.

 

 

When should you start kick counts?

Following your baby’s “kick counts” especially in the 3rd trimester is a way to ensure the baby moves 10 movements in an hour, at least twice a day. Fetal movement is noticed most often late at night between 9pm and 1am. If you notice there is less or decreased fetal movement during the day, you should drink a large glass of juice and lay on your left side to see if your baby will move with a sugar boost and blast of hydration.

 

 

 Will your baby be active leading up to and during labor? 

 During labor you will continue to feel your baby move but it may be less noticeable or vigorous.  Since you are not typically eating or drinking during labor, the baby is not being stimulated as much by the usual nutrients and may not move as actively. Plus, you are contracting every 2 to 3 minutes so you are more aware of what is happening with your uterus and body as opposed to the movement of the baby.  The baby’s heart rate is being continuously monitored during labor so you know everything is fine unless the nurse or obstetrician tells you otherwise. Focusing on the movement of the baby during labor is less of a priority. 

 

Should I worry if the baby seems to be moving less the closer I am to my due date?

It’s very common to feel a decrease in fetal movement a couple weeks before your due date but it tends to not be a true obstetrical concern. As the baby grows and gets larger the perception of movement will change and might be less noticeable as you get closer to your due date. If there is persistent decreased fetal movement, an ultrasound to check the fluid around the baby and non-stress test (NST) should be performed.  A lower amount of fluid around the baby is a concern that can lead to fetal distress and death.  Regular and frequent fetal movement directly correlates to the baby’s well-being. 

 

 

If your baby is active during labor, how does that feeling differ from contractions? 

 Pregnant women get used to feeling the baby move during pregnancy. One or many areas of the uterus move when a baby is moving around.  When your baby moves it’s a comforting and memorable sensation.  During labor, uterine contractions involve a symmetrically tightening of this very large muscle.  The entire abdomen is noticeably disrupted by a contraction compared to only certain areas of the uterus that are affected with the movement of the baby.

What are Braxton Hicks contractions?

 Simply put, Braxton Hicks contractions are painless contractions where real contractions are painful.  When you experience a Braxton Hicks contraction you will see your uterus tighten and become hard, like a rock, but it is not associated with pain. Braxton Hicks contraction are so subtle, most pregnant women doesn’t realize they are having them.

Braxton Hicks contractions are a normal part of pregnancy and do not really prepare your body for labor.

 

What do Braxton Hicks feel like? 

When you experience a Braxton Hicks contraction you will see your uterus tighten and become hard like a rock, but it is not associated with pain.  They occur irregular at intervals meaning there is no pattern to the frequency Braxton Hicks contractions.  They tend to be very subtle and most pregnant women don’t realize they are having them.

 Real uterine contractions start as menstrual cramp and continue getting more intense and painful, unlike Braxton Hicks contractions.

 

Do Braxton Hicks lead to labor? 

Braxton Hicks occur spontaneously and are completely normal throughout pregnancy especially in the third trimester. They don’t typically lead to going into labor unless they become regular in frequency and cause pain.

 

 

What are some common triggers for Braxton Hicks?

The uterus is one large muscle. Just like any muscle in your body, the uterus will flex when stimulated.  It contracts and relaxes for a number of reasons or for no reason at all.  Common reasons for the uterus to contract, unrelated to going into labor, is if you are dehydrated, exercising, after an orgasm, during sexual intercourse or have a full bladder.

 

Can you stop Braxton Hicks when they happen? 

If you can identify the common causes of Braxton Hicks contractions, then you can stop them from happening. As an example, if you are dehydrated and haven’t been drinking enough water throughout the day, you can rehydrate with water to stop them from happening. Emptying your bladder by peeing or resting during a workout can also calm the uterus and prevent BH contractions. 

What is the difference between Braxton Hicks contractions and real labor contractions?

Real uterine contractions start as menstrual cramp and continue getting more intense and painful, unlike Braxton Hicks contractions.

 

Are Braxton Hicks the same things as false labor?

“False labor” can occur before true labor actually begins.  False labor is described as irregular uterine pains or contractions that do not increase in severity and frequency. Contractions can occur every 10-20 minutes for a few hours and then stop all together. False labor creates a lot of confusion for expecting moms.  BH contractions should not cause you to feel pain so they are different than false labor.  If you have frequent BH contractions which increase in intensity and pain then this could be beginning of false or early labor. 

 

What are the most important changes that happen to the fetus during the second trimester?

During the second trimester the fetus continues to grow and starts looking like a developing baby on Ultrasound. From head to toe, limbs and organs are maturing and growing. Toenails, eyes, hair, skin, lungs and the central nervous system continue to form. Fetal movement can be felt in the early part of the second trimester if it’s your second pregnancy or by 21 weeks if it’s your first pregnancy.  The fetus starts to gain weight, sleeps a lot and can hear sounds and voices outside the womb.

During the second trimester, what are the most important things to do or keep track of?

During the second trimester the fetus is assessed for any genetic abnormalities, either through blood tests, an amniocentesis or on Ultrasound. Blood tests checking for gestational diabetes, anemia and any Rh-negative blood incapability may also be done during the second trimester. It’s an important trimester to make sure you are gaining the appropriate amount of weight, exercising regularly and getting adequate amounts of sleep.

What is the genetic testing available in the 2nd trimester?

An amniocentesis is an invasive form of genetic testing performed between 16 to 18 weeks.  A needle is inserted into the uterus removing amniotic fluid under ultrasound guidance to be tested for chromosomes and gender.  

 

What can be done about constipation during pregnancy? 

 

Definitely one of the more uncomfortable problems that can be exacerbated during pregnancy, constipation is a common complaint.  Between the hormonal effects of progesterone slowing down the motility of your intestines, the iron and calcium in prenatal vitamins, the displacement of the intestines by a growing uterus and the changes in our diets during pregnancy all lead to a disruption in bowel function.  Some have bowel changes consistent with a softer and more frequent stool, others have hard “rabbit” pellets and many others have bowel movements every 2-5 days.

Constipation during pregnancy can be prevented with the following lifestyle changes:

• • Drink plenty of fluids. Water is the best choice and I would recommend drinking at least 8-10, 8-ounce glasses a day. Fruit juice, especially prune juice, will help regulate your constipation.  Drinking warm liquids in the morning is also effective.
  • Physical activity and exercise should be a part of your daily routine.  Daily walks, lasting 30-45 minutes, and other aerobic activities can help prevent pregnancy constipation.  Exercising regularly aids in our digestion and makes you feel physically and emotional stronger and more energetic. 
  • Include more dietary fiber in your diet. Choose high-fiber foods, such as fruits, vegetables, beans and whole grains.  Fiber helps bring water into the intestines, softening the stool and allowing it easier to pass.  With your health care provider’s OK, consider a fiber supplement, such as Metamucil, Citrucel and Miralax.

• Stool softeners, such as Colace, moistens the stool allowing easier passage. I encourage most of my patients to take 50mg to 100mg of Colace two times a day throughout the duration of the pregnancy.  

• Cascara Sagrada is a natural laxative made of dried bark.  Take 1 to 2 capsules before bedtime with a large glass of water.  It’s a much gentler alternative then Sena.

Bulk forming laxatives such as fiber supplements are the gentlest on your body and safe to use during pregnancy.  Metamucil, Citrucel and Miralax are examples of this and are recommended throughout pregnancy.  Stimulant laxatives, such as Ex-Lax and Senokot are the hardest on your intestines and should not be used during pregnancy.

There are remedies and solutions for this serious and uncomfortable side effect of pregnancy.  As always consult with your health care provider for recommendations on the safest route to follow.  

 

What’s pregnancy acne about?

 Acne in pregnancy is extremely common, and it is often more difficult to treat.  “Pregnancy acne” is not a special form of acne.  Pregnancy acne occurs due to the overproduction of sebum oil which happens from all the hormonal changes.  Unfortunately, some women are more susceptible than others. Some studies show that as many as a third of cases actually improve in pregnancy but most women will report some worsening.  

 What are some general things to keep in mind when choosing acne products for pregnancy?

First things first when it comes to taking care of your face during pregnancy to minimize pregnancy acne.

The various forms of treatment include the following:

1. Wash your face twice a day.  You can use a mild cleanser with warm water and gently wash your entire face.
2. If you have oily hair, shampoo daily.  Be careful to keep your hair off your face.
3. Avoid picking, scratching, popping or squeezing acne sores.  These types of habits can spread infection and potentially cause scarring.
4. If you use cosmetics, stick to oil-free products.  Descriptions such as water-based, noncomedogenic or nonacnegenic. 
5. Avoid resting your face in your hands.  This can trap skin oils and sweat, which can irritate acne.

 

What medication is safe to use to treat pregnancy acne?

Medication is the second line of treatment for pregnancy acne.  Erthromycin (Erygel) or clindamycin (Clindagel) is often the drug of choice of pregnancy acne.  Azelaic acid (Azelex, Finacea) is another option.  Both of these medications are applied to the skin as a lotion or gel and are available by prescription.

Other more controversial and less studied products include benzoyl peroxide and other over-the-counter or prescription strength benzoyl peroxide during pregnancy.  

Medications to avoid during pregnancy include isotretinoin and other retinoids, minocycline, doxycycline and other tetracycline’s.

Initially you should consult with your obstetrician or health care provider for first line treatments.  If those prove to be unsuccessful consult with your dermatologist.  Together you can weigh the benefits and risks of various treatment options.

  

When does the third trimester start and end?

The third trimester is from week 27 to 40 weeks.

By 40 weeks, your baby will be about 19.6 inches (50cm), and weigh approximately 7.5 lbs (3.4kg)

What are the most common symptoms during your third trimester?

 

The most common symptoms during the third trimester include more frequent Braxton Hicks contractions, heartburn, backaches, shortness of breath, varicose veins, hemorrhoids, frequent urination, insomnia and anxiety in anticipation of delivery.

 

What are the most important changes that happen to the fetus?

 

During the third trimester the fetus is preparing for delivery. Hair growth, weight gain, practiced breathing, finger and toenails grow, testes descend into the scrotum for a male fetus and the skin becomes smooth.

 

When do most women give birth?

 

The majority of women give birth between 37 and 42 weeks.

 

 

What are some signs that something is wrong?

 

Concerning third trimester symptoms include vagina spotting or bleeding, uterine cramping, lower abdominal pain, persistent headaches, nausea and vomiting and decreased fetal movement.  

 

 

During the third trimester, what are the most important things to do or keep track of?

 

The most important things to keep track of during the third trimester is keeping track of daily fetal movement, getting adequate rest, eating a healthy well-balanced diet and preparing you and your partner for labor, delivery and preparing for a new born.

What causes feet to swell in pregnancy? 

Swelling in pregnancy is completely normal and expected. If you think about it, your body produces 50% more blood volume and other body fluids that help in the growth and development of the baby.  All the additional fluids will be evenly distributed throughout the body and be most obvious in the hands, legs, feet and face. It’s most noticeable after 28 weeks as you enter your third trimester of pregnancy.  During the third trimester, the growing uterus puts additional pressure on the lower extremities making the swelling even more pronounced in the legs, feet and ankles.  

When does swelling in pregnancy usually begin?

During the late second and third trimester the growing uterus puts additional pressure on the lower extremities making the swelling even more pronounced in the legs, feet and ankles.  “Cankles “are affectionately used to describe swelling of where the leg meets the ankle.  Swelling is more noticeable during the day and goes down at night. Pain, heaviness and tingling are common symptoms.  Prolonged standing and being on your feet for long periods of time will also make the swelling worse.  The last couple weeks of pregnancy are the most challenging. Your feet will increase by one shoe size during pregnancy.

Are swollen feet during pregnancy ever cause for concern? 

When swelling of the feet seems excessive and with a more rapid onset that could be a subtle sign of preeclampsia or high blood pressure of pregnancy. If one leg or calf appears to swell disproportionately to the other leg this could be a sign of a deep vein thrombosis.  Both of these conditions and swelling with pain or a rash should also be addressed by your obstetrician. 

 
If you develop “cankles” during the 3rd trimester, the best treatment is to elevate your legs above the level of your heart periodically throughout the day, wear support hose, comfy shoes and stay hydrated with plenty of water.

Every pregnancy is different.  Depending on the amount of weight you gain, frequency of exercising, foods (and salt!) you consume and what season you are during your third trimester will all affect the swelling in your body and feet! 

Avoid prolong standing and wearing too-tight of elastic stockings or socks.

 

What is the doctor doing when checking my cervix at 38 weeks?

 

The cervix can be checked in a couple of different ways.  

 

An internal pelvic exam uses two fingers by the doctor, nurse or midwife to check and feel how many centimeters the cervix is opened or dilated.  Zero centimeters means the cervix has not dilated at all and 10 centimeters means the cervix is completely open and the baby is ready to deliver. During a pelvic exam, the cervical softening or effacement can be checked as well. The more effaced the cervix is the more likely the cervix will dilate.

 

Alternatively, a pelvic ultrasound can also be used to measure the length and dilation of the cervix during any stage of pregnancy.

 

Is a Hospital Tour necessary?

Taking a tour of the hospital before you go into labor gives you and your partner helpful information about the layout of labor-land.  You can either sign up for a hospital tour physically or often do them virtually. A tour allows you to be familiar with the hospital, showing you where to park, which elevators to take you to labor and delivery and understanding the roadmap on the “big day!”

Taking a tour will make you feel more relaxed, more prepared and less stressed. 

 

Do I need a birth plan?

A birth plan allows the couple to do a deep dive into all aspects of the labor and delivery process and what happens with the baby during the first few days of life. But creating a birth plan is not for everyone and most couples do not make one.

A typical birth plans makes sure you and your partner cover every aspect of the delivery and postpartum process, from allowing the nurses to place an IV into your arm when you first arrive to whether or not the baby is placed directly on your chest immediately after delivering versus going to the baby warmer.  It’s your personalized road map through the entire process.

Other common highlights of a birth plan include acceptable baby monitoring, pain medication options during labor, preferences for who should be in the delivery room, cutting an episiotomy versus letting the vagina tear naturally, delayed umbilical cord cutting, maternal-baby bonding guidelines, acceptable baby vaccines and other postpartum wishes.

The most important thing to remember about a detailed birth plan is they may not go exactly as planned.  Even with your personalized road map there can be unexpected detours and obstacles that you did not anticipate. You have to be open minded and not feel defeated or a failure if it doesn’t go exactly as planned.  During the labor and delivery process, even as a practicing OBGYN, you have to expect the unexpected.

Remember, “man plans and God laughs” is a perfect metaphor for the labor and delivery experience.

 

What should be included in my hospital bag?

Pack your bag ahead of time! Slippers, robe, comfortable PJ’s, camera (charged!), back-up batteries for all electronics, cell phone, video camera, memory sticks, camera and cell phone chargers, your favorite playlists, special object (photograph, stuffed animal) to focus on during labor, cord blood kit for storage, toiletries including your personal shampoo, soap, toothbrush, hairbrush, “belly bandit” to wear postpartum, Baby memory book , favorite outfit you received from your baby shower to dress the baby in, favorite pillow and blanket, comfy sweats and nursing bra to wear postpartum.

 

What to know about labor?

It can be confusing knowing when true contractions are occurring versus Braxton Hicks contractions.  Simply put, Braxton Hicks contractions are painless contractions where real contractions are painful.  When you experience a Braxton Hicks contraction you will see your uterus tighten and become hard, like a rock, but it is not associated with pain. Real uterine contractions start as a menstrual cramp and continue getting more intense and painful unlike Braxton Hicks contractions.

 

Timing your contractions helps you differentiate between false and early labor.  Uterine contractions that have a pattern of every 3 to5 minutes for 2 hours help you become more aware labor is starting.  Measuring contractions from the beginning of one contraction to the beginning of another contraction is one way of tracking the frequency.  As long as you are consistent in how you time the contractions you will see a pattern that suggests labor is happening.

 

As labor progresses, the intensity and frequency of the contractions will become stronger and more painful.

 

What are the first signs that you’re in early labor? 

 

As you get closer to term (38 to 42 weeks) your uterus, which is one large muscle, will start to contract.  If the uterine contractions are irregular, occurring sporadically, and the pain in minimal, you are not in early labor.  Once the uterine contractions become regular, appear closer together with an increase in intensity this is a sign that labor has started. Regular and painful uterine contractions, occurring every 3 to 5 minutes for 2 hours, are a sign early labor has begun.

 

Another sign that early labor has started is if your bag of water breaks.  It may be a subtle “leak” or a “big gush” when your “water breaks” and you may or may not have uterine contractions.  But one thing is definite, early labor will begin within hours of your water breaking.

 

What are all of the reasons women might need to be induced and WHY is it imperative that they are? 

 

The majority of labor inductions occur as a result of medical complication that can negatively affect the health of the mother or baby such as maternal high blood pressure, diabetes or poor growth of the baby. Medically indicated inductions should occur after 34 weeks ideally unless it’s a matter of life and death for mom or baby. “Elective” inductions can also be considered for a nonmedical reason at 39 weeks if the cervix is favorable for induction.  An example of elective induction is if a previous delivery happened quickly and there are concerns the woman would not make it to the hospital when she goes into labor.   When deciding to have an elective induction it has to be after 39 weeks with the accurate dating of the pregnancy and an inducible or “favorable” cervix. A cervix is favorable when it’s thinned out and dilated before the induction begins.  Labor tends to go more quickly and is more likely to be a vaginal birth with a favorable cervix.  If the cervix is “unfavorable” the process of an induction may take a couple of days or end up in a cesarean section. 

 

What are the health hazards if they are not induced? 

 

If a medically indicated induction does not occur there can be potential health dangers to both the mother and baby.  The most concerning health hazard could be death to the mother and baby.  Other complications include infection, maternal seizures, stroke, emergency hysterectomy and significant blood loss. 

 

What is not a reason to be induced? 

If you have being induced electively you must have a cervix that is favorable for delivery.  If you don’t have a favorable cervix, you should not be induced unless there is a medical indication.  

Can Castro Oil induce my labor? 

The most common myth is using castor oil to put you into labor.  The problem with Castro oil is that it has side effects including diarrhea, dehydration and uterine irritability.  Unfortunately, all these recommendations are also known as old wives’ tales. If any of these suggestions put a woman into labor it’s just a wonderful coincidence.

 

What are some myths of what will put a woman into labor?

There are many suggestions given by friends, mothers, grandmothers and next-door neighbors about activities that will “definitely” put you into labor.  They include eating spicy foods, drinking special teas, having mind blowing sex, explosive (and multiple!) orgasms, intense exercise workouts and, of course, labor inducing-acupuncture.  

 

FUN MYTHS ABOUT LABOR AND DELIVERY

Here is a list of memorable myths of labor and delivery from my patients over the last 3 decades.

1. Once your water breaks your baby will pop out!  All women wish this was the case but it’s not.
2. When labor begins is obvious—not always!
3. Labor is always painful.  For a handful of lucky women, they don’t experience horrible and painful contractions.
4. Your obstetrician is present during most of your labor.  Unfortunately, the doctor comes and goes and then returns when the baby is just about to delivery.  The nurses are the ones who are with you during the entire process.
5. You rarely poop when you push out the baby’s head—sorry ladies most women do!  I will never say no to an enema!
6. Doctors don’t care if you wax or shave your vagina before giving birth—we may say we don’t care but it is easier to repair a vagina if there is less hair around the opening.
7. You can receive a “light” walking epidural if you want to walk around with mild labor pains.  In theory we tell patients that this is available but in practice it never happens.
8. Most women will delivery around their due date—rarely does a women delivery on her due date.
9. Episiotomies will reduce the amount of tearing that happens in the vagina—not true, if you can avoid one you should ask your doctor to do so.
10. Losing your mucus plug or having your cervix dilated means you will immediately going into labor—pregnant women wish this was the case!
11. Tall women have the perfect pelvis for a vaginal delivery—unfortunately even tall women have small pelvis.  You may look “wide” from behind but you may not have a large pelvis.
12. More babies are born during a full moon—studies don’t support this myth!
13. A well thought out “birthing plan” is key to a successful vaginal birth—if you ask the nurses on labor and delivery, most couples that create a 7 page birth plan for a vaginal birth are more likely to end up with a c/section.  Controlling new moms’ and dads are even more high risk to have a csection!  
14. Your labor will be just like your mom’s-there may be similarities in your pelvis but there are many other factors that make your labor go one way or the other.  Truth be told your labor will not be like your moms.
15. If I drink castro oil, take laxatives, eat Mexican food or go for acupuncture I can induce labor.  These are myths that are not reliable plus for some you will get major diarrhea as a result.

 

Here is my list of Labor-do’s and don’ts 

 

”Do” pay attention to you symptoms and “don’t” minimize what you are experiencing or feeling.

“Do” prepare yourself and your partner for the big day so you are aware of what labor will look like.  

 

“Don’t” wait to the last minute to prepare your birth plan and discuss it in detail with your healthcare provider.

 

“Don’t” be afraid to call your doctor is you are not sure what symptoms you are experiencing.

 

“Don’t” wait too long to pack your hospital bag.

Most importantly, “DO” go into labor with an open mind, trusting your doctor and knowing whatever happens is beyond your control.  “Don’t” have a planned labor agenda, it’s rarely followed!

 

How common are breech (butt or feet first) babies?

3-4% of term pregnancies are breech pregnancies.   97% of all deliveries are head first, also known as vertex. Vertex presentation can delivery vaginally, whereas breech baby’s need to be delivered by C-Section.

 

What happens if the baby is in the breech position at term?

Most pregnant women want to avoid a C-section at all cost and are willing to try old wife tales and Eastern methods to change this mode of delivery.  The good news is that homeopathic, Chinese and other Eastern approaches to turning a breech to a vertex presentation pose no real danger to the baby. Since the Tilt, Webster technique, Pulsatilla and Moxibustion are relatively safe techniques they are certainly worth a try.

External cephalic version (ECV) is an option for turning a baby who is in the breech position to a vertex. ECV is not for the faint of heart since it can be very painful and uncomfortable for the mom.  It’s performed in a hospital setting and the baby is continuously monitored.  The success of flipping a breech baby to the head down position is around 50%.  Preterm labor, premature rupture of membranes, fetal distress and placental abruption (damage) can occur from all the external pressure placed on the uterus with this procedure.  Fortunately, complications are rare.  If the ECV fails, a breech baby has to be delivered by C-section to ensure a healthy birth.

 

Are women ever induced when they really don’t need to be? 

 

The obstetrician is the doctor in charge in determining if a woman needs to be induced and what is the indication for delivery.  At times a high-risk obstetrician called a Maternal-Fetal Specialist is consulted to be involved in the discussion making process.  The field of obstetrics is not always black and white when it comes to major pregnancy decisions.  As a long time, practicing obstetrician, you sometimes have to go with a gut decision always having the woman and baby’s health at the top of the priority list.  As long as the doctor is not inducing you so he won’t miss his annual golf tournament I image most obstetricians have the mom and baby’s best interest in mind.  

 

How many weeks do inductions usually occur? What is the earliest/latest?

 

Inductions for medical complications putting the mother or baby at risk can be done at any time during pregnancy.  Ideally, it’s best to get to 39 weeks when it’s known that the lungs of the baby are completely developed.

The latest to induce a low-risk woman is at 42 weeks pregnancy.

 

What are some techniques for handling early labor pains? 

 

Early labor pains can be easily handled with a few classical techniques.

 

• Breathing in a calm and controlled manner where you take a breath slowly, in through your nose and out through your mouth.

 

• Relaxing your body, lower back and pelvis, keeping your body flexible-making circles with your hips.  Bouncing on a birthing ball and sitting in a rocking chair helps shifts pain during early labor.

 

• Messaging the lower back by your partner helps release extra tension builds up.

 

• Taking a warm bath or shower.

 

• Visualizing or focusing on a relaxing place such as a beautiful sunset or your favorite vacation spot.  This is referred to as going to your “happy place”.

 

When is it time to go to the hospital or birthing center? 

 

When to make the drive to the hospital varies for every pregnant woman.  If you are having painful and regular contractions every 5 minutes for 2 hours or break your bag of water it’s time to call your healthcare provider.  Depending on the amount of pain you are experiencing will determine when it’s time to go the hospital.  If you can tolerate the pain and are able to easily breathe through the contractions, you may be able to stay home a bit longer. Once the pain becomes more intense and increasingly painful then it’s time to gather your hospital bag and head over to the hospital.

 

How long does a “typical” labor last?

For first time moms who go into labor spontaneously, labor lasts 12-18 hours. If you have already had a vaginal delivery, labor lasts an average of 6 to 8 hours.  

 

Is it better to rest up or stay active (like walking) to keep things progressing?

 

It’s best to keep active during early labor.  Walking can help promote uterine contractions.  If you are in false labor walking may cause the uterine contractions to stop.

 

What should you eat or drink during labor?

 

Eating in labor is not recommended since many women become nauseous and have vomiting, especially during the active stage of labor and pushing.  The other concern about eating in labor is if there is fetal distress and an emergency cesarean section is necessary having food in your stomach can increase your risk of getting food in your airways (aspiration) during surgery.

 

Stick to ice chips and sips of water!

 

What are the pros and cons of ripping naturally during childbirth versus having an episiotomy? 

I always reassure my patients the decision of cutting the vagina or letting the tissue tear naturally is determined at the time of the delivery.  Some factors include how long the woman has been pushing, how large is the baby’s head, how swollen is the vagina and is there any reason to deliver the baby quickly due to fetal distress.  As long as you reassure a pregnant woman you have their best interest and the interest of the baby first and foremost, the conversation ends comfortably.

The episiotomy used to be the most common surgical procedure performed on women.  But now the episiotomy is on the decline and less recommended as the first choice of helping delivery a baby vaginally.  It used to be this procedure made enough room for the baby’s head to be delivered with the least amount of damage to the vagina.  Now it’s thought to be more damaging then helpful.

The “pros” have been it helps make the pushing phase led to a faster delivery, prevents tearing into the rectum or urethra, an heals faster than tearing. 

The “cons” or complications include infection, longer healing time, increased extension of vagina affected, bleeding, pain at the site of the episiotomy and future pain with intercourse.

Vaginal tearing is now a more common practice and recommended by Obstetricians. 

Why might a women’s vagina tear?

Women who are more likely to tear include the following:

• If it’s your first baby
• Having a larger than normal size baby
• Vacuum or forcep assisted delivery
• If the baby is being born face-up (occiput posterior)
• Uncontrollable pushing
• Needing to expedite delivery due to fetal distress

Severe vaginal swelling due to prolong pushing. There are times where an episiotomy allows for an easier vaginal delivery.  Unfortunately, the decision to do an elective episiotomy is not known until the moment the baby’s head is crowning.  Hopefully you have had the conversation with your Obstetrician to allow her to make that judgement call at the time of that unpredictable moment!

 

What problems can severe tearing or extensive episiotomies cause?

Severe tears or extensive episiotomies into the vagina or rectum can cause pelvic floor dysfunction and prolapse, urinary incontinence, fecal incontinence, sexual dysfunction including pain with intercourse.

What are risk factors that increase your risk of needing a C-section before a woman goes into labor?

 

Women who may be at higher risk to need a C-section while in labor include:

• Maternal Obesity
• Low Amniotic Fluid
• Postdates
• Unfavorable cervix 
• Twin pregnancy
• Maternal medical complications including High blood pressure of pregnancy (Pre-eclampsia), Gestational Diabetes, Heart disease
• Baby complications including smaller or larger than average, birth defects
• If the baby has an unusually large head.
• Previous Cesarean Section
• Breech or Transverse presentation
• History of a herpes infection

 

What are the complications during labor that a C-section would be medically necessary?

 

The most emergent reason to need a C-Section during labor would be fetal distress, placental abruption (placenta separates from the uterine wall), breech or transverse presentation and an active herpes outbreak.

 

Are epidurals safe for pain management during labor?

If they want pain medication I personal advice my patients to choose an epidural as the form of anesthesia since it is a nerve block and therefore does not affect the fetus during labor.  With the epidural the patient losses the pain sensation to the area of the uterus so pain from the strong force of uterine contractions is not felt. Lighter dosed epidurals are called “walking epidurals” and are used for those women that prefer less sedation.  With an epidural you do not have any problems feeling drugged or foggy as you would with intravenous sedating medications.  With an epidural, when the time comes to push the baby out you still can feel the rectal pressure that assists you in pushing effectively.  Ultimately your choice of pain relief will be determined by you and your partner’s preferences along with your health care provider.

 

What about using laughing gas in labor?

Laughing gas or happy gas is not a new fad to help take the edge off the agony experienced from the painful contractions during labor. It’s been used since the 1800’s for pain relief especially for use while in the dentist chair.  In the 1950’s, nitrous oxide which is the active ingredient to laughing gas, was used for women during labor. The pain of labor is truly no laughing matter. ☺  Once epidural anesthesia was introduced in the 70’s and found to be a more reliable and effective pain option, laughing gas lost its popularity. In Europe, nitrous oxide is regularly used for women in labor. 

The idea behind laughing gas is to use a cocktail of 50% nitrous oxide with 50% oxygen delivered through a breathing mask which gives you a feeling of euphoria and relaxation. Basically, you become less focused and aware of the intensity of the pain experienced during labor.  Midwives are especially excited to be able to use nitrous oxide for their laboring patients.    A recent study in Anesthesiology 2016 showed nitrous oxide may take the edge off but won’t be effective for extreme pain and these women will ultimately need an epidural for true relief. In other words, nitrous oxide will never replace an epidural as the ideal way to manage labor pain. 

Benefits include:

• Allows patient to move around in labor
• Short acting
• Self-administrated by inhalation
• Effective for mild pain of labor
• Safe alternative option of pain relief
• Easy to use
• Has a euphoric, anti-anxiety and relaxing effect
• Leaves the body in minutes
• Less expensive than current pain relief options
• Midwives and other trained medical staff can administer nitrous oxide
• Colorless and nonflammable gas with a slightly sweet odor

The side effects of nausea, vomiting and feeling light headed are no laughing matter, and often are a reason not to use method of pain relief.  

What medication is given for an elective C-Section?

The anesthesiologist is the doctor who decides whether a woman receives a spinal block versus an epidural.  In general, women having an elective C-Section are given spinal anesthesia, which is a onetime dose and is shorter acting than an epidural.  

Is it necessary to bank cord blood, cord tissue and placental tissue during the delivery? 

I feel it’s important to tell all my obstetrical patients the pros and cons of collecting cord blood, cord tissue and placental tissue and let them decide what’s best for them.  Even though statistically it is unlikely that the couple’s baby will ever need to use their own umbilical cord blood, cord tissue and placental tissue many feel it is an expense they are willing to spend for an extra “insurance policy” on their greatest gift! Future use of these resources could be lifesaving.

Umbilical cord contains “stem cells” that have endless potential to regenerate organs, nerves and other specific tissues in the body. The purpose of storing umbilical cord blood is to use it in the future for your child to treat a number of genetic, blood, and cancer conditions in children such as leukemia and immune disorders.  Examples of such condition include acute and chronic leukemia, lymphoma, aplastic anemia, sickle cell anemia, and thalassemia major.  Optimistic cord tissue research includes treatment for autism, cerebral palsy, diabetes, Alzheimer’s disease, spinal cord injuries, organ regeneration and other medical conditions.

 

Other family members including siblings, moms and dads may also be able to use cord blood and tissue collected by the donor child.  

 

Collecting cord blood is a more advanced in its research than collecting cord and placental tissue and how it may be useful for future use.  The hope is that cord and placental tissue, which has more cell types than cord blood, will ultimately offer additional benefits for babies with a variety of cancers or medical conditions.   If you believe in the possibilities using cord blood than I suggest collecting all three cells’ types from these sources.

 

Can I dye my hair during pregnancy?

As older women are getting pregnant in increasing numbers this question comes up frequently.  When you use hair dye or hair coloring preparations, a small amount of dye can penetrate the skin of the scalp.   Generally, the dye does not pose harm to a developing baby.  Most researchers would agree that it is unlikely that use of hair products before or during pregnancy would increase risk of any problems to an unborn baby.  The Organization of Teratology Information Services, which provides information on potential reproductive risks, states that “animal studies are reassuring and that there are no reports of hair dye causing changes in human pregnancies”.  Furthermore, they point out that very little of the chemicals in hair dye is actually absorbed into your system.  

Some women wait until the first trimester passes until they have any hair treatments done knowing that this is the time when the most harm can occur to a growing fetus.  Hair treatments using chemicals for highlighting, streaking, painting or frosting have little contact with your scalp and are safe alternatives to the all-over hair color process.  Vegetable and pure henna dyes are safe to use during pregnancy as opposed to synthetic chemical agents, containing p-phenylenediamine, dihydroxybenzene, and aminophenol, which are not.  Many hairstylists notice that the various coloring processes during pregnancy can be unpredictable due to the strong hormonal effect on the hair itself.  In terms of chemical-based hair curling or straightening processes, it would best to wait until after pregnancy to use them.

In general, when you chose a hair dye consider these precautions from the Food and Drug Administration:

• Follow package directions carefully if you are doing it yourself.
• Work in a well-ventilated space to minimize exposure to the chemical vapors.
• Wear gloves when applying hair dye.
• Leave the dye on your hair no longer than directed.
• Rinse your scalp thoroughly after using hair dye.

If you’re concerned about the use of hair dye during pregnancy, consult your health care provider or consider postponing any chemical hair treatments.  

 

What are some normal reservations women have around pregnancy sex?

 

Sex is completely safe during pregnancy for low-risk women.  There are misconceptions that sex can cause a miscarriage so pregnant women and their partners are often afraid to have sex during pregnancy. Men are often afraid to have sex with their pregnant partners for fear of hurting the baby.

 

What are some general reasons why they might not have it?

The most common reasons women don’t want to have sex include:

• Lack of interest in sex…for the entire 9 months and beyond
• Weight gain makes pregnant women feel depressed and not sexy
• Breast enlargement is loved by husbands and partners but typically not by the pregnant woman.
• Low sex drive in having sex with partner, more interest in masturbation
• Prefer intimacy to be cuddling and kissing to intercourse
• Husband/Boyfriends are afraid to have sex with their pregnant partner
• Women are afraid to have orgasm, think that it could cause miscarriage or labor.
• Ask if oral sex is safe?  Bacteria from the mouth can it cause infections? Can fingers placed into the vagina cause an infection?
• Pregnant women often wonder if vaginal intercourse can cause a rupture the membranes–break the bag of water surrounding the baby.
• Each trimester brings a whole new set of circumstances that set the stage of for sex and intimacy.

 

What are reasons why people don’t want to have sex in the first trimester?
In the first trimester between the hormonal changes, fatigue, nausea and fear of miscarriage, sex is not a high priority for couples, or at least for women.  Contrary to what many couples believe, sex during pregnancy will not cause a miscarriage.  

What are reasons why people don’t want to have sex in the second trimester?

Your second trimester is your best bet to have sex because you feel more energetic, have not gained a lot of weight and getting along well with your partner.

What are reasons why people don’t want to have sex in the third trimester?

 

In the third trimesters you are suffering from lower back pain, carrying 30 (or more) pounds of pregnancy weight, feel swollen all over, including your vagina, losing urine on a daily basis and worrying that sex will throw you into labor. Because of all reasons sex is not a priority. 

 

Will sex harm the baby? 

The good news is that the baby is surrounded by 1-2 liters of fluid which serves as a protective cushion during sex.  The baby may be bounced around but know that the baby is safe and insulated. 

 

How does pregnancy weight gain affect desire to have sex?

 

Body image insecurity is hard to anticipate but with each passing week and visit to the OB where you have to get on the scale…you are reminded about pregnancy weight gain.  Even if you know it’s the “right thing to do for your baby” it can be hard for your usual sexual pre-pregnant self when you have body insecurity.  For many women gaining more than 5 pounds can be emotionally devastating.  Weight gain and body changes are the hardest thing for women to overcome and may make getting naked an obstacle in the bedroom.

 

Will an orgasm be different during pregnancy and cause a miscarriage or labor?

 Pregnant or not, when you have an orgasm, muscles tighten and relax, there is increase blood flow to the genital area and your uterus contracts rhythmically.  When your uterus is a normal size, the size of a pear, you may not even notice that this is happening.  When you are pregnant and are 20 weeks and your uterus is the size of a melon you are aware of the contracting feeling or if you are 40 weeks when your uterus is the size of a watermelon you are even more of it.  The rhythmic contractions that you feel as a result of an orgasm are short lived and don’t persist.  It’s a bit of an old wives tale that orgasms can put you into labor.  Orgasms don’t officially cause you to go into labor, but it doesn’t hurt to try…with or without your partner. In pregnancy, women are more anxious and nervous about causing any harm to the baby or causing preterm labor.  Since having an orgasm requires your most important and largest sex organ, which is our mind to be relaxed and free of worry we have to be in the right mental state to allow an orgasm to happen.

 

Why can’t I have sex if I have a placenta previa?

Placenta previa is when the placenta covers or is near the covering of the internal cervical os.  This condition can be diagnosed with ultrasound.  Symptoms of a placenta previa include vaginal bleeding, hemorrhage and uterine cramping.  Due to the risk of excessive bleeding, sexual activity and intercourse in forbidden.

Why can’t I have sex if I am at risk for a miscarriage? 

If you are having irregular bleeding or uterine cramping you should not being have sexual intercourse or any sexual activity. A women’s risk for a miscarriage range from 10 to 50% depending on a woman’s age, the average risk being around 15%. The majority of miscarriages happen during the first trimester.  Sex will not cause you to miscarriage but you should not be active

Why can’t I have sex if I have ruptured my bag of water? 

The amniotic sac is filled with vital fluid that protects and nurtures the growing baby during pregnancy.  If the amniotic sac prematurely breaks or ruptures there is less fluid protecting the baby from infection and can be a very dangerous complication.  When PROM happens there is an increased danger to the baby and the mom.  Sexually intercourse is definitely not allowed if you have PROM.

Why can’t I have sex if I have had preterm labor? 

Preterm labor occurs when your body starts to go into labor before the baby is fully developed occurring before 37 weeks of gestation. Symptoms of preterm labor include uterine cramping and contractions, increased vaginal discharge, vaginal bleeding and backache. Sexual intercourse is not allowed since it can bring on some of these symptoms of preterm labor.

 

Why can’t I have sex if I have twins or triplets? 

More than 50% of twins and 90% of triplets are born premature.  If you are experiencing any signs of preterm labor including uterine cramping, contractions, back pain or vaginal bleeding sexual intercourse and sexual activity is not allowed.

Why can’t I have sex if I have a shortened cervix? 

During a pelvic exam or ultrasound the cervical length can be measured during pregnancy.  If there is shortening early in the pregnancy this may be a sign of an incompetent cervix which could put you at risk for a miscarriage or preterm labor.  If a shortened or incompetent cervix is suspected sexual intercourse is not allowed. 

 

Why do doctors often advise pregnant women to avoid doing things on their back?

When lying on your back after 20 weeks the uterus will put unwanted pressure on the large vessels carrying blood to the heart reducing the flow to and out from the heart causing dizziness and fainting.  For this reason, it is not recommended to do any kinds of exercise or activities while lying on your back. 

 Does this apply to sleeping as well? 

Sleeping on your back for long periods of time can ultimately reduce the blood flow to the baby which can affect the growth and, overall health, of the baby.

Why might it be bad for a pregnant woman to sleep on her back after a certain point in the pregnancy?

Dizziness, fainting, reduced blood flow to the baby and potential for stillbirth are all reasons to avoid sleeping on your back after 20 weeks and, especially during the 3rd trimester (after 28 weeks).

How concerned about sleeping on your back should pregnant women be?

It’s recommended for pregnant women to sleep on their right or left side since this helps with the best blood flow to a growing baby.

What can women do to get in the habit of sleeping on their side if they’re typically a back sleeper? 

Most pregnant women have the best intentions lying on their right and left side when sleeping. It’s often the case where they wake up flat on their back or their partner has to wake them up to change their position.  Using pillows, body size ones work well, wedged behind the back will help reduce the chance of a woman ending up on her back in the morning.

 

Why do people have unusual dreams during pregnancy? 

Sleep is such an important commodity, even more so, when pregnant. With an ever-changing body, being told to sleep on the right or left side, avoid lying on the back, and the emotional highs and lows, make sleeping even more challenging throughout pregnancy. 

Scientists tell us it’s still a mystery why dreams are more vivid during pregnancy, but we can definitely speculate on some potential contributing factors. Emotional, physical, mental, and hormonal changes create the foundation for unpredictable, vivid and, often, terrifying dreams.

Our normal sleep pattern, as we know it, is also disrupted during pregnancy. Sleep during pregnancy is interrupted, irregular, with more wake-up times, and trips to the bathroom which ultimately affects our REM sleep pattern, which is the cycle of sleep where dreams primarily occur.  Since REM sleep is interrupted it makes sense that pregnancy dreams are turned upside down.  

 

What are the differences between your first and second pregnancy?

 

During your first pregnancy it’s all about you and no one else. You can sleep 12 straight hours a night without worrying about a crying baby that needs to be breastfed.  You can take naps throughout the day and spend the entire weekend relaxing at home…all by yourself if you want too.

During the second pregnancy that freedom to relax and sleep as long as you want to is no longer easily available to you. I believe this is what makes the second pregnancy so challenging. 

Physically your lower back pain may start at 28 weeks instead of 36 weeks.  You also lose urine with laughing, coughing, exercise and even with sex. The varicose veins and stretch marks are more prominent and noticeable.   

During your second pregnancy, you may not create a photo album from every savored Ultrasound picture. You will also be less obsessed that the baby will be autistic.

You are less concerned about having a “natural delivery” and more interested in being induced at 39 weeks so that you don’t have to prolong the pregnancy.

 

Why are some women afraid to confide in their OB/GYN? 

 

Women are embarrassed and ashamed to tell their OB/GYN some of the things they know they are doing knowing its activities they should not be doing.

 

Top 7 secrets my pregnant patients keep hidden from me

• Closet smoking is an issue.  Some women are not typical smokers but do like a cigarette or two to destress. 

 

• Weed is medicinal 

 

• One glass of wine won’t hurt!

 

• Xanax helps me relax.

 

• Ambien helps me get a good night’s sleep.

 

• I hate exercising!

 

• My husband is not the father of this pregnancy

 

Why is it so important, specifically during pregnancy, to be open and honest with your OB/GYN?

 

When it comes to being pregnant, there is another person involved and certain behaviors and activities done can have a significant impact on a growing baby. Often pregnant women are unaware of harmful behaviors that could have a significant impact on their pregnancy.

 

Hopefully you have selected an obstetrician you feel comfortable with.  Having an open and honest relationship with your obstetrician has to be a top priority. If you don’t feel comfortable with your current obstetrician then you need to find the doctor that gives you that space to talk about all things comfortable and those things not so comfortable to talk about.

How worried do you think moms-to-be should be about secondhand smoke during pregnancy?

Second hand smoke is not healthy for mom and baby, this is not new information.

Second hand smoke contains thousands of harmful and toxic chemicals that affects the normal functioning of the heart, blood and vascular systems of mom and baby. 

It’s well known that exposure to secondhand smoke increases the risk of complications to the mom and baby including a greater risk to SIDS and infant breathing problems. Even though more studies are needed, this study supports the negative impact of second-hand smoke on the DNA methylation in umbilical cord blood that can cause underlying molecular mechanisms that might cause health issues for a newborn baby. These effects may lead to cancer, atherosclerosis, nervous systems disorders and cardiovascular disease of the newborn.

 

What can moms do to minimize the risks of secondhand smoke during pregnancy? 

It’s well known that exposure to secondhand smoke increases the risk of complications to the mom and baby.  Avoiding exposure to second hand smoke should be a priority to pregnant women. The most important way for a pregnant woman to avoid any potential unforeseen dangers to her newborn baby is to avoid second-hand smoke exposure.

 

How dangerous is gestational diabetes for the mom and for the baby?

 

1 in 5 pregnant women are diagnosed with gestational diabetes. Gestational diabetes puts the mom and baby at increased risk for pregnancy complications. Moms are at increased risk for high blood pressure or preeclampsia, preterm labor and needing a cesarean section.   The baby is at risk for being much larger than normal which can lead to a dangerous shoulder dystocia (shoulder’s get stuck coming out of the vagina) vaginal delivery, stillbirth and neonatal complications including low blood sugar, respiratory distress and longer days in the neonatal intensive care unit.

 

What can moms do to reduce the chances of developing gestational diabetes?

 

Preparing 3 to 6 months before getting pregnancy is the first step in lowering your risk for gestational diabetes. Eating a complete and well-balanced diet is a perfect way to optimize your health and energy level.  It’s important to know what your BMI is and what your healthy weight should be. Your BMI is calculated from your height and weight.  Being overweight can affect your ability to get pregnancy and have a healthy pregnancy. The Mediterranean diet has been embraced by the medical community as the model of healthy living. This style of eating combines a well-balanced diet, consumed in a relaxed environment and regular physical exercise.  Plant foods, fresh fruit, whole grains, fish, lean meats, unprocessed foods and healthy fats are the highlights of this diet which is perfect for the pre-pregnancy planning period.   Regular exercise, as little as 30 minutes of moderately intense exercise a day, can improve your health and well-being.  Exercise can reduce blood pressure, reduce blood sugar levels, lower cholesterol levels, control body weight and body fat and lower your risk of gestational diabetes and other pregnancy complications. A minimum of 3-5 times a week is excellent for overall good health and preparedness for pregnancy.  Starting pregnancy by eating well, controlling your BMI, exercising regularly and being your healthiest self will reduce your risk of gestational diabetes.

 

What are some of the best ways to help minimize the negative effects if you do develop diabetes?

 

If you are diagnosed with gestational diabetes a visit to a dietician is important to help, give you guidelines to create a low carbohydrate and high protein diet to control blood sugars.  You are also taught to monitor blood glucose levels first thing in the morning and 2 hours after eating meals.  You will be given a daily exercise regimen to help control blood glucose levels until you deliver.  

 

What advice do you have for moms to be regarding gestational diabetes?

 

All these dietary and lifestyle habits will help control blood glucose levels and lower your risk of pre-term labor, needing a cesarean section or having a very large baby born with low blood sugar levels.  You can definitely control your gestational diabetes when you are committed to your health and the health of your baby for at least 9 months.

 

What should I do if I am diagnosed with gestational diabetes?

If you are diagnosed with gestational diabetes, a visit to a dietician is important to help give you guidelines to create a low carbohydrate and high protein diet to control blood sugars.  You are also taught to monitor blood glucose levels first thing in the morning and 2 hours after eating meals.  You will also be given a daily regular exercise regimen to help control blood glucose levels until you deliver.  All these lifestyle and dietary habits will help control blood glucose levels and lower your risk of pre-term labor, needing a cesarean section or having a very large baby born with low blood sugar levels.

 

Can a pregnant person smoke, vape or eat cannabis?

5% of women between 18 to 44years use marijuana during their pregnancy especially during the first trimester to ease morning sickness. Marijuana use has been increasing steadily, while alcohol and cigarette has decreased. 

Use of marijuana during pregnancy is harmful and can lead to:

• Fetal Growth restriction (when a baby doesn’t gain the appropriate amount of weight before birth)
• A greater risk of stillbirth
• Preterm birth (born before 37 weeks)
• Low Brith Weight 
• Long-term brain development issues affecting memory, learning and behavior

“Avoiding marijuana during pregnancy (and breastfeeding) can give your baby a healthier start in life.” Substance Abuse and Mental Health Services Administration

Is any amount of alcohol safe to drink during pregnancy?

No amount of alcohol is safe or recommended during pregnancy. A recent study published in Pediatrics found the following on the hazards of alcohol consumption during all stages of pregnancy. “Specifically, first trimester drinking (vs no drinking) produces 12 times the odds of giving birth to a child with FASD [fetal alcohol spectrum disorder], first and second trimester drinking increases FASD odds 61 times, and drinking in all trimesters increases the FASD odds 65 times.” This same study showed that 1 in 10 women still drink alcohol during pregnancy.

Drinking alcohol during pregnancy also puts you at risk for miscarriage, stillbirth, prematurity and sudden infant death syndrome (SIDS).