Your Due Date
The duration of the average pregnancy is 280 days or ten lunar months. The emphasis is on the word "average." Only about 4% of all women will actually deliver on their "due date". However, over 90% will deliver within two weeks of that date. If you should go beyond that time, that is, 41 weeks from your last menstrual period, then some special tests must be done to insure that your baby is all right. If this situation arises, we will discuss it further at that time.
Travel
Travel by air in commercial aircraft can be unrestricted until you are close to delivery. After 36-38 weeks, it is more prudent to stay close to home unless there are extenuating circumstances. Most airlines will refuse you passage in your last month unless you have a note from your doctor. You should discuss any travel plans with your provider. If you are traveling after 32 weeks, you may want to have a cervical check done during the week before you go, as well as get a copy of your OB records to carry with you in case you need to be seen by a physician while you are away.
General Activity
You may continue with most sports and most activities during your pregnancy. It is normal to feel more easily fatigued during pregnancy and you should listen to your body and rest. It is recommended that you avoid undue fatigue or extreme exercise. If your activities have a potential risk of injury, please be sure to discuss with your provider. You should be able to continue most activities unless they are extremely hazardous.
Danger Signals
To insure that your pregnancy is a happy and healthy event in your life, you must be able to recognize when something is going wrong. If any of the following occur, report them to us immediately:
- Vaginal bleeding, no matter how slight, after 12 weeks.
- Swelling of the face or fingers, after 28 weeks.
- Severe, continuous headache, unrelieved by Tylenol
- Dimness or blurring of vision.
- Pain in the abdomen.
- Persistent vomiting.
- Chills and fever.
- Sudden escape of water from the vagina.
- Back pain that comes and goes, menstrual-like cramping or persistent contractions.
Diet & Weight Control
The average weight gain in pregnancy is about 30- 35 pounds. Most of the weight will be gained in the last half of the pregnancy. At term, your baby accounts for 7-1/2 lbs., the placenta 1 lb., amniotic fluid 2 lbs., the uterus 2-1/2 lbs., and there is about 10 lbs. distributed throughout your body. A high protein, low fat diet is ideal for pregnancy. Protein does not have to be expensive. Good sources of protein can be found in eggs, fish and soybean products.
You should also have a liberal intake of vitamin-rich foods such as raw vegetables. Pre-natal vitamin supplements are a good idea. Iron supplements are frequently necessary, as dietary sources cannot keep up with iron needs later in pregnancy. It is essential that your body have enough iron to make the red blood cells necessary to carry oxygen for both you and the baby. So, most women take a prenatal vitamin with Iron throughout pregnancy.
You may season your foods to taste; and unless specifically instructed otherwise, you may use salt if you wish. Although "water pills" were once used with great frequency, they are no longer felt to be necessary and, indeed, may cause problems.
Hygiene & Clothing
Douching is not recommended, especially in the last trimester. Unless told to do so by the doctor, don't do it.
Tub baths are fine throughout pregnancy. Caution must be used however, because equilibrium is sometimes difficult to maintain during pregnancy and it is much easier to slip and fall getting in and out of the tub. Hot tubs are generally not recommended because your body heat rises and this is not good for the baby. If you use a hot tub, it should be for only 5 to 1 0 minutes at a time (reduce the temperature).
A bra is necessary for proper support of enlarging breasts, but should not be too tight. Nursing bras (if you plan to breast-feed) should be purchased one size larger than your usual size and with a wide and deep enough cup.
Girdles are not advised. Sometimes though, specially designed maternity support devices can help back and abdomen pain. Ask your doctor.
Support hose are very helpful, especially if you're on your feet for long periods of time. With varicose veins, they are of great benefit. They should be put on first thing in the morning and they should fit snugly. The waistband should allow for plenty of expansion.
Breast care is very important if you are planning to breast-feed. From about the fourth month, you may notice a thin, sticky discharge from your breasts. This is normal and is known as colostrum. Nipples should be gently cleansed with soap and a washcloth as often as necessary to remove the crust. A nonallergenic mild cream, such as Masse cream, may be applied during the last month.
Dental hygiene - Pregnancy is a good time for a thorough dental checkup, as some women seem to suffer more cavities at this time (although it is not a proven fact). Special care should be given to the care of your gums. Dental x-rays and novocaine are safe in pregnancy.
Sexual intercourse - Unless otherwise instructed, intercourse is permitted until the onset of labor. If the bag of water breaks, or if there has been any vaginal bleeding, you should avoid sexual intercourse. It is common to experience some contractions after an orgasm. If they are persistent, call your provider.
Medication in Labor & Delivery
The more prepared you are for your birth experience, the less fear you have and the more relaxed you are. For even the most prepared mothers-to-be, labor can become an exhausting experience and you may lose your ability and interest in handling labor. There are three major choices for either analgesia or anesthesia.
IV Analgesia provides relief of pain between contractions allowing the mother to rest before the onset of the next contraction. It will not alleviate the discomfort of the contractions. The most common analgesics are Demerol, Fentanyl, Stadol, and Nubain. They work best when given directly into your vein, as through an "IV".
Regional anesthesia provides total or almost total relief of pain. An epidural block may be administered during labor and maintained for delivery. A spinal anesthetic (less common) is given directly into your spinal canal when we need faster or better pain relief for a cesarean section. It is not used for a labor anesthetic.
General anesthesia (where patient is temporarily put to sleep) is reserved for obstetrical emergencies.
Work
You may continue your employment as long as you wish. Many women feel fatigued and uncomfortable by the 38th week to carry on and may need to decrease work hours. Some jobs and occupations should be stopped sooner, but most can be performed until term. If you think yours is an unusual occupation that could adversely affect your pregnancy, please discuss it with your provider early on in your pregnancy.
Prepared Childbirth
We encourage you and your partner to enroll in a Child Birth Education class. Information is available in your 1st OB packet about locations and time of classes. Classes tend to fill up quickly so we recommend enrollment at around 20 weeks. As situations arise in labor, we will discuss them and offer appropriate types of analgesia. You are free to accept or refuse them as you wish. Partners are encouraged to be with you during labor & delivery.
Nutrition
Eat wisely during your pregnancy. When you are hungry, eat nutritious food. Pregnant women need approximately 2000-2200 calories a day with a concentration on a low fat, low refined-sugar diet. Eat plenty of fresh fruits and vegetables. Calcium may be obtained by eating 3 or 4 low fat dairy servings daily.
A weight gain of 30-35 pounds for most pregnant women is a good weight gain. Eat 3 balanced meals a day plus 2 snacks, or 5 small meals a day. You are less likely to feel nauseous if you have something in your stomach. Try not to eat a full meal within 2 to 3 hours before going to bed. Watch out for "hidden sugar". Fruit juices have more sugar than soft drinks. We recommend limiting both to no more than one glass daily. Also, small quantities of caffeine infrequently is okay.
Nausea is improved by frequent small snacks, Vitamin B6 50 mg every 12 hours, ginger (in food or in a capsule) every 6 hours, or by wearing "Sea Bands" obtained at a sporting goods store.
Exercise
During pregnancy, exercise is especially important. Exercise will help keep you healthy and feeling the best you can in your rapidly changing body. It is most helpful to tone, condition and care for your body to be ready for labor and giving birth. Exercise should not be intense in pregnancy. A good rule of thumb is that you should be able to talk easily while exercising.
Everyday Exercises for the Pregnant Woman:
- Good posture. Sit, stand, and lie down so your body can rest in these positions. Adjust your body posture as your center of gravity changes with your growing body
- Range of motion exercises are a good beginning and closing to your day. Range of motion means that you move every part of your body in every direction that you can. Start with your head and go to your toes. Take your time. Do not strain. Yoga, especially classes specifically for pregnant women, is also acceptable.
- Exercise when watching TV or visiting. Sit in a Taylor position (sifting cross-legged "indian style" on the floor). This stretches the thighs and pelvic floor muscles. Rotate your ankles. Twiddle your thumbs. Wave your hands. Bend your elbows. Shake a leg. In late pregnancy, be careful about “shaking your tail feathers” as your pelvic girdle (hips) are looser and this may cause discomfort.
- Walking is a great pregnancy exercise. Also swimming, if available is a wonderful non-stress non-shock exercise. Remember, exercise for your good health. It improves circulation, respiration, elimination and disposition. It will help you during labor and in giving birth.
We are frequently asked about exercise in pregnancy In general, in a low risk pregnancy, exercise will not cause harm to the fetus. For the mother, exercise has physical and emotional benefits. Women at high risk of premature labor, growth retardation (decreased blood supply to the placenta), or other high-risk conditions should not exercise. Consult your provider to determine if you are at increased risk.
Women who were in good aerobic condition prior to pregnancy may continue to workout at their previous levels. For women beginning their exercising program in pregnancy or, restarting after a break of one month or more, a safe 'rule of thumb' is to workout up to a target heart rate of 140 beats per minute. Vigorous exercise should be limited to no more than 15-20 minutes. Do not exhaust yourself. A good rule of thumb for aerobic exercise: aim for three - four times per week; at least 30 minutes per day.
Exercises Generally Considered Safe in Pregnancy:
- Low Impact Aerobics
- Pregnancy Fitness
- Bicycling
- Stationary Bicycle
- Golf
- Cross Country Skiing
- Jogging
- Racquet sports (non-competitive)
- Walking/hiking Swimming/ Water Aerobics
- Weight Training (avoid 'straining' and exercises lying on your back)
Exercises to be Approached with Caution and Common Sense:
- Baseball/ Basketball
- Gymnastics
- Downhill Skiing
- Mountain Climbing
- Horseback Riding
- Ice Skating / Roller-skating
Exercises to be Avoided During Pregnancy:
- Activities that require sudden forceful contact--boxing, football, hockey, soccer.
- Bungee Jumping
- Scuba Diving
- Sky Diving
- Water Skiing
Cigarettes
Smoking increases your risk of a miscarriage, placental abruption, and a small baby (which raises the baby's chances of problems at delivery), and the likelihood of your baby's health problems during infancy including SIDS and asthma. The chemicals in tobacco (nicotine and carbon monoxide) pass through the placenta to the baby. If you are smoking now, quit smoking for you and the baby. By quitting, you will help give your baby a healthy start and decrease your own chances of getting heart disease and cancer. If you can’t quit, reduce the amount you smoke as much as possible. Smoking may change the taste of your breast milk. Also, your infant may suffer increased throat and ear infections, asthma, and bronchitis from "re-breathing" your cigarette smoke.
Alcohol & Drugs
All alcohol and drugs pass from your blood, through the placenta to the baby. Alcohol, narcotics, marijuana and cocaine have long term effects on your developing baby. These may include problems at delivery, learning disabilities and mental problems. Alcohol and drugs of any type should be avoided during pregnancy. Even a small amount is harmful.
Episiotomy
An episiotomy is a cut made in the perineum from the vagina toward the anus. It enlarges the vaginal opening. An episiotomy is made only if necessary to prevent tearing of the vaginal opening. Some women prefer to allow a tear rather than undergo an episiotomy – in most situations this can be achieved. Kegel exercises (practiced tightening of pelvic floor muscles, as in stopping urination), warm compresses and a controlled birth can help prevent the need for an episiotomy.
Electronic Fetal Monitoring
External fetal monitoring is done with a machine that records the baby's heartbeat and the mother's contraction. Two straps are placed around your abdomen (belly) in order to hold the round monitors in place. Two wires attach the monitors to a machine that records the information. The recordings give the nurses and doctors information of how the baby is doing during and in between contractions. The wires are long enough that they allow you to get in and out of bed and move about the room while still connected to the monitor.
The internal electronic fetal monitor gives the same information as the external electronic fetal monitor but instead of straps around you, a wire is placed inside your vagina and a wire attaches to the baby's head. The bag of waters must be broken to have an internal electronic fetal monitor. An internal monitor is only used under certain circumstances and is not routinely done. If your physician feels it is needed, the reasons will be explained.
Maternity Leave
Most employers are comfortable with two weeks prenatal and six weeks postpartum. This is extremely variable and depends upon the personal desires, medical conditions, financial needs and type of birth. You will not be routinely excused from work two weeks prior to delivery. In fact, most of our patients work until they deliver. Although some employers may allow up to 12 weeks maternity leave, clinically six weeks is all that is necessary.
Previous Cesarean Section
Women who have given birth by cesarean section and have had a vaginal delivery may attempt a trial of labor. Usually this does not pose significant risk. Your doctor will talk to you about having a Trial of Labor. If you succeed in a vaginal delivery after a cesarean section, it is termed a VBAC (vaginal birth after cesarean).
Medicines
Most medications pass into the baby’s blood to some degree. Your provider can help determine which are safe and which should be avoided in pregnancy. Most importantly, we sometimes only learn of their impact 15 or 20 years later. Even though you don't think of things like over-the-counter headache and cold remedies, aspirin, and so forth as medicine, they all fall into this category. Be sure to mention anything you're taking or have taken earlier in the pregnancy. See the list of medications approved for pregnancy:
Headache/Sinus headache
Tylenol
Sudafed (pseudoephedrine)
Cough
chlorpheniramine
dextromethorphan (Benedryl)
hydrocodone
guaifenesin
Heartburn
Tums
Maalox
Mylanta
Rolaids
Riopan
Allergies/ Sinus
Claratin
Benadryl
diphenhydramine
Constipation
Fibercon
Colace
Citrucel
Metamucil
Antibiotics
penicillin
ampicillin
amoxicillin
erythromycin
azithromycin
Ultrasound
Ultrasound is a method of obtaining a picture of your baby to provide information about dating the pregnancy, some possible birth defects and fetal well being and growth. Ultrasounds are done based on the medical needs of each patient. The American College of Obstetrics and Gynecology recommends that one complete ultrasound is considered on each patient during pregnancy. This is usually performed between 18 and 22 weeks.
Father's/Partner's Participation
This is a great opportunity for couples to share in one of the most miraculous and heart-warming experiences of their lives. Please invite the partner (or someone who is close to you) to participate with you in prenatal care, childbirth preparation classes and the labor and birth of your baby. Bonding and attachment between the child and their parents begins during pregnancy.
Early bonding promotes family strength that is needed to deal with the stresses of parenting, which occur as your infant grows into childhood and adolescence.
Immunizations
We recommend pregnant women who will deliver at any time during the flu season receive the flu vaccine in October or November while they are pregnant. Pregnant women have reduced immunity and frequently will be more susceptible to illness and may suffer more severe illness.
If needed you may be vaccinated while pregnant to prevent:
- Flu
- Hepatitis B
- Tetanus