Common Questions During Pregnancy

What to do about bleeding in the first trimester?

If you should experience bleeding in the first trimester, it does not always suggest a miscarriage. It is not uncommon to experience light bleeding when the embryo implants in the uterus. Sometimes a blood clot can form at the implantation site and this may dissolve slowly and present itself later in the first trimester. Light bleeding may also arise from the cervix. This occasionally happens after intercourse or heavy activity.

However, due to the possible concern of a miscarriage or other pregnancy complication, please report any spotting or bleeding in pregnancy, even if the bleeding seems to have stopped. While it may turn out to be something minor, such as implantation bleeding or an irritable cervix, it could be a sign of a serious problem. You will probably need an exam to make sure you and your baby are fine and to rule out any complications.

You should seek medical attention if you have heavy bleeding especially with cramping. If you are actively bleeding (such as saturating more than three or four pads in an hour), have severe pain of any kind, and/or are experiencing dizziness or weakness, please try and contact your doctor immediately and consider heading straight for the emergency room for further evaluation.

If you have vaginal bleeding or spotting in pregnancy, it is important to know if your blood type is Rh positive or negative. Those women who are Rh negative and have vaginal bleeding will need a shot of Rh immune globulin to prevent the possibility of antibody formation against a positive blood type (if the fetus is positive). Ideally, and if indicated, the Rh immune globulin shot should be given within 72 hours of the bleeding episode.

Can I have caffeine while I’m pregnant?

Pregnant women should reduce caffeine intake or cut it out entirely. If you decide to have some caffeine, then be aware of your total intake and try to consume less than 200 mg of caffeine (equivalent to 10-12 oz of coffee) per day from all sources. Be aware that some over-the-counter medications may contain caffeine, so be sure to check their labels.

Can I use artificial sweeteners?

According to the Food & Drug Administration (FDA), sucralose (eg. Splenda) is safe for everyone to consume, including pregnant women. The FDA advises that aspartame (eg. Equal or Nutrasweet) is safe during pregnancy and lactation. Both sucralose and aspartame consumption should be limited to a moderate level. Aspartame is not safe for everyone – particularly not for those people with PKU (a rare metabolic disorder), certain liver diseases, or high levels of phenylalanines in their blood.

The FDA notes that the safety of saccharin (eg. Sweet-n-Low) in pregnancy remains questionable and therefore advises to avoid it in pregnancy.

What if I am exposed to chickenpox?

Most adults are immune to chickenpox either from previously having the disease, by forming immunity from a mild exposure, or from prior vaccination. If you have had chickenpox in the past, you and your baby are protected (immune). If you are not sure, contact your obstetrician to check your immunity with a blood test. If this shows you are immune, you and your baby are protected. If this shows no immunity, it is recommended that you receive a varicella immune globulin injection within four days of exposure to try and prevent chickenpox.

Can I see a chiropractor?

If you need or would like to see a chiropractor during your pregnancy, ask your provider for a chiropractor referral list to ensure that your chiropractor has been trained to work with pregnant women, uses a table that adjusts for a pregnant woman’s body and uses techniques that avoid unneeded pressure on the abdomen.

What is cord blood banking and why should I do it?

Cord blood is the blood that remains in the umbilical cord and placenta following birth, which is usually discarded. It serves as an abundant source of stem cells, which are genetically distinctive to your baby and your family and may be able to treat a small number of diseases or conditions in your baby or the parent or sibling of the baby.

Cord blood banking uses external facilities as a place to store and preserve your baby’s cord blood. There are fees for privately banking and storing cord blood; public banking is free of charge. Provided below is contact information for private and public cord blood banking companies.

Public banking:

Private banking:

Should my baby boy be circumcised?

Circumcision is the removal of the foreskin, which is the skin that covers the tip of the penis. The American Academy of Pediatrics does not feel there is sufficient medical data to recommend routine circumcision. However, many couples still wish to have their male infants circumcised for religious, cultural or cosmetic reasons.

Should you decide to have your baby circumcised, check with your pediatrician regarding procedure timing and fees. Your pediatrician will perform the procedure with local anesthesia in their office after the baby has been discharged from the hospital.

Can I go to the dentist?

Certainly — routine dental cleaning is safe and recommended during pregnancy. However do let your dentist know you are pregnant. Routine x-rays and elective dental work should be delayed until after the birth. If x-rays are needed for emergency dental work, ensure your abdomen is double shielded. Postpone non-emergency dental work until the second trimester or until after delivery if possible. Please request a copy of our dental protocol for your dentist if necessary.

What about exercise while I’m pregnant?

If you have been active, you may continue exercising. Low impact exercise is encouraged. Swimming and running are acceptable as long as you are used to doing them and feel comfortable. Horseback riding, waterskiing, snow skiing, or wakeboarding are not recommended.

Exercise at a moderate level so that you are able to talk normally while exercising. Try to keep your pulse rate at or below 130 beats per minute. Don’t get overheated and keep well hydrated. Avoid lying on your back after 20 weeks. Exercising at least 30 minutes a few times per week may decrease your risk of gestational diabetes, reduce backache and stress, help you sleep better, and improve muscle tone.

If any activity causes shortness of breath, pain or bleeding, discontinue the activity. If there is a suspicion of premature labor, ruptured membranes or bleeding, please contact your physician for activity restrictions.

What about the fatigue that I’m feeling?

Feeling tired generally improves after 14 weeks. Taking a nap may help. If you are feeling extreme fatigue, please discuss this with your provider.

When will I feel my baby move?

You are usually able to feel your baby move starting around 18-20 weeks with your first pregnancy and 16-18 weeks with subsequent pregnancies. You should report to your provider any marked decrease or lack of movement after 24 weeks.

Food & Nutrition — What should/shouldn’t I eat during pregnancy?

  • Eat: 3-6 sensible, balanced meals/snacks daily. Eating “for two” is unnecessary.
  • Drink: 8-10 glasses of water daily.
  • Caloric intake: You need approximately 300 calories more per day in pregnancy. Your recommended daily total caloric intake in pregnancy then will depend on your pre-pregnancy weight, body type, and activity level. For most active women and teenage young women this means about 2,500 calories per day and for sedentary women this means about 1,900 calories per day. If you are carrying twins, you will need approximately 600 additional calories per day and that translates to 2,700 to 2,800 calories per day if you are of average weight.
  • Your diet: should be balanced in food groups with not more than 30% fat and minimizing unnecessary carbohydrate intake. A reduction in salt intake is important. Eat plenty of fresh fruits and vegetables. Avoid sweets, starchy foods, fried foods and extra salt intake.
  • Protein intake: should consist of lean meats, cheese, eggs, legumes, fish and cooked seafood.
  • Minimize mercury consumption in fish and other seafood: Certain fish accumulate high levels of mercury – therefore, avoid eating shark, swordfish, king mackerel or tilefish. Tuna steak should be limited to six ounces per week. You may eat up to 12 ounces of other varied fish, shellfish or canned light tuna per week.
  • Unpasteurized dairy products and deli meats:can carry the bacteria Listeria. Although uncommon in the U.S., it is wise to avoid regular intake of unpasteurized milk and juices; soft cheese (such as brie, feta, blue-veined cheeses); raw or undercooked meats, poultry and shellfish; prepared meats, such as cold deli meats. Deli meats heated until steaming are safe.
  • Raw fish and meat: may carry parasites and other microbes and therefore should also be avoided.
  • Take your prenatal vitamin: each day as well as DHA which helps support fetal brain and retinal development.

Should I get the flu shot?

If a pregnant woman gets the flu, she is more likely to become very sick. The American College of Obstetrics and Gynecology (ACOG) recommends that all women who will be pregnant during the flu season (October through mid-May) be offered the vaccine.

According to ACOG, flu vaccination is an essential part of prenatal care that provides protection to both women and their babies. No adverse side effects have been shown in pregnant women. The flu vaccine is a “passive” vaccine and no live or dead virus is injected. There is no known fetal risks to passive immunization. Breastfeeding women can also safely get the vaccine. However, women with egg allergies, should not get the vaccine as the vaccine making process can include chicken eggs.

ACOG recommends TDAP (Tetanus, Diphtheria and Pertussis) after 30 weeks gestation. Whooping cough vaccination is also recommended for anyone who will be around the baby.

Can I color my hair?

Coloring your hair after the first trimester is probably safe. If you are concerned, consider highlights instead of coloring your whole head of hair.

Can I use herbal remedies?

There is little known about the safety of herbal medicine and nontraditional medications during pregnancy. Before starting or continuing herbal medications, be aware that the FDA does not regulate them and that they may have side effects or interactions with other medications, which could be even more concerning if you are pregnant. Therefore, it is advisable to avoid herbal remedy usage during pregnancy.

Can I use a hot tub or sauna while pregnant?

You can harm your baby if you raise the temperature of his/her environment over 100 degrees for prolonged periods of time. So avoid hot tubs and saunas while you’re pregnant.

Can I paint?

Avoid excess exposure to oil based paints, lead and mercury. You should minimize your exposure to latex paints that contain ethylene glycol and biocides. Avoid removing old paint used prior to the 1970s due to the possible risk of lead exposure. If you do decide to paint, ensure that you are in a well ventilated environment.

What about Parvovirus B19/Fifth’s Disease exposure in pregnancy?

Parvovirus is a common virus that many of us have been exposed to in the past, especially if we have, or work with, school-age children. An infection with Parvovirus, also known as Fifth’s Disease, causes a bright red rash and fever in children and little to no symptoms in most adults, although adults may get significant joint pain.

Once you have been exposed and develop antibodies to the virus, you are no longer at risk of getting it again nor passing it to your baby in-utero. If you have a new exposure during pregnancy and are unaware of your immunity, please call your physician’s office to have a blood test done to look for antibodies. If this is negative, we may want to repeat it in a few weeks to see if you develop new antibodies since the time of exposure. If your test turns positive, it may be necessary to follow your baby with ultrasound testing for a few months. It is rare for your baby to develop a problem from this infection.

What books do you recommend reading for newborn care?

Some book suggestions for newborn and infant care from our local pediatricians:

Can I wear my seatbelt?

You should always wear your seatbelt (both shoulder and lap belts). During pregnancy, the lap belt should be worn low on the hips and not over the uterus.

Are there other pregnancy safety concerns?

  • If you have a cat, have someone else change the litter box.
  • Avoid excess sun exposure. Wear a hat, sunglasses, and sunscreen.
  • Wear protective clothing and insect repellant to prevent mosquito exposure.
  • Avoid casual sexual contacts and use safe sex practices.
  • Bathing is permitted but bath water should be no hotter than body temperature. Hot showers are fine.
  • Avoid hot tubs and saunas.
  • Avoid alcohol, illicit drugs and herbs.
  • If you are now smoking, please take this opportunity to stop. It has been established that smoking is not only hazardous to you but also to your unborn child.
  • Eliminate environmental/work hazards and/or carcinogens.
  • Please notify us of any domestic violence issues.

Can I have sex during my pregnancy?

For a healthy woman with a normal pregnancy, intercourse is safe during pregnancy. You and your partner may want to experiment with different positions that may be more comfortable for you. If you are having problems in your pregnancy, such as bleeding, premature labor or ruptured membranes, your obstetrician may advise you to avoid intercourse.

Should I sleep in a certain position?

Early in your pregnancy, try to get into the habit of sleeping on your side. Lying on your side with your knees bent is likely to be the most comfortable position as your pregnancy progresses. It also makes your heart’s job easier because it keeps the baby’s weight from applying pressure to the large vein (called the inferior vena cava) that carries blood back to the heart from your feet and legs.

Some doctors specifically recommend that pregnant women sleep on the left side but in most cases, lying on either side should be fine and help take some pressure off your back. If you do find you rolled onto your back while sleeping, don’t panic, simply roll back onto one of your sides and go back to sleep. Some women will also find they need added support while sleeping which may be accomplished through use of additional pillows or a body pillow.

Is it normal to swell during pregnancy?

A certain amount of swelling, or edema, is normal during pregnancy, especially during the summer. Swelling occurs most often in the legs and mainly in the third trimester. To reduce swelling, try to rest and elevate your legs more and avoid prolonged standing or sitting. Increase your water intake. Do not take “water pills”, or diuretics, during pregnancy unless directed by your obstetrician. Let your obstetrician know if you have swelling in your hands or face.

Can I tan?

Tanning beds are not recommended.

Can I travel?

If you have an uncomplicated pregnancy it is usually safe to travel until you are likely to go into labor. Stay closer to home after 34 weeks gestation. Frequently, the most comfortable time to travel is in the middle of the pregnancy and this is when problems are least likely to occur. Make sure to get authorization from your doctor prior to traveling any time after your second trimester or if you have any medical problems or complications.

If traveling by car or plane, plan to walk around every two hours for a few minutes to maintain circulation and decrease your risk of leg clots. Try to stay adequately hydrated by drinking 8-10 glasses of water a day. Avoid elevations higher than 7,500 feet.

You may want to check with your travel carrier ahead of time to see if they require a note from your obstetrician that indicates that confirms that you are under the care of an obstetrician, any risks factors (or lack of), and the number of weeks gestation. Please be aware that there are risks involved with travel during pregnancy and a note will not signify permission to travel as this is a patient’s free will. An obstetrician can only advise and educate a pregnant woman about the risks of travel.

If traveling far from home, it is recommended that you be familiar with a nearby healthcare facility in the event problems or concerns arise. Also, it is advisable to bring a copy of your prenatal records.

I am having twins — What is different for me?

Twins can make you more uncomfortable and tired than usual during pregnancy because the uterus becomes much larger sooner. Consider resting more during the day.

Discuss your activity level at home and at work with your doctor as some women with twins may need to restrict their activity.

You will need to increase your caloric intake more while carrying twins. If you are of average weight, you will need to eat about 2,700 to 2,800 calories per day and you should expect to gain up to 45 pounds.

The risk of certain complications is higher with a twin pregnancy. You are more likely to develop high blood pressure, anemia, gestational diabetes, preterm labor and/or growth problems with the babies. Sometimes these problems can be prevented with early detection and care and this is why those carrying twins have more frequent prenatal visits. Be certain to report any problems or concerns to your doctor early.

In some instances, twins may deliver vaginally but your chance of cesarean section will be increased. To be considered for a trial of a vaginal birth, the first twin (called “twin A”) must be head down. On rare occasion, the first twin (“twin A”) is delivered vaginally and the second twin (“twin B”) is born by cesarean section.

Breastfeeding is still encouraged and preferred when you have twins. Your milk supply will increase to meet the demands of your twins. If the babies are born prematurely, then consider pumping and storing the milk until they are able to feed from the breast.

What about support for varicose veins?

Varicose veins, “varicosities,” are caused when the veins in your legs get weak and enlarge with blood. They have to work harder to carry blood back up from your legs to your heart. Sometimes pregnancy can aggravate this problem due to the fact that the enlarging uterus partially cuts off circulation from your legs.

Exercise will help. Short walks at different times during the day will help pump your blood faster. Support stockings may significantly help and are available over-the-counter or by prescription.

The vulvar area can also suffer from varicosities during pregnancy. Again, rest periods spread out during your day will help and consider placing a pillow under your buttocks to elevate your hips and aid circulation during rest periods and sleep.

What vitamins should I take?

Prenatal vitamins are recommended throughout your pregnancy and while breastfeeding. Consider taking a supplement containing 200-300mg of DHA as Omega-3 fatty acids may help fetal eye and brain development.

What medications can I used during my pregnancy?

It is advisable NOT to take any medications during the first trimester of pregnancy. Listed below are the over-the-counter medications recommended for common illnesses and complaints.

  • Headaches — Tylenol (not more than 2000 mg per day)
  • Heartburn — Tums, Rolaids, Maalox, Mylanta, or Zantac 75mg
  • Allergies — Claritin (plain), Alavert, Benadryl, Loratadine and Zyrtec
  • Cough — Robitussin (plain) or Mucinex
  • Diarrhea — Imodium AD
  • Nausea — Emetrol, Vitamin B6 25 mg three times per day, or Ginger Ale

Always ask your doctor prior to taking any other medications, supplements, vitamins, or herbs.

How much weight gain is typical?

Anticipated weight gain should be 25-35 pounds or approximately 3-4 pounds per month. Mothers who are underweight before pregnancy may gain 28-40 pounds and those that are overweight before pregnancy should limit their weight gain to 15-25 pounds. Women carrying twins may gain as much as 35-45 pounds.

How do I get Disability/FMLA paperwork completed?

If you have FMLA or disability paperwork that needs to be completed, please bring this to the office and give it to our front office staff. Please allow 7-10 business days for processing.