How can I calculate my due date?
Can I exercise?
Can I smoke or consume alcoholic beverages?
What do I do when I feel under the weather?
What medications can I take during pregnancy?
Can I use my hot tub, sauna or got to a tanning salon?
Is it okay to have sex while I’m pregnant?
May I travel?
We have a waterbed, is it okay to still sleep on it?
Can I wear a seatbelt throughout my pregnancy?
May I douche?
May I color my hair or get a perm?
I heard I need to be careful about my cat, is that true?
Am I able to paint?
Can I still visit the dentist?
May I have x-rays taken?
Lead poisoning concerns
Do I need to change my diet during pregnancy?
Where does the weight go?
What do I do if I have the following discomforts?
Heartburn or Indigestion
Nausea and Vomiting
Constipation and/or Hemorrhoids
Shortness of Breath and/or Faintness
Dizzy Spells & Lightheadedness
Dreams, Fantasies and Fears
HOW CAN I CALCULATE MY DUE DATE?
Due dates are calculated from the first day of the last menstrual period and are confirmed by the size of the uterus on exam. Ultrasounds are scheduled when medically indicated. The estimated due date is indeed just an estimate, as “term” is considered to be from 37 to 42 weeks. (Your estimated date is generally calculated at 40 weeks).
We will do a screening ultrasound between 18-22 weeks, should you desire or should it be medically indicated. This is a good time to visualize the baby’s anatomy which cannot be seen at earlier dates.
You should be aware that an ultrasound is not part of the global fee for your obstetrical care. Some insurance companies do not pay for screening ultrasounds. You may wish to call the customer service phone number on your insurance card to inquire about your particular coverage for ultrasounds.
- Aerobic exercise is good 3-5 times a week. Your heart rate should be no more that 140 beats per minute, for a maximum of 15-20 minutes.
- Drink lots of fluids before, during, and after exercise. If you are “red in the face”, you are working too hard.
- Only non-jarring or low impact exercise is recommended. This excludes: water skiing, skydiving, scuba diving, and horseback or motorcycle riding. Running is acceptable if you have been doing it consistently before pregnancy.
- Reduce weight-bearing exercise (running, weight machines) in favor of non-weight-bearing exercise (swimming, cycling). Cycling is good in early pregnancy, but can become more difficult later in pregnancy because of balance issues and the risk of falling. Stationary or recumbent biking is more acceptable.
- Avoid excessive stress to your lower back area.
- Limit the intensity of your exercise program to the same level as you set when you were not pregnant.
- Avoid any exercises on your back after the first trimester (12 weeks) of pregnancy.
- Walking and swimming are great!
- Women who exercise when pregnant have easier pregnancies, labor, delivery, and fewer Cesarean sections.
- Lifting/weight bearing activity not to exceed 20 pounds (or as directed by your physician).
CAN I SMOKE OR CONSUME ALCOHOLIC BEVERAGES?
Smoking cigarettes and drinking alcoholic beverages are absolute NO’s when pregnant or breast-feeding. Your baby is greatly affected by what you take into your body. If you have problems with smoking, alcohol, or drug use, please let us know right away. Your information is confidential and we are here to help you.
WHAT DO I DO WHEN I FEEL UNDER THE WEATHER?
When pregnant, please call us first for evaluation of your health problems. We may refer you to your family doctor or to a specialist. It’s always helpful if you can place the call yourself to answer any pertinent questions. Also, check your temperature before calling. If you have a fever greater than 100 degrees, take two Tylenol, drink lots of fluids, and notify your doctor.
WHAT MEDICATIONS CAN I TAKE DURING PREGNANCY?
Use NO medications, including over-the-counter preparations, unless authorized by our office. A listing of all herbs not to be used in pregnancy can be found below. If you must medicate yourself, the following medications have been authorized by your physician:
|Headache||Acetaminophen (Tylenol), Extra Strength is acceptable *could try a small amount of caffeine|
|Indigestion/Heartburn||Tums, Rolaids, Maalox, Mylanta, Pepcid AC, Tagamet, Prilosec OTC, Zantac|
|Cough||Robitussin (Plain or DM), cough drops|
|Congestion||Sudafed, Zyrtec, Claritin (plain), saline-only nasal spray|
|Sore Throat||Chloraseptic, Sucrets, warm salt water gargle|
|Diarrhea||Imodium AD, Kaopectate|
|Constipation||Fibercon, Senekot, Metamucil, Milk of Magnesia, Colace, Flaxseed|
|Hemorrhoids||Preparation H, Anusol|
|Cold||Vicks Vapor Rub|
|Motion Sickness||Bonine, Dramamine|
|Rash/Itching||Topical Benadryl cream, Benadryl 25mg 1 or 2 tablets @ bedtime|
CAN I USE MY HOT TUB OR GO TO A TANNING SALON?
Saunas, hot tubs, Jacuzzis and tanning beds are not recommended in pregnancy. Increased body temperatures can cause problems for you and your baby. Even a hot bath or shower may cause light-headedness, so moderate temperatures and minimal length of time in water is recommended.
IS IT OKAY TO HAVE SEX WHILE I’M PREGNANT?
Sex may be continued as long as you’re interested, and it causes no discomfort. Some women lose interest while pregnant, others have increased desire; either way is normal. Keep communication open with your partner and try varying positions for comfort. Your doctor will let you know if sex during your particular pregnancy is not appropriate.
MAY I TRAVEL?
Travel is allowed until the last month of pregnancy; that final month, don’t plan to drive more than 1-2 hours outside of Des Moines. Flying is allowed up to 36 weeks unless otherwise stated by your physician. It is advised to take a note from your physician with you. When flying, notify the airline that you are pregnant. Always drink plenty of fluids when traveling and stretch your legs every hour or so.
WE HAVE A WATERBED, IS IT OKAY TO STILL SLEEP ON IT?
Waterbeds are acceptable, if the temperature is not too hot. There is some question about electric blankets in pregnancy. If you need an electric blanket, please keep the temperature relatively low.
I HEARD I NEED TO BE CAREFUL ABOUT MY CAT, IS THAT TRUE?
Cats can be great fun, but their stool and litter can carry a virus that could harm the baby. If you have cats, let someone else clean the litter box. Wear gloves if you do gardening or yard work.
AM I ABLE TO PAINT?
Painting is fine, as long as you’re using water soluble (latex) paint and the area is well ventilated. Anything that smells strong enough to irritate your nose or eyes or give you a headache is an indication to leave, or to at least improve ventilation.
CAN I STILL VISIT THE DENTIST?
Dental care and dental visits are not only encouraged but are recommended. Teeth and gums need good hygiene, as usual. Be sure your dentist knows you are pregnant and postpone major dental procedures until after delivery, when possible.
Lead poisoning is a concern for all people, including pregnant moms and their babies. If you are around a remodeling or paint-chipping job, find out if they are working with lead based paint (commonly used in the 1950’s and 1960’s). If so, you should stay clear of the area until the job is done.
DO I NEED TO CHANGE MY DIET DURING PREGNANCY?
Current recommendation for weight gain in pregnancy is 25-35 pounds. Even if you are overweight, you should never try to lose weight when pregnant. Eat healthy, balanced, well-rounded meals at least 3 times daily, or eat more frequently in small amounts if you are having problems with nausea or fatigue. Here are guidelines for a day of balanced nutrition:
MILK GROUP: 4-5 servings/day. Single serving portions may be 1 c. milk; 1/2 c. evaporated or undiluted milk; 6 oz. cheese; 2 c. cottage cheese; 1 1/2 c. ice cream. Milk may be taken in other forms, such as soups, custards, and puddings. Dry nonfat milk can be added to meatloaf, mashed potatoes, cereals, sandwich spreads, and baked groups. 5 tbsp. is equal to 8 fluid ounces.
MEAT (PROTEIN) GROUP: 2-3 servings/day. Protein needs to be increased during pregnancy. A single serving would be 2-3 oz. meat, poultry, or organ meats (liver, heart, kidney); fish; 2 eggs; 3/4 – 1 c. cooked dry beans, peas, or lentils, 4 tbsp. peanut butter. Legumes such as dried beans and peas are also an economical source. Protein bars are a good snack but should not be used to replace a meal.
A Note Regarding Fish:
- Do not eat shark, swordfish, king mackerel or tile fish.
- You can eat up to 12 oz. of cooked fish per week from a restaurant or store
- Do not eat more than 6 oz. per week of cooked fish caught in local waters that are above FDA or EPA guidelines for water safety. For more information, see the EPA website at: www.epa.gov/ost/fish.
A Note Regarding Meat and Cheese:
- A pregnant woman can help protect herself and her baby from listeriosis by following these guidelines from the FDA:
- Do not eat hot dogs or lunch meats (cold deli meat sandwiches could be eaten in moderation) unless they are reheated until steaming hot.
- Avoid soft cheeses such as feta, brie, Camembert, Roquefort, blue-veined, queso blanco, queso fresco, or Panela unless they are labeled as made with pasteurized mild. Hard cheeses, process cheeses, cream and cottage cheeses are safe.
- Do not eat refrigerated pates or meat spreads. (Listeria thrives at refrigerator temperatures). Canned and shelf-stable versions are safe.
- Avoid refrigerated smokes seafood unless it has been cooked (as in a casserole). Canned and shelf-stable versions can be eaten safely.
- Do not consume unpasteurized milk or foods made from it.
Is it safe to consume raw sprouts and unpasteurized juices? Raw vegetable sprouts (including alfalfa, clover and radish) and fresh (unpasteurized) fruit and vegetable juices are loaded with vitamins. Unfortunately, they can carry disease-causing bacteria (such as Salmonella and E. coli), making them unsafe choices for pregnant women.
In healthy adults, salmonellosis and E. coli infection generally cause diarrhea, nausea, abdominal cramping and fever lasting for several days. However, pregnant women can sometimes become seriously ill from these infections. Occasionally, a pregnant woman can pass a Salmonella or E. coli infection on to her fetus. Diarrhea, fever, and less frequently, meningitis can develop in baby after birth.
A pregnant woman should drink only pasteurized juices. Check the label: the FDA requires that packaged unpasteurized juices carry a label stating that they are not pasteurized.
Is it risky to eat undercooked meat, poultry, or eggs during pregnancy? Lean meats, poultry, and eggs are rich in protein and some vitamins and are an important part of a healthy diet. However, pregnant women should avoid eating raw or undercooked meats, poultry, and eggs because these can increase their risk of a number of food-borne illnesses (including listeriosis, E. coli and Campylobacter infections, salmonellosis and toxoplasmosis).
Toxoplasmosis is a parasitic infection that often causes no symptoms or only mild flu-like symptoms. However, if a pregnant woman contracts it, there’s about a 40% chance she will pass it on to her unborn baby. Some affected babies develop vision and hearing loss, mental retardation, seizures and other problems. When toxoplasmosis is diagnosed during pregnancy, antibiotic treatment often can help reduce the severity of symptoms in the newborn. (Besides undercooked meats, another common cause of toxoplasmosis is contact with cat feces. A pregnant woman always should have someone else clean the litter box.)
VEGETABLE AND FRUIT GROUP: 4 vegetables and 3 fruits per day. One serving per day should be Vitamin C rich. Good sources are citrus fruits, juices, melons, and peppers. Fair sources are tomatoes, honeydew, watermelon, green vegetables, and potatoes. Two servings per day should be leafy, green vegetables, such as spinach, dark leafy lettuce, kale, broccoli, Brussels sprouts, asparagus, and cabbage. One serving per day may be of other fruits and vegetables. Prunes, apricots, and raisins also contain minerals. A serving may be 1/2 – 3/4c. fruits and vegetables, 1 c. if raw; 1 medium fruit, ½ grapefruit, 2 tomatoes or tangerines, 4 oz. orange or grapefruit juice; 12 oz. tomato or pineapple juice; 6 oz. drinks enriched with Vitamin C.
BREAD AND CEREAL GROUP: 9 servings per day. Single serv¬ing portions may be 1 slice bread; 1 large flour or 2 corn tortillas; 4 crackers; 1 tbsp. wheat germ; 1 oz. ready to eat cereal; 1 waffle; 1/2 – 3/4 c. cooked grits, cereal, macaroni, rice, noodles, or spaghetti. Course cereals and dark bread will add roughage to your diet.
Fried foods are higher in calories than foods prepared by other methods. For example, a fried egg has 120 calories, compared to 80 calories for a boiled or poached egg. If foods are fried, drain them well. Also fatty meats, fried foods, and highly seasoned foods may cause indigestion, so eat at your own risk. Foods made with milk will be lower in calories than if cream is used. Skim milk means even less calories, but has the same nutrients as whole milk. Canned fruits are available in light syrups and also in juice packs.
Avoid snacking on “junk food”. These provide little in the way of nutrients and may leave you with little room or appetite for the proper foods. When snacking, use foods from the daily requirements. For example, drink a glass of milk or eat fruit or raw vegetables or perhaps a sandwich (which would include both the cereal and meat groups). Caffeine and artificial sweeteners are both acceptable in moderation, which we would consider to be 1-2 servings daily.
Fluids are also important. Drink 6-8 glasses of water daily. Drinking a lot of water will not cause fluid retention. However, maintaining a low-sodium diet may help prevent fluid retention. For further information, try the book, “What to Eat When You’re Expecting” through Women Publishing. It’s an excellent reference.
PRENATAL VITAMINS should be taken daily while pregnant and breast feeding, however, if they cause increased gastrointestinal upset in early pregnancy, try omitting temporarily. Try taking them at bedtime with orange juice and toast or crackers. If still unable to tolerate, chew 2 Flintstones® vitamins every day.
DAIRY CONSUMPTION is a rather common concern. If you have trouble consuming the recommended quantity of dairy products, you may supplement with Tums with Calcium (4 daily) or calcium supplements. Your total calcium intake should be about 1200 mg.
DRINKING WATER in Des Moines is generally safe. However, if you hear warnings for infants, don’t drink it.
|Your Breast||2 pounds|
|Your Blood||4 pounds|
|Your Body Fluids||4 pounds|
|Maternal Stores (body protein, fat, and other nutrients)||7 pounds|
WHAT DO I DO IF I HAVE ANY OF THE FOLLOWING DISCOMFORTS?
Pregnancy is not an illness, but there are many changes for the body during pregnancy. How much this affects you is very individualized. We all have a different tolerance level and each pregnancy may be very different for the same person (that is, a second pregnancy may not be the same as the first, etc.)
HEARTBURN OR INDIGESTION
Indigestion may be present early in preg¬nancy, disappear, and begin again as the uterus enlarges and takes up more space in the abdomen. Avoiding highly seasoned foods, and/or fried foods. Eating more frequent, smaller meals may decrease heartburn. If nausea is worse in the morning, try a few soda crackers before rising. Gatorade is sometimes palatable if fluids are difficult.
- Sip on regular cola pop. You may have 1-2 caffeine servings a day
- Lemon juice in drinking water
- Suck on sour Jolly Ranchers, lemon drops, sweet tarts, or chew gum
- Sip on Squirt pop, grapefruit juice, or sports drink (All-Sport, etc)
- Crackers work well or try dry cereal or animal crackers
- 6 small meals a day seem to do better than 3 regular meals
- Vitamin B6 50 mg. twice daily
- Unisom: 1/2 of a tablet at bedtime
- Ginger – ginger ale, ginger snap cookies, ginger tea
CONSTIPATION AND/OR HEMORRHOIDS
Constipation may appear or be aggravated during pregnancy. Try to develop a regular time for elimination. Eating high fiber foods, and/or raw fruits and vegetables; plus allowing for a generous fluid intake (8-10 glasses/ day) will help.
This may occur in the legs or vulva and may be associated with aching of the legs. Support hose help. Avoid tight fitting garments on legs (such as knee-highs or socks with tight bands). Elevate legs when possible. Stand and walk hourly. If legs are crossed, cross at the ankles.
You might be notice this due to the pressure as the uterus grows and also from spasms of some of the supporting ligaments. You may experience sharp pain in either or both groin regions from stretching and spasms of the round ligaments. These cord-like structures originate beneath the groin regions and extend to the top of the uterus on both sides. Round ligament pain may be aggravated by sudden movements like rolling over in bed or walking. Lying down and supporting your knees with pillows may help. If you feel you want to try something more than rest periods, a maternity belt may help. Maternity belts can be purchased at local maternity shops.
Leukorrhea will increase during pregnancy. If the discharge is irritating, has an odor, causes itching, and/or becomes colored, report this to the office. Otherwise, unscented mini-pads and fresh cotton panties are the best response.
You may suffer headaches, which occur during the early part of pregnancy usually are relieved by taking a rest period and putting aside some of the stresses of the day. During the latter half of pregnancy, a headache may need to be evaluated. If the headache is persistent, occurs behind the eyes, or is accompanied by nausea/vomiting and/ or pain under the breastbone, call!
Nasal congestion may be more frequent during pregnancy; this is related to total body hormonal changes taking place. It is annoying, but does no damage. Portable humidifiers, or even a hot shower, may provide some relief.
Mechanical SHORTNESS OF BREATH and/or FAINTNESS
These may occur. The difficulty in breathing may appear as the growing uterus pushes upward toward the diaphragm. Sometimes just a change in position may be beneficial. Sit or lie down with your head lowered at any sight of lightheadedness, in order to avoid injury. You may feel faint in warm, crowded areas. Avoid such situations if this is a problem for you. Sometimes a faint feeling occurs when lying down on your back. This is the result of the enlarged uterus and its position upon your blood vessels. Simply turn to either side to relieve it.
During the early stages of pregnancy, you may experience dizziness or fainting. This can be caused by the circulation changes happening in your body and usually goes away by the second half of pregnancy. Lying on your back toward the end of pregnancy may also cause dizziness. Lying on your left side is recommended. Do not change positions suddenly. When you are lying down, ease yourself up to a standing position in stages. Do not move too quickly. Other causes of dizziness or lightheadedness could be low blood sugar and low fluid volume. Increasing protein and fluids may help. Incorporating additional protein into your diet may help reduce reoccurrences.
Swelling of the ankles affects many women later in pregnancy. It may be aggravated by prolonged sitting, standing, or warm weather. Elevate feet when possible. If edema of the face is noticed or there is persistent swelling of the lower legs, call!
Call any time, day or night, if you have any of the following:
- Vaginal bleeding
- Severe or continuous headache
- Severe abdominal pain
- Persistent dim or blurred vision
- Chill or fever (100 degrees or over)
- Painful urination
- Escape of fluid from the vagina
DREAMS, FANTASIES, AND FEARS
These may intensify during pregnancy. Some of these may be distressing. Try to put them into their proper perspective. Communication with spouse, a supportive friend, nurse, or physician may be helpful. Try to remember you are not the only one to find the unknowa bit scary. If your particular fear or dream is not a happy one, it may be helpful to know there is seldom any correlation between these fears and the actual outcome of the pregnancy.
Breast feeding is the method of choice for mothers who are willing and able. Both the American College of Obstetricians and the American Academy of Pediatrics recommend breast milk over formula feeding for several reasons:
- It is more easily digested by the newborn
- It has antibodies to help infants fight infection
- There are fewer allergy related problems (especially important if allergies run in the family)
- Most bleed less after delivery
- Better oral and facial development for newborns
- Breast feeding, even for a few weeks, is better than not at all.
If you are planning to breast feed, start nipple preparation the last four to six weeks of pregnancy. Some ideas for toughening your nipples include: rubbing with a fleece washcloth or towel after bathing; rolling the nipples between the forefinger and thumb for a moment or two, several times daily; and allowing increased air exposure to the nipples.
If breast feeding is not for you, your pediatrician will help you with formula selection, feeding techniques, and schedules.
HERBS NOT TO BE USED IN PREGNANCY
The herbs listed below are not to be used in pregnancy. Those herbs in bold print can be used in food/dietary items, but should not be used in medicinal concentrations. (For example, garlic may be used in food, but do not take garlic pills).
|Alder Buckthorn||Aloe Vera||American Mandrake||Angelica|
|Arbor Vitae||Autumn Crocus||Balsam Pear||Barberry|
|Black Cohosh||Bloodroot||Blue Cohosh||Borage Oil|
|Broom||Buckthorn||Cascara Sagrada||Castor Oil|
|Celandine||Chaste Berry||Chervil||Chinese Angelica|
|Juniper Berries||Kava Kava||Kelp||Licorice Root|
|Purging Buckthorn||Rue||Saffron||Saw Palmetto|
|Senna||Shepherd’s Purse||Siberian Ginseng||Southernwood|
|St. John’s Wort||Tansy||Thuja||Trillium|
|Uva Ursi||Valerian root||Wild Carrot Seed||Yarrow|