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Baby Book inside pmd

VIEWS: 23 PAGES: 64

									Great
 Expectations
      Your guidebook for understanding
      and enjoying your pregnancy




 Specialists in Obstetrics and Gynecology of Columbus
                                            Your Prenatal Guidebook


                                   Table of Contents
Initial Prenatal Care .............................................................................................. 4
Regular Office Visits ............................................................................................. 5
High Risk Pregnancy ........................................................................................... 6
Prenatal Diagnosis of Genetic Disorders ............................................................. 6
Keeping Track of Your Baby’s Health .................................................................. 8
Chorionic Villus Sampling (CVS) .......................................................................... 9
Alpha-Fetoprotein Test ........................................................................................ 9
Electronic Non-Stress and Stress testing ........................................................... 10
Biophysical Profile ............................................................................................. 10
Glucose Tolerance Test ...................................................................................... 10
Understanding Your Baby’s Development ........................................................ 12
Expect Some Changes ........................................................................................ 13
Physical Changes ............................................................................................... 13
Emotional Changes ............................................................................................ 19
Caring for Yourself ............................................................................................. 21
Diet .................................................................................................................... 21
Sensible Weight Control .................................................................................... 23
Plan Ahead ......................................................................................................... 27
Feeding Your Newborn ...................................................................................... 28
Exercises for Pregnancy ..................................................................................... 40
Caring for Your Unborn Baby ............................................................................ 42
Problems During Pregnancy .............................................................................. 47
Caring for the Rest of Your Family, Too ............................................................. 51
Back to You - Changes the Very Last Weeks ..................................................... 52
Is This Really Labor ........................................................................................... 53
What to Expect at the Hospital .......................................................................... 54
Labor and Delivery . . . The Birthing Process ..................................................... 54
Vaginal Delivery ................................................................................................. 54
Vaginal Birth After Cesarean (VBAC) ................................................................. 55
Cesarean Birth, or C-Section .............................................................................. 56
Childbirth Classes .............................................................................................. 57
Anesthesia and Pain Relief ................................................................................ 57
It’s Over Now, But . . . Don’t Expect Instant Beauty! ......................................... 58
Your Own Changes Don’t Stop Now ................................................................. 58
A Baby Has Real Needs, Too ............................................................................. 60
Now You’re a Mother ......................................................................................... 60
Index .................................................................................................................. 61
 Congratulations!
Congratulations!
You’re Pregnant!
You’ve got   Great Expectations . . . and you’ve got a lot of questions,
too. Whether this is your first pregnancy or your third, this booklet is designed to
help answer those questions. You’ll be going through some changes during the
following months, both physical and mental. Sometimes you’ll wonder “Is this
normal?” “What is going on?” This booklet will reassure you and keep you
informed. Please read it from cover to cover so you’ll know exactly what to expect
during your pregnancy. Refer to it when you have specific questions. The answers
may be right here.


For the first few weeks after you have been diagnosed as pregnant, all you’ll be able
to think about is, “I’m really pregnant.” It’s a happy and pretty emotional revela-
tion. Yet you may also be thinking about the impact on your life, your family, the
budget, and other matters. So there’s work to be done and many things to learn and
understand. In partnership with us and with this booklet as a reference guide, you
can make the best of your own



           Great Expectations
  4                                    Your Prenatal Guidebook

Initial Prenatal Care
Just as soon as you think you are pregnant, call our office. You’ll want to know for
sure. And you’ll want to start taking good care of yourself and your growing baby
just as quickly as possible.
 INITIAL OFFICE VISIT                               FOLLOW-UP OFFICE VISITS
 A. History & Educational Counseling                Mother
 B. Physical Examination*                                •Weight
 C.Laboratory*                                           • Blood Pressure
       Complete Blood Count                              •UrineSpecimen
       Urinalysis                                        •UterineGrowth
       Serology, Blood Type & Rh Factor                  • Pelvic Exams (late in pregnancy)
       Rubella Titer                                     • Special Blood Testing
       PAPSmear                                     Baby
       Urine, Cervical,Vaginal Cultures                  •FetalHeartTones
             (ifnecessary)                               • FetalActivity
       HIVtest                                           •SizeandGrowthofBaby
       Hepatitis B Screening                             •LocationofBaby
 *Includes all those procedures listed in subse-
 quent office visit


The First Office Visit                      Office Visits
The first office appointment may take longer than your other visits. Your medical
history will be taken by our nurse practitioner. Come early to the first exam, so you
can fill out a medical history.

At the first or second appointment some lab tests relative to pregnancy will be
done. Blood tests are especially critical since they tell us much about your medical
history which could have an effect on you or your baby’s well being. Depending
on special needs or individual medical problems, other testing may be done.

Follow -up visits are much shorter in duration than your initial visit. The focus of
these checkups is to make certain that you have not developed any problems
peculiar to your pregnancy. In addition, the growth and development of your baby
is monitored. Certain blood tests and other tests (e.g. sonography) are performed
at predetermined intervals throughout your pregnancy to monitor your progress.

We’ll set your due date at the first appointment with the doctor. We estimate your
gestational age and establish your due date by the crown-rump length of the fetus
on the ultrasound. We compare this date to the date expected based in your last
                          Your Prenatal Guidebook                                   5


menstrual period and decide whether to keep the original due date or to change it
based on the ultrasound results. It becomes a special “monitoring progress” date
for you and us. Only 1 in 20 babies is delivered exactly on the calculated day,
although most are born within 10 days of the expected day.

A full-term baby usually goes 266 days from conception to birth. You may know
exactly when you conceive. If so, tell us. At your initial exam, we will try to answer
as many questions as possible.

Frequency of Office Visits
The closer you get to your due date, the more frequently we will need to see you.
Through your sixth month, we’ll set up appointments every four weeks. Then, plan
to come in every two weeks during the seventh and eighth months, and every week
during that last month. These visits will take less time than your initial exam, but are
just as important to make sure your pregnancy is progressing well.

Discuss Your Stresses
If you have special problems like single motherhood or are considering adoption
alternative, let’s talk about these issues at your initial appointment. We’ll be happy
to help with suggestions and references.
The more you tell us, the more we’ll be able to help you . . . and you should have
fewer problems during your pregnancy.
   6                           Your Prenatal Guidebook


                   High Risk Pregnancy
  A pregnancy is called high-risk when a preexisting medical condition or preg-
  nancy-related complication threatens the well-being of you or your baby.
  Unfortunately, we can’t always predict high risk pregnancies but if complica-
  tions should arise during your pregnancy, we will monitor you very, very
  closely. Special testing may be performed in order to appropriately monitor
  your condition and to determine the best time to deliver your baby. More
  frequent visits may be required.
  If you have or should develop any of the following conditions, your preg-
  nancy may be considered high risk:
  • Viral illnesses like herpes, hepatitis B, AIDS, German Measles, cytome-
  galovirus, chicken pox
  • Bleeding late in pregnancy
  • Post dates pregnancy
  • Breech birth or other abnormal presentations
  • Nicotine, alcohol or other substance abuse
  • Incompetent cervix
  • Age 40 or older; Age 15 or younger
  • History of miscarriages, stillbirths or neurologically impaired infants
  • Rh disease
  • Multiple pregnancy (twins, triplets, etc.)
  • Diabetes
  • Heart disease
  • High blood pressure or toxemia
  • Preterm labor


Prenatal Diagnosis of Genetic Disorders
“Will my baby be normal?” That’s the question all parents ask, and some with good
reason. Knowing the family history of both you and your baby’s father will allow
us to anticipate certain problems that can be minimized with proper care. Today, we
have a better chance of diagnosing certain genetically inherited diseases, thanks to
medical technology. A procedure called amniocentesis, usually performed from 15
to 20 weeks of pregnancy, tests the fluid surrounding the baby and allows us to
detect certain diseases and other factors like the sex of the baby. Other highly
specialized tests may be required, depending on the family’s medical history.
                       Your Prenatal Guidebook                                7


         Genetic and Family History
There are certain family medical conditions that are important to the health of
your baby. The following questionnaire will help us determine if you are a
candidate for special genetic counseling or testing.
You should make note of any questions that you answer “Yes” and discuss
these with us at your earliest appointment. Check the appropriate answer.

1. Will you be 35 or older by the due date?                  Yes ___ No ___
2. Have you, the baby’s father or anyone in your family had:
         a. Down’s Syndrome?                              Yes ___ No ___
         b. Spina bifida or myelomenigocoele
                  (open spine)?                           Yes ___ No ___
         c. Hemophilia?                                   Yes ___ No ___
         d. Muscular Dystrophy?                           Yes ___ No ___
         e. Mental retardation?                           Yes ___ No ___
         f. Sickle Cell Disease?                          Yes ___ No ___
         g. Tay-Sachs Disease?                            Yes ___ No ___
         h. Cystic Fibrosis                               Yes ___ No ___
         i. Thalassemia                                   Yes ___ No ___
3. Have you or the baby’s father produced a child born with a defect not
   listed in question 2 or that was born dead?            Yes ___ No ___
4. Do you, the baby’s father or a close relative in either family have any
   inherited genetic or chromosomal disorder not listed?
                                                             Yes ___ No ___
5. Are you, the baby’s father or a close relative:
         a. Of Jewish ancestry or a descendant
                  from Eastern European people?              Yes ___ No ___
         b. Of Mediterranean ancestry?                       Yes ___ No ___
6. Have you or a previous spouse of the baby’s father had three or more
  miscarriages?
                                                          Yes ___ No ___
Thank you for taking the time to complete this very important questionnaire.
Remember to discuss with us any item that is answered “Yes.”
 8                           Your Prenatal Guidebook


Keeping Track of Your Baby’s Health
Throughout your entire pregnancy, the health of both you and your baby is our
concern. Listed below are the most common techniques used for evaluating a fetus.
Sonography or Ultrasound
Sonography is frequently used to detect a problem or monitor a condition in the
fetus or the mother’s womb. During the first few months of pregnancy, this test can
tell us if the baby is developing properly. Should vaginal bleeding occur, it can
help us learn why. A sonogram also can verify your due date and determine
whether or not you are carrying twins.
Unlike x-rays, sonography uses sound waves to produce an ultrasound video
“picture” of the fetus moving inside your uterus. This picture is generated from an
instrument that is placed either on your abdomen or in your vagina. You, too, can
actually see the baby on a special screen while we’re performing the test. If you are
six or more months pregnant and the baby is positioned correctly, we may be able
to tell the baby’s sex. Later in pregnancy, the test can track the baby’s growth,
locate the placenta, determine the volume of amniotic fluid, and detect some types
of birth defects.
The procedure requires little of your time and is performed either in the office or in
the hospital. No harmful effects have been reported to date from use of ultrasound
during pregnancy.
Amniocentesis
An amniocentesis involves withdrawing and testing a small amount of the amni-
otic fluid surrounding the fetus. It provides very reliable information about:
Rh disease, or blood incompatibilities between mother and baby;
Genetic defects such as Down’s Syndrome and others;
Certain defects related to abnormal brain and spinal cord development, or neural
tube defect; and
Fetal maturity near the end of pregnancy.
              Amniocentesis also will reveal the sex of your baby,
      but if you want us to keep it a secret, please inform us of your wish.
The timing of this procedure will vary depending on the initial reason for evalua-
tion. Genetic and neural tube defects, for example, usually are investigated at
about 16 weeks, while fetal maturity and blood incompatibility are looked at much
later in the pregnancy.
Amniocentesis is generally performed in conjunction with sonography to prevent
injury to the baby, the cord and the placenta. Only one or two tests can be run on
a sample of amniotic fluid, so it’s important that we know what problems we are
looking for before the procedure is done.
                             Your Prenatal Guidebook                                     9

There is a one in 200 to one in 400 risk of loss of the pregnancy due to infection,
bleeding or preterm labor with amniocentesis. This is not a routine test and it is
always optional. It is performed only to detect a highly probable medical problem.
You shouldn’t be concerned about the loss of amniotic fluid. Only a small amount
is withdrawn, and your body rapidly replaces it with no harm to the baby.
Chorionic Villus Sampling, or CVS
Chorionic villus refers to part of the placenta that attaches the placenta to the lining
of the uterus or womb. An actual sample of the placental tissue is removed and used
to diagnose chromosome abnormalities in the fetus. The procedure is performed
during the ninth to eleventh week of pregnancy and offers the advantage of an
earlier and more rapid diagnosis than amniocentesis.
This test is not done in our office, but can be done through the hospital.
Alpha-Fetoprotein Test (Quad. Screen)
This is an optional blood test performed between the 15th and 20th weeks of pregnancy.
This special blood test detects neural tube defects and Down’s Syndrome, Trisony 16, 18.
Neural tube defects are abnormalities in the brain and spinal cord of the fetus.
Defects in the central nervous system occur when the neural tube (the brain and
spinal cord tissues) fail to close as the fetus develops. When the brain and spinal
cord are exposed directly to the amniotic fluid which surrounds the baby, it is called
an open defect. Sometimes the poorly developed neural tube is covered by skin or
bone, referred to as a closed defect.
The two most common neural tube defects are anencephaly and spina bifida. Ba-
bies with anencephaly are born with deformities of the head and brain and die soon
after birth. Those born with spina bifida can live a long time, but may suffer paraly-
sis in the lower body and legs. Also, there is often a lack of bladder and/or bowel
control which may be treated with surgery.
The chance of producing a child with neural tube defect is 1-2 for every 1,000 live
births. Babies born to mothers who have had a previous child with the same prob-
lem are at greatest risk, as are those with parents or grandparents who have neural
tube defects.
As with all prenatal tests, a normal test does not guarantee a normal baby at birth. About 20
percent of the infants born with neural tube defects have normal alpha-fetoprotein (AFP)
levels. Most of these are closed defects which are typically less severe.
Conversely, an initial abnormal test reading does not mean the fetus has a neural
tube defect. Abnormal levels of AFP are frequent, occurring in about 50 of every
1,000 women tested. Only one or two of those 50 actually have a neural tube
problem. A high AFP may be due to a miscalculation of the baby’s age or due to
twins in the womb. Various other temporary fetal conditions can cause an elevated
AFP reading. Second AFP tests are normal in about half of those who are retested.
  10                           Your Prenatal Guidebook

If a second test also indicates an abnormal AFP, a sonogram is usually given to
determine the fetal age, look for more than one fetus, or scan for neural tube defects
and other abnormal conditions which may be responsible for the elevated test.
If the sonogram shows a single fetus at the approximate age determined by the
initial due date with no fetal abnormalities, an amniocentesis is offered. An abnor-
mally high level of AFP in the amniotic fluid indicates a 90 percent chance that a
serious problem can be present.
If the AFP test is positive for Down’s Syndrome, then an ultrasound and/or amnio-
centesis will be recommended for follow-up.

Non Stress Test and Stress Test
Late in pregnancy, prior to the onset of labor, a fetal monitor may be used to
determine the well-being of the baby. This is most frequently used if a baby is past
due or there are complicating medical conditions in the mother, such as high blood
pressure, diabetes, Rh disease, bleeding or kidney disease. It is also helpful in
evaluating a fetus who is not growing properly, or whose fetal movement has
significantly slowed down.
The non-stress (NST) is used to evaluate fetal heart rate patterns, especially dur-
ing fetal movements. Increases in fetal heart rate are reassuring of fetal well-being,
and the test is called reactive. A non-reactive test can be caused by medication or
a sleeping fetus, and may require further testing.
The contraction stress test (CST) will allow us to evaluate how the fetal heart
reacts to uterine contractions. Certain fetal heart tracing characteristics occur in
both healthy and unhealthy fetuses. The uterine contractions can be induced by a
medication called oxytocin which is administered intavenously or by stimulation of
the mother’s nipples (nipple stimulation test). The “stress” created by the contrac-
tions may reveal that the fetus is receiving a marginal blood and oxygen supply.

Biophysical Profile
This complex test combines various parameters from the ultrasound exam (includ-
ing fetal movements, breathing motions and amount of amniotic fluid) with the non-
stress test finding to “score” each pregnancy. The total score is helpful to us in
evaluating the well-being of the fetus, and it helps us determine, in part, how we will
manage your pregnancy. This is a more extensive evaluation than the non-stress or
contraction stress tests.

One Hour Post Glucola Blood Sugar
This safe and simple test is performed between 24 and 28 weeks of pregnancy to
screen for Gestational Diabetes, a condition developed by some women only during
pregnancy. Initially, you drink a concentrated sugar solution, at one hour your blood
is drawn and tested to determine how well your body uses or metabolizes the sugar.
                         Your Prenatal Guidebook                               11

Diabetes exists when there is a high amount of sugar in your blood due to the
body’s failure to handle the sugar substance in a normal fashion. For more informa-
tion on Diabetes, see page 49.

Fetal Movement (Kick Count)
Did you know that your baby has a sleep-wake cycle lasting from 20 minutes to 2
hours? This and many other factors influence the mother’s ability to feel her baby
move. Women typically feel that first flutter of life - what we call quickening -
between 16-20 weeks of pregnancy. Fetal movement is more perceptible in mid
pregnancy and may diminish as the pregnancy progresses to term. The baby’s
position, the mother’s blood sugar level, her occupation and eating habits, as well
as sound, light and physical stimulus to the uterus also can affect fetal movement.
Finally, each fetus has a movement rhythm which is typical for him/her, and each
pregnant mother has a different ability to recognize her baby’s movement.

Some medical authorities today suggest that fetal activity levels say a lot about the
baby’s well being. The Kick Count refers to spontaneous fetal movements experi-
enced by the pregnant mother. You should feel 6-10 movements an hour when
monitoring fetal movement. There is no universal consensus on a critical level of
fetal movement; however, one point appears certain, fetal activity is generally
reassuring, and the fetal inactivity may need further evaluation. Please notify us if
you have noticed that the baby’s activity has diminished from its previous pattern
of movement.

Fetal Maturity Tests
Several tests can be performed on amniotic fluid to determine the maturity of the
fetal lungs. The maturity of the baby’s lungs has more to do with its ability to
survive than does its weight at delivery. Babies born with immature lungs can
suffer from a condition called respiratory distress syndrome, or hyaline membrane
disease, which is the leading cause of death in newborns. This condition results
from lack of certain chemical substances which make it possible for the oxygen we
breathe to be transferred from our lungs to our blood, where it is carried to cells
throughout our body. Without oxygen, our body cells die. Amniotic fluid can be
tested for FLM, fetal lung maturity to determine if the lungs are ready for birth.

Two major chemical substances, abbreviated L/S and P/G, are found in the amniotic
fluid surrounding the baby. By amniocentesis, we can collect and measure these
substances in the amniotic fluid. Levels of fetal lung maturity typically occur
sometime after 35 weeks of pregnancy. This information is extremely valuable when
complications of the mother or baby call for early delivery or when we have an
uncertain due date. Size of the baby is not a determining factor in lung maturity.
 12                               Your Prenatal Guidebook


       Understanding Your Baby’s Development
Month One                                          Month Five
During your first month of pregnancy, your         You may feel the baby move for the first
baby reaches a half inch in length and is called   time. A word about this; if you feel that
an embryo. Amazingly, the circulatory sys-         little flutter of life one day and not again for
tem and other vital organs have begun to form,     several days, DON’T BE ALARMED. Be-
including the heart, brain, lungs, eyes and        cause your baby is suspended in a sea of
ears. The placenta and umbilical cord are          amniotic fluid, you may not be able to feel
developing, and the baby is well protected         its every move. And then, the fetus may get
from harm in a sac of liquid called amniotic       very active for a day or two and then settle
fluid.                                             down for a few days. It needs rest, too! It
                                                   has now grown to 10 inches in length.
Month Two
By eight weeks, arms and legs are starting to      Month Six
form, and the embryo is beginning to look          By this time, the fetus resembles a miniature
more human. Fingers and toes are growing           infant except for its reddish, wrinkled skin.
and facial features are becoming more pro-         It measures about 12 inches in length and
nounced. The head seems huge compared to           starts to move with increased frequency.
the body because the brain is growing at a
very rapid pace. By the end of eight weeks  Month Seven
the embryo is about one inch long.          From seven to nine months you’ll gain the
                                            most weight and your baby is growing in-
  The embryonic period ends two months credibly fast - up to 14 inches long by now.
after your baby is conceived. By this time, With special care, babies born now can sur-
     all essential structures are present.  vive.

Month Three                                        Month Eight
By three months, the baby is called a fetus.       At this stage, the fetus is about 17 inches
It is starting to grow faster and is now four      long and weights around 4 pounds. The
inches long. Fingernails and toenails are grow-    baby’s bones and nails are hardening and
ing, and for some a little hair may sprout. If     wrinkles disappear as fat begins depositing
you could see inside the uterus, you could         under the skin. Babies born during this
determine the sex. At this time, we may be         month are still premature but have a very
able to detect the baby’s heartbeat with a         good chance of survival.
doppler.
                                              Month Nine
Month Four
                                              The baby’s size and activity level during the
During the fourth month, many women be-
                                              last month may cause the mother consider-
gin to “look” pregnant. After all, the fast
                                              able discomfort. You may have difficulty
growing fetus is now more than six inches
                                              sleeping and need to urinate more frequently
long. The baby’s teeth, eyelids and eye-
                                              than before because the baby is putting more
lashes and extremities are developing in de-
                                              pressure on your bladder. At full term, the
tail.
                                              average baby weighs seven-and-a-half
The fetal period, which lasts from the end of pounds and measures 20 inches in length.
     the second month through birth, is
characterized by rapid growth and continuing
    definition of structures already present.
                         Your Prenatal Guidebook                               13


Expect Some Changes
Of course, you can expect to gain weight, but expect some other changes too, both
physical and mental . . . Right from the start! Let’s go over the physical changes
first.

Weight Gain
You should try to gain about 25 to 35 lbs. during pregnancy if you were average
weight before pregnancy. This weight gain seems to best nurture you and your
growing baby.

Mothers who are underweight before pregnancy may gain 28-40 pounds. Women
carrying twins may gain as much as 45 pounds. Mothers who are very overweight
should limit their weight gain to 15-25 pounds. Fifteen pounds should be a mini-
mum weight gain for any pregnant woman.

If you are simply ravenous, and start to gain weight quickly . . . talk to us. We can
suggest some foods that you can eat a lot of and still not gain those pounds that
will make labor difficult. Refer to the Diet Section (pg. 21) of this booklet for a
complete outline of suggestions.

  Sources of Maternal Weight Gain         Sources of Fetal Weight Gain

            Uterus - 2.5 lbs.                     Fetus - 7.5 lbs.
        Blood Volume - 3.5 lbs.          Placenta & Membranes - 1.5 lbs.
            Breasts - 2 lbs.                  Amniotic Fluid - 2 lbs.

                  Weight Gain
             Fluid - 4 lbs.



Breasts
Right from the beginning, your breasts may be larger, firmer and more tender than
usual. The areola, the dark area around your nipples, may get larger and grow
darker in color. Halfway through your pregnancy, your breast may start to secrete
fluid (colostrum) in small amounts. Be sure to keep them clean with frequent
washings, and towards the end of your pregnancy, you may want to put gauze
pads inside your bra to protect your clothes. The veins right under your skin may
become more noticeable too. This is caused by an increased blood supply prepar-
ing your breasts for milk production. If you are planning to breastfeed your infant,
no special nipple preparations are required. It is recommended that you keep your
nipples dry and wash with warm water with no soap.
  14                           Your Prenatal Guidebook

Urination
When your uterus expands, it puts pressure on your bladder. The need to urinate
is common in the first stages of pregnancy, and in the last two weeks. Don’t try to
control this issue by drinking less fluids. Your baby needs for you to drink at least
two quarts of liquids a day.

Nausea
Some women suffer with “morning sickness” and some women are rarely, if ever
nauseated. “Morning sickness” isn’t necessarily confined to the morning hours.
Try eating smaller meals of simple foods, avoiding spicy and highly acidic foods,
and lie down immediately after eating for just a few minutes. If your nausea is more
severe than this, try eating a dry saltine cracker just before getting up in the morn-
ing. Sometimes a little bland food in the stomach will help you keep down a break-
fast later. Few women suffer with nausea after the fourth month, but if it is unusu-
ally severe, call us. You need to keep some food down to grow a healthy baby.
Medication is usually reserved for those who have significant vomiting or dehydra-
tion. Take your prenatal vitamins or iron during the day when nausea is not a
problem.

       Morning Sickness Remedies
       • Eat bread or crackers before you get out of bed each morning.
       • Get out of bed slowly - don’t jump up!
       • Try yogurt, milk or juice before bedtime.
       • Avoid greasy, fried foods or spicy, heavily seasoned foods.
       • Eat several small meals during the day rather than a few
        large meals
       • When sick, get fresh air, take deep breaths and sip soda water.

Excessive Salivation
This condition is frequently confused with vomiting in pregnancy. It is caused by
excessive secretion of the salivary glands in the mouth and is quite annoying and
difficult to treat. It tends to diminish in the latter half of pregnancy. Mints, chewing
gum, frequent small meals and cracker snacks can be helpful.

Heartburn
Heartburn is another complaint of pregnant women. It is alright to use an antacid
preparation, but do not use baking soda or sodium bicaronate preparations for your
heartburn. Before you buy an over the counter remedy (see medication list), ask us
which we recommend. In severe cases of heartburn, you might want to elevate the
head of your bed to encourage stomach fluids to stay put!
                           Your Prenatal Guidebook                                   15

Constipation
You need to drink lots of fluids, 8-10 glasses a day, while you are pregnant. This is
one way to avoid constipation, a common complaint of pregnant women. Exercise
frequently and eat plenty of fruits and raw vegetables. Try all the natural remedies
first, including the addition of bran and bran product to your diet. If these don’t
work, let us prescribe a very mild laxative or stool softener. Don’t be shy about
discussing this problem because it is a common problem during pregnancy.

Shortness of Breath
This should only be a problem during the last month or two when the baby is large
enough to interfere with your breathing muscles. Slow down your movements and
practice deep breaths from the chest. If you have trouble sleeping due to short-
ness of breath, prop yourself up on pillows. If you have shortness of breath at
rest, you should call.

Backache
It is common to have low backache in pregnancy. As your womb grows, your
pelvic bone joints relax, which can also cause pain in your lower back. Comfortable
shoes may help a little, good posture may help, too, but exercise will probably
relieve your backache more than anything else. Strong muscles can take more
stress without hurting. Using a maternal girdle can help.
Develop a routine of back exercises everyday from the beginning of your preg-
nancy. There are many good books available about exercising and pregnancy.
The more important routines are described in this booklet on pages 40-41.
Towards the end of pregnancy, some women feel that the baby is pushing on a
nerve in their back . . or that the baby has positioned itself so that pain is radiating
in their back. Get on your hands and knees and let the baby’s weight fall towards
the floor. This will relieve the pressure on your back as the baby shifts, and may
give you a lot of backache relief.

Insomnia
Usually trouble with sleeping comes from the difficulty of finding a comfortable sleep-
ing position. Exercising a few hours before you go to bed or taking a warm bath, may
help you rest easier. It is important not to take alcohol or sleeping pills to try to solve
this problem . . . let’s work together to find a safer way. Shortness of breath or
heartburn may aggravate this situation, so prop yourself up at night. Also, an active
fetus can keep you awake, so don’t drink caffeinated beverages after dinner.

Skin Changes
Many women get very upset about changes in the color of their skin, but these
changes are common. Your skin may simply look flushed like you are blushing. Or
if you have especially pale skin, you may develop brownish markings on your face.
  16                           Your Prenatal Guidebook


Some women get a dark line down the middle of their abdomen, where the skin
darkened considerably from the navel to the pubic hair. Acne crops up to plague
some, or acne may actually be helped by pregnancy in others. Changing hormone
levels probably cause all of these skin color changes, but one thing is certain, they
usually all go away or fade dramatically after the baby is born.

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 your legs to
your heart. Pregnancy can aggravate this problem. The swelling uterus partially
cuts off circulation in your legs. Exercise will help. Don’t stand for long periods of
time without moving. When you sit, try to prop your legs up to make return
circulation easier.
Varicose veins are more of a problem for women having their second or third child.
But even if you are having your first baby, try to do as much as you can to aid
instead of hinder the circulation in your legs. Veins that simply look bad this
pregnancy could be throbbing with pain the next pregnancy if you don’t try to help
the situation now. Rest periodically with your legs up.
Short walks at different times during the day will help pump your blood faster.
Support pantyhose can help tremendously, but avoid all tight clothing like round
garters or knee highs that will only cut off circulation more.
The vulvar area can also suffer from varicosities during pregnancy. Again, rest
periods spread out during your day will help. This time place a pillow under your
buttocks to elevate your hips and aid circulation.

Hemorrhoids
Many women suffer with hemorrhoids, or get hemorrhoids for the first time while
they are pregnant. Hemorrhoids are enlarged veins right at the opening of the
rectum. Though they are sometimes due to the blockage of circulation caused by
the increased size of the baby you are carrying, they are also frequently caused by
straining due to constipation.

If you do suffer with hemorrhoids, try lying on your side with your hips elevated on
a pillow. Soaking in a warm tub can help too. But before you use any over the
counter ointment and remedies, be sure to ask us if they are safe for your baby. The
medication in ointments is frequently absorbed through the skin and may affect
your baby’s system. If you suspect your hemorrhoids are bleeding, call us. Pre-
vention is the word here! Eat correctly and add fruits, raw vegetables, bran prod-
ucts and lots of water to your diet every day.
                           Your Prenatal Guidebook                                   17

Vaginal Discharge
You may notice more vaginal discharge during your pregnancy. This mucus secre-
tion occurs from the cervix in response to the hormones of pregnancy. All this is
quite normal and there really isn’t much that can be done to change the situation.
Of course, excessive discharges that itch or have a bad odor, should be evaluated.
Many women seem to get yeast or other vaginal infections that need treatment
while they are pregnant, but these are not harmful to the baby.

Abdominal Pain
During the latter half of pregnancy you may suffer with lower abdominal pain. This
pain can come on one or both sides of the lower abdomen, and is usually caused by
the stretching of ligaments that support the uterus (round ligament pain). This may
occur early in pregnancy and feels like “menstrual cramps.” Constipation can also
cause abdominal pain. Resting with a heating pad may help, and you might want to
try a maternity support girdle. If abdominal pain is severe and continues, please call
us! There can be other more serious causes.

Pica
This is the medical term for the unusual cravings for strange foods that you might have
while pregnant. We don’t quite know why this happens, but many women experience
it. It is important to keep eating your balanced diet, no matter what your cravings are.
If you feel like eating a pot of spinach at 2 o’clock in the morning, go ahead. But if you
feel like eating hot chili or a half dozen of your favorite candy bars . . . that’s another
issue! A desire to eat strange foods might mean a nutritional deficiency.

Dizzy Spells
During the early months of pregnancy, you may get faint and light-headed all of a
sudden. Some pregnant women really do faint. This is caused by the circulation
changes happening in your body and usually goes away by the second half of preg-
nancy. Lying on your back toward the end of pregnancy may also cause dizziness; so
lying on your left side is recommended. Don’t change positions suddenly. When you
are lying down, ease yourself up to a standing position in stages.

Arthritis
Not infrequently, later in pregnancy, swelling can occur in the joints and cause pain
that feels like arthritis. This is especially seen with women who develop leg swell-
ing during the day and notice stiff, sore finger joints the following morning after
resting overnight. A similar situation occurs in Carpal Tunnel Syndrome where a
nerve that supplies sensation to the hands becomes entrapped in a tunnel of tissue
because of swelling. The involved nerve produces numbness in one or both hands
more frequently at night. Both conditions are improved by bed rest and salt restric-
tion during pregnancy and the natural fluid loss that occurs after delivery. A hand
splint may also be helpful.
  18                           Your Prenatal Guidebook

Swelling
Again, pressure from the growing uterus and your changing hormones can cause
swelling, especially in your legs. Some of this is due to blockage of drainage
pathways and some is caused by water retention. Support pantyhose and resting
with your legs elevated will help a little. Be sure to avoid excessive salt intake,
which will only make you retain more water. Brief periods (up to 2 days) of complete
bed rest are the best treatment of all.

Stretch Marks
Stretch marks may show up on breast, buttocks and the lower abdomen. They can
also appear on other areas of the body as well. Moisturizing creams probably won’t
do much to help because stretch marks are caused by the breakdown of elastic
tissue right below the skin surface. Excessive weight gain will make matters worse,
so keeping your weight gain under control will do more to avoid stretch marks than
anything. The good news is that stretch marks usually pale and become less
noticeable after pregnancy.

Nose Bleeds
Some women have frequent nose bleeds during pregnancy caused by extra blood
supply in the nasal lining. Treat with finger pressure on the side of the nose that is
bleeding. Call if the bleeding is heavy and you are unable to stop it with pressure.
Nasal congestion is also common. Avoid nose drops unless discussed with us.

Round Ligament Pain
You may experience sharp pain in either or both groin regions from stretching and
spasms of the round ligaments. These cordlike 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 in bed or walking. Re-
ducing physical activity and the application of warm heat can help.

Headaches
Headaches are one of the most common complaints along with nausea in the first few
months of pregnancy. Most headache remedies are not helpful. These headaches are
caused by blood circulation changes and will usually quit after the first half of the
pregnancy. If you notice the headaches are associated with sensitivity to light, exces-
sive nausea or vomiting, fever or other neurological signs, call our office.

Contractions
The uterine muscle contracts spontaneously from early pregnancy until the onset
of real labor. Usually the contractions are irregular and painless (Braxton-Hicks
contractions) and may produce “false” labor if they become painful. If they become
progressively close together, last longer and become more painful, notify us so we
can make certain you are not in early labor.
                          Your Prenatal Guidebook                                 19

Emotional Changes
Depression/Anxiety
Many pregnant women feel downright joyous one minute then crash into tears the
next. These up and down mood swings are just a part of the hormonal changes
going on in your body. These hormonal changes set up the environment for mood
shifts.
Emotional Mood Shifts
When any woman gets pregnant, she worries about the health of the baby and the
pain of labor. She considers the future and how she will adjust to being a mother,
along with a hundred different issues, all surrounding the addition of a baby into
her life.
What to do about moods?
Most of these anxieties can be eliminated by asking us medical questions or just
telling us your worries. If depression really gets you down, don’t hesitate to ask for
help.
Expect these mood shifts, and don’t think something is drastically wrong when
they occur. No matter how much a woman wants a baby, she still may feel inad-
equate once she becomes pregnant. The key to working through depression and
anxiety is communication. You should discuss your feelings, even if you think they
are embarrassing.
When you feel anxious, pamper yourself with a warm, relaxing bath. Keep your
thoughts on today’s events, not what could happen tomorrow. Make it a point to
get out of the house every day, even if only for a short walk. Reach out to others
when you need a comforting word.
Knowledge can erase many of your worries . . so read books on pregnancy and
child care. Prenatal classes are also a great idea. Pregnancy is a fascinating subject,
especially when you are in the starring role. Since this book cannot cover all
aspects of pregnancy and delivery, why not check out some books and read until
your heart’s content.
If you still feel depressed, be sure to talk it over with us. It can affect your overall
health. Let us help you discover that pregnancy can be a time of joy and happi-
ness!

Sexual Changes
With your mood shifts come other emotional changes, too, including your feelings
about sex. Desire for sex may rise or fall significantly during pregnancy. If you lose
interest in sex, don’t worry. It happens to a lot of women and doesn’t usually last
long. Be sure to discuss your feelings with your partner and have him read this
book.
20                            Your Prenatal Guidebook


                         Danger Signs
Pregnancy is a normal state for women, but sometimes complications arise
that require our immediate attention. Almost all complications give some
kind of warning sign, and you may be the first to notice a symptom that
needs attention. We check your blood pressure, urine, weight and fetal
heartbeat at each appointment because changes in these vital signs could
signal a problem. Problems that are caught early have the best chance of
being treated and eliminated.
Call us immediately if you experience any of these symptoms:
• Bleeding from the nipples, rectum, bladder or coughing up of blood
• Vaginal bleeding, no matter how slight (unless small amount after a
 pelvic exam or intercourse)
• Swelling of hands or face
• Dimness or blurring of vision
• Severe or continuous headaches
• Abdominal pains that don’t go away with heat and rest or a bowel
 movement
• Chills or fever over 100.40F
• Persistent vomiting
• Painful or burning urination
• Absence of fetal movement for a 24-hour period late in pregnancy or less
than 10 movements in 2 hours when lying down and just paying attention to
 baby
• Sudden or slow escape of fluid from the vagina
• Mid epigastric or right upper abdominal pain
• Uterine contractions more than four in an hour is abnormal before
 36 weeks
These symptoms may indicate a serious complication of pregnancy that


                   Danger Signs
need immediate attention.
                         Your Prenatal Guidebook                              21


Caring For Yourself
In order to make the most of your expectations and grow a beautiful, healthy baby,
you need to take extra special care of yourself. Pregnancy can bring you both great
joy and stress. As your weight and body changes, you’ll need to alter some of your
habits and routines. You might not be able to do everything you want to do for a
few months. Remember, taking good care of yourself is taking good care of your
baby. Here are some guidelines for taking good care of yourself.

Diet
Your diet is especially important because you’re eating for two. This does not mean
that you need to eat twice as much. It means you need to eat all the right kinds of
foods. The fetus gets all its food from its mother. Proper development of your
unborn baby depends on an appropriate amount of calories, proteins, vitamins and
minerals supplied from the mother’s diet. Only by eating a proper mixture of foods
will you get the balance that is needed to nurture your baby’s growth. The average
woman requires about 2,200 calories each day. A pregnant mother needs about 300
calories more each day to stay healthy and nourish her baby. It’s important you get
these calories by eating three or more meals spread throughout the day, instead of
just eating a single meal. Later in your pregnancy, you may feel more comfortable
eating five smaller meals a day instead of three.

The pregnant woman needs 30 mg/day of iron, a 50% increase over her general
needs. Good sources of iron are extra lean meat, fish, poultry, cooked dried beans
and peas, dried apricots, dark green leafy vegetables, raisins, and whole grains.

Dairy products provide the bulk of dietary calcium. One quart of milk contains
about 1 g. of calcium. Cheese, cottage cheese and yogurt are also major sources.
Other sources including eggs, broccoli, legumes, nuts, and whole grains.

The Food Guide Pyramid was developed by the U.S. Department of Agriculture to
assist adults in choosing foods that give these required nutrients. Each food group
supplies different nutrients, so you must eat the proper amounts of food from each
group every day to get all that you need. The “Food Guide Pyramid” will help you
structure your meals to make a healthier you and better nurtured baby.
  22                           Your Prenatal Guidebook

               Estimated Dietary Needs
         for Non-Pregnant and Pregnant Women
   Nutrient            Recommended      Recommended                     Breast
                         Intake for        Increase                    Feeding
                     Non-Pregnant Adult for Pregnancy

   Calories                2,200                 2,500                  2,600
   Protein(gm)             55                    60                     65
   VitaminA(iu)            4,000                 4,000                  6,000
   VitaminD(mcg)           5                     5                      5
   VitaminE(mg)            8                     10                     12
   VitaminC(mg)            60                    70                     95
   FolicAcid(mcg)          180                   400                    280
   Niacin(mgeq)            14                    18                     17
   Riboflavin              1.1                   1.4                    1.6
   Thiamine(mg)            1.1                   1.4                    1.5
   VitaminB6(mg)           1.1                   1.9                    2.0
   VitaminB12(mcg)         2.4                   2.6                    2.8
   Calcium(mg)             1000                  1500                   1500
   Iodine(mcg)             150                   175                    200
   Iron(mg)                15                    30                     15
   Zinc(mg)                12                    15                     19
   Magnesium(mg)           320                   360                    320
   *Dietary Reference Intakes, American Dietetic Association (June 1998).

Serving Sizes
The following represents true serving sizes in various groups of the Food Guide Pyramid
   • Milk, yogurt and cheese group: 1 cup of milk or yogurt; 1 1/2 oz. of natural
   cheese; 2 oz. processed cheese.
   • Meat, poultry, fish, dry beans, eggs and nut group: 2-3 oz. of cooked lean
   meat, poultry or fish (size of deck of card); 1/2 cup of cooked beans; 1 egg;
   2 tbsp. peanut butter.
   • Vegetable Group: 1 cup of raw leafy vegetables; 1/2 cup of other cooked or
   raw vegetables; 3/4 cup of vegetable juice.
   • Fruit Group: 1 medium apple; banana, or orange; 1/2 cup of cooked or
   canned fruit;3/4 cup of fruit juice.
   • Bread, cereal, rice and pasta group: 1 slice of bread; 1 oz. cereal; 1/2 cup of
   cooked cereal, rice or pasta.
                         Your Prenatal Guidebook                               23

Sensible Weight Control
Proper Dietary Balance of Calorie Intake
Sensible weight control during pregnancy is a balance between diet, exercise, and
rest. Weight gain from fluid retention during the latter stages of pregnancy can
assume an added role. Pregnancy is not a time to fad diet, so if you start out
overweight, don’t try to correct the situation now. For those attempting to control
calorie intake and maintain balance during pregnancy, the following modifications
to the five food groups will be helpful.
   • Meat, poultry, fish, dry beans, eggs and nuts group: Eat broiled fish, chicken
   and beans. Avoid red meat, bacon, pork, ham and luncheon meats.
   • Milk, yogurt and cheese group: Eat or drink skim milk, skim milk cottage
   cheese, skim milk cheese (farmer’s cheese) and yogurt. AVOID whole milk and
   its products including ice cream and most cheeses.
   • Vegetable group: Can eat most. AVOID vegetables with high fat content, such
   as winter squash, coconut, avocados and olives.
   • Bread, cereal, rice and pasta group: Can eat whole grain breads and cereals
   including pita bread, sourdough bread, whole grain bread, bran and shredded
   wheat cereals. AVOID many breads and cereals with refined flour and sugar.
   • Fats, oils, and sweets: AVOID ALL including mayonnaise and all fried foods.
   This group contains items with calories, fat and simple carbohydrates with little
   or no vitamins and minerals. Such foods have no nutritional value to you.
Appropriate Exercise and Rest
A mild exercise program that is an on-going affair is much more beneficial than one
that is impulsively and excessively practiced. As your pregnancy nears term, more
rest and less exercise usually will be more effective in weight control and promote
well-being for both you and your baby. Remember 25-35 lbs.weight gain during
pregnancy will usually result in a return to your “normal” weight afterwards.
Fluid Retention
A salt-free diet is not generally recommended but certain foods and liquids do
contain an excessive amount of salt that promote excessive fluid retention in some
patients. You may want to cut out:
   • All soda drinks (soft drinks) including diet drinks
   • Bacon, sausage, country ham, salt pork and luncheon meats
   • Canned soups, canned vegetables, canned meats and fishes
   • Salted popcorn, pretzels, potato chips, corn chips, salted nuts, saltines, etc.
   • Tomato juice, V8 juice, bouillon cubes, mustard, salt
Bed rest (lying on side) allows the kidneys to excrete sodium and water retained by
the hormones of pregnancy. This may prove as effective as diet manipulation for
the control of fluid retention late in pregnancy.
  24                          Your Prenatal Guidebook


Work
You’ll probably be physically able to work during your entire pregnancy, but you
should take some precautions. Your job shouldn’t allow you to be exposed to
chemicals or radiation which may be dangerous to your baby. Some physical
activities may become impossible because of changes in your body structure. Try
to arrange for short rest periods when you can sit and put your feet up. Many
restrooms have lounges where you can lie down for a few minutes three or four
times a day.
If you have complications, it will be unwise to continue certain jobs, especially in
the latter stages of your pregnancy. Discuss your job situation with us.
Travel
Travel is usually no risk to you or your baby, if you follow certain guidelines. You
shouldn’t plan to travel long distances away from home the last four to six weeks of
your pregnancy. Restrict your travel earlier if you’re having twins, bleeding, or
have pregnancy-related high blood pressure. When you do travel a great distance,
make sure you get up and walk around at least every two hours to keep your
circulation moving.
If you experience any complications with your pregnancy, it may be best not to
travel at all, especially far away from home. If an emergency arises and you must
travel during the last four to six weeks of your pregnancy, ask us for advice. A copy
of your medical record to carry with you might prove helpful. You may also need a
doctor’s note to travel by plane. If any problems arise during the trip, go to the
nearest medical facility immediately.
Baths
It is safe to bathe while you’re pregnant, even during the last month. The only time
it is not wise for you to bathe is when membranes rupture. You should call us if you
suspect this.
Tampons
Since you’ll be having more vaginal discharge than usual, you might wonder about
using tampons. You’ll want to keep your vagina as free from irritation as possible,
so we recommend you try using one of the lightweight mini-pads instead.
Exercise
Exercise is also essential. Walking is excellent exercise. You may start a mild
exercise program early in your pregnancy. Keep up any pre-pregnancy routine you
may have, unless you have a medical problem and we advise you otherwise. Nor-
mally, you don’t have to limit your exercise, except when it risks injury to you or
your baby. When exercising, drink lots of water, and wear good shoes and a
support bra. You should stop any exercise if you develop shortness of breath,
chest pain, extreme fatigue or dizziness.
                           Your Prenatal Guidebook                                  25


In all cases, you should apply these sensible guidelines:

  • Avoid impact exercise.
  • Avoid stress to your lower back area.
  • Limit the intensity of your exercise program to the same levels
  as you set when you were not pregnant.
  • Exercise for shorter periods of time and rest frequently.
  • Reduce weight-bearing exercise (running, weight machines)
  in favor of non-weight-bearing exercise (bicycling, swimming).
  • Avoid doing full sit-ups and raising both your legs while lying flat.


 Exercise Guidelines
If you experience certain complications during your pregnancy, you and your baby
would probably benefit from a sedentary activity level with little or no exercise.
We’d recommend this to you if you’re expecting twins or having high blood pres-
sure, an incompetent cervix, or a condition in which it appears that your fetus is not
growing properly. Common sense, good judgment and listening to your body’s
signals are the main guides to exercising during pregnancy.

Rest
Rest is essential. Don’t let yourself get worn out during work or play. Remember,
you will be more tired than usual in the early stages of pregnancy. That’s just your
body trying to tell you something - “Rest”. Get a good 8 to 10 hours of sleep each
night and don’t feel guilty about an hour’s nap in the middle of the day. Towards the
end of your pregnancy, you may even feel like taking two or three naps a day. If
you’re working, try to arrange for extra 10 to 15 minute breaks and space them out
through the day.

Seat Belts
Seat belts are safety devices that protect you and your baby in important ways. It’s
best you wear both the shoulder and lap belts if possible. Place your lap belt under
your abdomen, across your hips and thighs. Wearing your safety belt makes you
60% less likely to be injured or killed in an accident. Most fetal injuries relate directly
to the seriousness of the mother’s injuries, rather than to those caused by the seat
belt itself.
   26                          Your Prenatal Guidebook

Clothing
Comfort is the word in clothing. Get a good supportive bra because your breasts
will be getting larger and heavier. You can buy a maternity girdle if you like, but
unless you suffer from back pain or lax stomach muscles, a girdle is rarely needed.
If you do buy one, make sure it’s supportive, not tight! If you plan to wear hose,
buy pantyhose instead of garters or knee highs. Circular garters or elastic bands
that hold up your stockings are out.
You’ll want to allow as much circulation to your legs as you can. Support hose may
help your legs if they’re feeling tired or if you suffer from varicose veins. Wearing
a good pair of shoes that are secure and comfortable is only sensible.

Douching
There’s rarely a need to douche during pregnancy. If it becomes necessary, we’ll
give you specific instructions. Douching is not recommended while pregnant.

Teeth
Proper dental care is very important. Don’t hesitate to see your dentist for dental
problems so he can take precautions when giving x-rays or prescribing medica-
tions.
Frequent brushing, dental flossing and proper diet can minimize your dental prob-
lems during pregnancy.
Swollen and bleeding gums are common problems for the pregnant woman. You
can minimize bleeding by using proper oral hygiene (frequent brushing and dental
flossing).

Immunization
Talk with us about immunizations you think you might need, especially those re-
quired for foreign travel. Some booster shots like tetanus are okay during preg-
nancy. Others are not.
You definitely do not want to be given live-virus vaccines such as mumps, measles
or rubella (German Measles). These are potentially harmful to your developing
unborn child. Ideally, you should be immunized before you’re pregnant. This
allows a certain amount of immunity to be passed on from you to your child without
the harmful effects a live virus might cause.

Insecticides and Household Chemicals
You should avoid heavy or prolonged exposure to as many household chemicals as
possible. They can absorb into your system right through your skin, or through
tiny cracks in your skin. If you must use strong household cleansing aids, wear
gloves and work in well-ventilated areas.
                           Your Prenatal Guidebook                                  27

Also avoid insecticides, pesticides, and weed killers. If you’ve had your house
sprayed for bugs, allow it to air out before you return. Give up using aerosol
sprays and use mechanical pump sprayers instead. Exercise the same caution for
hair dyes and permanents.

We recommend using latex paint when painting indoors. You want to avoid lead-
based paint because it has the potential to harm your baby. Although oil-based
paint and organic solvents like turpentine and lacquer have not been proven to be
harmful, they do produce strong fumes that you should probably avoid. Keep the
room well ventilated.

Saunas and Hot Tubs
Very hot water and steam should be avoided during your pregnancy. 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 while you’re pregnant. If you need
to soak your aching feet, that’s fine . . . but for awhile, avoid plunging in all the way.
Saunas are out completely.

Sex
You might not want to have sex if it’s uncomfortable during the last four to six
weeks. And, if you have a history of miscarriages, pregnancy related vaginal
bleeding or other complications, we’ll probably suggest you don’t have sex. Oth-
erwise there is no reason to interrupt your normal sex life. Orgasms will not start
labor or cause bleeding or other problems in a normal pregnancy. Many partners
are afraid that having sex will hurt the baby. Don’t worry. Your baby is so well-
protected by fluid, muscle, and bone, your motions aren’t going to harm the baby.
It’s much healthier for your relationship if you continue to be sexually intimate.

Plan Ahead
Part of caring for yourself is planning ahead, especially for the first two or three
weeks after you bring your new baby home. Prepare yourself for the baby ahead of
time. Read up on baby care. Know that you’re going to be tired, so plan to have
some help those first two weeks if possible.

Also, plan to have your baby clothes, diapers and bedding ready. This is the time
to decide on your new baby’s doctor as well. Ask your friends or us about recom-
mendations. Then you can relax and give all your attention to your new child, to
yourself and your partner.
  28                            Your Prenatal Guidebook

Feeding Your Newborn
Breastfeeding
As new parents, it is your responsibility to make sure your baby will get off to a
good nutritional start. With your choice to breastfeed you have joined the majority
of American women who feel this is the best and most ideal way of feeding your
baby. Almost as important as getting your baby off to a good nutritional start is the
contribution the breastfeeding makes toward the infant’s emotional development.
Breastfeeding will also promote wellness in your infant due to the presence of
antibodies in breast milk.
There is no doubt that breast milk contains all the nutrients required and is per-
fectly matched for your baby’s needs for proper growth and development. Studies
prove that breast milk provides optimal health and benefits the newborn for as long
as you choose to breastfeed. Your choice to breastfeed, though, is just that - your
choice. It is an entirely personal decision. Do not let others make up your mind for
you. You will hear pros and cons from other women, from your mother to the
friendly women in the grocery store, about their life experiences with breast feed-
ing. Some of what you will hear will make you cringe and may sway you to not even
try even if you thought this might be something you wanted to do. Other women
will make you feel that you will be a terrible mother if you do not choose to breastfeed.
Look deep inside yourself and decide what it is YOU want to do. Whatever you
decide, it will be the right decision because you made it yourself.
Once you make your decision and if you choose to breastfeed, then there are three
things you should do:
1. Talk to your health care professional about your decision
2. Become well-informed about breastfeeding through information you can obtain
from your physician’s office, or take classes on breastfeeding from your hospital.
3. Find yourself a knowledgable contact and support person who can answer ques-
tions and listen to you if you have any nursing questions or problems.
Benefits
Both popular and medical opinions agree that there are many benefits to breastfeeding
for both mother and baby.
  For Baby - Breast Milk Benefits:         For Mother - Breastfeeding Benefits:
  • Easily digested                        • Convenient
  • Perfectly matched nutrition            • Economical
  • Filled with antibodies that            • Helpful with the process of the uterus
  protect against infection.               returning to its normal size.
  Benefits to Both Baby and Mother
  • A beautiful and intimate way a mother can bond with her baby
  • Contributes to a very special and loving relationship
                          Your Prenatal Guidebook                                29

Anatomy of the Breast
The breasts are delicate organs made of glandular, connective and fatty tissue.
The nipple contains 15 to 25 tiny openings through which the milk can flow. These
tiny openings are surrounded by muscular tissue that cause the nipple to stand
erect when stimulated. Surrounding the nipple is an area of darker skin called the
areola. This area will become darker and larger in size during pregnancy due to
hormonal changes. The areola contains pimple-like structures near its border that
are called Montgomery glands. These glands secrete a substance that helps to
lubricate and cleanse the area.
Physiology of the Breast
Stimulation of the nipple by the baby’s sucking sends messages to the tiny pitu-
itary gland in the brain. It in turn secretes a hormone called prolactin. Prolactin
stimulates the milk gland cell within the breast to begin producing milk.
The second hormone that is released is known as oxytocin. This hormone causes
the muscle cells around the milk glands to contract and squeezes the milk down the
milk ducts. The milk pools behind the nipple and beneath the areola, in the milk
sinuses. This response is known as let-down or milk ejection reflex.
The sensations you may notice are as follows:
      • Tingling sensation
      • Warm upper body sensation
      • Feeling your breasts become full
It may take a minute to several minutes until the milk ejection reflex occurs. Please
know that emotional upsets, fatigue, or tension can slow down the let-down re-
sponse. Some mothers only know that their milk has let down by seeing milk in the
baby’s mouth.
Things that cause the milk to let-down are the following
       • Your baby crying
       • Thought of your baby
       • Smell of a baby or baby products
       • Seeing other babies
By 16 weeks of pregnancy, your breasts are fully capable of producing milk. Some
women will notice drops of fluid on the nipple during these early months. This
fluid, known as colostrum, is the “first milk”. It is what the baby will receive until
your higher volume milk is produced which takes 3 days after delivery.
Colostrum is described as follows:
        • A thick, yellowish fluid commonly called “Liquid Gold”
        • Very high in protein
        • Easily digested
        • Serves as a laxative and helps clear the baby’s intestinal track
        • Beneficial in loosening mucous in baby
        • Provides protection by containing antibodies and passive immunities
        • Coats the stomach and intestines and provides protection
   30                          Your Prenatal Guidebook

Preparation of the Breast for Nursing:
• Expose both breasts to room air a few minutes a day.
• Avoid soap to the nipple and areola; this will only cause dryness.
• Wear a good supportive bra during pregnancy.
• Allow your breast to air dry after showering and also during the day if you are
leaking colostrum.
• If leaking Colostrum, you may want to purchase breast pads. The pads may be
either disposable or washable. Do not use a “mini-pad” inside your bra. The sticky
area on it prevents air from being able to circulate and may cause nipple soreness.
• Have someone knowledgable about nursing bras help you with the purchase of a
well-fitting bra.
• Be careful about underwire bras. The wires may place pressure on the ducts and
cause blockage of milk.

Supply and Demand
As long as your baby nurses frequently and is allowed to finish the feeding com-
pletely, then he or she will have all the milk needed for proper growth and develop-
ment. Milk production is regulated by supply and demand. The concept being the
more milk that is removed, the more milk that is made. The less milk that is removed,
the less milk that is made.

Nipple Problems
Occasionally a mother will exhibit a flat or inverted nipple. These problems can be
corrected and should not discourage someone from trying to nurse. Early detec-
tion and correction can help to promote a positive nursing experience. Ask your
healthcare professional if you are suspicious of a nipple problem. A simple test you
can do is the “pinch test”. When pinching or stimulating the nipples, they should
stand erect and not stay flat or be drawn inward.

Breastfeeding Relationship
A good breastfeeding relationship takes time. As a new mom, you tend to have
unrealistic expectations of yourself and your newborn. It is easy to become dis-
couraged if things are not going well. Although a lot of reactions and responses are
innate, breastfeeding is a learned experience and it will take time for you and the
baby to be comfortable with one another. Readiness is important and there are
three C’s you must review with yourself every time you start breastfeeding.

1. Calm
This is a good time to use any breathing techniques learned in childbirth classes.
Your emotions are tied in very closely to the let-down response and the baby can
sense if you are uptight, so relax and breathe!
                          Your Prenatal Guidebook                                 31

2. Comfortable
Have pillows all around you in a comfortable chair for support and elevate your
legs. This will take the pressure off of your bottom and help with your comfort
level.

3. Close
You must hold and position the baby close to you. Proper positioning and latch-on
are the key to successful breastfeeding. Remember, even though breastfeeding is
a natural process, it is also a learned process. It is important for you to take a
breastfeeding class. Classes can assist your breastfeeding experience by teaching
you how! Your instructor will review position and proper latch-on techniques that
are important for you in getting off to a good start. See your hospital or clinic about
available classes.

Breastfeeding: When and How
Initiate breastfeeding as soon after delivery as possible. While in the hospital,
learn as much as you can from your nurse about your baby. ASK QUESTIONS!
Have the nurse watch you latch the baby on so you can go home feeling comfort-
able and confident that you know and understand the proper techniques.
There are different positions to hold your baby while nursing. This will prevent the
same position pressure points on your nipples, and help with more breast-empty-
ing throughout the day. These positions are as follows:
Watch for the early hunger cues such as lip smacking, mouth opening, and hand to
mouth. In the early days, some babies are sleepy and often do not cry when they
are hungry, so stay attentive to the cues. After the first sleepy week, crying is a late
cue.
Correct Latch-On
Getting the baby to latch-on correctly is one of the most important steps in suc-
cessful breastfeeding. The baby must open his/her mouth wide enough to get at
least 1 inch of the areola tissue in his/her mouth. It is the compression of the milk
sinuses that are located beneath the areola that will allow the milk to be drawn out
through the nipple as the baby sucks and let-down occurs.
• Latch On: The baby is positioned on the breast with all the nipple and at least an
inch of the areola in his/her mouth. The baby’s lips are flanged out. It is the
compression of the milk sinuses located beneath the areola and the baby’s tongue
resting on top of the lower gum which will allow the baby to draw the milk out
through the nipple. If the baby latches on to just the nipple only, you will become
sore and the baby will not get very much milk.
  32                           Your Prenatal Guidebook

The Following Guidelines Will Help You To Properly
Position and Latch The Baby To Your Breast:
• Prepare yourself by washing your hands, getting comfortable, and deciding on a
position.
• Align the baby so that he/she is tummy to tummy with you.
• Hold your breast in a “C” positions and gently lift and support the breast. Make sure
your fingers are well away from the areolar tissue.
• Gently stroke the baby’s lower lip with your nipple to elicit the rooting response.
• Keep repeating this motion until the baby opens his/her mouth the widest. Do not
allow the baby to latch on to your nipple! This will cause your nipples to break down
and become sore and cracked. It is very painful if the baby sucks on the nipple!
• When the baby opens wide, quickly pull him/her towards your breast and latch on.
• Signs of a good latch-on
    -All of nipple and at least 1 inch of areola is in baby’s mouth
    -Lips flanged out
    -Tongue over lower gum
    -Baby stays on breast
Burping
To take the baby off the breast, slide your finger into the corner of the baby’s
mouth, between his/her mouth and your breast, to break the suction. Do not pull
the baby off your breast. This will traumatize your nipples and lead them to becom-
ing sore and cracked. It is important to burp the baby between breasts and after the
feeding to get rid of any air swallowed during the feeding.
Effective Ways Of Burping Are As Follows
   • Over the shoulder
   • Lying belly down across your lap
   • Sitting in your lap with chin supported
Usually the pressure on the baby’s belly is enough to bring up the air. Pat the
baby’s back gently or stroke the back with an upward motion. Sometimes babies
will not burp. If they did not get a lot of air in the stomach during the feeding, it is
likely that they will not. After a few minutes resume with the feeding.
Guidelines and Technical Points for Frequency and Duration of Feedings
• A baby needs and naturally requests 8-12 feedings in a 24 hour period
    -approximately every 2-3 hours with one 4-5 hour stretch (hopefully at night)
    -may cluster feed - your baby may want several feedings in a row. It is impor-
    tant to feed your baby when they request
• Each cluster feed counts toward the 8-12 in a 24-hour period
• In early sleepy days, the baby tends to not request feeds often enough.
    -notice hunger cues-wake the baby by 2 1/2 hours from the beginning of last feed
    -keep baby interested and awake
    -anticipate longer intervals occurring at night (hopefully)
                          Your Prenatal Guidebook                                  33

• Nurse until the baby shows signs of being full
    -self-detaches
    -sucking less vigorously
    -breast is emptied in 7-10 minutes
    -nutritive sucking important to listen for
• First three days may be difficult to hear swallowing with the small amounts of
colostrum but can be heard. It sounds like a soft “Ca-Ca” or a soft expiration.
• After larger milk volume arrives, you will hear a definite suck to swallow ratio
change.
• Offer both breasts each feeding as this is important for stimulation in milk produc-
tion
    -keep baby interested and awake
    -if they choose to take only one breast at a feeding, make sure you begin with
the other breast at the next feeding
• Alternate the breast with which you begin each feeding. To help you remember
this, use a safety pin on you bra strap. This will help with the proper milk removal
of the breasts.
If you follow these steps you will ensure proper milk removal completely and regu-
larly, increase milk production, reduce breast engorgement and nipple tenderness,
and maximize infant weight gain. The first sleepy week or two may be a challenge
for you to keep them interested in the feeding.
             Note - Take cues from the baby: He/she will let you know!
How Do I Know The Baby Is Getting Enough
To Eat?
The most common concern that you will have is whether the baby is getting enough
to eat. Unfortunately there are no ounce markers on the breast for you to see the
exact amounts your baby is taking in. This can be unnerving at times. There are
many clues that indicate that everything is going well.
Be Attentive To The Following:
• Baby eating every 2-3 hours during the day
    -sleeping no longer than 3 hours between feeds during the day
    -may have one 4-5 hour stretch at night
• Baby wetting diapers
    -1 diaper in the first 24 hours after delivery
    -3 on the second and third day of life
    -5 to 6 wet paper diapers or 6-8 cloth diapers of urine that is light yellow in color
    once milk is in
• Baby will be passing meconium for first few days
• Stool changing to mustard color, runny, and seedy in texture once the milk is in
    -2 to 4 of these stools per day
   34                           Your Prenatal Guidebook

If you have any concerns about how the baby is doing, call your baby’s doctor.
Most offices will allow you to bring them in for a weight check. Sometimes that is
all you need to make you feel better! Weight gain is an important clue to your
baby’s doctor that the baby is feeding properly.

Other Positive Signs Are The Following
• Audible swallowing - actually hearing the milk being swallowed
• Breast feels less full after feeding
• Baby satisfied - falls away from the breast at the end of feeding
• Baby content between most feedings
• Baby weight gain of 4-7 ounces per week once milk is in (expect initial weight loss
after delivery - should be back to birth weight by week two).

Time of Awareness and Perseverance
Engorgement
Two to three days postpartum, your breasts may become engorged. This is caused
by an increased flow of blood to the breast, swelling of the surrounding tissue, and
the accumulation of milk. The breasts will be swollen and uncomfortable for some
women and they may experience a throbbing sensation and discomfort with the
milk ejection reflex, or let-down. Some women will become only slightly full. As
with labor, we are all different in our experiences. Engorgement usually lessens
within 24-48 hours.

Some Effective Treatment                            Measures           For
Breastfeeding  Mothers
• Wear a supportive bra even at night, but make sure it is not too tight (this tends to
suppress milk production).
• Apply warm compresses or stand in shower to initiate let-down.
• Nurse frequently.
• Manually express or pump milk to soften the areola and nipple - the baby cannot
latch-on if it is too hard (common problem with breast engorgement).
• Apply cold compress to breasts after nursing to relieve the swelling and soothe
the discomfort.

Allowing yourself to become engorged beyond the initial engorgement should be
avoided if at all possible. If the baby refuses to eat or you have to skip a feeding,
then pump or manually express your milk. Engorgement sends signals to the brain
to slow down milk production and can cause other problems as listed below. As
mentioned earlier, milk production is regulated by supply and demand. If you slow
down your feedings, you will see a significant decrease in your milk production.
                         Your Prenatal Guidebook                               35

Sore Nipples
There is no doubt that sore nipples tend to discourage you from this wonderful
bonding experience. Expect some tenderness by the second to third day, but it
should resolve by day seven to ten. Usually, extreme soreness is due to improper
positioning and latch-on which can be relatively easy to fix. If you cannot identify
the problem, call a knowledgeable friend or a lactation consultant. Do not let the
problem get worse. Remember, breastfeeding should feel good - it should not hurt.

Cracked Nipples
This problem is usually due to improper positioning and latch-on or traumatic
removal from the breast. Excessively dry tissue is another reason for this problem.
Treatments of cracked nipples include correcting the positioning and latch-on, and
proper breaking of suction before removing the baby from the breast. Rub some
expressed breastmilk into the area and allow to dry. You can also talk to your doctor
about applying lanolin into the affected area.

Blocked Ducts
These are felt as lumps under the skin and in the substance of the breast and are
sore to the touch.
These May Be Caused By The Following:
    • Change in frequency of feeding or skipping feedings
    • Nursing from only one breast
    • Overabundant milk supply
    • Heavy breast not well supported
    • A tight bra or underwire bra that puts too much pressure over a duct
Treatment of Blocked Ducts Includes The Following:
    • Warm showers or compress to affected areas
    • Frequent feedings
    • Massaging of affected area toward nipple while nursing
    • Placement of the baby in a position where the baby’s chin is facing the
         blockage

Mastitis
If the blocked duct persists and does not become relieved, it can turn into a breast
infection. It is not the breast milk that becomes infected but the tissue surrounding
the blockage. This needs immediate medical attention. Treatments consist of
nursing frequently, applying warm compresses, massaging while nursing, getting
plenty of rest, and drinking fluids. Antibiotic therapy should also be used, so
please call if the breasts are painful and you have fever of greater than 1010F.
Remember to inform the baby’s doctor if you are placed on medications!
  36                           Your Prenatal Guidebook

Dietary Requirements for the Mother
Nutritional requirements are similar to those of pregnancy as far as keeping your
diet well balanced. A nursing mother needs an additional 500-600 calories per day.
Milk production is independent of what you eat the first 4 weeks because it derives
the calories it needs for production from the fat accumulated during the pregnancy.
If you do not eat properly from the beginning, you will find yourself being very
fatigued. The baby gets what it needs-you are the one who suffers.
Another important aspect of nursing is that you will find yourself very thirsty. The
best advice is to drink to quench your thirst. You must listen to what your body
needs. The body takes water from your system to make breast milk. If you do not
drink at least 6-8 glasses of fluid per day, you may find yourself being constipated.
When you sit down to nurse, have water or juice so you get your daily require-
ments. No foods are universally restricted from your diet. Your baby will let you
know! Gastric disturbances may be displayed by the baby if you consume large
quantities of a particular food. Examples would be cabbage, onions, garlic or
beans. If the baby exhibits a diaper rash, it may also be due to something you
ingested. Food affects the milk 4 to 24 hours after it is eaten. So think back and try
to discover the culprit. If dairy is the culprit, it may take two weeks for it to stop
bothering the baby once it is eliminated from mom’s diet.
Supplemental Feedings For Your Baby
It is a well-known fact that introducing bottles too soon after birth can cause nipple
confusion. Most of your doctors will agree that until your milk is well established
and you have developed a good breastfeeding relationship, a supplemental feed-
ing of water or formula is not necessary. There are some extenuating circumstances
in which your pediatrician would prescribe a supplemental feeding. All babies are
different and have different needs. This does not mean you will not be successful
at breastfeeding.
After your milk is well established, it is a great idea for your partner to feed the baby
a bottle. It can be either pumped breast milk or formula. Whatever you decide,
along with your baby’s doctor, will be fine. Try to exclusively breastfeed for the
first 3-4 weeks. Most literature agrees that 3-4 weeks is a good recommended time
to start introducing a first bottle. Do not overdo the bottle though. The baby could
develop a bottle preference at any age if too many bottles are given.
Storage Of Breast Milk
Make sure when storing breast milk that you label and date the container so that
you can be sure that your baby is receiving breast milk that is not outdated. You
can use plastic bottles or bowls for storage of breast milk. Never microwave or boil
breast milk. Microwaving could cause “hot spots” in the milk because microwaves
heat unevenly and could potentially burn the baby’s mouth and throat. Also, it can
alter the protein make-up of the breast milk and may destroy the antibody compo-
sition of the milk. All you need to do is run it under warm, tap water. You can also
                         Your Prenatal Guidebook                              37

place it in a bowl of warm water to thaw or warm the milk, bringing it to room
temperature. Make sure to shake the thawed breast milk well. It will separate upon
storage and the creamy portion of the milk needs to be redistributed.

Common Concerns
• My breast are too small.
      -Breast size has nothing to do with milk production. Do not let anyone tell
you otherwise.
• How can my partner find me the least bit attractive?
       -Sexuality and recapturing closeness as a couple both take time. You and
your partner both may feel overwhelmed. Some women are embarrassed about all
the changes to their bodies and feel unattractive and distant toward their partner.
Men, do not take this temporary diminished interest from you as a rejection. Talk
and laugh with each other, and make time for yourselves. Communication is the
key!
• My breasts leak all the time!
       -It is not uncommon for you to be out in public and hear another baby cry,
causing your milk to let-down. Applying gentle pressure to the nipple will usually
stop the flow of milk. Disposable or washable breast pads are available to protect
your clothes from wet spots! Change them as needed to avoid the breakdown of
nipple tissue. Leakage is less problematic as time goes on.

Father’s Concerns - A Note to Dads
The extreme closeness of a nursing mother and baby may contribute to feelings of
isolation in a new father. Feelings of uselessness and being deprived of one of the
most enjoyable ways of relating to the baby often surface the first few weeks. You
will find most of the attention will be directed toward the mother and the baby and
you may become the “gofer.” There are ways that you can become close to the
baby even if you are not taking part in the feeding aspect. Diapering, bathing, and
cuddling are great ways to be involved. Your touch is very important to your baby
and he/she will learn much from it.
Fatherhood is an addition to your life. It will demand an enormous lifestyle change
for you and your partner, yet it may be the most rewarding time of your life. Be
patient with yourself and your partner. You are now a DAD.

Going Back to Work and Continuing to Breastfeed
In the past, employers have recognized six weeks as a reasonable time to recover
form the delivery of the baby. On occasion, your doctor may require that you stay
home longer because of a special medical problem. Financial considerations may
require that you return to work earlier.
   38                          Your Prenatal Guidebook

Breastfeeding mothers can do the following:
     • Pump their milk and save it when away from their babies
     • Breastfeed when they are with the baby and wean to formula when they are
     away; or
     • Wean baby completely, though the baby would benefit greatly from receiv-
     ing even some breast milk every day.
There are great breast pumps on the market today that can help support your
decision to continue to breastfeed. Check with your hospital or lactation center for
breast pump rental and purchase prices. Your employer may be flexible and have
several options for you. You should explore the possibilities as soon as possible.
Formula Feeding
Even though there are many advantages to breastfeeding, formula feeding is an
acceptable alternative for many mothers. Scientific advances make it possible to
prepare formulas, made from cow’s milk or soy proteins, that provide safe substi-
tutes for breast milk.
There are a few mothers who may not be able to produce milk. Certain breast
reduction surgeries with nipple relocation are examples of this situation. Studies
have shown, though, that there have been some women successful in breastfeeding
by producing milk or using a supplemental device. Virtually all medications you
take are transferred through the breast milk to your infant. Therefore, if you are on
cancer treatment drugs, certain antibiotics such as tetracycline, or antidepressants
such as lithium, you should consult your physician and your baby’s doctor.
Your pediatrician or family physician will start your baby on the formula that is right
for him/her. Initially your baby will want to eat every 2-4 hours. Your nurse and
doctor will instruct you on the appropriate amounts of formula your baby will need
and how often. Before you are discharged from the hospital, make sure that all of
your questions are answered.
The following steps will help you in feeding your baby from a bottle:
      • Make sure you have plenty of bottles and nipples and a bottle brush to clean
      all of the bottle parts.
      • Wash the top of the can with soapy water then rinse well with water to
      remove any dirt from the lid.
      • Always check the can and know what you are preparing. Sometimes we
      think we grabbed “ready to feed” at the store but it is actually “concentrate.”
      • Check the expiration date on the can.
Make certain that the bottles and nipples are thoroughly cleaned and rinsed.
If you cannot prepare all the bottles at that time, then cover the can and store it in
the refrigerator. Prepare the rest within 48 hours of opening it. If you do not use it
in the allotted time, throw it out.
                          Your Prenatal Guidebook                                39

Before feeding the baby, make sure that the temperature of the formula is what the
baby prefers. Never microwave formula. This could burn the baby’s mouth. Mi-
crowaves heat unevenly, and there could be a hot spot in the formula. If you need
to warm it for the baby, just place the filled bottle under warm running tap water to
take the chill off.

Tilt the bottle to check the nipple hole. If the formula is running out, then the hole
is too big and the baby could choke. Throw that nipple away. If nothing comes out
and the baby seems dissatisfied, then the hole may not be large enough. The
formula should drip from the tilted bottle with ease.

Never prop the bottle and leave your baby for any length of time. This could cause
your baby to choke.

If your baby does not finish the entire bottle, you must throw whatever is left away.
Bacteria will grow very quickly in the leftover formula because saliva from your
baby’s mouth is transferred into the bottle during the feeding.

Take your time with the feeding, letting your baby look around and discover the
world. This is a wonderful time to learn about your baby and your baby to learn
about you, so hold him/her close and enjoy!

The Choice Is Yours!
In the end, how you feed your baby is your choice. Millions of children have been
raised using both techniques without any major long-term effects. What’s impor-
tant is for you to feel comfortable with how you feed your baby. Do what’s best for
you - not what everyone else wants you to do!
   40                            Your Prenatal Guidebook

Exercises for Pregnancy
Whether you are going to have a “natural” childbirth with little or no anesthesia or
whether you choose some pain-killing drugs, you still need to exercise during your
entire pregnancy to develop muscle strength for labor. Exercise also helps with
backaches, circulation, insomnia and weight control as mentioned in other sec-
tions of this booklet. Here are a few exercises to help everyone during pregnancy.
These exercises will help you relax and stretch. They will strengthen inner thigh
muscles and pelvic muscles and limber pelvic joints. Do them faithfully on a daily
basis.

Standing Up:
Keep your back straight, tighten your buttocks, bend your knees slightly, and rock
your pelvis back and forth. This is actually a belly dancing technique, called the
hinge. To enjoy your daily exercise more, put on some music and slowly walk about
doing the pelvic rock, or hinge. Your abdomen and bottom should work like a
hinge, while the rest of your body stays pretty upright. Once you get the hang of
it, you can understand why belly dancing is so popular as a form of exercises, even
for pregnant women - it’s fun!

The Pelvic Rock:
This is probably the most common exercise taught in childbirth classes, and for
good reason - it is excellent. You can use it before and after delivery, first to give the
fetus good support and then to firm those abdominal muscles. You can do it lying
on your back, standing or in the “all fours in the ground” position.

All Fours:
Get on your hands and knees with your legs and hands parallel to the floor. Pull
your buttocks down and slightly arch your back, tilting your pelvis forward. Then
push your buttocks out and back, tilting your pelvis back. Don’t let your back
curve in as the pelvis is rocked.

Kegel Exercises:
You can also do another excellent exercise to tone the muscles in the pelvic area
and improve circulation. This exercise should be continued after delivery to pro-
mote more rapid healing and to improve the tone of the vagina. What you want to
do is control and relax certain sets of pelvic muscles, one at a time. First contract
your muscles like you are holding back urination. Then tighten your muscles like
you are holding back a bowel movement. Finally, contract the vaginal muscles. It
may take some practice to isolate each of these sets of muscles, but keep practic-
ing. Relax and contract each set of muscles separately, contracting them harder
and longer each time. Do these anytime.
                         Your Prenatal Guidebook                               41

The Squat:
Stand with your back against a wall. Lower your body slowly down the wall, with
your hands against it, until you are in a squatting position. Keep your feet parallel
and your heels flat on the floor, then slowly raise your back up. A variation of the
squat: hold onto a heavy piece of furniture that won’t tip over, squat down, keeping
your heels flat on the floor and your back straight, and letting your knees spread
open. Slowly rise back up. This exercise will help your back and it is good practice
for proper lifting of heavy weights. (Always lift heavy objects with your back
straight, squatting and using your leg muscles to propel you up.) Practice both
types of squat exercises daily.

Stress and Tension:
Be good to yourself during pregnancy. You do not need additional stress during
this special period in your life. You can expect moodiness and plan for it. Do not
put yourself in situations that you know stress you. Do not plan too many busy
activities. Rest. Use periods of total quiet during your day to sit and breathe
deeply for a few minutes, relaxing your body and your mind.
Exercising during pregnancy is absolutely vital to a healthy pregnancy, an easy
delivery, and a speedy postpartum recovery. Don’t skimp in this area with excuses
of “not enough time.”

It is best to avoid exercise that requires you to be flat on your back the last 3
months of your pregnancy.
   42                                    Your Prenatal Guidebook


Caring For Your Unborn Baby
Alcohol
Whatever goes into your body affects your baby, too.
Avoid alcohol while you’re pregnant. Drinking alcohol during pregnancy can
cause birth defects learning disabilities, behavioral problems, and mental retardation
in your baby. Fetal alcohol syndrome is the medical term that describes the many
physical and mental problems that affect children born to mothers who drank during
their pregnancy. The adverse effects of drinking depend on the amount consumed,
the stage of pregnancy, and certain susceptibilities in the mother and her baby. The
effects of even small amounts of alcohol on the unborn baby are still unclear.
Therefore, the safest course to take while you’re pregnant is not to drink alcohol at
all.
If you have a drinking problem, discuss this with us. If you find you can’t stop
having a drink or two, several times a week, we’ll need to work together quickly to
help your situation. Your baby’s health is at stake. Don’t be embarrassed about
any problem you may have with alcohol. One in ten people has some type of
drinking problem. Talk to us! We can help.
Medications
Avoid using medications of any kind during your pregnancy, unless we specifically
prescribe or recommend one for you. This also, applies to over-the-counter drugs.
Don’t even take an aspirin without consulting us, because all medicines you take
will be circulated to your developing baby as well. Even hemorrhoid treatments and
cold medications should be cleared through us before you take them. Any of these
types of drugs may contain ingredients that could be harmful or associated with
transient disorders during the baby’s newborn period. See the following list for
meds that are ok.

                 Medications That Are Okay During Pregnancy
  For Allergies ..................................................................................... Benadryl
  For a Cold .......................................................................................... Sudafed
  For a Cough ................................................................................... Robitussin
  For a Sore Throat .............................. Chloraseptic, Cepacol, Halls Lozenges
  For Nausea & Vomiting .......................................... Emetrol, Clear Liquid Diet
  For Heartburn/Gas ....................................... Maalox, Mylanta, Tums, Rolaids
  For Headaches/Aches & Pains .................... Tylenol, Extra-Strength Tylenol,
                                                                        Avoid Aspirin and Ibuprofen
  For Constipation .... Metamucil, Fibercon, Milk of Magnesium, Colace, Miralax
  For Diarrhea ........................................................... Kaopectate, Imodium AD,
                                 BRAT Diet: Bananas, Rice, Applesause, Tea & Toast
  For Hemorrhoids ............................................. Preparation H, Anusol, Tucks
                          Your Prenatal Guidebook                                  43

Caffeine
You should consume <300 mg of caffeine per day. This chemical is a powerful
stimulation to your central nervous system and its effects on your unborn child
have never been conclusively tested.
Aspartame (NutraSweet)
There’s no evidence to suggest that aspartame (NutraSweet) is a risk to your baby
while you’re pregnant. But until more evidence is available, we advise you to avoid
excessive use during pregnancy.
Hard Drugs
Substance abuse during your pregnancy victimizes your unborn child.
Amphetamines, crack, barbiturates, narcotics and cocaine have all been linked with
low-birth-weight babies, fetal distress, and premature birth. These newborns often
begin life by fighting withdrawal symptoms. They also run the risk of sudden infant
death. Some drugs reach your developing baby easier than drugs taken by mouth.
They include drugs taken intravenously, nasally, or by inhalation (cocaine, “crack”
and marijuana). These illicit drugs have proven adverse effects during pregnancy.
Infants born to drug-addicted mothers can actually be born addicts themselves and
may suffer withdrawal symptoms immediately following birth. Certain medications
you take while pregnant can have permanent effects on your baby or may be
associated with transient medical disorders during their newborn period.
It’s very important for you to tell us if you’ve used one of the “hard drugs” because
your newborn child could suffer permanent damage, even death, if this problem
isn’t recognized and treated during the newborn period.
Smoking
It’s a proven fact that women who smoke during pregnancy give birth to babies
whose birth weights are lower than average. If you smoke, you’ll have a greater
chance of miscarriage or stillbirth. You’ll also run a greater risk of having a premature
baby or one that dies early in life from crib death (sudden infant death syndrome).
Certain learning disabilities and behavioral disorders may also be related to mothers
who smoke. Second-hand smoke is potentially harmful to your other children.
If you smoke, this is the perfect time to quit. More than one-fourth of all smoking
women choose to give up their habit during pregnancy. Smoking isn’t good for
your health and it’s not good for your baby’s health. The difference is that you
have a free choice but your baby doesn’t.
X-Ray Studies
If necessary, dental and other limited diagnostic x-rays may be performed during
your pregnancy. If your x-ray studies are elective, postpone them until after your
delivery. Be sure to tell the x-ray technician about your pregnant condition so they
can shield your baby when x-rays are taken.
   44                           Your Prenatal Guidebook

Genital Herpes
Genital Herpes is a viral disease that affects the sexual organs in both men and women.
It plays an extremely important part in pregnancy since a newborn can experience
serious permanent neurological damage and even death if he or she is infected during
delivery. Approximately one-half of infants born to mothers experiencing their first
outbreak at the time of delivery will be infected with the virus. Mothers with recurring
infections (recurrent herpes) are not nearly as likely to infect their newborn babies.
We absolutely must know if you or your husband have ever had herpes so that we can
take proper precautions at the time of delivery. You should tell us about every flare-up
you have during your pregnancy so we can examine you and take a culture if it’s
necessary.
A Cesarean delivery should be performed if you have active lesions when you go into
labor or rupture your membranes. If you have no history of recent flare-ups or visible
lesions at the time of your labor, a vaginal delivery is recommended.
German Measles (Rubella)
German Measles, a viral disease, is especially important in the first three months of
your pregnancy when your baby’s organs are developing. It can cause many birth
defects involving your baby’s eyes, ears, and heart. Several skin rashes associated
with fever mimic German Measles, but blood tests will tell us which is which.
If you suspect you’ve been exposed to German Measles, call us immediately. We may
already have blood tests from this or one of your previous pregnancies that tells us
you shouldn’t be concerned about this disease. Remember, you must actually contract
the disease in order to put your developing baby at risk. Exposure alone will do no
harm. Once you’ve had the illness, you’re immune for life. If your blood test results
show you’ve never had this infection, we will recommend you get immunized after this
pregnancy.
Toxoplasmosis
Toxoplasmosis is an infection that you can get from eating raw or undercooked meat or
by transfer from cats. Cats generally get the parasites from mice or rats, then excrete
the organism in their stool. If you get infected during your pregnancy, you’ll experience
mild flu like symptoms. It’s during this illness that your baby will become infected.
Your unborn child may suffer permanent eye and neurological damage.
Precaution is the key to avoiding this disorder. You should avoid eating raw or
undercooked meat. Allow someone else to empty your cat’s litter box while you’re
pregnant. Wash your hands carefully after you have handled your cat. Strictly indoor
cats are usually not a problem.
Hepatitis B In Pregnancy
Hepatitis is an infection of the liver caused by many different viruses. If you have ever
been infected by the hepatitis B virus and become pregnant, there may be problems for
your newborn baby. A certain number of people who contract hepatitis B develop
                           Your Prenatal Guidebook                                  45

chronic hepatitis – a condition which can eventually destroy the liver. Also, it can
allow the infected person to give the virus to others without knowing it. This is the
problem with the pregnant mother and her baby.
A very high number of mothers who test positive for hepatitis B surface antigen will
unknowingly infect their newborn babies. One out of four of these infected babies will
die from its infection. By detecting this infection in the pregnant mother, the vast
majority of these newborns can be treated at birth. This prevents the baby’s infection
and its risk of dying from the disease. It also prevents the child from unknowingly
passing the infection on to others and to their babies later in life. We will perform this
relatively simple and inexpensive test early in your pregnancy. Your baby’s doctor
may routinely immunize your newborn infant against this immediately following birth.

Chickenpox (Varicella)
Most women have already had chickenpox during their childhood. That’s why the
disease is so uncommon during adulthood. It is, however, likely to be more severe in
adult and pregnant women who do get it. Pregnant women can develop chickenpox
pneumonia which can be quite serious and life-threatening.
Development of chickenpox during early pregnancy has been implicated in miscarriage
and congenital malformations only infrequently. There is a drug called varicella-zoster
immunoglobulin that can be given to a pregnant woman who becomes infected. This
may prevent her from developing a severe form of the disease if given within 72 hours
of exposure. If you become infected at or near the time of delivery we will also give
your baby a special immunoglobulin injection to prevent him/her from getting the
serious infection.
Fortunately, once you’ve had this disease, you don’t have to worry about being
exposed to someone who has chickenpox while you’re pregnant. You have life-long
immunity!

Influenza (Flu)
Beware of flu epidemics. Pregnant women are more likely to get the illness. The
development of pneumonia is a grave concern. We will consider giving you a
vaccination if you happen to be pregnant during an epidemic, but there’s no evidence
to link this illness with birth defects or miscarriage.

(HIV) Human Immunodeficiency Virus
There is no vaccine to prevent HIV today, and there is no cure once you have it.
Therefore, the most effective way to protect yourself and your baby is to learn about
the disease and avoid becoming infected. Women should be tested with every
pregnancy. If treated early it can decrease the risk of transmission to your baby from
30% down to 2%.
  46                             Your Prenatal Guidebook

HIV is caused by a virus that attacks the body’s natural ability to defend itself against
infection and sickness. The immune system helps you recover from colds and flu, as
well as allowing wounds to heal. When the immune system fails, such as in individuals
with HIV, the body is an easy target for infections and cancers that rarely afflict normal
immune systems.
The three most common ways to contract HIV are by sharing intravenous needles,
having sex with an infected person, or mothers passing it to their unborn babies. The
risk of a mother passing the virus to her newborn child is high, occurring 10 – 50
percent of the time. Medications can now reduce the risk to less that 10 percent in the
newborn baby. To avoid vertical transmission, a C-section before labor begins is
recommended.
Initially, HIV was contracted mostly by homosexuals and bisexual males, but the number
of heterosexual women is increasing. And there is no evidence that the disease can be
contracted by casual contact with others, or through water, environment or food. You
can significantly reduce the risk of getting HIV if you use condoms during sex and
avoid sharing needles if you use drugs.
A simple blood test will determine if you have been exposed to the virus. However, it
may be years before HIV symptoms become obvious, if ever. Between the time of
exposure and the development of noticeable signs of the disease, symptoms are non-
specific or nonexistent.
All women who are current or former drug users and those whose sexual partners use
intravenous drugs, engage in bisexual activity, or who have HIV are considered high
risk. Female prostitutes and those who have received blood transfusions between
1978-1985 should also be screened. Because a blood test may not reveal abnormalities
until several months after infections, women who have been recently exposed sould
be tested periodically.

Cytomegalovirus (CMV)
This is the most common viral infection that affects the newborn infant. If you become
infected, you’ll experience a non-specific illness characterized by sore throat, fever,
and swollen glands or you may have no symptoms at all. Because of its trivial nature
it’s rarely recognized. This virus can remain in healthy adults for a lifetime and
periodically become active. When active, the virus can cross the placenta to your
unborn baby and cause physical impairments at birth.
It appears that a baby is at greatest risk if the mother becomes infected for the first time
during her pregnancy. Risk to the baby is not nearly so great if the mother experiences
a flare up during pregnancy from a previously acquired infection. Fortunately, those
infants born to mothers who have the most severe form of infection only rarely develop
the serious consequences of the disease in the newborn period.
                          Your Prenatal Guidebook                                 47

We can test your blood for this disorder as with other viral infections, but the
nature of this disorder makes it difficult to interpret the results. Currently, there is
no effective treatment available for either the pregnant mother or her newborn
baby. Contraction of the disorder is largely unavoidable, and you can only prevent
this disease by avoiding close personal contact and using good hand washing and
hygiene practices.

Mumps
Mumps is uncommon during pregnancy because of the childhood vaccine and low
infection rate in susceptible adults. However, it does appear to increase the rate of
miscarriages and premature labor. Newborns rarely have abnormailities just because
their mothers had the mumps during pregnancy.


Problems During Pregnancy
There are many problems that can arise during pregnancy. Some are trivial, but
some can be serious.

Early Pregnancy Bleeding
There are many causes of bleeding during pregnancy. Possible causes depend
upon when it occurs. If you experience bleeding early in your pregnancy, we’ll
perform a pelvic exam and sonogram to determine the cause. Two serious causes of
early pregnancy bleeding are miscarriage and ectopic pregnancy.

Miscarriage is the most common serious cause of early bleeding and occurs in 15-
20 percent of all pregnancies, usually within the first three months. Miscarriages
cannot be prevented. They are nature’s way of dealing with pregnancies that are
not developing properly. A miscarriage is characterized by bleeding more than a
heavy period and there is usually cramping.

An ectopic pregnancy, or the implantation of an embryo outside the womb (usually
in a fallopian tube), is another serious cause of early bleeding. Ectopic pregnancies
occur in less than one percent of all pregnancies and are almost always associated
with severe pain. Most of the bleeding is internal, which can be life-threatening
because of its hidden nature.

Late Pregnancy Bleeding
Bleeding late in pregnancy can be serious, but the most common cause is “Bloody
show,” one of the first signs of labor. This is caused by the thinning of the cervix
and is usually associated with thick mucous. Cervical irritation and pelvic exams
can also cause bleeding.
 48                           Your Prenatal Guidebook

The most serious late-pregnancy bleeding is caused by either placenta previa or
placental abruption. When these conditions occur, they are most often in the final
three months of the pregnancy.
Placenta previa results when the placenta partially or completely covers the cervix.
As your cervix thins in preparation for labor, massive bleeding occurs. The other
serious cause of late bleeding, placental abruption, occurs when the placenta
prematurely detaches from the inner lining of the womb. This is usually accompanied
by abdominal pain. Either condition can lead to the death of the unborn baby.
If you experience significant bleeding late in your pregnancy, you may be hospitalized
for observation and evaluation. If bleeding is serious, or if fetal distress is detected
by the fetal monitor, a Cesarean delivery may be required.
Most bleeding is the result of minor causes that require no treatment. It is important,
however, for you to know that bleeding can indicate serious problems. You should
report all bleeding to us immediately.

High Blood Pressure in Pregnancy
Fewer than ten percent of pregnant women develop preeclampsia. The cause of
this potentially serious condition is unknown. When changes of blood pressure
are detected and treated early the mother and the baby can avoid serious problems.
If untreated, however, high blood pressure can cause permanent damage to the
eyes, kidneys, brain and liver of the mother. The fetus can suffer from a lack of
oxygen and nutrients, which can lead to growth problems, mental retardation or
even death.
Teenage mothers are more likely to develop the disorder, usually during the last
three months of their first pregnancy. Women who are overweight, diabetic or older
than 35 years are also at risk. Mothers with kidney disease, twins or a history of
high blood pressure are also likely candidates.
High blood pressure is caused when the blood vessels in the body contract,
increasing the pressure and lessening the amount of blood flowing to the uterus,
the placenta and the fetus. Mild changes in blood pressure for a brief period are
unlikely to cause problems. However, prolonged and severe spasm of the vessels
can be potentially harmful to mother and baby.
A sudden weight gain of more than two pounds per week or swelling of the face and
hands can indirectly signal high blood pressure. Some women experience no distinct
symptoms at all. Headaches, visual disturbances, or pain in the upper abdomen
may indicate a more serious blood pressure problem. By monitoring your blood
pressure, weight and urine at each prenatal checkup, we are able, for the most part,
to make an early diagnosis of the problem and avoid serious complications.
                          Your Prenatal Guidebook                                 49

We treat each case of preeclampsia differently depending upon a variety of factors
usually determined by special testing and by how close you are to your due date.
Bed rest at home or hospitalization may become necessary, but the eventual delivery
of your baby will cure the disorder.

Diabetes
There are several kinds of diabetes, all relating to the delicate balance of sugar
(glucose) in the blood. Insulin is a hormone that converts glucose into the body’s
main source of energy. When the body fails to produce enough insulin or produces
too much glucose, the level of sugar in the blood becomes too high, which can be
dangerous for you and your baby. Gestational diabetes is a kind of diabetes that
only occurs in pregnant women. The condition usually subsides after pregnancy,
but women who have had gestational diabetes are more likely to develop overt
diabetes later in life.
Some women are more likely to develop gestational diabetes than others, particularly
those who have previously delivered a large infant weighing 9 pounds or more and
women who are obese. Women who have had stillborn babies or a family history of
diabetes may also develop diabetes.
Gestational diabetes is a serious condition because it can cause the birth of a large
baby, which may mean a difficult vaginal birth or a Cesarean delivery. Babies born
to gestational diabetics are also prone to having low blood sugar levels and jaundice
after delivery, which can lead to permanent neurological problems.
Pregnant mothers with gestational diabetes may also have too much fluid
surrounding the baby which can cause premature labor and increase the risk of
respiratory distress syndrome in the baby. They are also more susceptible to
urinary tract infections and high blood pressure.
Because it is important to detect and treat gestational diabetes, we will test your
blood for gestational diabetes at 24-28 weeks of pregnancy, regardless of
predetermining factors. This simple and safe test requires only that you drink a
sugar cola and have a blood sample checked one hour later. This is called a one-
hour glucose tolerance test. If the test reveals a high level of glucose in your blood,
we’ll conduct a more extensive three-hour glucose test to make a more definitive
diagnosis of your condition.
Most gestational diabetics can control their sugar levels with mild exercise and
modified diets. Occasionally however, gestational diabetes is severe enough to
require insulin injections to control sugar levels.
A dietician or a person specially trained in modification of diet to lower blood sugar
will assist you in your diet changes. The dietary principles to lower blood sugar
involve a reduction of calorie consumption, and eating smaller and more frequent
meals consisting of more complex carbohydrates such as rice, pasta, bread, corn,
cereal and beans. Foods with simple sugars will be limited or excluded from your
diet.
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By our carefully screening and treating you for gestational diabetes, you will be
more likely to have an uneventful pregnancy and a successful delivery of a normal
baby. And mothers who have had gestational diabetes can avoid the development
of overt diabetes later by continuing strict diet and weight control following the
pregnancy.
Warning Signs of Preterm Labor
Premature labor is labor that starts before 37 weeks of pregnancy, or more than 3
weeks before your due date. Premature labor can often be stopped if you catch it
early.
       These are the signs:
           1. Uterine contractions – more than 4 in one hour.
           2. Menstrual cramps – may come and go or be constant.
           3. Abdominal cramps – with or without diarrhea.
           4. Low backache – comes and goes or constant.
           5. Pelvic pressure – feels like baby pushing down.
           6. Change in vaginal discharge – a sudden increase in amount or it
           may become mucous-like, water or slightly bloody.
If you have one or more of these symptoms, you might be in premature labor and
you should call your healthcare provider.
Preterm Labor
Labor usually occurs sometime after the thirty-seventh week of pregnancy. (40
weeks is term.) A baby born before 37 weeks is premature. These infants may
require special care in breathing and maintaining their body temperatures. This
complication is the greatest risk to your newborn baby.
Rh Disease and Its Prevention (RhoGam)
A routine blood test will be performed at one of your prenatal checks to determine
your blood type and Rh factor. The most common blood type is Type O; the most
common Rh factor is positive. People with Type O, B, A, or AB positive blood have
a positive Rh factor. Those with Type O, B, A, or AB negative blood have a negative
Rh factor.
When your blood type is Rh neative, and the father’s is Rh positive, the baby could
inherit the father’s positive blood type, which could cause a problem during
pregnancy or, more frequently, at the time of delivery.
If your blood type is Rh negative, your body’s immune system can recognize the
baby’s Rh positive blood cells that escape into your circulation. These cells are
different from yours. Because they are different from yours, your body will produce
antibodies to destroy your baby’s red blood cells. This is not a problem in the
FIRST pregnancy but can cause problems in subsequent pregnancy as these
antibodies not only attack the baby’s blood cells that are in your circulation, but
                         Your Prenatal Guidebook                                51

also cross the placenta to destroy the baby’s blood cells in its circulation. These
antibodies may not be a problem during your first pregnancy, but can lead to a
serious disease with subsequent pregnancies called hemolytic disease of the
newborn. These kinds of antibodies can also be produced as a result of a blood
transfusion, amniocentesis, turning of a breech baby, pregnancy termination, tubal
pregnancy and miscarriage.
When your body produces a high level of antibodies, more of your baby’s blood
cells are destroyed. Eventually, this produces anemia in your baby, which can lead
to fetal death prior to the baby’s birth. Live births can be complicated by severe
jaundice, which can lead to mental retardation, hearing loss or cerebral palsy. With
each successive pregnancy, the risk of hemolytic disease of the newborn increases.
Fortunately, we can prevent hemolytic disease of the newborn most of the time by
giving you a special injection of gamma globulin (RhoGam) that prevents your
immune system from reacting to your baby’s red blood cells. The RhoGam finds the
fetal red cells in your circulation and neutralizes them so you don’t produce
antibodies against your baby’s red blood cells. We give this injection routinely at
28 weeks of pregnancy and within 72 hours following delivery. It’s also typically
given after any vaginal bleeding or abdominal trauma. Please call your Dr. if any of
these occur.
If your Rh factor matches the father’s, you are Rh positive, you have nothing to
worry about. Rh disease cannot affect you or your baby.
Group B Strep – (GBS)
Group B strep is a common bacteria that can be found in up to 4 of 10 pregnant
women. In women it is most commonly found in the vagina or rectum and may
cause serious medical problems for the newborn baby. Fortunately, most babies
who acquire this infection from their mothers do not have any problems.
Only 1-2 percent of all babies who are exposed to GBS during pregnancy become
infected. Babies can develop early infections during the first week of life or later,
after they leave the hospital. The early infections can be quite severe and effect the
baby’s lungs, blood, spinal cord or brain, which can lead to death in 15% of affected
babies. Late infections usually manifest themselves as meningitis, which can have
long-term effects on the baby’s nervous system.
We will do a culture for the bacteria at 35-37 weeks gestation.
The best way to prevent GBS infection is the use of antibiotics during labor. If your
culture is positive, you will be given antibotics in labor.

Caring For The Rest Of Your Family, Too
Fathers
While you are pregnant the baby’s father is also sort of “pregnant.” He, too, is
going through changes, anxieties, fears, doubts, joys and stresses — just like you!
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Try to include your partner in the pregnancy as much as possible. This can be one
of the closest emotional ties in your relationship, so take time to discuss your
expectations and fears. Go to birthing classes together, and try to make your
partner a part of your daily exercises, especially your evening walks. Bring him
along to see us and encourage him to ask all the questions he has about the
pregnancy. Also, try to maintain your physical intimacy, including sexual intercourse.
If intercourse becomes uncomfortable, or if you stop for medical reasons, find other
way to express your physical love.
As always, communication is an important aspect. Your partner may feel left out
and not really a part of things once you’re pregnant. He may worry about how the
baby will affect your love for him. Talk about the fears, concerns and delights both
of you are experiencing. Pregnancy is not just a special time for you alone. And
because it can help strengthen your love, it is a special time for your relationship.
After all, you both have high expectations for your new child.

Other Children
If this isn’t your first child, give other children advance notice about the new baby.
They will become curious as your belly enlarges. Depending on the age of the
child, you may want to tell them some of the facts of life. There are so many good
books that tell “where babies come from,” that we won’t try to cover this subject
here. Get some books and sit down with your child to read them together. Don’t
take their fears lightly. They may feel left out, too, and have questions and worries
about their position in the family. They need to be reassured before and after the
birth that they are still loved.
Don’t tell your children how great having a baby is going to be. Tell them the truth!
Babies are a lot of fun and a lot of trouble, too. They cry. They are messy. And, still
they are wonderful. Prepare your children for the reality of having a new baby in the
house, and there will be less room for fear and resentment. Ask your child, “How do
you feel about this baby?” before and after the birth. Then just listen. And, don’t
say, “That’s silly,” or “You shouldn’t feel that way.”
Children usually have very mixed feelings about a new baby. Try including them in
the pregnancy by letting them help buy baby clothes, paint the nursery and plan for
the baby’s arrival. Don’t be shy about your body. Let them see how it is expanding.
This is a beautiful experience, so don’t hide it. Ask us about an appropriate time to
bring the older children to our office so they can hear the baby’s heartbeat.

Back To You – Changes The Very Last Weeks
You can expect some more change the last weeks of your pregnancy. You’ll be
anxious to give birth by now. It may seem you’ve been pregnant forever. You’ll also
be tired and need more rest.
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One day, you may notice a difference in how you are carrying the baby. This is
when the baby “drops” or settles down into the bony part of your pelvis. When
this happens, you might be able to breathe easier. (Sometimes this won’t happen
until you are ready to deliver).
Your breasts enlarge even more near the end of the pregnancy, and milk may start
to seep from them. Your appetite may be gone altogether, and you may be nauseated
again. Pressure is sometimes reported in the vaginal area, and you may feel the
need to urinate frequently.


Is This Really Labor?
First babies are notoriously slow about being born, so plan to monitor your first
few contractions in the comfort of your home. You should prepare to leave for the
hospital when your membranes rupture or when your contractions are from five to
seven minutes apart. Prepare to leave earlier if you live quite a distance from the
hospital. We recommend that you not eat or drink anything if you think you are in
real labor. An empty stomach is much safer for you since many women get nauseated
and vomit during labor. Also, on occasion, a general anesthetic is needed for a
specific medical situation.
False labor is a common phenomenon and it is important to know the difference
between real and false labor. False labor involves cramps or contractions of the
lower abdomen, similar to real labor, but there is a vital difference. False labor does
not cause a change in the cervix, it doesn’t come in regular intervals, and it may
disappear altogether if you change positions or walk around. Time the minutes
from the start of one contraction to another for several contractions. If you have
one contraction now and one forty-five minutes later and another three hours later,
then you are having false labor, especially if you walk around during these
contractions and they seem to ease up or stop.
On the other hand, if you time your contractions and find they are evenly spaced,
and are coming closer and closer together, and do NOT go away if you change
position or walk around, then you are possibly experiencing real labor. Some real
labor contractions cause back pain and some cause lower abdominal pain. When
you think you are in labor, sit down and time your contractions. There isn’t any
need to immediately panic and rush for the phone, especially if this is your first
baby. Labor usually takes a while.
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Timing of Contractions
Frequency – Time from the start of one contraction to the beginning of another
Duration – Time from the start of one contraction to the end of the same contraction
   False Labor                                 Real Labor
   • There is no “bloody show”                 • A “bloody show” may be the first sign.
                                               It is usually associated with cramp-like
                                               pains.
   • Contractions are irregular and            • Contractions get stronger, occur more
   not progressively closer together.          frequently and last longer.
   • Walking, changing activity or positions   • Walking, changing activity or position
   may relieve or stop the contractions.       doesn’t affect intensity or frequency of
                                               contractions.
   • There is no change in cervix.             • Cervix dilates.


What to Expect at the Hospital
Before you go to the labor and delivery room at the hospital, you should pack your
bags. Try to relax and ignore the contractions as much as possible. When you get
to the hospital, a nurse will come and check to see how much your cervix has
dilated. She will try to keep you comfortable and prepare you for your delivery. A
catheter will be placed in your arm for intravenous fluids and medication.
A nurse will periodically check your cervix to monitor your labor progress.
Remember to let her know if you have any questions. After all, she’s there to help
you! If your partner can’t go to the hospital with you, try to arrange for a friend or
relative to drive you there and for someone to be with you during labor.

Labor and Delivery . . . The Birthing Process
The birthing process generally includes 3 methods – vaginal birth, Cesarean birth,
or vaginal birth after cesarean (VBAC). Each is described in more detailing on the
following pages.

Vaginal Birth
The first stage of labor starts with the onset of labor and is completed when the
cervix is completely dilated or 10 centimeters.
The first stage of labor can take quite a long time especially with a first baby. It
isn’t at all uncommon for the first stage of labor to last 12 to 14 hours. Don’t try to
fight these contractions by tensing your abdominal muscles. Your uterus is doing
the work for which it was designed. Tensing muscles will only make the contractions
seem worse. Try to RELAX even while you are having a contraction. Concentrate
on relaxing your muscles. This isn’t easy, but try!
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The second stage of labor starts with the cervix becoming fully dilated and is
completed with the delivery of the infant.
The second stage of labor is much shorter than the first stage. By now your cervix
has dilated enough for the passage of the baby’s head and when the head has
descended enough, you will be prepared for delivery. You will remain in your room
for delivery. You will be moved to the delivery room if you need a C-section or have
twins. The contractions now are very close together and the baby is being pushed
out. You are “pushing” involuntarily. It may feel like your bowels are moving, but
don’t worry about this it is just the pressure of the baby’s head on the rectum.
Each time you have a contraction, the baby moves farther and father down. At this
point, we may do an episiotomy, if necessary, which is an incision in the vaginal
wall that allows the baby to pass through the vagina easier and keeps your delicate
vaginal tissues from tearing. You may have a local numbing agent and not feel this
incision at all.
As you bear down, or push, the baby begins to appear. Finally, the baby is born.
We’ll remove any mucous or amniotic fluid from your baby’s mouth and nose.
Then your baby will take a breath of air and might begin to cry. LIFE! A new person
in the world! You might begin to cry also when we show you your new little boy or
girl. You’ll feel exhausted and excited: all your Great Expectations are here, finally!
The third stage of labor begins after the delivery of the infant and is completed
with the delivery of the placenta.
But your work isn’t totally over. The third stage of labor is the passing of the
afterbirth, or placenta. This usually takes just a few contractions and takes only a
few minutes more. Then it’s time for some well-earned rest and bonding with your
newborn baby.

Vaginal Birth After Cesarean (VBAC)
An effort is being made to allow certain women to deliver vaginally after a previous
Cesarean birth. This option is obviously not for everyone, but can be accomplished
in more than 60 percent of the instances when it is attempted.
Vaginal birth after Cesarean (VBAC) is associated with a less costly and shorter
hospital stay. It also allows for a speedier recovery and resumption of normal
activities. C-sections are somewhat more risky because they involve major surgery
and some type of anesthesia. Infection, bleeding and wound complications occur
more frequently with Cesarean births.
The first factor that is considered in the option for VBAC is the type of uterine
incision that was used with your previous Cesarean birth. The skin incision that
you have on your abdomen is not necessary in the same direction as your uterine
(womb) incision. It is imperative that your previous surgical records are used in
evaluating this factor.
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Certain other factors may preclude an attempted VBAC such as twins, breech birth
and above-average sized babies.

Most women who have had a previous Cesarean birth may attempt VBAC. Special
medical precautions will be taken to protect both you and your baby. You’ll definitely
have an IV in your arm and special monitoring will be performed on your baby to
alert us of any signs of fetal distress.

VBAC is not without risk. The most important risk is of uterine rupture which
happens in 1-3% of cases. This complication can be life threatening for both the
fetus and mother.

Cesarean Birth (C-Section)
Cesarean birth involves removal of the baby through the mother’s abdominal wall.
It is used when a vaginal delivery is not possible or there is danger to the baby.
There are numerous reasons for Cesarean deliveries. Some are known prior to
labor, but many aren’t known until after labor begins and progresses. Any one or
a combination of the following conditions can lead to a Cesarean birth.
• Previous Cesarean Birth – The previous scar in the uterus may be weak and
allow rupture of the uterus during labor. A trial of labor may be allowed. (See
VBACs, P. 55)

• Fetal Distress – The baby’s heartbeat may appear abnormal during labor, indicating
possible trouble for the baby.

• Cephalopelvic Disproportion – The baby’s head or body is too large to pass
through the birth canal.

• Abnormal Presentations – The baby’s position prevents a normal head-first
delivery. The passage of a baby’s legs or buttocks (breech birth), or arm or side
(transverse-lie birth) creates a great risk to the baby’s well being.

• Prolapsed Cord – The baby’s umbilical cord drops out of the vagina ahead of the
baby and can endanger it by cutting off its oxygen supply.

• Maternal Bleeding – The placenta can separate from the uterus prematurely and
disturb the oxygen supply to the baby. Additionally the placenta can become
positioned over the cervix and prevent passage of the baby.

• Maternal Medical Condition – Toxemia, genital herpes, diabetes, HIV, heart disease,
severe Rh disease and certain other medical conditions in the mother can lead to a
Cesarean birth in some situations.
                          Your Prenatal Guidebook                                57

It is important not to feel disappointed or a sense of failure because you could not
deliver the baby vaginally. Many mothers feel depressed because of this. Remember
the safety and long-term outcome of the precious infant is ultimately what is
important to you and us.

Childbirth Classes
There are a number of educational courses to prepare couples for pregnancy and
the eventual delivery of their newborn. Mothers who take these classes report
they need less pain medicine and anesthesia during labor and have had more
positive feelings about their birth experience. Expectant fathers are more help
during labor when they have attended these childbirth classes with you and then
practiced with you at home. Remember, no matter what type of delivery you choose,
you will still find the information from the classes very, very helpful. We
wholeheartedly encourage you to learn as much as possible about this process.
Visit birthofamom.com.

Anesthesia and Pain Relief
Each expectant mother in labor will require different amounts of medication depending
on her special situation. Many patients who have attended “natural childbirth
classes” require little or no pain medication. Other patients request specific type of
anesthesia to release the pain of childbirth. Our role in your labor is to attempt to
keep you and your baby from having a complication related to either the childbirth
process or the pain-relieving process of labor.
We encourage all couples to attend a prepared childbirth class. This will serve to
educate you about the delivery process and take away fears. This is not to say that
every couple should “go natural” because not all couples should. The classes will
serve every laboring couple, even though they may elect another type of anesthetic.
Each person has a different tolerance to pain and you should not feel a sense of
failure if you request, or we suggest, medication for pain relief. There are two major
types of anesthesia.
Regional Anesthesia is given in the birth canal or the lower region of the back near
the spinal cord. The different locations of administration produce various numbing
effects.
    • Local and Pudendal Blocks – anesthetic given just prior to delivery to numb
    the lower birth canal.
    • Paracervical Block – anesthetic injected into the cervix to partially relieve
    pain during labor. It is rarely used today.
    • Spinal or Saddle Block – anesthetic injected into the lower back just prior to
    delivery producing numbness of the lower abdomen, legs and birth canal.
    •Epidural or Caudal Block – anesthetic injected through a catheter in the
    lower back producing numbness of the lower abdomen, legs, and birth canal.
  58                          Your Prenatal Guidebook

General Anesthesia is not frequently used for vaginal deliveries unless a
complication arises. It is used for C-sections in emergency situations.
Many types of medications and anesthetics are available to reduce the discomfort
of childbirth. There is not a single technique of pain relief that is appropriate for
everyone. After labor begins, we will give careful instructions about the dosage
and timing of the various medications (if required) so as not to slow your labor or
cause your baby to be sleepy at birth. If you desire no pain medication, please
inform us prior to, or during, labor.

It’s Over Now, But. . . Don’t Expect
An Instant Beauty!
Some mothers are shocked, disappointed, or even frightened when they see their
newborn. Babies are not born beautiful enough to pose for diaper commercials.
Photogenic full cheeks and alert sparkling eyes come later. Babies are born with a
whitish, thin, substance called vernix covering their skin and they are bloody. Since
their heads have been conforming to the birth canal, their skulls may even be
distorted. Don’t fret; that little “cone head” usually disappears within hours. So
don’t worry and don’t feel guilty if this little red, wrinkled messy screamer doesn’t
immediately grab your heart. It doesn’t mean you’re a failure if you don’t feel an
immediate bond. Some mothers bond when they first nurse. And some need a
couple of days to develop that special, beautiful, mother-child feeling.

Your Own Changes Don’t Stop Now
Now that your months of Great Expectations have taken the form of a baby boy or
girl, you can expect more physical and mental changes in yourself in the weeks right
after delivery.
You’ll be sore from delivery and quite tired. Your hormone levels will return to
normal and, in the process, your moods may swing much the same as in the beginning
of pregnancy. And, you may become quite depressed. These “baby blues” are
common, so expect them. Usually, though, postpartum “blues” don’t last longer
than a few days. But if you feel really down for long, let us know.
You’ll be having a bloody vaginal discharge for awhile, as the lining of the uterus
sheds completely. Your normal period may not start again for several months if you
are breastfeeding.
Your uterus will continue contracting which enables it to return to original size.
Expect abdominal cramps for a few days, especially if this is your second or third
baby. These may happen more during breastfeeding since breastfeeding causes
the uterus to contract much more noticeably.
                           Your Prenatal Guidebook                                  59


If you are bottle-feeding, your breasts may fill up with milk and become
uncomfortable. Tightly binding the breasts and applying ice bags may help relieve
some of the discomfort, but don’t pump your breasts to relieve the pain. The more
milk you expel, the more milk will come in. Eventually, if your breasts are unstimulated,
your milk will dry up.

If you have problems urinating right after delivery, let us know. Some women do.
This can be caused by the type of anesthetic, the size of the baby, or just general
discomfort, especially with stitches. But you need to completely empty your bladder.
If you have too much trouble in the hospital, we might empty your bladder with a
catheter. This is painless. But once you leave the hospital, you shouldn’t be
having this problem.

You can resume sexual intercourse after your four-to-six-week checkup. To foster
intimacy between you, your partner and your new baby, try feeding your baby in
bed, cradled between the two of you.
Your stomach isn’t going to be instantly flat. Don’t expect to leave the hospital and
be back to your pre-pregnant size. Your stomach won’t get back to normal right
away, but with exercise, your abdomen should flatten out again in very little time.
Depending upon your condition, we may recommend that you start exercising just
a few days after delivery, or we may ask you to wait a while longer if you had a
Cesarean birth or tubal ligation.
  60                            Your Prenatal Guidebook


A Baby Has Real Needs, Too
Girl or boy, your baby will have a number of basic needs. The time to prepare for
“homecoming” is throughout your pregnancy. Friends are most helpful. Think of
those close friends who have had babies in the last five years. Chances are they
still have plenty of wearable and useable items that their children have outgrown.
Here’s a practical list of needs you’ll want to consider.
    • Crib                              • Portacrib
    • Baby Recliner/Carrier             • Blankets
    • Changing Table                   • Car Seat
    • Disposable Diapers                • Diapers and Diaper Pins
    • Rubber Pants                     • Outer Clothing
    • Bottle and Plate Warmer           • Pacifier (for first 6 months, possibly)
    • Ear Thermometer                   • Safe Bed Animal or Soft-Sculpture Toy
    • Diaper Bucket and Bag             • Cleaning Soaps for gentle skin
    • Cotton Swabs for cleaning ears and nose
    • Oil, Lotion, Soap, Vaseline, Baby Towel and Wash Cloths
    • Bottles (even if you plan to breastfeed, there could be times when you’ll
    need to supplement with Formula)
    • Rattles and Playthings that aid small muscle and large muscle
    development as well as sensory stimulation
Specialty and department stores have a complete array of items you may need – and
many you may not “need,” but desire. Also check the baby section of your drug
store for items you may find convenient.
If you have any doubts about what you’ll need, just get together with three or four
mothers. Hours later, you’ll have a long, long list. Take care of the list while you still
feel like getting out and shopping or visiting friends.

Congratulations – Now You’re A Mother!
It’s A New Experience … Even If You Have Other
Children
What a new and exciting experience. Instead of a couple, you’re a family! Whether
this is your first baby or your seventh, the thrill of seeing your own infant for the
first time is still there – tiny feet, tiny hands. A wonderful fresh chance for the world.
All those months of Great Expectations have come to life in one tiny child, and we
are happy to have been a part of it.
                                              Your Prenatal Guidebook                                                                 61

                                                                Index
abdominal pain .................................... 17,20               drugs ..................................................... 42-43
alcohol use ................................................. 4 2       ectopic pregnancy .................................... 4 7
Alpha-fetoprotein test ......................... 9-10                   electronic non-stress/stress testing ......... 1 0
amniocentesis ............................ 6, 8, 10, 11                 emotional changes .................................... 1 9
anatomy of the breast .............................. 2 9                epidural anesthesia .................................... 5 7
anencephaly ................................................ 9          episiotomy ................................................ 5 5
anesthesia                                                              exercise ................................................ 40-41
      • regional ........................................... 5 7        fainting ...................................................... 1 7
      • general ............................................. 5 8       false labor .................................................. 5 4
anxiety ....................................................... 1 9     family history ............................................. 7
arthritis ...................................................... 1 7    fetal development .................................... 1 2
artificial sweeteners .................................. 4 3            fetal distress ............................................... 5 6
baby development .................................... 1 2               fetal maturity tests ................................... 1 1
backache .................................................... 1 5       fetal movement test ................................. 1 1
baths ........................................................... 2 4   fever ........................................................... 2 0
biophysical profile .................................... 1 0            formula feeding ......................................... 3 8
bleeding ......................................... 20, 47-48            genital herpes ............................................ 4 4
Braxton-Hicks Contractions ................... 1 8                      German measles ........................................ 4 4
blurred vision ............................................. 2 0        gestational diabetes ............................. 10-11
breastfeeding ....................................... 28-38             glucose tolerance test ......................... 10-11
breast ................................................... 13, 29       Group B Strep ............................................ 5 1
breech birth ............................................... 5 6        hard drugs ................................................... 4 3
burping ....................................................... 3 2     headaches ................................................... 1 8
Carpal Tunnel Syndrome ......................... 1 7                    heartburn ................................................... 1 4
caudal anesthesia ....................................... 5 7           hemorrhoids .............................................. 1 6
Cesarean birth ........................................... 5 6          Hepatitis B .......................................... 44-45
chicken pox ............................................... 4 5         high blood pressure ............................. 48-49
childbirth classes ....................................... 5 7          high risk pregnancy .................................... 6
chorionic villus sampling (CVS) ................ 9                      (HIV) Human Immunodeficiency
cigarette smoking ..................................... 4 3             Virus ..................................................... 45-46
clothing ...................................................... 2 6     hot tubs ...................................................... 2 7
colostrum ............................................ 13, 29           household chemicals ........................... 26-27
constipation .............................................. 1 5         hyaline membrane disease ....................... 1 1
contractions .............................................. 1 8         immunizations .......................................... 2 6
contraction stress test .............................. 1 0              influenza .................................................... 4 5
cytomegalovirus ....................................... 4 6             insecticides .......................................... 26-27
danger signs ............................................... 2 0        insomnia .................................................... 1 5
delivery ................................................ 54-56         intercourse ................................................. 2 7
depression .................................................. 1 9       inverted nipples ........................................ 3 0
diabetes ...................................................... 4 9     kick count .................................................. 1 1
diet ........................................................ 21-23     labor ..................................................... 53-56
dizzy spells ................................................ 1 7            • real labor
douching ..................................................... 2 6           • false labor
Downs Syndrome .................................... 6-7                                                    (continued next page)
    62                                                Your Prenatal Guidebook

                                                      Index              (cont.)
latch-on ............................................... 31-32           sex .............................................................. 2 7
miscarriage ................................................ 4 7         sexual changes ........................................... 1 9
mastitis ...................................................... 3 5      shortness of breath ................................... 1 5
morning sickness ...................................... 1 4              siblings ........................................................ 5 2
mumps ........................................................ 4 7       skin changes .............................................. 1 5
nausea ......................................................... 1 4     smoking ..................................................... 4 3
neural tube defects ............................... 9, 10                sonography .................................................. 8
nipple problems ................................. 30, 35                 spina bifida .................................................. 9
non-stress test ........................................... 1 0          spinal anesthesia ....................................... 5 7
nose bleeds ................................................. 1 8        stretch marks ............................................ 1 8
painting ...................................................... 2 7      stress test ................................................... 1 0
paracervical block .................................... 5 7              swelling ...................................................... 1 8
physiology of the breast .......................... 2 9                  tampons ..................................................... 2 4
pica ............................................................. 1 7   teeth ........................................................... 2 6
placenta abruption .................................... 4 8              toxemia ................................................ 48-49
placenta previa ......................................... 4 8            toxoplasmosis ........................................... 4 4
postpartum depression ............................. 5 8                  travel .......................................................... 2 4
prolapsed cord ........................................... 5 6           triple screen test ......................................... 9
preeclampsia ....................................... 48-49               tri screen test .............................................. 9
pudendal block .......................................... 5 7            twins ............................................................. 6
quickening .................................................. 1 1        ultrasound .................................................... 8
respiratory disease syndrome .................. 1 1                      VBAC ......................................................... 5 5
Rh disease ............................................ 50-51            vaginal discharge ....................................... 1 7
RhoGam ..................................................... 5 0         varicose veins ............................................ 1 6
round ligament pain ................................. 1 8                vomiting .................................................... 2 0
saddle block ............................................... 5 7         weight .................................................. 13, 23
salivation ................................................... 1 4       work ........................................................... 2 4
saunas ......................................................... 2 7     x-rays ......................................................... 4 3
seat belts .................................................... 2 5
        Your Prenatal Guidebook




Notes
        Your Prenatal Guidebook




Notes

								
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