Pregnancy

Can I have intercourse through pregnancy?

Yes. Intercourse will not cause harm. You may notice some spotting or light bleeding up to 48 hours after intercourse. This is normal. If bleeding is heavy or persists beyond 48 hours, please call our office.

What should I do before I get pregnant to ensure a healthy pregnancy for me and my baby?

A typical pregnancy is nine months long, but to give your baby a healthy start, think of it as twelve months — including the three months before you get pregnant. This means that when you start thinking about trying to conceive, you should:

  • See your doctor for a prepregnancy checkup. Don’t forget to ask about things like family medical history, risk of birth defects, genetic conditions, and chronic illnesses. Discuss all the medications you take and make sure they’re safe during pregnancy.
  • In addition to eating a healthy diet (lots of leafy greens, lean proteins, and fiber), boost your nutrients with a multivitamin specially formulated for pregnancy — usually called a prenatal vitamin. It’s particularly important to get sufficient folic acid before getting pregnant. This nutrient helps prevent birth defects like spina bifida; because many of these conditions arise very early in pregnancy, you need healthy levels of folic acid right from the start. Look for a multivitamin that contains 400 micrograms of folic acid. Ask your doctor or midwife to recommend a vitamin for you.
  • If you smoke, quit. Smoking poses a host of risks to adeveloping baby, including birth defects and low birth weight. It also doubles your risk of having an ectopic pregnancy. You may also find it more difficult to become pregnant in the first place if you smoke, as smoking is strongly linked with infertility in both women and men.
  • Get checked for hepatitis B and C, sexually transmitted infections, and HIV.
  • Get any health problems — like diabetes and high blood pressure — under control. If you are seriously overweight, talk to your doctor about how to maintain a healthy weight.
What should and shouldn't I eat while I'm pregnant?

While pregnant, you’re eating for two, as the old saying goes — but just what are you two supposed to be eating?

  • Get all essential vitamins and minerals daily. That means sticking with the prenatal vitamins you started prior to becoming pregnant, as well as eating a healthy diet.
  • Fill your plate with leafy greens, fruits, veggies, and whole grains (like wheat breads and cereals). Get plenty of calcium-rich foods like broccoli and low-fat milk and yogurt, to help build your baby’s bones and teeth. Stick to lean meats like chicken and turkey.

Foods to avoid during pregnancy include:

  • Fish with lots of mercury. High levels of mercury can damage a baby’s developing brain. But don’t cut out fish completely — they give you important omega-3 fatty acids. Cut out fish like swordfish, tilefish, and shark. If you love your tuna and snapper, you can still eat it — just cut back to no more than one serving a week. You can eat up to two servings of fish like salmon, catfish, mahi mahi, and cod, along with shellfish like shrimp, crab, and scallops. For a more detailed list of fish and their mercury levels, go to http://www.americanpregnancy.org/pregnancyhealth/sushimercury.htm.
  • Raw fish. Sorry, sushi and sashimi lovers.
  • Unpasteurized soft cheeses like brie, Camembert, feta, gorgonzola, and Roquefort. They may contain bacteria called listeria that can cross the placenta, potentially causing miscarriage or leading to a life-threatening infection.
  • Unpasteurized milk, which can also contain listeria.
  • Cold ready-to-eat meats, like hot dogs and luncheon meats; these can also contain listeria. Reheat these foods until they are steaming.
  • Uncooked or cured eggs and meats, like prosciutto, runny eggs, and sauces made with raw eggs (like some hollandaises).
  • Alcohol. There is no known safe level of exposure to alcohol for a fetus. Prenatal exposure to alcohol can interfere with healthy development and lead to fetal alcohol syndrome, one of the most common causes of mental retardation and the only one that is completely preventable.
  • Caffeine. While some studies show that moderate caffeine intake during pregnancy is OK, others have found a link to miscarriage, so it’s particularly important to steer clear of caffeine during the first trimester. Large amounts of caffeine have been linked to premature birth and low birth weight, so do your best to switch to decaf. If you can’t cut it out entirely, limit intake to 300 milligrams per day or less (1-2 cups of coffee).
Are there other activities I should steer clear of while pregnant? Do more of?

Do this. Don’t do that. Wait, no, do this! Don’t do that! It seems that the list of things you should and shouldn’t do in pregnancy just keeps getting longer. Here are some key dos and don’ts:

DO:

  • Exercise. Light to moderate exercise during pregnancy is good for you, strengthening your back and abdominal muscles, improving your balance and helping to speed your recovery after delivery. (See more about this in question 4 below.)
  • Have sex. Unless you have a high-risk pregnancy and your doctor has advised you against it, sex during pregnancy is safe. The baby is cushioned by your amniotic fluid. Especially in later pregnancy, though, avoid lying flat on your back during sex; the uterus can compress the veins in the back of your abdomen and leave you lightheaded or nauseous.
  • Wash your hands before preparing food, before meals, after handling raw meats, and after using the bathroom.
  • Clean house. Sorry, most household cleaning products, including bleach, are safe for use during pregnancy. Just be sure the room is well ventilated, read warning labels, and avoid mixing chemicals (like ammonia and bleach) — good advice for cleaning safety whether you’re pregnant or not.
  • Travel by airplane — sometimes. The American College of Obstetricians and Gynecologists (ACOG) says that the second trimester is the safest time for air travel, when you’re at the lowest risk of miscarriage or premature labor. Generally, if you have a healthy, uncomplicated pregnancy, there’s no special risk posed by commercial air travel. (ACOG recommends that pregnant women stop flying at 36 weeks’ gestation.) Be sure to stay hydrated during the flight by drinking plenty of fluids, and keep your seat belt on! And no matter whether you’re traveling by car, train, bus or plane, get up and move around every so often, and be sure to stretch your legs and back.
  • See your dentist. Preventive cleanings and annual exams are a very good idea during pregnancy, as your rising hormone levels can cause bleeding gums and irritation. Since gum infections have been associated with preterm births, keeping your mouth healthy is important.

DON’T:

  • Change the cat’s litter box. No, this isn’t just an excuse to get out of an icky task; cat feces can transmit an infection called toxoplasmosis, which can lead to severe problems in newborns, including low birth weight, jaundice, mental retardation, and convulsions.
  • Use saunas, hot tubs, and tanning booths. Excessive heat can be harmful to the baby, and has been linked to spinal malformations.
  • Paint. Let somebody else paint the baby’s room; pregnant women shouldn’t be exposed to toxic substances and chemicals, which include paint and cleaning solvents.
  • Get an X-ray. Unless you absolutely have to, avoid tests like X-rays and mammograms while pregnant, because they can be dangerous to your growing baby. If you absolutely must have an X-ray, make sure that your doctor or dentist knows you are pregnant so they can take extra precautions.
  • Ride the Great American Scream Machine or the Tower of Terror. Though no studies have been done to document this, there is concern that the rapid stops and jarring forces of rides like this could cause placental abruption (premature separation of the placenta from the uterine wall). Play it safe and stick to the Ferris wheel until the baby’s born.
What can I do to relieve or prevent pregnancy symptoms like nausea and vomiting, heartburn, leg cramps, and hemorrhoids?

Pregnancy may come with a host of uncomfortable symptoms, but you don’t have to suffer. Here are some tips for preventing some of the most common symptoms of pregnancy — or at least easing some of the discomfort.

  • Nausea and vomiting: Get up slowly in the morning; movement can make nausea worse. Don’t let your stomach completely empty: eat five or six small meals throughout the day. Drink plenty of fluids, get lots of fresh air, and avoid fatty foods that are hard to digest. And trust your instincts. If something smells good to you and the thought of it doesn’t make you nauseous, you can probably eat it.
  • Leg cramps: Exercise regularly, get plenty of fluids, and avoid sitting in the same position for a prolonged period of time. Stretch your legs before going to bed by straightening your leg heel first and wiggling your toes. Massage your legs and apply heat to relieve a cramp.
  • Heartburn: Avoid greasy or fatty foods, garlic, spicy foods, and drinks containing caffeine. Eat smaller meals, and avoid bending or lying down right after a meal.
  • Hemorrhoids: Drink plenty of liquids, eat a high-fiber diet, exercise regularly, and avoid long periods of standing or sitting. To relieve hemorrhoid pain, take periodic sitz baths, apply cold compresses, and ask your doctor which OTC creams are safe to use.
  • Backache: Wear low-heeled shoes with good arch support to avoid straining your lower back muscles. Avoid lifting heavy objects or standing for long periods of time. Make sure your mattress is firm, and that chairs you sit in have good back support (a small pillow placed in the small of your back can help). Don’t take medications for back pain unless OK’d by your doctor. Try a heating pad, warm water bottle, or cold pack instead.
How much weight should I gain during pregnancy?

Pregnancy doesn’t equal a get-out-of-jail-free card for a caloric spending spree. Weight gain during pregnancy is a lot like Goldilocks and the Three Bears: you don’t want too much, you don’t want too little — you want “just right.” If you gain too much weight, you’re at risk for conditions like gestational diabetes; too little, and your baby may be born at a low birth weight. What’s “just right” for you?

  • If you’re at a normal weight before pregnancy, gain between 25 to 35 pounds during pregnancy.
  • If you are overweight before pregnancy, gain 15 to 25 pounds.
  • If you are underweight prior to pregnancy, gain 28 to 40 pounds.
  • For multiple births, consult your doctor (usually, you should gain about 35 to 45 pounds for twins).

The average woman should gain about 2 to 4 pounds during her first three months of pregnancy, and 1 pound a week for the remainder of her pregnancy.

When should I call my doctor between regular prenatal visits?

You’ll be seeing your obstetrician, midwife, or other prenatal care specialist very regularly over the next nine months. But how do you know when to call the doctor between prenatal checkups? What’s normal and what’s not? If you’re pregnant and experience any of the following symptoms, call your health care provider immediately:

  • Unusual or severe cramping or abdominal pain
  • Significant reduction in the baby’s movements after 28 weeks (less than 10 movements in a 2-hour period)
  • Shortness of breath or difficulty breathing
  • Any bleeding in the second or third trimester
  • Signs of premature labor, such as regular pains or tightening in the lower back or abdomen or significant fluid discharge
  • Pain or cramping in the arms, legs, or chest
  • Fever over 100 Fahrenheit (37.5 Centigrade)
  • Severe or persistent diarrhea or vomiting
  • Fainting spells or dizziness
  • Blurred vision or spots in front of your eyes
  • Swelling in your hands, fingers, or face
How can I prepare for breastfeeding my baby after childbirth?

You know that breastfeeding is best for both you and your baby. It helps protect your child against a host of diseases in infancy, childhood, and even later on in life — everything from ear infections, diarrhea, and respiratory illnesses, and possibly even diabetes, obesity, asthma, and leukemia. Plus, it also protects you: breastfeeding moms have a lower risk of breast and ovarian cancers.

But breastfeeding doesn’t always come easy for every woman. It’s easy to get discouraged early on, especially if you expect your baby to just latch on and start suckling, only to find he has a “difficult latch” or you’ve developed mastitis (an infection in the breast). Support organizations are there to help while you’re getting used to breastfeeding. Here are resources:

  • National Women’s Health Center’s Breastfeeding Helpline: 1-800-994-9662. Staffed with trained La Leche League counselors, the helpline is open Monday-Friday from 9 a.m.-6 p.m. Eastern Time, and can take questions in English and Spanish. Their counselors can answer common breastfeeding questions on issues ranging from nursing positions to pumping and storage, and provide you with support to make breastfeeding a success.
  • Find a lactation consultant near you. International Board Certified Lactation Consultants (ILBCLCs) can provide you with everything from prenatal breastfeeding education to postnatal home and hospital visits, educational literature, and support groups. Visit them online at www.ilca.org.
  • Find a La Leche League group in your area at www.lalecheleague.org, or get mom-to-mom support and advice in their online forums.
  • Visit Gotmom (http://www.gotmom.org/), a resource created by the American College of Nurse-Midwives to support breastfeeding.
What should I know about postpartum depression?

Depression during or after pregnancy is perfectly normal. In fact, researchers believe it’s one of the most common complications associated with pregnancy. It’s thought to be caused by a combination of the fluctuating hormone levels associated with giving birth, the major transition to parenthood (or to having more than one child), and other life stresses that accompany pregnancy, childbirth, and parenting. If you have other major stressors affecting your life at the same time, or if you’ve been prone to depression in the past, you may be particularly vulnerable to postpartum depression. Symptoms can include feeling sad and hopeless; crying often; withdrawing from friends and family; eating or sleeping too little or too much; feeling worthless or guilty; and even being afraid of hurting yourself or the baby.

Many new mothers — as many as 80%, according to the National Mental Health Association — experience the “baby blues” right after delivery, and these relatively mild symptoms (mood swings, crying spells, irritability) can go away within a few days to a few weeks. Treatment isn’t necessarily needed, but support can be invaluable. Try seeking out new-mom support groups through the hospital or birthing center where you delivered.

If the feelings linger, become severe, or if you have a family history of depression, it’s important to get treatment for postpartum depression. Two great sources of help are Postpartum Support International (http://www.postpartum.net/), which has a helpline at (800) 944-4PPD ((800) 944-4773), and the National Mental Health Association (http://www.nmha.org/). You can search for a mental health professional near you on its web site, or call them at (800) 969-6642.

Infertility

How is infertility diagnosed?

You and your partner will have thorough exams. You will be asked about: your sexual history, including previous pregnancy, miscarriage, or abortion, your medical and family history, your diet and exercise habits, stress, your use of drugs, alcohol and tobacco, your sexual intercourse practices, such as how often you have sex and whether you use lubricants. You may need to find out if you are ovulating each month. Your healthcare provider can tell you how to take and chart your body temperature each morning. Your temperature will rise after ovulation. You can buy kits at the drugstore that can help predict ovulation. Blood test and an ultrasound of the ovaries can also be used to see if you are ovulating. Other tests that may be done are: urine and blood test to check for infections and a hormone imbalance, test of samples of cervical mucus and tissue from the lining of your uterus, tests of your partner’s semen to check the number and quality of sperm in the semen. You may have the following procedures to check for a blockage in your tubes or uterus, scar tissue, or endometriosis: hysteroscopy, laparoscopy, hysterosalpingogram.

What is Infertility?

Infertility is usually defined as not being able to get pregnant after trying for at least one year. Women who are able to get pregnant but then have repeat miscarriages are also said to be infertile. Infertility is a problem for one of every six couples. It can be caused by problems in a man’s or woman’s reproductive system. Problems in the woman’s body are responsible for about half of the cases of infertility. Often the reason for infertility in a woman is that her ovaries are not releasing eggs. For example, when a woman gets older, the ability of the ovaries to release healthy eggs declines, especially after the age of 35. Other things that may affect the eggs and the release of eggs (ovulation) are: hormone problems, overweight or underweight, smoking, too much stress, unhealthy diet, ovarian tumors or cysts, intense exercise, abuse of alcohol or drugs, tumors in the pituitary gland, chronic illness, such as diabetes and some medicines. A woman who is not ovulating normally may have irregular or missed menstrual periods. An abnormal or damaged fallopian tube or uterus can be another cause of infertility. When an egg is released, it must pass through a fallopian tube to the uterus. A man’s sperm must join with (fertilize) the egg along the way. The fertilized egg must then attach to the inside of the uterus. A fallopian tube or uterus may be damaged by an infection, such as a sexually transmitted disease, a birth defect in the female organs, growths in the uterus, such as polyps or fibroids, scar tissue from surgery (called adhesions), endometriosis which is tissue from the uterus growing outside the uterus, DES syndrome, which you may have if your mother took the medicine DES when she was pregnant with you. You may have problems with your cervix that make it hard for the sperm to reach and fertilize the egg, such as cervical stenosis (a cervix that is very narrow or closed), abnormal cervical mucous, cervicitis, which is inflammation or infection of the cervix. In rare cases, a woman’s body is allergic to sperm and destroys it. Some rare genetic problems also cause infertility. Thirty percent of infertility cases have no known cause.

My husband and I have been trying to get pregnant for the past six months without luck. When should we seek medical help for infertility?

Approximately fifteen percent of couples in the United States struggle with infertility and are unable to get pregnant. Typically, infertility is diagnosed after twelve months of trying to conceive without the use of birth control. I would encourage you and your spouse to keep trying. If you aren’t pregnant after six more months, you may want to see a doctor and have an infertility evaluation. Tests can be done to find the cause of Infertility after which you can discuss treatment options if necessary.