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These are some of the common issues that patients ask about. If your pregnancy is high risk or you have questions about this information please ask. Breast care Your breasts will become larger and more sensitive during the first trimester of pregnancy. This may increase again as you get closer to delivery. There may also be leaking of clear fluid from the nipples. It is important to wear a good supportive bra during pregnancy and nursing. You should continue your monthly self-breast exams during pregnancy. If you notice a lump, bring it to our attention so we may help with assessment and referral to a breast specialist. Breast cancer is rare but may develop during pregnancy so never ignore a new or changing lump. Breast feeding Shady Grove Adventist Hospital has been designated as baby friendly. We are highly supportive of nursing mothers and there will be outstanding help with nursing while you are in the hospital. There will be nursing classes and lactation support on a one-on-one basis. If you choose to bottle feed your pediatrician will help you make formula choices and provide any additional information you need. Caffeine You do not have to eliminate caffeine, but you should keep consumption under 300mg a day. These are some of the common sources of caffeine. Black tea: 50mg/5 oz cup Coffee: Instant regular 175mg/8 oz. Instant decaf 12mg/ 8 oz. Chocolate: 1oz. dark chocolate/35 mg. One oz milk chocolate/15mg Cola: 65mg/12 oz. Remember to think about the calories as well. Cats Cats that hunt and eat their prey or cats that eat raw meat are at risk for carrying toxoplasm, a parasite that causes toxoplasmosis. It may be found in litter boxes, gardens or sandboxes. If you must clean the litter box, use disposable gloves and wash your hands afterwards. The litter should be changed daily as it is less infective in the first few days. Wash your hands after handling cats. Use disposable gloves when gardening if you have cats that frequent your yard. Childbirth classes Luz Cutler, RN, teaches child birth classes specifically for our patients. Please see here for more information or to register. Colds and viruses No one likes a cold under any condition, but it feels much worse when you are pregnant. Colds are a virus and do not respond to antibiotics, but there are things that will help relieve symptoms. Saline nose drops will loosen secretions. Do not use Afrin or Neo-Synephrine without asking a doctor. Take Tylenol or cold medications on the list as needed following directions on the bottle. If your temperature is over 101 degrees, call us day or night. It is important that fevers be managed. Increase fluid intake. REST. A cool mist vaporizer will help with breathing. If you think you have been exposed to a communicable disease such as Fifths Disease or Chicken Pox, please let us know before you come in so we may see you when the reception area is empty at the end of the day. Diabetics should not use Robitussin. Women with high blood pressure should not use pseudophedrine. WE STRONGLY RECOMMEND FLU SHOTS FOR ALL PREGNANT WOMEN. Constipation and hemorrhoids Constipation in pregnancy often leads to hemorrhoids. They generally improve after delivery. The following will help decrease constipation and prevent hemorrhoids. Drink plenty of fluids. Increase dietary fiber. Try to avoid becoming constipated. Increase exercise. Stool softeners Dental care All pregnant women should see their dentist. There are reports that suggest poor oral hygiene increases the risk of preterm labor and delivery. Generally dental work should be done as indicated. You should be double shielded for x-rays and they should be delayed until the second trimester if possible. Exercise Exercise strengthens muscles used in labor and delivery and decreases some of the aches and pains of pregnancy. It improves energy, mood, endurance, muscle tone, and helps with sleep. In an uncomplicated pregnancy exercise is very beneficial. If you have a high-risk or complicated pregnancy, discuss specific recommendations with us. Ideal frequency of exercise is 3-5 times a week. If you are new to exercise, we recommend a walking program. Invest in good athletic shoes. Keep your heart rate under 140 and drink more water. Start with about 10 minutes a day and increase as your stamina improves. If you routinely exercise, keep it up. We will be happy to discuss modifications of your training program as can a qualified trainer. High intensity or high impact exercise is not recommended as joints loosen and balance changes during pregnancy and it is easy to become injured. Likewise, extreme flexion or over-extension is dangerous for your joints. Fetal movement You will begin to feel your baby move by about 20 weeks; as early as 16 if you have been pregnant before. Movements will increase in strength and frequency as you progress through your pregnancy. By the third trimester there is often a change in the quality and quantity of movement. The baby’s wake/sleep patterns may be clearer. Once a day you should count baby movements within the first hour after a meal. There should be about 10 movements. If you note that the baby’s movements are different than normal or if you realize you have not been feeling the baby move for a while, you should call the office or on call doctor immediately. You will be brought in to have the baby evaluated. Hair color “May I color my hair?” This is the most common question we hear. There is no evidence that hair coloring is harmful. In your first trimester, the smell of products may increase nausea and vomiting, so if your sense of smell has become acute you might want to wait until the second trimester. Headaches Headaches are common in pregnancy, especially at the beginning of the second trimester. If they do not respond to Tylenol, are frequent, or are associated with blurred vision contact the office. Heartburn This is a common complaint in pregnancy. It occurs when food and liquid are pushed from the stomach into the esophagus. Relaxation of the sphincter at the top of the stomach and pressure from the growing uterus make symptoms worse. Eat small frequent meals. Avoid foods that you find hard to digest. Avoid dairy in the evening. You may find that elevating the head of your bed helps. See the medication list for antacids. Insomnia Excitement of pregnancy or physical discomfort may cause insomnia. These are some home remedies that may help. Have a warm bath before bed. Drink something warm such as chamomile tea. Avoid stimulating activities before bed. There is strong evidence that watching TV or working on the computer may increase insomnia. Try relaxation techniques or meditation. Benadryl 25mg or Tylenol PM may help but should not be used regularly. Try to keep regular hours for sleeping and rising. Intercourse In a normal pregnancy intercourse is safe until the last weeks of pregnancy. You may find a change of position is more comfortable. If you are high risk or have any concerns about whether or not intercourse is safe for you, please discuss your concerns at an office visit. Medication list The following is a list of medications that are safe to take during pregnancy. Headaches Tylenol Regular or Extra Strength Colds Actifed Benadryl Cough Drops Cough Syrup i.e. Robitussin (do not take if you are diabetic) Decongestants Mucinex Saline Nose Drops (not Afrin or Neo-Synephrine) Sudafed Throat lozenges Vicks Vapor Rub DO NOT TAKE ADVIL, MOTRIN, OR IBUPROFEN AFTER 26 WEEKS Remember to drink plenty of water. Herbal tea with honey and lemon will help cut mucous. Limit dairy as well when you are not feeling well. Allergies Allegra Benadryl Claritin Zyrtec Constipation/Hemorrhoids Benefiber Metamucil Miralax Preparation H Prune Juice Senakot Tucks Medicated Pads Diarrhea Imodium Indigestion Gas-X Maalox Mylanta Pepsid Tagamet Tums Zantac Miscellaneous Dramamine Monistat Please review all prescription medications with us in the office, as some medications may not be safe in pregnancy. Nausea and vomiting Most pregnant women experience some degree of nausea and vomiting especially in the first trimester. They may be accompanied by headache and even some dizziness. The following suggestions may help. If you are having trouble keeping food down, vomit blood, faint, or lose more than 3 pounds a week, contact the office immediately. Any calories are good calories at this point. If it stays down it is good food. Eat frequent small meals. You should eat something at least every 2 hours. Starch is generally well tolerated. Try to drink 64 ounces of fluid a day. Milk may be intolerable. Popsicles, smoothies, or soda (not diet) are often better tolerated than water. Avoid foods that smell badly to you or to which you have developed an aversion-even if they are good for you. Some people find tart foods decrease nausea. Try ginger or B Natal Pops. Vitamin B6 25mg. three times a day If you cannot tolerate your vitamins, be sure to take Folic Acid 1mg a day. Painting Latex paints are mercury and lead-free. They are safe to use in pregnancy. Work in a well-ventilated space and stay off ladders to reduce the risk of falls. Preterm labor In the third trimester you should note occasional mild tightening of the uterus. These episodes of tightness are called Braxton-Hicks contractions. They are completely normal. They should never occur more often than every 10 minutes. How do you tell them from preterm labor? You should call the office if you note: More than 5 contractions an hour. Menstrual cramps low in the pelvis that come and go or are constant Low dull backache not relieved by Tylenol or change of position. Sudden change or increase in vaginal discharge, especially if pink or watery. A general feeling that something is not right. You may not be able to say why, but this is an important feeling. Saunas, hot tubs and tanning booths None of these is recommended for pregnant women. Extreme heat may have a damaging effect on your baby’s development. Bath water should be under 100 degrees Fahrenheit. Travel Most women are able to travel safely during their pregnancy. We recommend the following guidelines: Discuss travel plans well in advance. For automobile travel, be sure to wear your seat belts-both lap and shoulder. The lap belt should be low on the hips and not over the uterus. Do not sit in a car for over 2 hours. We recommend that you not sit with your legs crossed because of the increased risk of blood clots. We recommend against domestic air travel after 35 weeks and international air travel after 28 weeks. Airlines often have restrictions for pregnancy and you should be certain to know the policy involved. Because of the risk of blood clots during flying, we recommend moving about the cabin and drink at least 8 oz. of water per hour. If you plan to travel in your third trimester check with your insurance company to be certain that they will cover if you deliver out of the area. Ask for a copy of your records to take with you and come in for a visit before you leave. There is always a risk you could deliver in a strange location and with an unfamiliar care group. Weight gain Weight gain varies with individuals in pregnancy. You only need an additional 300 calories a day to grow a baby! Avoid empty calories such as fast food, desserts, and sodas. The ideal weight gain for a woman of ideal body weight is 25-30 pounds. That is about ½ to 1 pound a week. If a woman is overweight it is advisable to keep weight gain to 10-15 pounds. Mothers of twins generally will gain closer to 45 pounds. Most women feel better and recover faster if they adhere to these guidelines. If you would like assistance, we may refer you to a dietitian. Work Most pregnant women are able to work until the end of their pregnancy. If you do heavy lifting you should not lift over 30 pounds. Be careful of good lifting posture. By the third trimester you may have to modify your work patterns. If you have concerns please address them at your visit. Additional Information American College of Obstetrics and Gynecology is the official web site and provides a great amount of current medical information. Baby Center is an excellent site for new parents containing information on pregnancy and new baby questions. The FDA website provides information on food such as fish and cheese safety in pregnancy. The March of Dimes provides information on pregnancy and baby health. Shady Grove Adventist Hospital is our preferred hospital for obstetrics and surgery. There is a site for the birth advisor as well as general health information. Mayo Clinic Health is sponsored by Mayo Clinic and has current and accurate information on a multitude of subjects.

General Pregnancy Information

These are some of the common issues that patients ask about.  If your pregnancy is high risk or you have questions about this information please ask.

Breast care

Your breasts will become larger and more sensitive during the first trimester of pregnancy. This may increase again as you get closer to delivery. There may also be leaking of clear fluid from the nipples. It is important to wear a good supportive bra during pregnancy and nursing. You should continue your monthly self-breast exams during pregnancy. If you notice a lump, bring it to our attention so we may help with assessment and referral to a breast specialist. Breast cancer is rare but may develop during pregnancy so never ignore a new or changing lump.

Breast feeding

Shady Grove Adventist Hospital has been designated as baby friendly.

We are highly supportive of nursing mothers and there will be outstanding help with nursing while you are in the hospital. There will be nursing classes and lactation support on a one-on-one basis. If you choose to bottle feed your pediatrician will help you make formula choices and provide any additional information you need.

Caffeine

You do not have to eliminate caffeine, but you should keep consumption under 300mg a day. These are some of the common sources of caffeine.

  • Black tea:  50mg/5 oz cup
  • Coffee:  Instant regular 175mg/8 oz.  Instant decaf 12mg/ 8 oz.
  • Chocolate:  1oz. dark chocolate/35 mg.  One oz milk chocolate/15mg
  • Cola:   65mg/12 oz.

Remember to think about the calories as well.

Cats

Cats that hunt and eat their prey or cats that eat raw meat are at risk for carrying toxoplasm, a parasite that causes toxoplasmosis. It may be found in litter boxes, gardens or sandboxes. If you must clean the litter box, use disposable gloves and wash your hands afterwards. The litter should be changed daily as it is less infective in the first few days. Wash your hands after handling cats.  Use disposable gloves when gardening if you have cats that frequent your yard.

Childbirth classes

Conveniently held in our office on Saturdays. For more information, https://www.birth-class.com/

Colds and viruses

No one likes a cold under any condition, but it feels much worse when you are pregnant. Colds are a virus and do not respond to antibiotics, but there are things that will help relieve symptoms.

  • Saline nose drops will loosen secretions. Do not use Afrin or Neo-Synephrine without asking a doctor.
  • Take Tylenol or cold medications on the list as needed following directions on the bottle.
  • If your temperature is over 101 degrees, call us day or night. It is important that fevers be managed.
  • Increase fluid intake.
  • REST.
  • A cool mist vaporizer will help with breathing.
  • If you think you have been exposed to a communicable disease such as Fifths Disease or Chicken Pox, please let us know before you come in so we may see you when the reception area is empty at the end of the day.
  • Diabetics should not use Robitussin. Women with high blood pressure should not use pseudophedrine.
  • WE STRONGLY RECOMMEND FLU SHOTS FOR ALL PREGNANT WOMEN.

Constipation and hemorrhoids

Constipation in pregnancy often leads to hemorrhoids. They generally improve after delivery. The following will help decrease constipation and prevent hemorrhoids.

  • Drink plenty of fluids.
  • Increase dietary fiber.
  • Try to avoid becoming constipated.
  • Increase exercise.
  • Stool softeners

Dental care

All pregnant women should see their dentist. There are reports that suggest poor oral hygiene increases the risk of preterm labor and delivery. Generally dental work should be done as indicated.  You should be double shielded for x-rays and they should be delayed until the second trimester if possible.

Exercise

Exercise strengthens muscles used in labor and delivery and decreases some of the aches and pains of pregnancy. It improves energy, mood, endurance, muscle tone, and helps with sleep. In an uncomplicated pregnancy exercise is very beneficial. If you have a high-risk or complicated pregnancy, discuss specific recommendations with us. Ideal frequency of exercise is 3-5 times a week.

If you are new to exercise, we recommend a walking program. Invest in good athletic shoes. Keep your heart rate under 140 and drink more water. Start with about 10 minutes a day and increase as your stamina improves.

If you routinely exercise, keep it up. We will be happy to discuss modifications of your training program as can a qualified trainer. High intensity or high impact exercise is not recommended as joints loosen and balance changes during pregnancy and it is easy to become injured. Likewise, extreme flexion or over-extension is dangerous for your joints.

Fetal movement

You will begin to feel your baby move by about 20 weeks; as early as 16 if you have been pregnant before. Movements will increase in strength and frequency as you progress through your pregnancy.  By the third trimester there is often a change in the quality and quantity of movement. The baby’s wake/sleep patterns may be clearer. Once a day you should count baby movements within the first hour after a meal. There should be about 10 movements. If you note that the baby’s movements are different than normal or if you realize you have not been feeling the baby move for a while, you should call the office or on call doctor immediately. You will be brought in to have the baby evaluated.

Hair color

“May I color my hair?” This is the most common question we hear. There is no evidence that hair coloring is harmful. In your first trimester, the smell of products may increase nausea and vomiting, so if your sense of smell has become acute you might want to wait until the second trimester.

Headaches

Headaches are common in pregnancy, especially at the beginning of the second trimester. If they do not respond to Tylenol, are frequent, or are associated with blurred vision contact the office.

Heartburn

This is a common complaint in pregnancy. It occurs when food and liquid are pushed from the stomach into the esophagus. Relaxation of the sphincter at the top of the stomach and pressure from the growing uterus make symptoms worse.

  •  Eat small frequent meals.
  •  Avoid foods that you find hard to digest.
  •  Avoid dairy in the evening.
  •  You may find that elevating the head of your bed helps.
  •  See the medication list for antacids.

Insomnia

Excitement of pregnancy or physical discomfort may cause insomnia. These are some home remedies that may help.

  • Have a warm bath before bed.
  • Drink something warm such as chamomile tea.
  • Avoid stimulating activities before bed. There is strong evidence that watching TV or working on the computer may increase insomnia.
  • Try relaxation techniques or meditation.
  • Benadryl 25mg or Tylenol PM may help but should not be used regularly.
  • Try to keep regular hours for sleeping and rising.

Intercourse

In a normal pregnancy intercourse is safe until the last weeks of pregnancy. You may find a change of position is more comfortable. If you are high risk or have any concerns about whether or not intercourse is safe for you, please discuss your concerns at an office visit.

Medication list

The following is a list of medications that are safe to take during pregnancy.

Headaches

  • Tylenol Regular or Extra Strength

Colds

  • Actifed
  • Benadryl
  • Cough Drops
  • Cough Syrup   i.e. Robitussin (do not take if you are diabetic)
  • Decongestants
  • Mucinex
  • Saline Nose Drops (not Afrin or Neo-Synephrine)
  • Sudafed
  • Throat lozenges
  • Vicks Vapor Rub

DO NOT TAKE ADVIL, MOTRIN,  OR IBUPROFEN AFTER 26 WEEKS

Remember to drink plenty of water. Herbal tea with honey and lemon will help cut mucous. Limit dairy as well when you are not feeling well.

Allergies

  • Allegra
  • Benadryl
  • Claritin
  • Zyrtec

Constipation/Hemorrhoids

  • Benefiber
  • Metamucil
  • Miralax
  • Preparation H
  • Prune Juice
  • Senakot
  • Tucks Medicated Pads

Diarrhea

  • Imodium

Indigestion

  • Gas-X
  • Maalox
  • Mylanta
  • Pepsid
  • Tagamet
  • Tums
  • Zantac

Miscellaneous

  • Dramamine
  • Monistat

Please review all prescription medications with us in the office, as some medications may not be safe in pregnancy.

Nausea and vomiting

Most pregnant women experience some degree of nausea and vomiting especially in the first trimester. They may be accompanied by headache and even some dizziness.

The following suggestions may help. If you are having trouble keeping food down, vomit blood, faint, or lose more than 3 pounds a week, contact the office immediately.

  • Any calories are good calories at this point.  If it stays down it is good food.
  • Eat frequent small meals.  You should eat something at least every 2 hours.
  •  Starch is generally well tolerated.
  • Try to drink 64 ounces of fluid a day.  Milk may be intolerable.  Popsicles, smoothies, or soda (not diet) are often better tolerated than water.
  • Avoid foods that smell badly to you or to which you have developed an aversion-even if they are good for you.
  • Some people find tart foods decrease nausea.
  • Try ginger or B Natal Pops.
  • Vitamin B6 25mg. three times a day
  • If you cannot tolerate your vitamins, be sure to take Folic Acid 1mg a day.

Painting

Latex paints are mercury and lead-free. They are safe to use in pregnancy.  Work in a well-ventilated space and stay off ladders to reduce the risk of falls.

Preterm labor

In the third trimester you should note occasional mild tightening of the uterus. These episodes of tightness are called Braxton-Hicks contractions. They are completely normal. They should never occur more often than every 10 minutes. How do you tell them from preterm labor? You should call the office if you note:

  • More than 5 contractions an hour.
  • Menstrual cramps low in the pelvis that come and go or are constant
  • Low dull backache not relieved by Tylenol or change of position.
  • Sudden change or increase in vaginal discharge, especially if pink or watery.
  • A general feeling that something is not right.  You may not be able to say why, but this is an important feeling.

Saunas, hot tubs and tanning booths

None of these is recommended for pregnant women.  Extreme heat may have a damaging effect on your baby’s development. Bath water should be under 100 degrees Fahrenheit.

Travel

Most women are able to travel safely during their pregnancy. We recommend the following guidelines:

Discuss travel plans well in advance.

For automobile travel, be sure to wear your seat belts-both lap and shoulder. The lap belt should be low on the hips and not over the uterus. Do not sit in a car for over 2 hours. We recommend that you not sit with your legs crossed because of the increased risk of blood clots.

We recommend against domestic air travel after 35 weeks and international air travel after 28 weeks. Airlines often have restrictions for pregnancy and you should be certain to know the policy involved. Because of the risk of blood clots during flying, we recommend moving about the cabin and drink at least 8 oz. of water per hour.

If you plan to travel in your third trimester check with your insurance company to be certain that they will cover if you deliver out of the area. Ask for a copy of your records to take with you and come in for a visit before you leave. There is always a risk you could deliver in a strange location and with an unfamiliar care group.

Weight gain

Weight gain varies with individuals in pregnancy. You only need an additional 300 calories a day to grow a baby!  Avoid empty calories such as fast food, desserts, and sodas.

The ideal weight gain for a woman of ideal body weight is 25-30 pounds. That is about ½ to 1 pound a week. If a woman is overweight it is advisable to keep weight gain to 10-15 pounds. Mothers of twins generally will gain closer to 45 pounds. Most women feel better and recover faster if they adhere to these guidelines. If you would like assistance, we may refer you to a dietitian.

Work

Most pregnant women are able to work until the end of their pregnancy. If you do heavy lifting you should not lift over 30 pounds.  Be careful of good lifting posture.

By the third trimester you may have to modify your work patterns. If you have concerns please address them at your visit.

Additional Information

American College of Obstetrics and Gynecology is the official web site and provides a great amount of current medical information.

Baby Center is an excellent site for new parents containing information on pregnancy and new baby questions.

The FDA website provides information on food such as fish and cheese safety in pregnancy.

The March of Dimes provides information on pregnancy and baby health.

Shady Grove Adventist Hospital is our preferred hospital for obstetrics and surgery. There is a site for the birth advisor as well as general health information.

Mayo Clinic Health is sponsored by Mayo Clinic and has current and accurate information on a multitude of subjects.

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