As long as you don’t have any medical issues or high risk pregnancy complications, shoot for 30 minutes of low-impact exercise, such as walking or stationary cycling, at least five days a week. Along with keeping your weight in check, it can ease constipation, insomnia, lower back pain, and other pregnancy discomforts while building stamina for labor and delivery.
If you have a balanced diet, you do not have to take a prenatal multivitamin. However, most women, do supplement their nutrition with prenatal vitamins. Prenatal vitamins come in different sizes and shapes. They have vegan options as well. Most importantly, make sure you pick a prenatal vitamin that has the following nutrients:
Folic Acid: also known as folate, is a B vitamin that is important for pregnant women. Before pregnancy and during pregnancy, you need 400 micrograms of folic acid daily to help prevent major birth defects of the fetal brain and spine called neural tube defects. Current dietary guidelines recommend that pregnant women get at least 600 micrograms of folic acid daily from all sources. It may be hard to get the recommended amount of folic acid from food alone. For this reason, all pregnant women and all women who may become pregnant should take a daily vitamin supplement that contains folic acid.
Iron: is used by your body to make a substance in red blood cells that carries oxygen to your organs and tissues. During pregnancy, you need extra iron—about double the amount that a nonpregnant woman needs. This extra iron helps your body make more blood to supply oxygen to your fetus. The daily recommended dose of iron during pregnancy is 27 mg, which is found in most prenatal vitamin supplements. You also can eat iron-rich foods, including lean red meat, poultry, fish, dried beans and peas, iron-fortified cereals, and prune juice. Iron also can be absorbed more easily if iron-rich foods are eaten with vitamin C-rich foods, such as citrus fruits and tomatoes.
Calcium: is used to build your fetus's bones and teeth. All women, including pregnant women, aged 19 years and older should get 1,000 mg of calcium daily; those aged 14–18 years should get 1,300 mg daily. Milk and other dairy products, such as cheese and yogurt, are the best sources of calcium. If you have trouble digesting milk products, you can get calcium from other sources, such as broccoli; dark, leafy greens; sardines; or a calcium supplement.
Nausea and vomiting of pregnancy is a very common condition. Although nausea and vomiting of pregnancy often is called “morning sickness,” it can occur at any time of the day. Nausea and vomiting of pregnancy usually is not harmful to the fetus, but it can have a serious effect on your life, including your ability to work or do your normal daily activities.
Nausea and vomiting of pregnancy usually starts before 9 weeks of pregnancy. For most women, it goes away by the second trimester (14 weeks of pregnancy). For some women, it lasts for several weeks or months. For a few women, it lasts throughout the entire pregnancy.
Some women feel nauseated for a short time each day and may vomit once or twice. This usually is defined as mild nausea and vomiting of pregnancy. In more severe cases, nausea lasts several hours each day and vomiting occurs more frequently. Deciding to seek treatment depends on how much nausea and vomiting of pregnancy affects your life and causes you concern, not whether your condition is “mild” or “severe.”
Having nausea and vomiting of pregnancy usually does not harm your health or your fetus’s health. It does not mean your fetus is sick. It can become more of a problem if you cannot keep down any food or fluids and begin to lose weight. When this happens, it sometimes can affect the fetus’s weight at birth. You also can develop problems with your thyroid, liver, and fluid balance.
Diet and lifestyle changes may help you feel better. You may need to try more than one of these suggestions:
- Take a multivitamin.
- Try eating dry toast or crackers in the morning before you get out of bed to avoid moving around on an empty stomach.
- Drink fluids often.
- Avoid smells that bother you.
- Eat small, frequent meals instead of three large meals.
- Try bland foods. For example, the “BRATT” diet (bananas, rice, applesauce, toast, and tea) is low in fat and easy to digest.
- Try ginger ale made with real ginger, ginger tea made from fresh grated ginger, ginger capsules, and ginger candies.
If diet and lifestyle changes do not help your symptoms, or if you have severe nausea and vomiting of pregnancy, medical treatment may be needed. If other medical conditions are ruled out, certain medications can be given to treat nausea and vomiting of pregnancy:
Vitamin B6 and doxylamine—Vitamin B6 is a safe, over-the-counter treatment that may be tried first. Doxylamine, a medication found in over-the-counter sleep aids, may be added if vitamin B6 alone does not relieve symptoms. A prescription drug that combines vitamin B6 and doxylamine is available. Both drugs—taken alone or together—have been found to be safe to take during pregnancy and have no harmful effects on the fetus.
“Antiemetic” drugs—If vitamin B6 and doxylamine do not work, “antiemetic” drugs may be prescribed. These drugs prevent vomiting. Many antiemetic drugs have been shown to be safe to use during pregnancy. Others have conflicting or limited safety information. You and your obstetrician or other members of your health care team can discuss all of these factors to determine the best treatment for your personal situation.
Although there have been many studies on whether caffeine increases the risk of miscarriage, the results are unclear. Most experts state that consuming fewer than 200 mg of caffeine (one 12-ounce cup of coffee) a day during pregnancy is safe. You can drink a cup of average brew coffee.
Some types of fish have higher levels of a metal called mercury than others. Mercury has been linked to birth defects. To limit your exposure to mercury, follow a few simple guidelines. After 20 weeks, you can choose fish and shellfish such as shrimp, salmon, catfish, and pollock. Do not eat shark, swordfish, king mackerel, orange roughy, or tilefish. Limit white (albacore) tuna to 6 ounces a week. You also should check advisories about fish caught in local waters.
You can visit your dentist and undergo most common procedures with precautions without any adverse effect on your pregnancy. We can provide a note for that. It can reduce your risk of going into preterm labor.
The amount of weight gain that is recommended depends on your health and your body mass index before you were pregnant. If you were a normal weight before pregnancy, you should gain between 25 pounds and 35 pounds during pregnancy. If you were underweight before pregnancy, you should gain more weight than a woman who was a normal weight before pregnancy. If you were overweight or obese before pregnancy, you should gain less weight.
- Smoking: stop or cut-down if you have a history of smoking
- Alcohol: Avoid ALL alcohol during pregnancy. Fetal Alcohol syndrome is assoc with alcohol intake during pregnancy
- Avoid hot tubs
- Avoid Vitamin A derivatives or ACNE products that contain vitamin A derivative. It is teratogenic
- Avoid raw meat, uncooked meat, unpasteurized milk, deli meats.
- Avoid cleaning the cat litter box.
- Avoid NSAIDs (aspirin, ibuprofen etc), unless approved by your doctor.
- Avoid lifting >20 lbs of weight.
In our office, we perform several important tests at different milestones of your pregnancy.
Initial visit may include the following
• Pap Smear (done in the first trimester) – a test for cancer of the cervix
• Urine Culture- a test for bacteria that can cause complications during pregnancy
• Prenatal Blood Work (First trimester)
o Blood type and Rh factor, Complete blood count (CBC), Rubella titer (test to see if you are protected against the German measles), VDRL (screening test for syphilis), HIV (recommended test for all pregnant), Hep B (screening test for Hepatitis B).
• Ultrasound (1st trimester & 20 weeks) – Done to confirm your due date and to screen for abnormalities.
• Glucose Tolerance test (24-28 weeks) – Screening test for diabetes in pregnancy. A second trimester (32 week) blood draw is often performed to assess changes to your health during pregnancy.
• Group B Streptococcus (35 weeks) – a test for bacteria found in some pregnant women that can be passed to the infant during delivery. Obtained via vaginal and rectal swab.
• Optional but commonly included tests: Genetic Screening Tests: Baseline risks of baby with chromosomal abnormality is approximately 1:500 with Down Syndrome prevalence at approximately 1 in 800 births. Genetic screening test can be accomplished via a combination of blood test and Ultrasound analyses. If screening test is positive, further diagnostic testing may be needed.
Consider Non-Invasive Prenatal Testing (NIPT) to screen baby for chromosomal abnormalities as early as 10-11 weeks.
We request level II Ultrasound with a Perinatologist in the community to assess fetal anatomy around 18 weeks. If both the above tests are negative, you are at low risk for fetal chromosomal imbalance or aneuploidy.
Cold / Congestion
--Tylenol Cold and Sinus (Avoid drugs with Phenylephrine)
--Heated, humidified air
Pain (headache, backache)
--Tylenol (avoid ibuprofen, aleve, midol or other non-steroidal anti-inflammatory medications)
--Unisom (Doxylamine) (Diclegis) (Bonjesta) – one tablet at bedtime
--Maalox / Mylanta
--Saline Nasal Rinse
--Steroid nasal sprays (Flonase, Veramyst, Rhinocort)
--Metamucil or Fibercon
--Colace (Docusate) – stool softener
-- Miralax (last resort!)
-- Rest, Hydration, Electrolyte rich drinks (Gatorade) (Avoid Immodium)
-- Most over the counter preparation are ok (Eg; Preparation H, Anusol etc)
Most women may feel some flutters or movement as early as 15-16 weeks.
Regular movements (10x in 2 hours) are not percieved until 24 weeks.
At 28 weeks, fetal movements become strong and frequent that it may wake you up at night :)
By 37 weeks, as the baby grows bigger and there is limited space in the womb, the movements may become less in intensity but remain the same frequency.
On average, you should feel the baby move 10 x in 2 hours. If you feel that your baby is not moving, drink cold water/juice and sit in a quiet room. If you still dont feel the baby move, call our office for an appointment or go to the hospital.
In some women, the hormonal changes in pregnancy can lead to higher than normal glucose levels in the blood. This elevated glucose levels can cause excessive weight gain for the fetus (Macrosomia), excessive fluid around the fetus (Polyhydramnios) and is associated with other pregnancy related complications (Elevated blood pressure, Preeclampsia, abnormal labor, increased risk of cesarean section etc).
Around 24-28 weeks, we give pregnant mothers a fixed amount of glucose (50g sugar drink) and measure their glucose levels afterwards. If they are above normal limits, they are sent for a diagnostic test with a higher glucose drink that is used to diagnose Gestational Diabetes. Patients diagnosed with gestational diabetes require closer monitoring and testing. Often, they may be selected to deliver earlier than 39 weeks to prevent complications arising from elevated maternal blood glucose.
The best way to prevent Diabetes during pregnancy is to control your diet and continue exercising to prevent excessive weight gain.
As you get closer to your due date, you will start experiencing uterine cramps, or contractions. These are often irregular and far apart in time. They are often referred to as Braxton Hicks Contractions, However, if the contractions start to get painful and increasing in frequency (every 5 minutes for 2 hours), then you may be in labor. We encourage our patients to call the office for directions and often, we are able to see them in the office to assess if they are in labor.
Women with prior pregnancies may progress into labor faster than a new mother with her first pregnancy.
We do our best to help mothers deliver without any interventions to help promote a natural child birth. However, we select the delivery method that is safe for both the mother AND the baby. In select patients, when there are certain complications that arise, a cesarean section may be a better delivery choice.
Common indications for cesarean sections include:
Absolute disproportion: Small maternal pelvis, making vaginal birth impossible
Chorioamnionitis (amniotic infection syndrome): Infection of the placenta and possibly of the fetus, requiring immediate delivery
Maternal pelvic deformity: Anatomical malformation, making vaginal birth impossible
Eclampsia and HELLP syndrome: Life-threatening complications of pregnancy, usually leading to cesarean delivery
Fetal asphyxia or fetal acidosis: Life-threatening situations for the fetus that can lead to fetal hypoxia
Umbilical cord prolapse: Prolapse of the umbilical cord between the head of the fetus and the vaginal opening, which can lead to fetal asphyxia
Placenta previa: Anomalous placental position, impeding vaginal delivery
Abnormal lie and presentation: Anomaly of fetal position that makes vaginal delivery impossible (Eg: Breech fetus)
Uterine rupture: Acute situation threatening the life of both mother and fetus, requiring immediate delivery by cesarean section
Prior Uterine Surgery: Patients with history of fibroid surgery (myomectomy) are unsafe to deliver vaginally and require delivery by cesarean section.
Pathological cardiotocography (CTG): May provide indication of acute hypoxia or fetal asphyxia. If fetal acidosis occurs, the birth should be completed either as an instrumental delivery (suction and/or forceps) or by cesarean section
Failure to progress in labor (prolonged labor, secondary arrest): Delayed delivery or cessation of labor can result in an adverse outcome for the fetus or newborn
Multiple cesarean section: It is widely assumed that having had 2 or more cesarean section makes it impossible to have a vaginal delivery in subsequent pregnancies. Certain patients may be eligible for a vaginal birth after a cesarean section (VBAC) after one cesarean section.
Continuous Leakage of Water – This may indicate that your water has broken. This is typically a large amount of fluid that will soak through your clothes and continues to leak even after the initial gush. If this happens, call us. A small leakage of fluid that does not continue may just be urine leaking and is unlikely to indicate that labor is approaching. If you suspect that you have rupture of membranes, go to the hospital for evaluation immediately.
Heavy Vaginal Bleeding – If you begin to have bleeding like a heavy period, call us. This may be a sign that labor is beginning. It is very common to have some spotting, especially after using the restroom. This is not usually associated with labor and will stop with time.
An epidural block (sometimes referred to as “an epidural”) is the most common type of pain relief used for childbirth in the United States. In an epidural block, medication is given through a tube placed in the lower back. For labor and vaginal delivery, a combination of analgesics and anesthetics may be used. You will have some loss of feeling in the lower areas of your body, but you remain awake and alert. You should be able to bear down and push your baby through the birth canal. For a cesarean delivery, the dose of anesthetic may be increased. This causes loss of sensation in the lower half of your body.
You can move with an epidural, but you may not be able to walk. Although an epidural block will make you more comfortable, you still may be aware of your contractions. You also may feel vaginal exams as labor progresses.
What are rare side effects of an Epidural?
As with systemic analgesia, use of opioids in an epidural block increases the risk that your baby will experience a change in heart rate, breathing problems, drowsiness, reduced muscle tone, and reduced breastfeeding. These effects are short term.
Less common side effects include the following:
Decrease in your blood pressure
Serious complications with epidurals are very rare and include the following:
Injury to your spinal cord or nerves
Breathing problems if the anesthetic affects your breathing muscles
Numbness, tingling, or rapid heartbeat if the anesthetic is injected into a vein instead of a nerve--Tylenol (avoid ibuprofen, aleve, midol or other non-steroidal anti-inflammatory medications)
Circumcision is a surgery that removes the skin that covers the tip of the penis, called the "foreskin". Circumcision is usually done when a boy is between 1 and 10 days old. It is more common in some parts of the world than others. Circumcision is also a common tradition in some religions. It is a elective procedure.
The benefits of circumcision are listed below:
Circumcised boys seem to have slightly lower rates of:
●Urinary tract infections
●Swelling of the opening at the tip of the penis
Circumcised men seem to have slightly lower rates of:
●Urinary tract infections
●Swelling of the opening at the tip of the penis
●HIV and other infections that you catch during sex
●Cervical cancer in the women they have sex with
Even so, the risks of these problems are small – even in boys and men who have not been circumcised. Plus, boys and men who are not circumcised can reduce these extra risks by: Cleaning their penis well and Using condoms during sex
●Bleeding or infection from the surgery
●Damage to the penis
●A chance that the doctor will cut off too much or not enough of the foreskin
●A chance that sex won't feel as good later in life
Only about 1 out of every 200 circumcisions leads to problems. There is also a chance that your health insurance won't pay for circumcision.
It is encouraged that babies receive no foods or liquids except breast milk for the first six months of life and then get complementary foods along with continued breastfeeding when your baby is 6-12 months of age.
Health benefits for infants:
• Stronger immune system
• Reduced risk for sudden infant death syndrome (SIDS)
• Reduced risk for gastrointestinal and severe lower respiratory tract infections
• Lower risk for developing asthma
• Protection against allergies and intolerances
• Promotion of correct development of jaw and teeth
• Association with a higher intelligence quotient and school performance
• Reduced risk for later development of chronic diseases such as obesity, diabetes, heart disease, high blood pressure, and high cholesterol.
• Lower risk of developing childhood leukemia (cancer of the blood)
Health benefits for the Mother:
• Strong bonding with infant
• Easier to return to pre-pregnancy weight due to the extra 300-500 calories burned in the body’s production of milk
• Faster shrinking of the uterus, helping reduce blood loss after birth
• Delays the return of menstrual periods after birth
• Decreased risk for developing type 2 diabetes
• Lower risk for developing breast and ovarian cancer later in life
• Decreased risk for post-partum depression
• Enhanced self-esteem in the maternal role
• Time and money saved from not having to buy and mix formula