Pregnancy Frequently Asked Questions & Concerns

Body Changes

Backache

Backaches can be common in pregnancy. Maintain a good posture, squat instead of bending, rise from lying by rolling on your side and pushing yourself up with your hands, exercise daily, wear comfortable low-heeled shoes, wear a maternity girdle and sleep on a flat, firm mattress.

Bleeding Gums

Bleeding gums are common during pregnancy from the increased dilation of the blood vessels. Gentle brushing with a soft bristle brush may prevent your gums from bleeding. Call your doctor if you experience nonstop or excessive bleeding.

Breast Tenderness

Breast tenderness is common during pregnancy, but wearing a supportive cotton bra can help. As your pregnancy continues, it is not uncommon to produce milk even before you deliver.

Constipation

Constipation can be common in pregnancy. Make sure to increase fluids to six to eight glasses of water per day. You can also take stool softeners (Colace or Dulcolax), Miralax, Milk of Magnesia, mineral oil or increase fiber intake in your diet. Mild laxatives are okay if a stool softener is not successful. Do not use an enema unless approved by your doctor.

Cramps

During your early and mid-trimesters, you may experience cramping from the enlarging of the uterus and from stretching of ligaments. Tylenol and exercise are recommended only for mild cramping. Call your OB/GYN if you experience severe cramping or bleeding with cramping.

Diarrhea

Your gastrointestinal tract may be more sensitive during pregnancy, which can result in diarrhea, which can be treated with Imodium, Metamucil, Kaopectate, and an increase fluids. Contact your OB/GYN if you have blood or mucus in your stool or if diarrhea persists for more than 48 hours.

Dizziness

It is common during pregnancy to become dizzy or lightheaded when you stand for long periods or change positions. Increase rest on your left side, eat small frequent meals and increase fluid intake throughout the day.

Gas and Bloating

Gas and bloating are common during pregnancy. Follow these tips to help with gas and bloating:

• Avoid foods that cause gas
• Avoid fried, fatty and greasy foods
• Eat small, frequent meals

Hair Care

During pregnancy, it is normal for your hair to become brittle and or to fall out at a higher rate. You may also notice increased hair loss during postpartum. Relaxers, perms and hair dyes are allowed after the completion of the first trimester.

Headaches

For headache relief during pregnancy, regular strength Tylenol is safe. Call your OB/GYN if you experience a headache with blurry vision or your headache is not relieved by Tylenol.

Heartburn

During pregnancy, your stomach produces more gastric acid which can lead to heartburn. Follow these tips to help with heartburn:

• Avoid spicy foods
• Remain upright for at least one hour after eating
• Use antacids such as Tums or Rolaids
• Use over the counter Pepcid, Maalox, Mylanta

Hemorrhoids

During pregnancy you will experience more pelvic pressure, which can cause hemorrhoids. Contact your doctor if the pain persists or if you experience excessive rectal bleeding. Follow these tips to help with hemorrhoids:

• Avoid constipation
• Use hemorrhoid creams or wipes, such as Anusol or Preparation H
• Use astringents such as Tucks Medicated pads

Increased Salivation

Increased salivation during pregnancy can be alleviated with unmedicated throat lozenges or by eating crackers.

Leg Cramps and Spasms

Calf muscle cramps spasms are common during pregnancy, especially at night and can be alleviated by massaging, stretching or applying a warm heating pad to the area of pain. Avoid toe pointing and lying flat on your back for relief. Call your OB/GYN if your leg cramps do not improve or occur only in one leg.

Nausea and Vomiting

Nausea and vomiting are common during the early stages of pregnancy but call your OB/GYN if you are unable to keep anything down for more than 24 hours. Follow these tips to help with nausea and vomiting:

• Avoid fatty, greasy and spicy foods
• Avoid sudden movements
• Eat small frequent meals.
• Stay hydrated
• Take 25mg of Vitamin B6 twice a day with half a Unisom tablet
• Try ginger in any form (ginger ale, ginger snaps, ginger tablets, etc.)

Nosebleeds

Nosebleeds may occur often during pregnancy due to increased dilation of the blood vessels. Cold compresses, lying down, tilting your head back and pinching your nose for five minutes can help stop nose bleeds. Call your OB/GYN if nosebleeds persist.

Palpitations

During pregnancy, you may feel as though your heart is racing or skipping a beat. While this is normal, call your OB/GYN if your palpitations are associated with chest pain, shortness of breath or fatigue.

Round Ligament Pain

Round ligaments are a pair of cordlike structures in the pelvis that help support the uterus by connecting the front of the uterus to the groin region. Pain in these ligaments can occur as the uterus grows and stretches and can worsen when you walk for long periods or when you move from sitting to standing. Follow these tips to help with round ligament pain:

• Stay hydrated
• Taking a warm bath
• Taking regular strength Tylenol
• Using a warm (NOT HOT) heating pad
• Wearing a maternity belt

Skin Changes

During pregnancy, you may notice changes to your skin, nails, and hair, and some of the most common changes include dark spots on the breasts, nipples, or inner thighs. You may also develop stretch marks. You may minimize the appearance of stretch marks by using cocoa butter lotion, Vitamin E oil or other over the counter products.

Swelling

During pregnancy, the extra fluid in the body and the pressure from the growing uterus can cause swelling in the ankles and feet and tends to get worse as a your due date nears, particularly near the end of the day and during hotter weather. Follow these tips to help with swelling:

• Avoid salty foods
• Avoid standing for long periods of time
• Elevate your feet higher than the level of your heart
• Wear loose clothing
• Wear wrist braces, especially at night, for carpal tunnel syndrome

Contact your OB/GYN if your experience headaches, blurry vision, swelling in your face or swelling in only one calf only, contact your doctor.

Vaginal Bleeding

You may experience vaginal bleeding for the following reasons:

• After a vaginal exam, you may have broken blood vessels in your cervix. The broken blood vessels can cause spotting.
• Having sex may cause some of the blood vessels to break and results in some spotting.
• A vaginal infection may cause bleeding.

Call your OB/GYN if you experience bright red blood, blood clots or sharp abdominal pains.

Vaginal Discharge

An increase in vaginal discharge is normal during pregnancy due to hormonal changes. Bath or shower daily and keep your vagina clean by washing with a mild/unscented soap. Wear cotton panties and avoid tight pants. Call your OB/GYN if you have burning, itching, pain or a foul odor with your discharge.

Varicose Veins

Varicose veins can occur from dilation of the blood vessels during pregnancy. To help prevent varicose veins, wear support pantyhose, avoid standing for long periods of time and elevate your legs at frequent intervals.

Weight Gain

Weight gain depends on your health and your body mass index (BMI) before you were pregnant. If you were underweight before pregnancy, you should gain more weight than a woman who had a normal weight before pregnancy. If you were overweight or obese before pregnancy, you should gain less weight. The amount of weight gain differs by trimester:

• During your first 12 weeks of pregnancy—the first trimester—you might gain only 1 to 5 pounds or none.
• If you were a healthy weight before pregnancy, you should gain a half-pound to 1 pound per week in your second and third trimesters.

Breastfeeding

How soon should I start breastfeeding after childbirth?

Most healthy newborns are ready to breastfeed within the first hour after birth. Holding your baby directly against your bare skin (called "skin-to-skin" contact) right after birth helps encourage the baby to start breastfeeding.

You also should ask about "rooming in," which means having your baby stay in your room with you instead of in the hospital nursery. Having your baby nearby makes it easier to breastfeed while you are still in the hospital.

How long should I breastfeed my baby?

Exclusive breastfeeding is recommended for the first 6 months of a baby’s life. Breastfeeding should continue up to the baby’s first birthday as new foods are introduced. You can keep breastfeeding after the baby’s first birthday for as long as you and your baby would like.

How often should I breastfeed my baby?

Let your baby set the schedule. During the first weeks of life, most babies feed at least 8 to 12 times in 24 hours, or at least every 2 to 3 hours (timed from the start time of one feeding to the start time of the next feeding).

Many newborns breastfeed for 10 to 15 minutes on each breast. But they also can nurse for much longer periods (sometimes 1 to 2 hours at a time) or feed very frequently (every 30 minutes, which is called “cluster feeding”).

Some babies feed from one breast per feeding, while others feed from both breasts. When your baby releases one breast, offer the other. If your baby is not interested, plan to start on the other side for the next feeding.

What should I do if I am having trouble breastfeeding?

If you are interested in breastfeeding, Baton Rouge General’s highly trained lactation nurses are available to help you and your baby learn everything you need to know. Part of our commitment to caring for you and your baby is giving you full access to our Guided Infant Feeding Techniques (GIFT) Certified Breastfeeding Support Team during your hospital stay. We're available to answer questions and be your personal guide through this amazing bonding experience with your little one.

To talk with one of your breastfeeding specialists, call (225) 763-4127 or email Breastfeeding@BRGeneral.org.

Can I drink caffeine while breastfeeding?

Drinking caffeine in moderate amounts (200 milligrams a day) most likely will not affect your baby. Newborns and preterm infants are more sensitive to caffeine’s effects. You may want to consume a lower amount of caffeine in the first few days after your baby is born or if your infant is preterm.

Can I drink alcohol while breastfeeding?

If you want to have an occasional alcoholic drink, wait at least 2 hours after a single drink before you breastfeed. The alcohol will leave your milk as it leaves your bloodstream—there is no need to express and discard your milk. Drinking more than two drinks per day on a regular basis may be harmful to your baby and may cause drowsiness, weakness, and abnormal weight gain.

Breeching

What does it mean when a fetus is breech?

In the last weeks of pregnancy, a fetus usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation. A breech presentation occurs when the fetus’s buttocks, feet, or both are in place to come out first during birth. This happens in 3–4% of full-term births.

What are the options for birth if my fetus is breech?

Most fetuses that are breech are born by planned cesarean delivery. A planned vaginal birth of a single breech fetus may be considered in some situations. Both vaginal birth and cesarean birth carry certain risks when a fetus is breech. However, the risk of complications is higher with a planned vaginal delivery than with a planned cesarean delivery.

What complications can occur during a vaginal birth of a breech fetus?

In a breech presentation, the body comes out first, leaving the baby’s head to be delivered last. The baby’s body may not stretch the cervix enough to allow room for the baby’s head to come out easily. There is a risk that the baby’s head or shoulders may become wedged against the bones of the mother’s pelvis. Another problem that can happen during a vaginal breech birth is a prolapsed umbilical cord. It can slip into the vagina before the baby is delivered. If there is pressure put on the cord or it becomes pinched, it can decrease the flow of blood and oxygen through the cord to the baby.

What things do I need to consider if I want to have a vaginal birth and my fetus is breech?

If you are thinking about having a vaginal birth and your fetus is breech, your health care professional will review the risks and benefits of vaginal birth and cesarean birth in detail. You usually need to meet certain guidelines specific to your hospital. The experience of your health care professional in delivering breech babies vaginally also is an important factor.

Car Safety

If I am pregnant, when should I buy a car seat for my baby?

You cannot take your newborn home from the hospital without a car seat. Plan to have the car seat at least 3 weeks before your due date so you will have time to install it correctly and learn how to buckle the baby in safely.

What should I keep in mind when choosing a car seat?

Know whether your car has the LATCH system. LATCH stands for Lower Anchors and Tethers for Children. Instead of seat belts, special anchors hold the seat in place. If your car and car seat do not have the LATCH system, you will need to use seat belts to install the car seat.

Try locking and unlocking the buckle while you are in the store. Try changing the lengths of the straps.

Read the labels to find out the seat’s height and weight limits.

The National Highway Traffic Safety Administration offers parents a five-star rating system on its web site (http://www.nhtsa.gov/nhtsa_eou) based on how easy certain car seats are to use.

What do I need to do after I buy a car seat?

After you buy the seat, register it with the maker using the card that comes with the seat, or register it online with the National Highway Traffic Safety Administration at https://www.nhtsa.gov/equipment/car-seats-and-booster-seats#registration. Registering your car seat allows you to get updates and recall notices.

You can take your car and the seat to a car seat inspection station. These stations can check whether your car seat is installed correctly after you have installed it yourself. Find a station near you at www.safercar.gov.

Food & Nutrition

Why is nutrition during pregnancy important?

Eating well is one of the best things you can do during pregnancy. Good nutrition helps you handle the extra demands on your body as your pregnancy progresses. The goal is to balance getting enough nutrients to support the growth of your fetus and maintaining a healthy weight.

How much should I eat during pregnancy?

The popular saying is that pregnant women “eat for two,” but now we know that it’s dangerous to eat twice your usual amount of food during pregnancy. Instead of “eating for two,” think of it as eating twice as healthy.

If you are pregnant with one fetus, you need an extra 340 calories per day starting in the second trimester (and a bit more in the third trimester). That's roughly the calorie count of a glass of skim milk and half a sandwich. Women carrying twins should consume about 600 extra calories a day, and women carrying triplets should take in 900 extra calories a day.

How can listeriosis affect pregnant women?

Pregnant women are 10 times more likely to get listeriosis than the general population. Vomiting and diarrhea can cause the body to lose too much water. This is called dehydration. Listeriosis also can cause miscarriage, stillbirth, or preterm labor.

What are the symptoms of listeriosis?

Listeriosis can cause mild, flu-like symptoms such as fever, chills, muscle aches, and diarrhea or upset stomach. You also may have a stiff neck, headache, confusion, or loss of balance. Symptoms may appear as late as 2 months after you have eaten something with Listeria. Many pregnant women do not have any symptoms. Even if you do not feel sick, you can pass the infection to your fetus.

How can I help prevent listeriosis?

To help prevent listeriosis, avoid eating the following foods while you are pregnant:

• Unpasteurized milk and foods made with unpasteurized milk, including soft cheeses
• Hot dogs and luncheon meats, unless they are heated until steaming hot just before serving
• Refrigerated pâté and meat spreads
• Refrigerated smoked seafood
• Unwashed raw produce such as fruits and vegetables

Avoid all raw and undercooked seafood, eggs, meat, and poultry while you are pregnant. Do not eat sushi made with raw fish (cooked sushi is safe). Cooking and pasteurization are the only ways to kill Listeria.

What other food safety guidelines should I follow?

Follow these steps for food safety:

Clean

• Wash your hands for at least 20 seconds before and after touching raw food, and after using the bathroom, changing diapers, or touching an animal.
• Rinse all raw produce thoroughly under running water before eating, peeling, cutting, or cooking.
• Do not rinse raw meat or poultry before cooking. That can spread bacteria to other kitchen surfaces.
• Keep your kitchen clean. Wash your utensils, countertops, and cutting boards with soap and hot water after using them.

Separate

• Keep raw meat, poultry, eggs, seafood, and their juices away from other food.
• Use a separate cutting board for raw meat, poultry, and seafood.
• Do not put cooked food on a plate that also held raw food, unless the plate was washed.
• Do not put cooked food in the same sauce that was used to marinate raw food, unless the sauce is boiled first.

Cook

• Use a food thermometer to check that meat, poultry, seafood, and eggs are at a safe temperature.
• Place the food thermometer in the thickest part of the food, away from bone, fat, and gristle.
• Cover, stir, and rotate food in a microwave to cook the food evenly. Allow for standing time before using a food thermometer.

Chill

• Keep your refrigerator at 40°F or below and your freezer at 0°F or below.
• Thaw food in a refrigerator, microwave, or cold water. Cook food immediately after thawing in a microwave or cold water.
• Meat and poultry thawed in the refrigerator may be refrozen before or after cooking. If thawed in a microwave or cold water, cook before refreezing.
• Do not leave perishable food at room temperature for more than 2 hours (1 hour when the outside temperature is above 90°F).
• Only buy eggs that are refrigerated. Store eggs in the refrigerator in their original carton and use within 3–5 weeks.
• Only buy precut produce that is refrigerated or surrounded by ice. Keep precut produce refrigerated at home.

Exercise

Is it safe to exercise during pregnancy?

If you are healthy and your pregnancy is normal, it is safe to continue or start regular physical activity. Physical activity does not increase your risk of miscarriage, low birth weight, or early delivery.

It’s still important to discuss exercise with your obstetrician–gynecologist (ob-gyn) during your early prenatal visits. If your ob-gyn gives you the OK to exercise, you can discuss what activities you can do safely.

How much should I exercise during pregnancy?

Ideally, pregnant women should get at least 150 minutes of moderate-intensity aerobic activity every week. An aerobic activity is one in which you move large muscles of the body (like those in the legs and arms) in a rhythmic way. Moderate intensity means you are moving enough to raise your heart rate and start sweating. You still can talk normally, but you cannot sing.

Examples of moderate-intensity aerobic activity include brisk walking and general gardening (raking, weeding, or digging). You can divide the 150 minutes into 30-minute workouts on 5 days of the week or into smaller 10-minute workouts throughout each day.

If you are new to exercise, start out slowly and gradually increase your activity. Begin with as little as 5 minutes a day. Add 5 minutes each week until you can stay active for 30 minutes a day.

If you were very active before pregnancy, you can keep doing the same workouts with your ob-gyn’s approval. But if you start to lose weight, you may need to increase the number of calories that you eat.

What precautions should I take when exercising during pregnancy?

Drink plenty of water before, during, and after your workout. Signs of dehydration include dizziness, a racing or pounding heart, and urinating only small amounts or having urine that is dark yellow.

Wear a sports bra that gives lots of support to help protect your breasts. Later in pregnancy, a belly support belt may reduce discomfort while walking or running.

Avoid becoming overheated, especially in the first trimester. Drink plenty of water, wear loose-fitting clothing, and exercise in a temperature-controlled room. Do not exercise outside when it is very hot or humid.

Avoid standing still or lying flat on your back as much as possible. When you lie on your back, your uterus presses on a large vein that returns blood to the heart. Standing motionless can cause blood to pool in your legs and feet. These positions may cause your blood pressure to decrease for a short time.

What exercises should I avoid during pregnancy?

While pregnant, avoid activities that put you at increased risk of injury, such as the following:

• Contact sports and sports that put you at risk of getting hit in the abdomen, including ice hockey, boxing, soccer, and basketball
• Skydiving
• Activities that may result in a fall, such as downhill snow skiing, water skiing, surfing, off-road cycling, gymnastics, and horseback riding
• "Hot yoga” or “hot Pilates,” which may cause you to become overheated
• Scuba diving
• Activities performed above 6,000 feet (if you do not already live at a high altitude)

Labor

What happens to the body when labor begins?

As labor begins, the cervix opens (dilates). The muscles of the uterus contract at regular intervals. When the uterus contracts, the abdomen becomes hard. Between the contractions, the uterus relaxes and become

What changes should I watch for?

Certain changes may signal that labor is beginning. These changes include:

• Lightening
• Loss of the mucus plug
• Rupture of membranes
• Contractions

You might or might not notice some of these changes before labor begins.

What do contractions feel like?

As your uterus contracts, you may feel pain in your back or pelvis. This pain may be like menstrual cramps. Labor contractions happen in a regular pattern and get closer together over time.

What are Braxton Hicks contractions?

Braxton Hicks contractions are mild and irregular contractions that occur less than four times in an hour and are common after 20 weeks.

If you experience regular contractions before 36 weeks which occur greater than 4 times an hour and are not relived by increased water intake and lying down on your side, call your OB/GYN.

After 36 weeks, call your OB/GYN if your contractions occur every five to eight minutes for two hours.

How will I be able to tell the difference between “false” labor and “true” labor?

Usually, “false” contractions are less regular and not as strong as “true” labor. Time your contractions and note whether they continue when you are resting and drinking water. If rest and hydration make the contractions go away, they are not true labor contractions.

What should I discuss with my health care team before my due date?

Well before your due date, talk about the following with your health care team:

• The right time to call your ob-gyn or other obstetric care provider
• How to reach your doctor, provider, or nurse after office hours
• Whether to call first or go directly to the hospital
• Special steps you should take if you think labor has begun

Will my epidural wear off if given too early in the laboring process?

This is a common misconception. Epidurals can be given whenever the patient is ready and they DO NOT wear off at any time.

Medications

The medications listed below are considered safe for use during pregnancy.

Acid Reflux/Heartburn Medication

• Tum’s
• Rolaids
• Pepcid
• Nexium
• Prilosec OTC

Allergy Medication

• Benadryl
• Rhinocort Aqua nasal spray
• Claritin
• Zyrtec
• Allegra

Cold & Cough/Nasal Congestion Medication

• Cough Drops
• Tylenol Cold & Flu
• Robitussin DM (sugar free)
• Mucinex (without Dextromethorphan)
• Sudafed (without Phenylephrine - PE)
• Saline nasal spray

Constipation Medication

• Milk of Magnesia
• Metamucil / Citrucel
• Colace / Ducolax
• Miralax
• Mineral Oil

Diarrhea Medication

• Imodium
• Phazyme

Hemorrhoid Medication

• Tucks Medicated Pads
• Preparation H (ointment/wipes)
• Anusol

Motion Sickness Medication

• Dramamine
• Nausea Medication
• Ginger (Ale, Snaps, Tablets)
• Unisom (Doxylamine) Sleep Tablets with Vitamin B6

Pain Medication

• Tylenol (not ibuprofen)

Rash Medication

If you have itching that lasts a few days, call your doctor’s office.

• Caladryl
• Hydrocortisone 1%
• Oatmeal bath
• Benadryl

Yeast Infection Medication

• Monistat 7

Testing & Screenings

What tests are done early in pregnancy?

Several routine lab tests are done early in pregnancy, including:

• Complete blood count (CBC)
• Blood type and Rh factor
• Urinalysis
• Urine culture

Also, pregnant women typically are tested for specific diseases and infections early in pregnancy, including:

• Rubella
• Hepatitis B and hepatitis C
• Sexually transmitted infections (STIs)
• Human immunodeficiency virus (HIV)
• Tuberculosis (TB)

What is the first step to screen for birth defects during pregnancy?

Screening for birth defects begins by assessing your risk factors. Early in your pregnancy, your obstetrician–gynecologist (ob-gyn) may give you a list of questions to find out whether you have risk factors. If you do have risk factors, you might want to see a genetic counselor for more detailed information about your risks.

What factors increase the risk of birth defects?

Most babies with birth defects are born to couples without risk factors. But the risk of birth defects is higher when certain factors are present. Risk factors include:

• Having a personal or family history of birth defects
• Belonging to certain ethnic groups
• Being 35 or older
• Having diabetes before pregnancy

What is the difference between screening and diagnostic testing for birth defects?

When done during pregnancy, screening tests assess the risk that the fetus has certain common birth defects. A screening test cannot tell whether the fetus actually has a birth defect. There is no risk to the fetus from screening tests.

Diagnostic tests can detect many, but not all, birth defects caused by defects in a gene or chromosomes. Diagnostic testing may be done instead of screening if a couple has a family history of a birth defect, belongs to a certain ethnic group, or already has a child with a birth defect. Diagnostic tests also are available as a first choice for all pregnant women, including those who do not have risk factors. Some diagnostic tests carry risks, including a small risk of pregnancy loss.

Am I required to have screening or testing for birth defects?

No, screening and testing are a personal choice. Some couples would rather not know if they are at risk of having a child with a birth defect or whether their child will have a birth defect. Others want to know in advance.

Knowing beforehand allows the option of deciding not to continue the pregnancy. If you choose to continue the pregnancy, knowing beforehand gives you time to prepare for having a child with a disorder. This means you can organize the medical care your child may need. Talk with your ob-gyn or genetic counselor about your test results.

What is carrier screening?

Carrier screening is a type of genetic test that can tell you whether you carry a gene for certain genetic disorders. When it is done before or during pregnancy, it allows you to find out your chances of having a child with a genetic disorder.

How is carrier screening done?

Carrier screening involves testing a sample of blood, saliva, or tissue from the inside of the cheek. Test results can be negative (you do not have the gene) or positive (you do have the gene). Typically, the partner who is most likely to be a carrier is tested first. If test results show that the first partner is not a carrier, then no additional testing is needed. If test results show that the first partner is a carrier, the other partner is tested. Once you have had a carrier screening test for a specific disorder, you do not need to be tested again for that disorder.

What carrier screening tests are available?

Carrier screening is available for a limited number of diseases, including:

• Cystic fibrosis
• Fragile X syndrome
• Sickle cell disease
• Tay–Sachs disease

Some of these disorders occur more often in certain races or ethnic groups. For example, sickle cell disease often affects people of African descent. Tay–Sachs disease typically affects people of Eastern or Central European Jewish, French Canadian, and Cajun descent. But anyone can have one of these disorders. They are not restricted to these groups.

What tests are done later in pregnancy?

The tests done later in pregnancy include glucose screening and group B streptococcus (GBS) screening.