The first fetal movements are called “quickening” and can be felt sometime between 16-20 weeks in most patients.  These usually start as “flutters” of movement and then eventually progress to full fetal movements.  Fetal movements then become consistent by 24 weeks, but may begin to slow in the later third trimester due to the larger size of the baby and patients becoming used to the movements.

If you notice a decrease in your baby’s movements, we recommend performing kick counts in which you focus closely and count any fetal movements.  If you feel 10 movements within a 2 hour period, this is reassuring.  If you do not, call our office for further recommendations.

The important warning signs of pregnancy are:

• Vaginal bleeding
• Leaking vaginal fluid
• Change or decrease in baby’s movement (once you start feeling movement at 20-24 weeks) — see section above
• Severe headaches accompanied by increased swelling in hands and feet and/or face and visual changes such as blind spots in your vision
• Burning with urination
• Temperature above 100.4 degrees

If any of these occur please contact the office immediately.

Diarrhea – Should this happen increase your fluids intake to at least 6 to 8 glasses every day. Sports drinks such as Gatorade or Powerade are helpful.  Avoid milk or milk products until the diarrhea has stopped. Eat foods such as bananas, rice, apple sauce, tea, and toast. You may use Imodium as directed which can be purchased without a prescription. If the diarrhea continues for more than 24 hours, please call the office.

Constipation – You should be drinking 8 to 10 glasses of liquids a day while you’re pregnant. This will help to prevent you becoming constipated in the first place. Fruit juices such as prune and apple juice are very good at keeping you regular and should be included. You should also increase the fiber in your diet by eating bran or shredded wheat cereals, bran muffins, raw fruits and vegetables. Daily exercise, particularly walking, will also help to prevent constipation. If constipation should occur, there are several non-prescription medications that may be used – Metamucil, Citrucel, Fibercon, Haley’s MO, and Milk of Magnesia.  Occasional use of laxatives may also be needed.  Ask your doctor for further recommendations.

Heartburn or Indigestion – Eat small, frequent meals (5 or 6 a day). Drink liquids, especially milk, between meals rather than with meals. Avoid fatty or fried foods, alcohol (which we recommend you avoid at all times during your pregnancy) and carbonated beverages. Sit up during and for one hour following meals. You may use non-prescription low sodium antacids such as Maalox, Tums, Rolaids or Gaviscon. Zantac or Pepcid may be helpful. You can also try eating crackers. If you obtain no relief with these measures, certain prescription medications are safe in pregnancy, so please notify your provider.

Nausea (Morning Sickness) – Nausea and vomiting in pregnancy is commonly referred to as “morning sickness”, but it can occur at any time of the day or night, usually when the stomach is empty. Keeping something in your stomach by eating small, frequent meals (5 or 6 a day) will help to prevent it from happening. Avoid spicy and greasy foods. Drinking liquids between meals instead of with meals may be helpful. Try antacids to help settle your stomach and eat a clear liquid diet for 24 hours. If nausea is a problem when you get up in the morning, try a high protein snack before bed and eat something before getting out of bed in the morning such as pretzels or soda crackers. Dehydration can also increase your nausea so drink plenty of fluids. Avoid unpleasant odors. Over-the-counter seasickness medication helps some people. Taking your vitamin at night may help, or switching to a chewable formula. Vitamin B6 and B-natal therapops or lozenges over-the-counter are a good first choice in treating morning sickness. If these conservative measures are not successful in getting your nausea/vomiting to an acceptable level, please notify your provider.

You should call the office anytime you are unable to keep fluids down for 24 hours.

Urinary Tract Infections – Symptoms of a urinary tract infection include pain or burning with urination and increased frequency of urination. The urine may be cloudy or have a strong odor. Unexplained lower abdominal cramping, often accompanied by a backache, as well as a fever greater than 100.4 can also mean a UTI. An untreated urinary tract infection can cause premature labor, so do not delay seeking treatment. If you suffer from these symptoms you should call the office and we will arrange a urinalysis for you. It is essential to drink plenty of water (8 to 10 glasses a day) if you think you have a urinary tract infection. Cranberry juice may also be helpful.  You should also avoid caffeinated and carbonated beverages, as they can irritate the bladder and increase your pain and discomfort.

Edema – Some edema, or swelling, is normal during pregnancy. Generally edema appears in the ankles and legs during the final months of pregnancy, and swelling in the hands is also very common. To reduce your discomfort you should elevate your legs whenever possible.  Other things you can do are to rest on your left side and reduce your intake of foods containing salt (many foods such as fast food, pizza, deli meats, boxed food, ready made meals and food from a can or jar such as spaghetti sauce and canned tomatoes contain large amounts of salt). Drinking an adequate amount of water is the best way to get rid of excess swelling, so drink 8 to 10 glasses a day. Please call the office if the swelling is severe or if accompanied by a headache unrelieved by Tylenol, or if you have visual changes, or upper right abdominal pain.

Bleeding – Spotting of blood may occur in 40% of all normal pregnancies during the first trimester. Possible causes of bleeding in the first trimester unrelated to miscarriage include: recent intercourse, recent pelvic exam or an irritated cervix. If you are spotting, begin bedrest and call the office. Avoid heavy lifting, exercise, and sexual intercourse for 48 hours after the last episode of spotting.

The weight gain recommended during a single gestation pregnancy is generally around 20-30 pounds. However, this can be different for each individual. As everyone is different you should discuss your particular situation with your doctor.

Meat, fish and poultry are all part of a healthy diet but you should make sure they are well cooked. The FDA also recommends heating deli meats to help prevent Listeria infection.  Toasting is preferred to microwaving.

Fish is recommended in your diet because of the health benefits of fish oil. However, fish and shellfish all contain traces of mercury which may be harmful to a baby’s developing nervous system. Therefore, you should limit all fish & seafood intake (including canned tuna) to 2 servings per week.  Also, pregnant or breastfeeding mothers should avoid shark, swordfish, mackerel and tilefish as these are higher in mercury.

Alcohol – Alcohol can cause mental retardation and slow growth. Because medical researchers do not know how much alcohol it takes to affect the developing baby during pregnancy, we recommend you do not drink. The fetus is especially vulnerable during the first trimester when all the major systems are forming.

Drugs – Recreational drug use, especially cocaine, can cause serious complications – miscarriage, fetal stroke, brain damage, and even fetal death. Your baby may become addicted to any drugs you take. If you have used such a substance during pregnancy, please stop immediately and alert your physician.

Smoking harms your baby! Women who smoke during pregnancy have a greater risk of smaller babies, premature births, miscarriage, stillbirth, and increased respiratory problems in the baby after birth because smoking interferes with the oxygen and nutrient supply. In addition, the fetus is exposed to carbon dioxide, tar, and nicotine. Some studies show an increased risk of Sudden Infant Death Syndrome (SIDS) in babies exposed to cigarette smoke during pregnancy. There is recent evidence linking smoking to learning disabilities and growth retardation. If you are a smoker and have just discovered that you are pregnanct, stop NOW!

Dental cleaning and even procedures are okay and recommended when you are pregnant, but you should make sure the dentist knows you are pregnant. If they take x-rays your abdomen should be covered with a lead drape. It is ok to have local anesthetic, antibiotics, and/or nitrous if the dentist deems necessary.

Your gums may bleed more easily when you are pregnant. This is because of the increased blood supply to the oral tissues during pregnancy. You should brush at least twice daily using a soft toothbrush and also floss once a day.

Travel by any mode of transportation is considered safe up until 36 weeks of gestation in an uncomplicated healthy pregnant patient.  Some airlines may have other restrictions.  If you are flying, it is important to move your lower extremities regularly during a flight to prevent venous thrombosis (blood clots).  Compression stockings worn during air travel may also help decrease this risk. It is also a good idea to walk the aisle at least once every 1-2 hours.   Your seat belt should be worn at all times when sitting to avoid trauma due to potential air turbulence.

Remember to bring healthy snacks and plenty of water to drink on longer trips. When in a car, you should get up or stop every couple of hours and stretch your legs. Always use seat belts, and place the lap belt low on the hips (below your baby). If you are planning travel in the third trimester, check with your doctor beforehand.

Regular exercise is important. Thirty minutes or more of moderate exercise a day on most if not all days of the week is recommended by the American College of Obstetrics and Gynecology.  Walking, swimming, cycling, and prenatal exercise classes are all recommended. Swimming is safe during pregnancy as long as your bag of water is not leaking. Low impact aerobics are an excellent way of exercising during pregnancy and classes are available in the community. If you are already a competitive athlete or partake in more strenuous activities, many of these can be continued during your pregnancy, but you should discuss the specifics of your exercises with your doctor for further recommendations.  If any activity causes you pain you should discontinue it immediately.

Exercises that increase risk of abdominal trauma are not recommended during pregnancy.  These include: snow or water skiing, gymnastics, and horseback riding.  You should also avoid SCUBA diving at any point in pregnancy.

Unless you’ve been told to refrain or there is a specific problem with the pregnancy, such as placenta previa, bleeding, leaking bag of water, or preterm contractions, sexual intercourse is safe during pregnancy. If intercourse is painful or causes bleeding or prolonged contractions (it is normal to have some spotting or contractions following intercourse), please talk with your physician.

We do not advise hot tubs due to the high temperature of the water. This is especially important in the first trimester as extreme maternal temperature could potentially cause a neural tube defect. You should also avoid a tub bath where the water is so hot that your skin becomes reddened or you become dizzy when you stand up. Water this hot raises the core temperature of your body and is not healthy for your baby.

Caffeine, in moderation, is safe. We recommend limiting intake to no more than 200mg of caffeine per day. This usually is equivalent to 1-2 caffeinated beverages daily. Beverages that contain caffeine include coffee, tea, chocolate and many carbonated soft drinks.

You should avoid changing the kitty litter if at all possible since cat bowel movements may contain a parasite that can cause a serious infection. These infections can lead to birth defects. If you have to change the litter, use rubber gloves, wear a mask and wash your hands afterward. You should also wear gardening gloves when digging in the dirt in an area the neighborhood cats may use as a kitty litter box.

There are not good studies on the effects of hair dye in pregnancy, but the sytemic absorption of these chemicals in a healthy patient is minimal. As long as you have your hair colored, highlighted or permed in a well-ventilated room it should be safe. However, due to hormonal changes caused by pregnancy your hair may not react in the same way as it did before you became pregnant.

It is perfectly fine to paint the inside of your house during pregnancy. Make certain that the room is well ventilated, opening windows if possible, or using ceiling fans. Always make certain that the paint you are using is lead-free.

As skin cancer is now the most common form of cancer with more than a million new cases every year we recommend that you do not use them. All medical practitioners recommend you use a sun screen when outdoors whether pregnant or not.

Shingles and Chicken Pox are actually caused by the same virus. While you cannot catch Shingles from a person who has Shingles, the virus would be more likely to affect the non-immunized patient in the form of Chicken Pox. If you have had Chicken Pox or have had the vaccine, you should be immune to the virus.

Fifth’s Disease is a common childhood disease that is most often transmitted through respiratory secretions and hand-to-mouth contact. While many women have been previously exposed and are immune to this virus, if infection occurs, it can cause anemia in the fetus during the second trimester. If you think you have been exposed, please call the office, and we will set up a lab appointment to determine your immunity to this virus.

• Your membranes rupture (your “water breaks”), even if you are not having any contractions
• You are bleeding from the vagina (other than bloody mucus)
• You are having contractions every 5 minutes or closer for 1 – 2 hours

The following are other signs that should prompt you to call or go to the hospital: 

• You have constant, severe pain with no relief between contractions
• You notice the baby is moving less often