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Prenatal FAQs
When will I feel the baby move?
Fetal movement (quickening) is typically noted at about 20 weeks of pregnancy. However, this is for a first time mother-to-be. Multiparous women (women that have already given birth) feel fetal movement much earlier. I have patients that claim they feel movement as early as 15-16 weeks gestation. The movement is described as a flutter. Movement this early is not noted daily. The most active time during a pregnancy is around 24-32 weeks. At this point the fetus is large and strong enough to give very strong motions. Additionally there is a lot of amniotic fluid allowing space for the fetus to move around.
The utilization of sonograms allows visualization of the fetus as early as 6 weeks. Fetal movement can be noted as early as 8 weeks with ultrasound.
Why is calcium important during pregnancy
Calcium is a mineral that is required for normal body function. It is critical for the formation of strong bones and teeth. Calcium is also necessary for the contraction of all muscles, and the blood clotting process. American women on average do not consume adequate amounts of calcium when they are not pregnant. Pregnant women need 2000 milligrams of calcium daily. Prenatal vitamins generally do not have this high level of calcium. Therefore additional calcium must be consumed from food sources such as dairy products, enriched soy milk, yogurt, collard greens, broccoli and dried beans.
What is the cause of morning sickness and how can I treat it
The exact cause of morning sickness is not known. It is postulated that the pregnancy hormone HCG (human Chorionic gonadotropin) which is secreted by the placenta is the culprit.
However, all pregnancies have HCG and not all pregnant women experience morning sickness.
Morning sickness is a misnomer. It can occur at any time of the day or night. Mild nausea or even vomiting will not cause harm to the fetus or mother-to-be as long as she does not become dehydrated. Some pregnant women may not gain or may even lose weight in the first trimester and this is acceptable if not extreme.
Mild nausea and vomiting can easily be treated by minimal changes in the diet and lifestyle. Small frequent meals may help to decrease symptoms. Avoid fried, fatty foods which are harder to digest. Some pregnant mothers find that ginger or flat ginger soda helps smooth the symptoms of morning sickness. Antacids will also help decrease the acid reflux. Dairy products are difficult to digest because of their fat content. Try substituting soymilk for cow's milk. Soymilk is easier on the digestive system. Brands can be found that are calcium and vitamin D enriched.
In severe cases of vomiting, the medical term hyperemesis gravidarum is used. Hyperemesis gravidarum is currently treatable at home with home hydration therapy. Home hydration therapy is the placement of an intravenous catheter in the arm of the pregnant mother-to-be. I.V. fluids are then administered as needed to prevent dehydration. If necessary, antiemetics can be given intravenously to prevent vomiting.
Most cases of morning sickness are self-limited with minimal discomfort to the mom and with no harm to the fetus.
When should I schedule my postpartum visit with my physician?
Generally if you had an uncomplicated pregnancy with a vaginal delivery you should schedule your postpartum visit 6 weeks after delivery.
At this visit your blood pressure will be checked along with your weight and urine. Additionally a pap test is usually performed. A complete pelvic examination will also be performed to insure that the uterus has returned to its pre-pregnancy shape and size. The vaginal area will also be inspected to confirm that full healing has occurred.
At this visit, your health care provider will also review your birth control choices along with any other questions that may have developed. This visit is very important and it is the patient's responsibility to schedule it in a timely manner.
Why do nosebleeds commonly occur during pregnancy?
Pregnancy represents an elevated estrogen state for the body. Estrogen has multiple effects, including growth of mucous membranes and dilation of blood vessels.
The nasal passages are lined by mucous membranes that filter, moisten and heat inhaled air. These membranes also respond to estrogen. If any of the blood capillaries rupture a nosebleed ensues. Nosebleeds are greater during pregnancy because the blood vessels are larger and more delicate.
Why do my gums bleed more since I became pregnant?
Pregnancy is a physiological state of increasing estrogen levels. Estrogen has multiple effects on the body including growth of mucous membranes and the dilation of blood vessels.
Gums are a mucous membrane that respond with hyperplasia (growth) to estrogen. Swelling by the gums cause them to be more delicate and therefore bleed more easily.
There are several ways to prevent bleeding. The most important is excellent dental care with daily flossing. It is also important to see your dentist or dental hygienist during pregnancy for dental cleanings and periodontal care. Mouthwash can also decrease gum inflammation. Always remember not to swallow the mouth wash because it commonly contains alcohol.
I recently found out that I am pregnant, how often will I visit my physician?
Pregnancy is a time in which prenatal visits are individualized based on the medical health of the mother-to-be and the health of the fetus. Problems can develop during the course of the pregnancy that may necessitate more frequent visits. Twins and triplets must be seen more often for an excellent outcome.
The American College of Obstetrics and Gynecology has developed guidelines for scheduling prenatal visits. A general outline is prenatal visits every 4 weeks during the first 28 weeks of pregnancy. Visits every 2-3 weeks between 28-35 weeks and weekly appointments after 36 weeks.
This is a very flexible guide. Certain testing must be performed at specific times. Therefore visits even in an uncomplicated pregnancy may be more than the recommended guidelines. A rule is each patient has as many visits as she requires.
I recently found out that I was pregnant. How do I calculate my due date?
A due date or estimated date of confinement (EDC) is an approximate number, derived to estimate when a baby may be born. It is assumed that a mother-to-be is having regular menstrual cycles every 28 days with ovulation occurring 14 days after the first day of the last menstrual period.
If a woman has irregular menstrual cycles or recently stopped oral birth control pills, the above assumptions will not hold true. The obstetrician will then calculate the EDC using pelvic ultrasound to measure the developing fetus.
In a regular menstruating woman the average pregnancy has a duration of 40 weeks or 10 lunar months. Most obstetricians use a common language of weeks to describe a pregnancy not months. A term pregnancy is any birth between 37 to 42 weeks. As can be realized there is a 5-week window of time for a term delivery to occur. This is the reason that it is impossible to predict the exact time of any birth. Only about 5 percent of births occur exactly on the due date.
To easily calculate an EDC use the following formula. Take the first day of the last menstrual period (LMP), add 7 days and subtract 3 months. For example if the LMP is 12/21 adding 7 days to obtain 12/28 and subtract 3 months to calculate a due date of 9/28.
Most obstetricians carry a pregnancy wheel that allows for the easy calculation of any EDC and how far the pregnancy has progressed.
Is drinking coffee safe during pregnancy?
It is not coffee per se that is the concern during pregnancy but rather the caffeine component of coffee that may be harmful during pregnancy.
Caffeine is a chemical stimulant. The ingestion of caffeine causes heart palpitations, increased blood pressure, and nervousness. Caffeine is a ubiquitous chemical that is present not only in coffee, but also chocolate, tea, and some sodas especially cola products.
In animal studies rats and mice were fed very large quantities of caffeine over a prolonged period of time. This was the equivalent of drinking 80 cups of coffee a day. In these animals birth defects were noted at this high level of caffeine consumption. However, no human studies have demonstrated birth defects in which caffeine was consumed at acceptable levels (approximately 2-3 cups of coffee per day). There is literature that has demonstrated that the daily consumption of 500 mg/day of caffeine can cause increased fetal activity and smaller than average birth weights.
Caffeine has also been implicated in increased breast fibrocystic changes and increased breast pain and tenderness.
An easy way to decrease caffeine intake is to mix caffeinated and decaffeinated products. In an individual that is accustomed to consuming moderate to large quantities of caffeine, the sudden withdrawal can cause headaches. It is better to gradually decrease caffeinated products by mixing decaffeinated with caffeinated products. Gradually increase the decaffeinated component until the caffeine is completely eliminated.
Can I travel during my pregnancy?
This is a common question in the global society in which we currently live. Travel can be related to pleasure, business or a combination of both. Business travel can be particularly grueling depending on the individuals occupation and schedule.
The answer to this question is twofold and is based on the gestational age of the mother-to-be and the destination of travel. It is generally recommended that if there are no complicating conditions, travel within the United States can continue until 32-34 weeks of pregnancy. Travel within the United States allows for the rapid access to quality medical care should an emergency arise.
Travel abroad is a more difficult question to answer. For example, travel to certain areas of Africa necessitates the administration of malarial prophylaxis medication. Certain of these drugs are contraindicated during pregnancy. The other important concern is the availability of quality health care. This may not be possible on a small island or less developed country. These are issues that must be discussed with your health care provider prior to booking the trip!
At the airport it is safe to through the metal detector. There are no reported adverse outcomes form airport metal detectors. All jet aircraft have pressurized cabins and therefore prevent any attitude sickness. A helpful recommendation is to walk around the airplane cabin frequently to improve circulation in the lower extremities. Also drink large quantities of water to prevent dehydration.
Travel is safe and should be enjoyable during pregnancy, however the excursion should take into consideration the availability of medical care and the distance to be traveled. The future mother-to-be should carry a copy of her recent medical records for reference should an emergency occur.
Can you explain to me how taking folic acid helps my pregnancy?
Each year worldwide approximately 300,000 infants are born with neural tube defects. In the United States 4,000 children are born with this anomaly. This calculates to an incidence of 1/1000 pregnancies.
The neural tube is the structure embryologically that develops into the spinal cord and brain. The neural tube developmentally closes by 28 days post conception. The exact mechanism of closure has not been discovered. Neural tube defects have been subclassified into open or closed. Open defects are if the neural tissue is exposed and in closed defects the neural tissue is covered by skin. The most common types of neural tube defects are spina bifida and anencephaly. The burden to the individual and family with a neural tube defect is enormous. All children born with anencephaly die shortly after birth. Infants with spina bifida have life-long disabilities such as bowel, bladder dysfunction plus learning disabilities.
Folic acid (which is a vitamin) has been clearly demonstrated to reduce the incidence of neural tube defects significantly. The consumption of 0.4 milligrams of folic acid daily can reduce the rate of neural tube defects by 50%. The best outcomes are obtained when the folic acid is taken prior to conception. Obviously this is a simple task to prevent a major congenital anomaly.
Foods that contain folic acid are green leafy vegetables, citrus fruits, enriched breads, cereals, grains and soybeans. Most physicians prescribe a prenatal vitamin prior to conception to ensure adequate folate levels.
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