Entries Tagged 'Pregnancy Care' ↓

Nausea and Vomiting

Nausea and vomiting appear in most pregnancies during the first three months. The nausea subsides after the third missed period. Women should com­plain about this nausea to their physicians, who can assure them that it is related only to changes in the body associated with early pregnancy.

Eating dried fruits in small amounts and keeping the stomach slightly coated with food frequently helps to control nausea. Dried crackers, biscuits, or stale rye bread may be helpful early in the morning. Frequently, nausea is made worse by late rising and a rush to get to one’s job. Relaxation and unhurried movements in the morning tend to minimize the nausea.

If nausea is severe, mild sedation may be helpful. At times, various antinausea drugs may provide relief when taken either orally or rectally, as directed by a physician. If the patient is not able to eat or drink for 24 hours, the doctor should be notified immediately.
Heartburn

Heartburn or burning pain in the area just below the ribs is frequent in the middle and later months of pregnancy. It is probably due to changes in the position of the stomach, related to the enlargement of the uterus, and to changes in acidity of the stomach. A quarter of a glass of skim milk will reduce the heartburn. Various standard antacid products may prove to be helpful, but bicarbonate of soda should be avoided because, although it will relieve heartburn, it can produce swelling of the entire body.

Spells of shortness of breath frequently occur in the later months of pregnancy, from pressure of the enlarging womb upon the diaphragm. This is not related to any disease of the lungs. Propping up the patient on two or three pillows frequently helps.
Flatulence or Intestinal

Flatulence or intestinal gas commonly occurs in pregnancy; the intestines are merely slowing down due to effects of hormones produced by the pregnancy. Discomfort may be reduced somewhat during pregnancy, by not consuming gas-forming foods such as cabbage, baked beans, cauliflower and broccoli.
Muscle Cramps

Muscle cramps are frequent, particularly in the lower extremities, about the calves and thighs. These are associated with changes in the mineral content of the muscles during pregnancy. Limiting the consumption of milk to one glass a day for a week may reduce the cramps.
Back Pain

Back pain is a common disorder. Back pain commonly occurs from changes induced by pregnancy. All the ligaments attached to bones become softened. The protruding abdomen and weakened abdominal muscles affect the posture or “stance” of the pregnant woman. Also, there are various neuromuscular relationships that may be affected by the advancing pregnancy.

Generally, the disturbing back pain can be lessened by good standing posture and sitting on hard well-shaped chairs rather than soft cushioned couches or chairs. Standard simple exercises of abdomen and back muscles ease the discomfort. The bed should have a hard mattress, perhaps even a board placed under the mattress. Frequent car riding may produce back pain. Hard backrests are available to support the back muscles and improve driving posture. Driving may have to be curtailed if back pain is very severe and none of these measures help. A light, well-fitted supporting garment may be used to improve posture in walking and sitting.
Sleeping Habits

Sleeping habits of the pregnant woman may be upset. Emotional factors, such as worrying that something is wrong with the baby or that the baby is not moving, may keep her from falling asleep readily. Reassurance is important and worries should be talked out with doctor. Sleeping as well as breathing is easier in the last months of pregnancy if two or three pillows are used to prop the patient. In the last six weeks of pregnancy it is wise not to eat too late in the evening or to eat too large a meal. Mild sleep-inducing medications may be given safely if the sleeplessness is severe.

The beneficial effects of reasonable amounts of physical exercise in promoting conditions favorable to dropping to sleep at night should not be overlooked.
Faintness

The pregnant woman may get light-headed and possibly faint at least once during her pregnancy. If a fainting spell comes on, lie down or bend the head down between the legs and dizziness and faintness will subside quickly. Some women worry that they will “pass out” while driving a car. However, unless fainting spells occur with great frequency, driving is usually not forbidden. Premonitory sensations give a chance to pull over to the side of the road and lie down with the head at seat level. Carry a lump of sugar or piece of hard candy, chew on this, and dizziness and faintness will usually disappear. Fainting spells are at their maximum between the third and sixth months of pregnancy and rarely occur later.
Varicose Veins

Varicose veins often appear in pregnancy. The simplest way to prevent worsening of the varicosities is not to use constricting garters or rolled socks about the legs. When resting, elevate the legs on another chair or couch. If the veins are extensive, full-length elastic stockings may be worn, particularly when standing or walking for extended periods of time. Elastic stockings should fit tightly and are best put on by raising the leg far above the body and rolling them on from the foot. If a vein becomes tender, reddened and swollen it may be the early onset of phlebitis and the doctor should be consulted promptly for proper care. Surgery for removal of varicose veins is usually not recommended during pregnancy.
Hemorrhoids

Hemorrhoids are quite common during pregnancy. Hemorrhoids are large veins about the opening of the rectum. Increased pressure of the enlarging abdomen and uterus tends to over distend these veins. They may protrude outside the anus and be aggravated by hard or infrequent bowel movements. These are best treated by additional rest during the day and by cold compresses of diluted witch hazel. Discomfort may be relieved by anesthetic ointments prescribed by the doctor. Occasionally, a small hemorrhoid may become thrombosed (develop a blood clot in it) and be very painful. The doctor should be consulted and he will promptly relieve the discomfort. Surgery for hemorrhoids is not indicated during pregnancy.
Vaginal Discharge

Vaginal discharge is quite frequent during pregnancy. Moisture about the vaginal entrance tends to increase as pregnancy progresses toward the time of delivery. There are two common causes for abnormal vaginal discharge. A fungus called monilia causes a white flow. This is treated by specific drugs, either anti fungal agents or gentian violet preparations. The other infection causes a foamy, bubbly discharge produced by trichomonas parasites. A new antitrichomonal drug which may be taken either by mouth or vaginally, is datively specific for eradication of this condition.
Vaginal Bleeding

Vaginal bleeding is quite frequently encountered during pregnancy. At the time of the first missed period, some staining and slight bleeding may be related to implantation of the fertilized egg in the wall of the uterus. This bleeding usually subsides in several days. If bleeding progresses it may be due to a threatened abortion and the doctor should be informed. Occasionally, bleeding is due to a benign growth at the neck of the uterus called a polyp, or by a softening of cervical tissue, called an erosion. This area bleeds easily on pressure. The doctor can control it. Occasionally, bleeding is produced by intercourse.
Exercise

Exercise is important during pregnancy. Walking for a mile or so is fine for the average pregnant woman, but a long hike of four or five hours would be overdoing it. Dancing in its milder and less vigorous forms may be recommended. Sports such as tennis, golfing, or swimming, for short periods of time, are good relaxation for patients who are accustomed to them. This is too much activity for the final two months of pregnancy. More strenuous activities which are hazardous or fraught with tumbles, such as ice skating, skiing, horseback riding, diving, aqualunging and water­skiing are to be avoided during pregnancy. Even the exercises recommended are not advisable if the pregnancy is complicated by bleeding or cramps. Every patient is an individual and the type of exercise good for her should be discussed with the physician.
Traveling

Traveling is not hazardous for the normal pregnant woman. Airplane transport in pressurized cabins is the easiest form of travel. Rail travel is a little more difficult because of continuous pounding. Automobile travel for long distances is even more strenuous than train travel. Trips by car should be limited to two to three hundred miles a day, with frequent breaks to get out of the car, move around, and rest. Of course, some complication may make it unwise for a particular pregnant woman to travel; if so, the doctor will advise her.

It is not unusual for a woman in the first six months or so of pregnancy to make a long trip to a distant part of the country or even to go abroad. In such case she should have the name of an obstetrician who practices at her destination. She can also communicate with her own doctor by long distance telephone. In the final five or six weeks of pregnancy she should stay within 30 miles, or about an hour’s easy traveling time, of the hospital.

Seat belts should be used at all times when driving or as a passenger in a car. The safety belt must not be placed high on the abdomen, but lower down, snug about the hipbones which can take the shock of a sudden stop.
Clothing

Clothing should not fit tightly. Purchase lightweight undergarments that may be worn in both warm and cool weather. There is no reason why usual undergarments - a two-way stretch, for example can’t be worn in the early months of pregnancy, until they become too tight. When backache becomes troublesome, maternity girdles usually give considerable relief. High heels are an extra hazard when the abdomen enlarges and balance is precarious at best. However, a short woman married to a tall man may feel ill at ease in flats, and for morale reasons she may be permitted to wear moderately high heels if she is aware of the dangers involved.
Drugs

Drugs should be used only for absolutely necessary reasons during pregnancy, particularly in the first three months when the vital structures and organs of the baby are being organized. The various antibiotics should not be used during pregnancy except for reasons the doctor considers compelling. Not only does the use of these drugs sometimes produce an annoying vaginal discharge, but strains of germs resistant to the drugs’ actions may emerge. Such infections in a newborn infant are serious. Any drugs to which the patient is sensitive should be noted and used with caution if at all during pregnancy.
Smoking

Smoking during pregnancy has occasioned some furor. There is statistical evidence that infants tend to be smaller and the incidence of prematurity greater if the mother smokes excessively. It may be cruel, and frequently futile, to forbid cigarettes entirely to a woman who is accustomed to them, but nothing but good can come from cutting consumption from a pack or two a day to perhaps a half dozen cigarettes.

All women should be screened for colonization with GBS from the vagina and rectum at 35 to 37 weeks gestation. A swab from the vagina and rectum is sent to the laboratory for culture. The only exceptions to this are women who have already demonstrated GBS in their urine during the current pregnancy or women who had a previous infant with invasive GBS disease.
Prophylaxis During Labor(preventive treatment with an antibiotic) is recommended in the following situations:

*

Previous child with invasive GBS disease.
*

GBS in the urine culture during this pregnancy.
*

Positive GBS screening culture during the current pregnancy, unless a planned cesarean delivery is performed, before the woman goes into labor and before her membranes have ruptured.
*

If the GBS status is not known because the culture wasn’t done or is incomplete(was done too recently for the colonization to be documented) or if the results are unknown for any other reason and any of the following circumstances exist:
*

Delivery before 37 weeks gestation.
*

The membranes have been ruptured for 18 hours or longer(even at greater than 37 weeks gestation).
*

A temperature develops in labor of 100.4° F or greater(38.0° C or greater) (this may require a different antibiotic therapy).

Prophylaxis During Labor(preventive treatment with an antibiotic) is not recommended in the following situations:

*

Previous pregnancy with a positive GBS screening culture(unless a culture was also positive during this pregnancy).
*

Planned cesarean delivery performed in the absence of labor or rupture of membranes(regardless of whether the GBS culture is positive or negative).
* Negative vaginal and rectal GBS screening culture in late pregnancy during the current pregnancy.

Antibiotics are given during labor through an intravenous line. A usual dosage schedule is penicillin G 5 million units for the first dose, then 2.5 million units every 4 hours until delivery. If a woman is known to be penicillin allergic, Cefazolin may be given if she is not considered to be at high risk for serious reaction(anaphylaxis). If she is at high risk for an anaphylactic reaction, then clindamycin or erythromycin may be used. All medications are given intravenously.

If the culture shows the organism to be resistant to these medications, then a very strong antibiotic is used, called vancomycin.

Two risks exist with this treatment:

1.

some women may have a potentially dangerous allergic reaction to penicillin, and
2.

the development of resistant organisms is possible with widespread treatment.

New Approaches

Currently, researchers are investigating two other approaches: the development of a vaccine against group B strep and the development of a rapid, easily available, and accurate screening test that could be performed in labor with immediate results. A screening test would identify the women who carry GBS at the time of delivery and reduce the overall number of women receiving treatment. Screening tests are currently available but not considered accurate enough to determine treatment to prevent newborn GBS infection.
Informed Consent

To allow for informed consent, women should know the following:

*

Approximately 1 in 200 newborns born to a mother colonized with GBS will develop GBS disease early in the newborn period.
*

The risk of a newborn’s acquiring GBS from a mother who tests positive for the organism is 29 times higher than the risk for a newborn whose mother had a negative prenatal culture.
*

The risk of a newborn’s acquiring GBS in a labor that is preterm or complicated by long duration of membrane rupture or fever is 7 times higher than the risk for newborns born without these labor complications.
*

Five to 20 percent of newborns infected with GBS Will die.
*

The treated woman’s risk of a mild allergic reaction to penicillin is 1 in 10.
*

The treated woman’s risk of a serious allergic reaction to penicillin is 1 in 10,000.
*

The risk of dying from an allergic reaction to penicillin is 1 in 100,000 treated women.
*

Treatment for GBS before labor is not effective in preventing newborn GBS disease.

What is in store for the pregnant woman on the verge of childbirth when she arrives at the hospital?

Usually she is escorted to her room and is given a complete shave and an enema. The latter makes her more comfortable in labor and frequently stimulates contractions to greater effectiveness. After preparation the patient is taken to her own room on the delivery floor where a nurse trained in the care of labor patients is in constant attendance. From time to time the obstetrician will drop in to do a rectal or vaginal examination to determine the progress of labor and whether any medication is needed for comfort.

The waiting period in the labor room ends when a small part of the baby’s head is visible at the entrance of the vagina, in a first pregnancy. The visible part of the head is usually about the size of a quarter or half dollar. However, a woman who has had children is taken to the delivery room with the onset of pushing sensations or when the cervix is dilated about four inches.
Delivery of The Baby

The delivery room is virtually the same as an operating room. There are anesthesia machines with tanks of gases. Everybody wears a cap, gown, and mask. The large table on which the patient lies on her back has stirrups to support the legs fully. Metal hand pieces or bars are available for the patient to push against during contractions. An overhead surgical light illuminates the birth area and an attached mirror allows the mother to watch the birth if she wishes.

As the patient’s legs are being put into the stirrups, the lower part of the table is slid under the remaining part and the patient’s vaginal area, lower abdomen and inner thighs are scrubbed with an antiseptic. The entire area is covered with a sheet with a window for the vaginal opening.

As the vagina becomes distended, the obstetrician usually does an episiotomy. This is an incision in the vaginal margin, done under local anesthesia. The purpose is to prevent the tearing of tissues as the baby’s head is extruded.

The baby’s head appears slowly during a contraction, with the face turned toward the floor. As the full head appears it rotates to the left or right. The shoulders are then born and the abdomen and lower extremities rapidly follow suit. Fluid remaining in the uterine cavity is expelled with a gush.

The baby, entering a world where it is “on its own” for the first time, begins to cry. Sometimes assistance is needed to initiate breathing. The umbilical cord is cut and the baby is placed in a heated crib. An identification tag identical to the one worn by the mother is placed on the baby’s wrist.

A resident physician who is present at delivery examines the baby thoroughly. He examines the heart, lungs, abdomen, eyes, nose, palate, notes if the rectum is open and, in boy babies, that the testicles are descended into the scrotum. A rubber bulb with a glass catheter is used to suck out the baby’s mouth, and frequently to draw fluid from the stomach to prevent it from being inadvertently inhaled into the baby’s lungs.

A decision as to whether the mother wishes to breast feed the baby must be made on the first day after delivery. Realistically, the decision is motivated by factors such as her background, whether she would really enjoy it, and the opinions of her husband and mother. The fact that it might be beneficial for her does not often predominate.

If the nipples are inverted or the baby is premature it is not advisable to breast feed. If the mother decides to nurse, the baby is brought to her about 12 hours after delivery and allowed to suck no more than five or ten minutes on each side. Usually the baby is not very desirous of sucking until the second or third day. Around the third day the breasts become engorged (very heavy and firm) and the milk comes in or is “let down.”

Before each nursing session the breasts, and particularly the nipples, should be washed carefully with an anti­septic to prevent breast infection. The nurse will assist the mother. If there is scantiness of milk the baby should be brought out every four hours through the night. But if the milk is plentiful and the mother wishes to sleep, the two a. m. feeding may soon be eliminated, particularly if the baby is large.

The uterus and tissues of the nursing mother tend to recover their normal state more rapidly. Bleeding following delivery ceases sooner. However, lactation may prevent the menstrual period from returning for as long as six months (the average duration of breast feeding) .

The only way to determine whether nursing is feasible is to try it. Capacity for milk production varies. Enthusiasm and encouragement by the husband help. If a woman is very active in social or other activities outside the house, nursing should be discouraged.

Pregnancy may occur during the nursing period even though menstruation does not. This is unusual but if pregnancy occurs, nursing should be stopped. The baby can be weaned by giving a bottle at alternate nursing periods and gradually diminishing breast feeding until feeding is completely by the bottle after a week or ten days.

Many mothers do not wish to nurse and for them there are various compounds that prevent the milk from coming in. These are principally the estrogens which prevent the pituitary gland from secreting lactogenic hormone that stimulates milk flow. If the estrogens are taken, usually by mouth, for ten days to two weeks, there is usually no engorgement of the breasts. Sometimes the breasts become engorged after the estrogens have been stopped. With breast engorgement, a tight brassiere should be worn and fluid intake should be restricted to a minimum. A little aspirin and codeine for 24 hours will alleviate the pain.

Most important in choosing a physician, midwife, or group practice for your maternity care is that you be comfortable with the thought of working with this person or group. You must have confidence in the individual or individuals, and this in itself is a good reason for looking into their qualifications and attitudes before making a commitment to them for example, you have strong feelings that you wish to breast-feed, it is not good for you to get your care from someone who is cool to the idea.The same goes for the conduct of labor. If you have attitudes about or experience with fetal monitoring, you should find out whether it is practice where you intend to deliver to require it or to individualize its use. If you have had a previous birth by cesarean and wish a vaginal birth, you should find out the attitudes toward such care on the part of those you choose to assist you in labor. What do you want your main source of pain relief to be? If you want to use relaxation, breathing, support. massage, and other nonpharmacologic remedies as much as possible, make sure your physician or midwife is comfortable with these options and won’t pressure you into medications or epidural anesthesia. If you want an episiotomy only on indication and not routinely, make sure that your obstetrician or midwife doesn’t believe in routine episitomy. If you want rooming-in with your baby 24 hours a day, but the hospital where your physician or midwife delivers does not provide for that you might think about switching providers. If you want an intravenous (IV) feeding tube only if you are dehydrated or need it for labor augmentation or medication, but the hospital at which your physician or midwife attends births insists on routine IVs, then you might want to find a provider at another facility, or consider a birthing center-or compromimise and have an IV

The fact that you have gone to a provider or facility does not mean that you are contracted to stay with it, if it turns out in the course of prenatal care that you are not at ease. If necessary, discuss this candidly with the people who have been providing your care so some resolution of the problem can be worked out amicably. Most of us who provide maternity care consider prenatal care as a commitment to follow through. We are often aware of the women who are uncomfortable in our care and are quite accepting when such women transfer themselves elsewhere. Of course, care will not be refused when you don’t exactly see eye-to-eye with your practitioners. Try to continue to raise your concerns and come to compromise solutions if you have no choice, as when you live in a small town and there are no alternative providers.

If you have trouble raising your concerns, something is a miss. You should never feel silly asking any question, you should not feel rushed, you should never feel that your concerns are made to seem trivial. It’s an old cliche, but the only silly question is the one you didn’t ask.

If you discover at the end of pregnancy that you are unhappy with what your practitioner is offering for labor and birth, you can certainly switch providers even at that late date, although some practitioners and birthing centers will not accept a woman late in pregnancy.

Most women at some point in their pregnancy, notice swelling in their feet and lower legs. Most times, the swelling is confined to the lower extremities. Swelling in your lower legs is made worse when you stand for long periods of time. If leg swelling is starting to become a problem, try to take several breaks during the day where you lie down with your feet raised. If you are working, try to move around frequently during the day. The action of your leg muscles helps return some of the excess fluid to other parts of your body. If you notice that one leg is much more swollen than the other, notify your care provider, since this can be a sign of a blood clot in your leg. However, remember that it is normal for the right leg to be slightly more swollen than the left, since the uterus tilts in such a way as to compress the drainage of blood from your right leg more than your left.

What do avoid

Diuretics are not safe in pregnancy.

Leg Cramps

Some women find that they wake up at night with sudden leg cramps. It’s not clear why these cramps become more common during pregnancy. Calcium supplementation may reduce symptoms and is safe during pregnancy. If leg cramps make you wake up at night, try to walk off the pain or place a warm compress on your calf. If you have persistent cramps try to pay special attention to your calves before going to bed. Stretch them out gently by stepping up on to a step and pressing your heels down one at a time. If you still have problems, talk to your doctor about magnesium supplements. Do not take magnesium supplements with out checking with your care provider first.

What’s safe to use

Calcium supplementation of 1 gm twice per day for 2 weeks.

Restless Legs Syndrome

About 10-20 percent of women will develop restless legs syndrome (RLS) during the second half of pregnancy. RLS usually occurs as you try to fall asleep. You might have tingling or other sensations in your lower legs, which give you the overwhelming urge to move your legs around. However, moving your legs or walking around does not relieve RLS. If your sleep is becoming disrupted, talk to your care provider. Sometimes this condition is associated with iron deficiency anemia, so iron supplementation may help. It’s best to avoid caffeinated drinks in the last half of the day because these may make symptoms worse.

Varicose Veins

The pressure of the growing uterus and consequent increased blood flow causes a notable increase in prominent veins in your upper and lower legs. As the pressure in your veins increases weakness in certain areas of the veins can cause the sides to balloon out. These are varicose veins. They may also occur in your vulva.

Varicose veins are more common with second and third pregnancies, but many women have them in their first pregnancy as well. Whether you get varicose veins or not is mostly genetic. You may be able to reduce the size of enlarged veins in your legs by wearing good support hose designed for pregnant women. However, many women find these hose hot and uncomfortable and of only slight benefit in reducing the appearance of varicose veins. Lying down with your feet up several times during the day may also help. If your veins remain enlarged after your pregnancy you can consider one of several cosmetic options, including laser treatments, sclerotherapy, and surgery. You should wait until after your have completed all your pregnancies to treat enlarged veins, since they are likely to return in subsequent pregnancies.

Stretch Marks

About half of all pregnant women will get stretch marks during pregnancy. Stretch marks often occur on the abdomen, but can also develop on your breasts and bottom. They are caused by microtears that occur in the connective tissue in your skin as the skin stretches more than it is able. Despite the claims made by manufacturers of various creams, no cream will prevent you from getting stretch marks. However, you can slightly reduce your chances of stretch marks by limiting your weight gain during pregnancy to 25-35 lb (11-16kg).

Stretch marks will fade over time, becoming faint and silvery. While you can’t prevent stretch marks, you can have them treated after pregnancy. Laser therapy is one option that is gaining in popularity. Plan on waiting to treat stretch marks until after all your pregnancies are completed since you are likely to develop more with each pregnancy. Treating stretch marks is considered cosmetic and is usually not covered by insurance.

Skin Changes

During pregnancy your skin undergoes enormous changes. Starting early on in pregnancy there is a big increase in the blood supply to your skin, which is euphemistically referred to as the glow of pregnancy.

Early in pregnancy, the most common skin change you may notice is an increase in acne as a result of hormone changes. It is safe to treat acne during pregnancy with creams and gels such as benzoyl peroxide or, after consultation with a dermatologist antibiotic creams. As you move in to the early second trimester, you may start to notice that your skin is darkening pregnancy stimulates production of the pigment melanin. You mal notice that pigmented areas of your body, including existing moles and your nipples, darken. New areas of pigment may also appear as your pregnancy progresses, including a dark line between your belly button and pubic hair called linea nigra. Some women also develop pigmentation across the nose and cheeks. Both these areas of pigmentation should fade after your pregnancy.

About two-thirds of women with lighter skin notice that the palms of their hands turn red. It results from the increased levels of the hormone estrogen in your body, and will disappear when you are no longer pregnant. Increased blood flow to your skin during pregnancy can also cause tiny red bumps surrounded by little red lines to form. These blemishes are called spider angioma and occur most often on the face, neck and upper chest but will fade after pregnancy. No treatment is needed unless he spider angioma are still present 3 months after pregnancy md you don’t like their appearance.

Sweating

Almost all pregnant women tend to feel warm during pregnancy. With this change in the way you perceive temperature and your increased metabolic rate, you are likely to notice that you are perspiring more. This is normal but can be irritating. Deodorant is safe during pregnancy so don’t worry if you find you need to use it more frequently.

Itching And Rashes

Many women have itchy skin during pregnancy, especially over their abdomen. Most of the itching seems to be associated with the physical skin stretching of pregnancy. Some women find that a cool sensation relieves some of the feeling of itching. Cool oatmeal baths or moisturizing lotion kept in the fridge may provide temporary relief. Itching may also be a sign of a condition called cholestasis of pregnancy, which sometimes develops in the third trimester. It is diagnosed with a blood test that examines the level of bile acids (produced by your liver) in your blood. If your doctor diagnoses this condition you will be given medication to reduce the excess bile acids. Thc usual treatment is a drug called ursodeoxycholic acid. High levels of bile acids can increase the chances of complications in your current pregnancy and may prompt your care provider to induce your labor prior to your due date. It is not know whether treatment with agents like ursodeoxycholic acid reduce the likelihood of pregnancy complications.

Warning Signs

If itching is accompanied by any of the following you should see your doctor.

• A significant bumpy rash on your abdomen this may be a condition called which is specific to pregnancy and needs more intensive treatment with prescription drugs.
• Persistent severe itching on your arms and legs with out a noticeable rash in the third trimester of pregnancy. This may be a symptom of a condition called cholestasis of pregnancy where bile acids from your liver build up in your skin, causing itching.

Safe Lifting

If at all possible, avoid lifting anything heavy, including your older toddler. If you do have to lift something, use the following technique.

• Stand with your feet hip-distance apart.
• Bend from your hips and knees, keeping your back straight.
• Keeping the object close to your body, use the strong muscles of your legs to lift.
• Keep your back straight for the whole lift.

The extra fluid retention of pregnancy can exacerbate a common condition known as carpal tunnel syndrome. Between 25 and 50 percent of pregnant women will notice some symptoms of carpal tunnel syndrome. This condition occurs because one of the nerves that supply sensation to the hand, the median nerve, has to pass through a very narrow space in the wrist, called the carpal tunnel, where the nerve enters your hand from your arm. During pregnancy, even slight swelling in the hands can cause the nerve to become compressed as it goes through the carpal tunnel. The severity of nerve compression is also related to the amount of weight you gain during pregnancy.

The most common symptoms are pain and numbness in the thumb, index and middle fingers, and weakness in the muscle that moves your thumb. The main treatment for carpal tunnel syndrome during pregnancy is usually limited to simple things like wearing a splint at night to help reduce pressure on the nerve that occurs when the wrist is bent. About 80 percent of women will notice a reduction in symptoms just with splinting. If you develop severe carpal tunnel syndrome, you may be referred to an orthopedic specialist who may recommend steroid injections in to the wrist to reduce swelling and inflammation. Do not take oral anti inflammatory agents such as ibuprofen while pregnant, and try to avoid sleeping on your lower arms and hands. Symptoms usually improve within about 4 weeks of giving birth to your baby.

What to avoid

Aspirin and nonsteroidal anti inflammatory drugs such as ibuprofen.

Back Pain

Back pain during pregnancy can be a serious problem, and is one of the few problems that often persist after pregnancy. Roughly one half of pregnant women will experience some back pain during pregnancy, and the older you are the more likely you’ll experience back pain. Carrying an extra 201b (9kg) or more around your waist is hard on your back; each pregnancy puts a strain on your back and increases the chance that you will have persistent back pain. The best way to protect your back is by keeping your abdominal muscles in shape before you get pregnant. During pregnancy make sure that if you lift something heavy (like your other children) you use your legs and not your back alone. Listen to your body and stop lifting something if you feel strain in your back.

Make sure your mattress is firm, giving your back good support while you sleep. If you have a soft mattress, consider slipping a firm board between your mattress and your box spring for extra support during pregnancy. If you do strain your back, take up to 650mg of acetaminophen, and try using a hot pack or ice pack on your back for 10 minutes (whichever works for you). If you have back pain that comes and goes, make sure to call your care provider because this can be a symptom of preterm labor. If you’ve had back pain before and during pregnancy there’s a strong.

What’s safe to use

Acetaminophen (650mg), heat or ice packs.

What to avoid

Aspirin and nonsteroidal anti inflammatory drugs such as ibuprofen.

Sciatica

Sciatica refers to nerve pain that, hoots rapidly from your buttocks down one of your legs, usually ending at your foot. Sciatica is caused either by one of the intervertebral disks (which lie between each vertebra) in your pine pressing on a point where the spinal nerve branches from the spinal cord or by the uterus pressing on your sciatic nerve (which runs from the lowers back down your leg). In addition to pain, you may have other signs of nerve compression, including numbness or a pins and needles sensation in the effected leg. True sciatica is actually quite rare in pregnancy, affecting about 1 percent of pregnancies. If you think you have sciatica, discuss the problem with your care provider.

A good first step in promoting a healthy and satisfying pregnancy is to become as educated as possible. Many books for pregnant women are available besides this on. Some are general information books, similar to this, others cover such specific topics as pregnancy and parenting for the working woman, nutrition and special diets for pregnancy, herbs to use in pregnancy, exercises to prepare for and recover from delivery, and care of the newborn. Many books are devoted entirely to breast-feeding, Some volumes focus on the emotional or spiritual aspects of pregnancy, others on lovemaking during pregnancy. You can find books that describe each of the several approaches to psychological and physical support for the woman in labor: There are books about home birth and books that help you decide how you would like your birth carried out. There are books on midwifery. Books for pregnant women with diabetes and for women who have had cesarean births available. There are books to help women cope with pregnancy loss. Books have been written for expectant fathers and for children expecting a sibling. A recently published book provides a guide to pregnancy expressly for African-American women. If you are a reader, you will not be at a loss for material.Besides books, there are several other excellent resources. These include the American College of Obstetricians and Gynecologist, the American College of Nurse-Midwives, the Midwives Alliance of North America, the March of Dimes, La Leche League, the International Childbirth Education Association, and the American Society for Psychoprophylaxis in Obstetrics. Your public library most likely has a special section of books and videos on pregnancy, breast-feeding, and baby care. Your neighborhood video store may be a resource for tapes on childbirth and pregnancy exercise. Childbirth education groups in your community also may be able to supply you with audio and videotapes.

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Here are some questions to think about with your partner and to ask your physician or midwife. They relate to a variety of decisions about birth. Generally, when a woman and her partner have no preference, the physician or midwife will do what she or he is accustomed to doing. Therefore, it is good to know what the usual practices of your provider are and what restrictions are put upon her or him by the institution where your birth will be. If you don’t know what your own preference would be in answer to any of the following questions, continue reading this book. See the book list in the Appendix. Talk to other mothers and fathers. Look at videos, watch television, search the internet, think about what feels best for you. Nobody can really tell you that except yourself.

• How many members are there in the practice? What are their specialties?
• Will you have a primary provider, or will you see all members of the group during your pregnancy? Will this provider be of your own choosing and can you choose between a physician and midwife?

The labor

• Will your primary provider be your birth attendant or will you be cared for in labor by whomever in your group practice is on call that day?
• Can you choose between a physician and midwife to attend your birth?
• Will your physician or midwife meet you in the admitting area of the hospital or birthing center or will you be examined initially by a resident who will then contact your provider?
• Will you have a routine pubic shave (not shown to be effective in reducing infection rates)?
• Will you have a routine enema (not shown to be effective in stimulating or shortening labor and may have side effects)?
• Will you be allowed to walk around in labor (shown to help reduce the length of labor)?
• Who and how many people will be able to accompany you in labor?
• Will children (if you wish) be able to be present in labor?
• What is the provider’s rate of epidural anesthesia? The institution’s? What other pain relief measures does the provider generally utilize or recommend? If you have an epidural, will it be a low-dose, “walking” epidural?
• Can you bring your own pillows, clothes, food?
• Will you be able to eat/drink in labor?
• Will you routinely have intravenous (IV) tube feedings?
• Will you have routine continuous electronic fetal monitoring, intermittent electronic fetal monitoring, or intermittent monitoring of the fetal heart tones by fetoscope? Will the type of monitoring be determined by your risk status?
• What is the limit to how long each stage of labor will be able to go on, as long as progress is being made?
• What is the limit to how long you will be able to push as long as progress is being made?
• Will you be able to push in a variety of positions, such as knee­chest, side-lying, squatting, on the toilet?

The birth

• Will you be able to birth in the same-room as your labor?
• Will you be able to birth in a variety of positions, including squatting or side-lying, as you prefer at the time?
• Who and how many people will be able to be with you at the birth?
• Will children (if you wish) be able to be present for the birth?
• Will your partner or other support person be able to cut the umbilical cord? Will he or she be able to put hands on the baby at the delivery?
• Is there a policy regarding audio or video taping of labor and/or birth should you want this option?
• What is the physician’s or midwife’s rate of episiotomy (should be very low as routine episiotomies have not been shown to be beneficial) ?
• What is the provider’s rate of cesarean birth? (This may be difficult to evaluate as it will depend on the type of practice the provider has, for example, if the provider is known as a “high­risk” physician, or is certified in the subspecialty of maternal and fetal medicine, other physicians may send women with serious problems to this physician, increasing her or his cesarean birth rate. in any case, it should be as low as possible. The Healthy People 2000 goals of the U.S. Public Health Department advised a cesarean birth rate of 15 percent by the year 2000. While this takes into consideration not only what IS desirable, but what is possible, It can be used as a reasonable cut-off for a cesarean birth rate, even by a specialist in problem pregnancies.)
• Will your partner/support person(s) be able to accompany you if you have a forceps, vacuum, or cesarean birth?
• Will you be able to have epidural anesthesia for a cesarean birth, except in the situation of severe fetal distress requiring the fastest type of anesthesia available (most likely general anesthesia)?

The period after birth (postpartum)

• Will you be able to hold the baby immediately? Will the physician or midwife put the baby on your abdomen as soon as s/he is born?
• Will you be able to nurse immediately after birth?
• Will you ever need to be separated from the baby-i.e., will you have 24-hour rooming-in starting immediately?
• Will the baby’s physical examination be at your bedside or, if not, can you go to the newborn nursery for the examination?
• How many hours/days will you and the baby need to stay in the hospital/birthing center?
• Will you be able to stay in the hospital if the baby needs to re­main there longer than you do?
• What kind of emergency care is available should the baby need special care? Is this care on-site or via transfer? If transfer, what is the transfer system?
• Will the nurses give the baby formula if you do not have 24-hour rooming-in or will they wake you up to nurse?
• Does the hospital have a breast-feeding specialist or lactation consultant on staff?
• What, if any, type of classes for newborn and mother care are available postpartum?
• What are visiting policies postpartum-for your partner, other family members, friends, other children? Does having visitors mean the baby will have to go to he nursery?
• If your baby needs special care, is kangaroo care available ?
• What are visiting policies for the mother/father/others in the special care nursery (often called the NICU-Neonatal intensive Care Unit)?
• Can the parents participate in the newborn’s care in this nursery?

Health care practices today are increasingly following the team model. An obstetrician will often work, for example, with a midwife, a physician assistant, and a nurse practitioner. A physician assistant (PA) is specially trained to provide some components of medical care and work directly under the supervision of a physician. A nurse practitioner (NP), also called an advanced practice nurse, provides primary health care. In a maternity care service, the NP might be an adult nurse practitioner (ANP), a woman’s health nurse practitioner (WHNP), an obstetrical and gynecological nurse practitioner , or a family nurse practitioner (FNP). PAs and NPs generally provide in-office care, bur usually do not attend births.In group practices such as these, you mayor may not have a choice of provider. Sometimes prenatal care is rotated among the many different types of practitioners and either a physician or midwife will attend your birth, depending on who is on-call when you go into labor. In other such practices you can choose your birth attendant the midwives and physicians see separate groups of women. This is based on you preference, your health, and whether your pregnancy is complicated by problems. Of course, in any of these cases, an obstetrician is always available for emergency care should the need arise.

Many women feel that collaborative practices offer the best of all possible worlds. In many of these practices, other health care personnel also are available to provide components of care. These may include, for example, a nutritionist, a childbirth educator, a massage therapist.

Doulas

A doula is an old concept and a new profession. A doula is somebody who provides support to the laboring woman and the new mother. Labor doulas are sometimes called labor coaches or monitrices. They are often on-call, like obstetricians, midwives, and other birth attendants, and will be with you for labor and birth. The advantage of a doula is that she (generally she) is especially trained or experienced in attending births and can provide excellent psychological and physical support. She can be great at massage, assisting with breathing techniques, helping with relaxation. She can often act as an advocate for you, intervening when hospital policies and your wishes seem incompatible.

The disadvantage of a doula, for some women, is that she is another professional. She is not a loved one and can interfere with the bonding that can occur during childbirth between a woman and somebody she loves. In well-staffed hospitals, nurses can provide the type of care that doulas provide. As midwifery, by definition, means “with woman,” many midwives provide the same type of support that doulas provide, as well as managing the labor and birth.

In some cultures men are prohibited from being present during child­birth, or are not allowed to touch the woman in labor. In such cultures, a female doula may provide invaluable support. Some partners travel or may be otherwise unavailable for birth and again, in this situation, a doula may be a big help. Well-conducted, controlled studies in a variety of countries and settings consistently have shown that a trained support person in childbirth has definite benefits in labor, including reduced use of pain medication, lowered incidence of vacuum or forceps delivery, and fewer cases of a 5-minute Apgar score below 7.

Support has been shown to shorten labor. Many doulas also provide care for mother at her home after the birth. Unlike a baby nurse, doulas focus on the physical and emotional needs of the mother. Some doulas provide only postpartum care.