NORMAL BODY CHANGES THAT OCCUR DURING PREGNANCY

Body changes occur during pregnancy. If you are aware of these changes you will be less likely to worry. Your breasts can increase in size and become tender. Mood changes are also normal. You may get tired more easily. Skin changes can occur such as stretch marks, pigment changes, acne, or body hair can increase.

MORNING SICKNESS

Nausea occurs in pregnancy and can be worse in the morning. However, it can last the whole day. Try eating small, more frequent meals. Bland, low-fat foods are usually retained best. (Bananas, rice, applesauce, and toast). Keep crackers, melba toast, or dry cereal within reach of your bed. Eat some before getting out of bed. Stagger the times you eat and drink. Drink liquids mainly between meals. Avoid drinking coffee and tea. Try to take adequate fluids in even if you can not handle solids. Try food with high water content like watermelon, grapes, cantaloupe, lettuce, and tomatoes. Use Sea-bands or acupressure devices that put pressure on the wrist to help relieve nausea.

CONSTIPATION

Prevent or relieve constipation by drinking 2-3 quarts of fluids daily. Warm or hot fluids are especially helpful right after you get up. Increase your fiber by eating high fiber cereals and generous amounts of whole grains, legumes, fruits, and vegetables. Fiber can also be added through pills, powders, etc. Take part in physical activities such as walking or swimming.

HEARTBURN

Avoid heartburn in pregnancy by eating small, more frequent meals rather than three large meals. Avoid certain foods that are highly seasoned, fried, or fatty. Drink fluids mainly between meals and avoid coffee. Avoid lying down for 1-2 hours after eating or drinking, especially before going to bed. Sleep with your head slightly elevated.

VARICOSE VEINS

To prevent or reduce discomfort with varicose veins wear support maternity hose or knee-highs. Avoid sitting or standing for long periods of time, heavy lifting, or crossing legs and ankles.

BACKACHE

Backaches can be common complaints during pregnancy. It is important to maintain proper posture, wear low heels, and use good body mechanics. Avoid standing or sitting for long periods of time. Sleep on a firm mattress. You can use a heating pad or take a warm bath. Pelvic tilt exercises can be helpful. Belly bands or other maternity girdles are strongly recommended.

DIFFICULTY SLEEPING

Finding a comfortable position and sleeping become increasingly difficult as your pregnancy progresses. Decrease lights and noise and use pillows under your knees, back, and abdomen. Decreasing stress, exercising, and using relaxation techniques can be helpful. Avoid caffeine and try drinking hot water with lemon or warm milk before bed. Taking short naps can also help you sleep better at night.

Breastfeeding can be a rewarding experience that develops a special bond between mother and baby with benefits for both. Some nursing moms find breastfeeding easy and uncomplicated, while others find it more challenging. Preparing to breastfeed and surrounding yourself with a good support system can be crucial to the success of your experience. We recommend that you continue taking a prenatal vitamin while you nurse your baby. If at any time your breasts become painful, red, and very hard that does not relieve with breastfeeding, call the office. This may indicate an infection of the breast. You may continue to breastfeed.

PREPARATION BEFORE BABY

Take a breastfeeding class. Choose a doctor or nurse practitioner for your baby who supports breastfeeding. Join a support group for breastfeeding mothers. Find clothing that makes nursing easier, such as tops that button in the front. Prints hide leaks better than solid colors. Even if you do not plan to return to work, a breast pump can be helpful. Choose a pump that mimics the way a baby breastfeeds and is designed for comfort.

AFTER BABY ARRIVES

Focus on building a good milk supply. Drink plenty of fluids such as water and nurse or pump your breasts often. Remember breast milk availability works on a supply and demand basis. Maintaining a good milk supply depends on the regular stimulation provided by the baby or by pumping. Remember, your breasts are never empty. Milk volume is greater in The morning. Three short 10-minute pumping sessions are more effective than one long one. Do not cut your calorie intake severely. Nursing moms need about 500 extra calories a day.

BREASTFEEDING CHECKLIST

Nursing Bras
Nursing pads
Comfortable armchair or rocking chair
Pillow on which to prop the baby or for support in bed
Lanolin breast cream for sore nipples
Footstool to brig your lap closer to your breast without putting strain on your back
Water and nutritious snacks
Breast pump (manual or electric)
Four-ounce bottles with collars and nipples (for storage)
Bottle and nipple brush for cleaning

SORE NIPPLE PREVENTION

Breastfeeding is meant to be a comfortable, pleasant experience. However, many new moms find their nipples are tender for the first few days when the baby starts nursing. This usually disappears in 1-2 weeks. Correct positioning and latch are essential to prevent nipple soreness. There are several different positions that can be used while nursing. It is important to alternate between at least 2 of these positions. Make sure the baby’s lips are behind the nipple, encircling the areola. The tip of the baby’s nose should be touching the breast. Breastfeed frequently, every 1 ½ to 3 hours. This helps avoid frantic feeding and vigorous nursing because the baby is too hungry. This type of feeding can make your nipples tender. Release the suction before you remove your baby from the breast. Do this by placing a clean finger in the side of your baby’s mouth between his jaws. Do not take them away until you feel the suction break. After nursing your baby, express a little breastmilk and massage it into your nipples and areola, then air dry.

SORE NIPPLE MANAGEMENT

Nurse on the least sore side first. Express a little milk first to stimulate let down. Massage your breasts while nursing to help stimulate the milk flow. Use non-plastic lined bras and bra pads. Change the pads frequently to keep the nipple dry. Lanolin cream can be used to form a moisture barrier so they stay dry. Engorged breasts make it difficult for your baby to latch on. Expressing a little milk by hand or pump helps make the areola softer, the nipple more erect and latch-on easier. Wear multiple holed breast shells between nursing to allow air to circulate and protect your nipples from further rubbing by your bra.

STORING BREAST MILK

Always store breast milk in a clean, airtight container. Allow one inch at the top for expansion if you are freezing the milk. Breast milk can be kept at room temperature for about 4 hours and in the refrigerator for 72 hours. If you must keep it longer than this time frame, you can freeze the milk. Breastmilk should be placed in the freezer within 24 hours. Breast milk can be kept in the freezer for 6 months.

GENERAL ACTIVITY

You will want to take it easy for several days after the delivery. Resume your normal activities slowly as tolerated. Be careful not to do too much. Try to avoid becoming overly fatigued and try to rest as much as possible. Avoid lifting anything heavier than the baby. Limit stair climbing, only once daily if possible. Call the office if you have any problems or questions. Keep your appointment for your six-week checkup.

DRIVING

You may ride in a car without restriction. Avoid driving for 2-3 weeks until you can move your foot from the accelerator to brake without discomfort. When you first drive, take someone with you. Do not drive if you are taking prescription pain medication.

DIET

Resume your normal diet. Eat a well-balanced diet. Drink plenty of water daily. You may take a mild laxative or stool softener (Senekot, Colace, Pericolace, Metamucil, Milk of Magnesia) or drink prune or apple juice if you experience constipation. Avoid straining to have a bowel movement.

EXERCISING

Avoid vigorous exercise or straining. Walking and low impact moderate exercise may be started slowly after six weeks. Wait until after your six-week checkup before beginning a regular exercise program.

VAGINAL DISCHARGE

You will experience some vaginal bleeding for one to two weeks after delivery. You may continue to have brown, pink, or yellow discharge for up to six weeks. A thick yellow or green discharge, foul odor, or extreme tenderness in your lower abdomen is not normal and you should call the office immediately.

INCISION CARE

Keep the area clean and dry. You may shower without restriction. Tylenol and Ibuprofen are safe for routine pain and soreness. If you develop a fever, chills, incisional drainage, or severe abdominal pain, call the office immediately.

TAMPONS, DOUCHING, & INTERCOURSE

Avoid tampons, douching, and intercourse until after your postpartum visit. Severe infection may result. The first menstrual period after delivery will probably be delayed and different from your normal period. Use protection to avoid pregnancy.

WORK, SCHOOL, & TRAVEL

You may return to work or school in six weeks or as directed by your health care provider. If you are going to be traveling, you need to stop every two hours and walk for 10 minutes. This will prevent blood clots from forming in your legs.

GENERAL ACTIVITY

You will want to take it easy for several days after the delivery. Resume your normal activities slowly as tolerated. Be careful not to do too much. Try to avoid becoming overly fatigued and try to rest as much as possible. Avoid lifting heavy objects (more than 15-20 pounds). If you need refills on your Prenatal vitamins, please call. Call the office if you have any problems or questions. Keep your appointment for your six-week checkup.

DRIVING

You may ride in a car without restriction. Avoid driving for 1-2 weeks until you can move your foot from the accelerator to brake without discomfort. When you first drive, take someone with you. Do not drive if you are taking prescription pain medication.

DIET

Resume your normal diet. Eat a well-balanced diet. Drink plenty of water daily. You may take a mild laxative or stool softener (Senekot, Colace, Pericolace, Metamucil, Milk of Magnesia) or drink prune or apple juice if you experience constipation. Avoid straining to have a bowel movement.

EXERCISING

Avoid vigorous exercise or straining. Walking and low impact moderate exercise may be started slowly after three weeks. Wait until after your six-week checkup before beginning a regular exercise program.

VAGINAL DISCHARGE

You will experience some vaginal bleeding for one to two weeks after delivery. You may continue to have brown, pink, or yellow discharge for up to six weeks. A thick yellow or green discharge, foul odor, or extreme tenderness in your lower abdomen is not normal and you should call the office immediately.

PERINEAL CARE

Keep the area clean and dry. You may shower. Sitz baths help reduce pain or swelling – use for 10-15 minutes twice daily during the first week. You may add Dreft Soap to the water. You may sit in the bathtub. You may shower without restriction. Tylenol and Ibuprofen are safe for routine pain and soreness. If severe pain or swelling develops, call the office immediately.

TAMPONS, DOUCHING, & INTERCOURSE

Avoid tampons, douching, and intercourse until after your postpartum visit. Severe infection may result. The first menstrual period after delivery will probably be delayed and different from your normal period. Use protection to avoid pregnancy.

WORK, SCHOOL, & TRAVEL

You may return to work or school in six weeks or as directed by your health care provider. If you are going to be traveling, you need to stop every two hours and walk for 10 minutes. This will prevent blood clots from forming in your legs.

1. Know your Group B status (GBS) and/or if you have been dilated when you call. If you are GBS positive (+), call when your contractions are 10-15 minutes apart.
2. If this is your first baby, call when your contractions have been 5 minutes apart for one hour. Each of these contractions should be painful enough that you can not walk or carry on a conversation through them.
3. If this is not your first baby, call when your pains are 10-15 minutes apart for one hour. If you live more than a 20-minute ride from the hospital, ask specifically when you should call.
4. Call immediately if you experience a large gush of fluid, continuous leaking, or if you think your water breaks.
5. Do not be alarmed if you have bloody show unless it becomes heavier than a menstrual period, in which case call. A small amount of show is normal after vaginal exams.
6. Call the office if you are not feeling the baby’s movements.
7. If anything happens to alarm you about which you have not been warned, call immediately.
8. Please call yourself when you are in labor or having any trouble. Others calling can be confusing and the doctors prefer to speak directly to you.
9. It is not necessary to break traffic laws on the way to the hospital.
10. Make sure you have chosen a pediatrician before you go to the hospital to deliver.
11. Having a small bag packed and ready with a few essentials in it is advisable to avoid confusion when it is time to go to the hospital.

CONSTIPATION

Colace, Surfak, Senekot, Metamucil, Fibercon, and Citrucel. You may use Miralax, Milk of Magnesia, Dulcolax, or glycerin suppositories

DIARRHEA

Immodium or Kaopectate

HEMORRHOIDS

Tucks, Anusol, Preparation H, and Americaine ointments

HEART BURN

Tums, Mylanta, Maalox, Pepcid, or Zantac

NASAL CONGESTION

Claritin, Claritin D, Tylenol Cold-Sinus, Benadryl, Ocean Nasal spray

SORE THROAT

Gargle 1 tsp salt dissolved in 8 oz warm water, throat lozenges, chloraseptic spray

COUGH

Robitussin CF or DM, Cough drops

PAIN & HEADACHES

Tylenol or Extra-Strength Tylenol

LEG & CALF CRAMPS

Calcium 500 mg twice per day

NAUSEA

Vitamin B6 75 mg plus ½ tab Unisom at bedtime

ALLERGIES

Claritin, Zyrtec, Allegra, Benadryl, Tylenol Sinus

These are only suggestions of Over-the-Counter products that are safe to use during pregnancy. Use only as directed on the package unless otherwise instructed by a physician.

Please inform our office if you are taking prescription medications from another doctor or dentist or if you develop a medical condition during your pregnancy before taking any of these Over-the-Counter products.

Eating a healthy diet during pregnancy will ensure that you are taking in enough nutrients to support the demands pregnancy places on your body. It is important to eat healthy foods and vary your diet to get all the nutrients you need (Refer to chart for recommended servings). Remember, you only need to increase your calorie intake by 300 calories per day.

DIET RECOMMENDATIONS

• A healthy diet should include high-fiber foods that are enriched. Examples include cereals, pasta, rice, whole-grain breads, fruits, and vegetables.
• Iron-rich foods will help you get enough of this important element needed during pregnancy and breastfeeding. Sources include red meats, green leafy vegetables, molasses, liver, and nuts such as almonds, pistachios, and cashews.
• Choose a diet low in fat, saturated fat, and cholesterol.
• Use sweets, sugars, and soft drinks only in moderation.
• Eat small to moderate-sized meals at regular intervals.
• Caffeine should be limited to 2-3 servings or less daily. Coffees, colas, teas, and chocolate are sources of most caffeine intake.
• Prenatal vitamins ensure you are consistently getting enough vitamins and minerals every day.

SPECIAL FOOD CONSIDERATIONS

• Artificial Sweeteners can be used in moderation in pregnancy. Approved sweeteners include aspartame (Equal or Nutrasweet), sucralose (Splenda), and acesulfame (Sunett). Saccharin (Sweet-NLow) should be avoided during pregnancy.
• Unpasteurized milks and cheeses should be avoided during pregnancy. Most soft cheeses are often unpasteurized. Pasteurized cheeses including most hard cheeses, processed cheese, cream cheese, and cottage cheese need not be avoided.
• Raw, undercooked, deli meats and hot dogs are examples of foods to be avoided unless they are reheated until steaming hot.
• Watch for mercury in fish. Certain fish should be avoided due to high levels of mercury content. Swordfish, shark, king mackerel, and tilefish should be avoided. Check with the local health department before eating game fish (trout, salmon, or bass). Limited tuna and albacore to 6 oz. per week. Cooked shellfish is fine when limited to 12 oz per week. Avoid raw fish like sushi, oysters, and clams.

FOOD SERVINGS

Bread
No. of Servings: 9
Example of Single Serving: 1 slice of bread; 1/2 cup cereal, rice, or pasta
Vegetables
No. of Servings: 4
Example of Single Serving: 1 cup of raw vegetables or 1/2 cup cooked vegetables
Fruit
No. of Servings: 3
Example of Single Serving: 1 medium fruit, 1/4 cup raisins, or 4 ounce glass of juice
Meat, Eggs, & Nuts
No. of Servings: 3
Example of Single Serving: 2-3 ounces of poultry, fish, or meat; 1 egg, or 2 tbs of peanut butter
Dairy Products
No. of Servings: 3
Example of Single Serving: 1 cup of milk or yogurt, 1 1/2 ounces of low-fat cheese

WEIGHT GAIN IN PREGNANCY

Underweight: 28-40 Pounds Gained
Normal Weight: 25-35 Pounds Gained
Overweight: 15-25 Pounds Gained
Obese: 15 Pounds Gained
Carrying Twins: 35-45 Pounds Gained

ADVICE FOR EXERCISE DURING PREGNANCY

• We recommend women stay active during pregnancy. Most women can safely continue or begin mild to moderate exercise during pregnancy.
• Swimming, stationary cycling, walking, running, hiking, low-impact aerobics, yoga, and pilates can all be enjoyed during pregnancy.
• Try exercising a minimum of 30 minutes at least three times a week.
• Avoid potentially dangerous sports activities. No horseback riding, downhill skiing, scuba diving, or contact sports. Avoid activities where you could potentially be hit in the abdomen or are at risk of falling.
• Do not lie flat on your back to exercise after 20 weeks gestation.
• Drink water liberally during exercise.
• Vigorous exercise should not be performed in hot, humid weather.
• Stop exercising if any of the following are experienced during exercise:
  Vaginal bleeding
  Shortness of breath
  Dizziness
  Headaches
  Chest pain
  Signs of preterm labor

OPTION #1: SEQUENTIAL SCREENING

Sequential Screen is a screening test that shows if you are at increased risk of having a baby with Down syndrome, Trisomy 18, or an open neural tube defect. It is a noninvasive test performed in two steps. This test is done at Akron Children’s Hospital. You would receive an early preliminary result in the first trimester, and a final result in the second trimester. Sequential Screen leads to detection of approximately 90% of Down syndrome and Trisomy 18 cases and 80% of open neural tube defects. If the screening test is abnormal, it does not necessarily mean that the baby has one of these birth defects. If you have a “positive” screen you will be offered further testing. This typically includes a very targeted ultrasound and the possibility of Chorionic villi sampling (CVS)* or Amniocentesis*. A “negative” result does not guarantee the birth of a healthy baby.

How it is Done:

Between 11-13 weeks of your pregnancy, a blood sample and ultrasound measurement, called nuchal translucency*, will be taken. If you are not identified to be at increased risk during the first part of the test, you will come back in at 16 weeks for a second blood test. You will receive preliminary results after the first part of the test and final results after part two.

OPTION #2: QUAD SCREEN

The quad screen is an optional screening test offered around 16 weeks of pregnancy. The test screens primarily for open neural tube defects, Down syndrome, and Trisomy 18. The Quad screen offers about 75-80% detection rate. If the screening test is abnormal, it does not necessarily mean that the baby has one of these birth defects. If you have a “positive” screen you will be offered further testing. This typically includes a very targeted ultrasound and the possibility of Amniocentesis. A “negative” result does not guarantee the birth of a healthy baby.

How it is Done:

A blood sample is obtained between the 16-20th week of pregnancy. A calculation is made based on certain medical information and this blood work.

OPTION #3: ALPHAFETOPREOTEIN (AFP) BLOOD TEST

The AFP blood test screens for open neural tube defects only. The two main types of defects are Spina Bifida and anencephaly. Babies with anencephaly usually will die at birth or shortly afterward. Spina Bifida results in a spinal column defect and may range from mild to severe. Mild defects can be corrected with surgery.

How it is Done:

A blood sample is obtained between the 16-20th week of pregnancy. A calculation is made based on certain medical information and this blood work.

OPTION #4: DECLINE ALL OPTIONAL SCREENING TESTS

Some families choose to decline all genetic screening. Choosing or declining screening is a very personal matter to which there is no right or wrong answer. Your decision may depend on religious beliefs, level of anxiety, or course of action that would be taken with abnormal screening results.

*Nuchal Translucency (NT) is a measurement of the fluid-filled space at the back of the developing fetus’ neck.
*Chorionic Villi Sampling (CVS) is a procedure that takes a small amount of tissue from the developing placenta. CVS is associated with a small risk of miscarriage.
*Amniocentesis is a procedure that withdraws a small amount of fluid that surrounds the fetus. This procedure is associated with a small risk of miscarriage; however, the risk is lower than that for CVS.

NAUSEA AND VOMITING

Nausea and vomiting can be normal occurrences during pregnancy. They can also be signs of problems that require medical attention. It is possible to become dehydrated during this time. If you experience persistent nausea and vomiting for over 24 hours, please call the office for advice.

ABDOMINAL PAIN AND CRAMPING

Mild cramping or discomforts can be normal in early pregnancy as your uterus grows and stretches. Severe cramping or abdominal pain can be signs of threatening miscarriage. If you are between 24 and 36 weeks, report more than 4-6 contractions in an hour.

BLEEDING

Any bleeding should be reported to us. If you are near your due date, light bleeding/spotting may follow an exam done in the office. If you experience heavy bleeding like a period at any time, call immediately.

OTHER TIMES TO CALL

Fever or chills that cannot be easily explained by cold or flu symptoms needs to be reported. After the 24th week, you need to report persistent headaches or any visual changes, upper abdominal pain, or swelling of the hand and feet that do not resolve after rest.