Your Pregnancy

During pregnancy there are a couple warning signs to watch out for. No need to panic your midwife will provide you with a phone number that goes directly to a midwife that is on call. There is always someone on call 24/7, so no need to worry about office hours.

1^st trimester

Bright red bleeding

-It can be common to spot after sexual intercourse or after lifting heavy objects, but if you are bleeding a moderate amount, call the midwife

Severe nausea or vomiting

-If you can’t keep fluids or food down for 8 hrs or more, call the midwife

Pain while urinating

-If you have pain or burning while urinating, feel like you can’t empty your bladder, notice blood in your urine, or go to the bathroom multiple times urinating small amounts this could be a sign of a urinary tract infection, call the midwife

Fever

-If you have a fever greater than or equal to 100.4 F, call the midwife this could be a sign of infection that requires further follow-up to keep you and your baby safe

Increased vaginal discharge

-If you experience unusal vaginal discharge accompanied by itching, burning, foul odor, or bleeding call the midwife to schedule an appointment, these are signs of vaginal infection that could require treatment

2^nd trimester

Bright red bleeding

-If you experience a large amount of bright red blood, call the midwife right away for further follow-up; bright red bleeding is a concern

Consistent contractions

-If you start to experience contractions that become regular, occuring every 10-15 minutes, call the midwife, this could be a sign of preterm labor

Leaking of Fluid

-If you experience a gush of fluid, or a constant dribble coming from your vagina, call the midwife and go to the hospital, this could be a sign that your water broke

Decreased fetal movement

-If you feel like your baby is not moving as much as they normally do, drink cold water or a sugary drink and lay on your left side. If you feel like baby still is not moving very much as they have been call your midwife and go to the hospital for further some testing

Injury/trauma to stomach

-If you fall down and land on your stomach, or get in any kind of accident, call the midwife for further follow-up, she may want you to come to the hospital for some testing

Pain while urinating

-If you have pain or burning while peeing, feel like you can’t empty your bladder, blood in your urine, or go to the bathroom multiple times and only urinate small amounts this could be a sign of a urinary tract infection. Urinary tract infections can lead to preterm labor if they are not treated adequately, call the midwife

Fever

-If you have a fever greater than 100.4 F, call the midwife this could be a sign of infection that requires further follow-up to keep you and baby safe

Increased vaginal discharge

-If you experience unusal vaginal discharge accompanied by itching, burning, foul odor, or bleeding, call the midwife to schedule an appointment, these are signs of vaginal infection that could require treatment

Headache

-If you experience a headache that is not relieved by Tylenol, rest, or drinking fluids call the midwife, this could be a sign of high blood pressure that requires further follow-up

Blurred vision

-If your vision becomes blurry and it is accompanied by dizziness, call the midwife for further follow-up, this is another sign of high blood pressure.

3^rd Trimester

Consistent contractions

-If you start to experience contractions that become regular, occuring every 5-10 minutes call the midwife, this could be a sign of labor. Your midwife will help you decide if it’s time to come to the hospital

Leaking of Fluid

-If you experience a gush of fluid, or constant dribble coming from your vagina, call the midwife for further follow-up. If you are 37 weeks gestation or greater she will give options to proceed with birth

Bright red bleeding

-It can be normal to have spotting after sexual intercourse but if the bleeding is a large amount and not stopping or accompanied by abdominal pain, call the midwife and go to the hospital immediately

Itching

-Sudden onset of extremely itchy hands and feet. This could be a sign of cholestasis, sometimes it presents in the night and is non-stop scratching and itching to the point you cause bleeding. Cholestasis is a condition that slows down the normal flow of bile into the gallbladder, causing a buildup of bile acids in the liver — which in turn spills into the bloodstream, causing this horrible intense itching. Call the midwife if you are experience itching.

Decreased fetal movement

-If you feel like your baby is not moving as much as they normally do, drink cold water or a sugary drink and lay on your left side. If your baby is still not moving, call the midwife and go to the hospital for further follow-up

Injury/trauma to stomach

-If you fall down and land on your stomach, or get in any kind of accident, call the midwife for further follow-up. She may want you to come to the hospital for further testing

Pain while urinating

-If you have pain or burning while urinating, feel like you can’t empty your bladder, notice blood in your urine, or go to the bathroom multiple times while only urinating a small amount this could be a sign of a urinary tract infection. Urinary tract infections can lead to preterm labor if they are not treated adequately, call the midwife

Fever

-If you have a fever greater than 100.4 F, call the midwife this could be a sign of an infection that requires further follow-up to keep you and your baby safe

Increased vaginal discharge

-If you experience unusal vaginal discharge accompanied by itching, burning, foul odor, or bleeding, call the midwife to schedule an appointment, these are signs of vaginal infection that could require treatment

Headache

-If you experience a headache that is not relieved by Tylenol, rest, or drinking fluids call the midwife, this could be a sign of high blood pressure that requires further follow-up

Blurred vision

-If your vision becomes blurry and it is accompanied by dizziness, call the midwife for further follow-up, this is another sign of high blood pressure.

Swelling

-If you experience sudden swelling in your face, hands, accompanied by blurred vision, seeing spots, and/or headaches, go to the hospital immediately and call the midwife, this could be a sign of preeclampsia a severe pregnancy complication

Perhaps one of the biggest pieces of advice I could tell you during your pregnancy is to stay active! It sounds a lot easier than it is but oh the rewards are great. I know what your thinking….it is hard enough to get out of bed in the morning or get yourself off the couch in the evening. However, I promise you that if you can make yourself exercise your chances of having a positive birth experience is much higher. Even going for evening walks is a great way to stay active and on top of that, fresh air is always therapeutic.

A personal experience. My second baby was breech, I stayed active during the beginning of this pregnancy but I have to admit by the third trimester I was not exercising at all. My third pregnancy I was determined to stay active mentally and physically. My third birth went a lot smoother and I attribute this to staying active. Not to mention in my experience in midwifery thus far, I have seen the benefits of women who stay active during their pregnancy. Did I mention how many muscles we use during labor when we are pushing our sweet babe through the birth canal?! Take my word, we use a lot! Some of my favorite exercises included attending yoga, swimming laps, walking, and cardio classes. Yoga did so much for my mind, muscles, and stress level. Swimming was also a favorite, it’s nice to feel weightless in the water. Give it a try and let me know if you have the same experience.

There are numerous other ways to stay active. Find what works for you and continue it throughout your pregnancy. You will be so grateful when it comes time to give birth. Staying active also reduces your chances of developing gestational hypertension, gestational diabetes, and even preeclampsia. When we exercise our body releases endorphins a hormone that makes us happy. So here is to a happy pregnancy.

Don’t forget to drink plenty of water before, during, and after exercise. Exercise can be continued during your entire pregnancy as long as no compilations arise and you aren’t having any discomforts. Talk to your midwife if you are having any concerns or need some good local recommendations.

Weight gain during pregnancy

Oh, the many joys of pregnancy, one of them being gaining weight. Just think, that weight is going to your growing baby and the fluids around the baby. Try not to get to caught up in what the scale says…..just remember to stay active and eat healthy.

Your midwife will recommend gaining 25-35 lbs over the next 9 months. She might recommend more weight gain if your underweight during the start of your pregnancy (BMI less than 18.5). Or your midwife might recommend gaining less weight if your overweight (BMI above 25) [1].

The fact of the matter is that your midwife is here to help you during your entire pregnancy so just talk with her about what is the right amount for you. Remember there is never any judgment from your midwife just guidance to support you and your baby through your pregnancy.

Resources

1. http://onlinelibrary.wiley.com/store/10.1016/j.jmwh.2010.09.003/asset/j.jmwh.2010.09.003.pdf?v=1&t=iz91y269&s=78a2e197dfbff46fc5fe828d80dede673e7990a9
2. http://onlinelibrary.wiley.com/store/10.1016/j.jmwh.2009.08.019/asset/j.jmwh.2009.08.019.pdf?v=1&t=iz91zbpc&s=6c7ecc56689c319f98574cc20458ac1a62826844

Today, there are numerous tests available to pregnant women that detect genetic syndromes and diseases. These screening tests are between 80-95% accurate in detecting specific disorders. The most common disorders these test screen for include Down syndrome (trisomy 21), spina bifida, and Edwards Syndrome (trisomy 18). In you are 35 years or older or have had a baby with a previous genetic disorder you are considered higher risk and the initial screening tests can be skipped.

Initial testing is screening tests only. This means that the tests will only predict an “increased risk.” If you complete the screening and your results report you are at an “increased risk,” diagnostic testing will be offered. It is important to understand that out of a 100 women that are reported to have an “increased risk” 95 of these women will have a baby without a genetic condition. In other words these tests can be false and this is important to understand. The following test are screening test.

• Non-Invasive Prenatal Testing (NIPT): This is a new test that allows examination of the fetal DNA taken from the mother’s blood. This has the potential to be very accurate without putting the fetus or mother at risk from the testing. It can be done as early as 9-10 weeks of gestation. This will not detect neural tube defects such as spina bifida.

• betaHCG: This is a hormone test that is used for confirming pregnancy, however, this blood test can also be used to indicate a risk for Down Syndrome, Trisomy 18, molar pregnancy, twins, and stillbirths. This is a part of the second trimester blood test known as the “Quad” screen.

• PAPP-A (Pregnancy Associated Plasma Protein A): This is a protein that is detected in the blood and it is decreased in conditions like Down Syndrome, Trisomy 13 and Trisomy 18. It may also predict a baby that is small for gestational age or a stillbirth. Very high levels can predict a large for gestational age baby. This may be done in the first trimester along with a nuchal translucency measurement completed by ultrasound.

• Nuchal Translucency Measurement (NT): This is a specialized ultrasound done between 11 and 14 weeks that can indicate an increased risk for Down Syndrome. This ultrasounds measures the the fluid around the baby’s neck. This is a screening that is also a part of the “Quad” screen.

• Quad Screen: This is a blood test that can be done between 15 and 22 weeks that is composed of 4 different tests. It includes maternal serum alpha-fetoprotein, maternal serum estriol, maternal beta hcg, and inhibin A. Combinations of high, low and normal levels are used to calculate a risk profile for trisomy 13, 18, 21 and neural tube defect. These risk profiles can be different depending on age, race, weight, and health history. If your gestational age of the baby are is off at all, it can significantly decrease the accuracy of the test. This test can usually be ordered and completed by your midwife.

• Materni T21: This test is a blood draw at about 10 weeks gestation and can test for trisomy 21, trisomy 18, and trisomy 13. This test has been reported to detect 99% of trisomy disorders.

• Maternal serum alpha-fetoprotein: This is the test for spina bifida and cannot be done before 15 weeks. It is part of the Quad Screen and other integrated screening, but may be done alone.

The following two tests are diagnostic tests—meaning they can diagnose your baby with certain genetic conditions. These two tests carry a risk of ending the pregnancy because they require sampling of amniotic fluid or placenta tissue. This means that there is a chance you could miscarry after the procedure.

• Chorionic Villus Sampling (CVS): This test involves removal of a small amount of the placental tissue and can be completed as early as the first trimester. This tissue sample contains fetal cells that can be tested for genetic disorders. Results are available within a week.

• Amniocentesis: This test is completed in the second trimester using a long needle to remove a small amount of fluid. The cells are then grown for about 2 weeks until the chromosomes can be closely examined for. Complications from this procedure can include cramping, bleeding, accidental rupture of the membranes, infection, and miscarriage. The risk for fetal loss is between 0.5%-1%.

Some women choose to test because they want to know before the baby is born if the baby will have a genetic disorder. This helps the woman and her partner prepare to have a child with special needs by accessing the right resources and joining support groups beforehand. In some cases women choose to terminate the pregnancy. For some women, the risks of miscarrying associated with diagnostic testing are not acceptable and the results of the test would not change their choice to keep the pregnancy so they decided not to get genetic testing done.

There is NO right answer about testing. The choice is entirely up to YOU and your partner. This information is presented as information only and not an opinion or judgment on what any pregnant woman should choose. Remember to check with your insurance company first to see what they will cover as these tests can be very pricey. Some tests may not be covered by insurance unless you are considered high risk.

I’m sure you know by now testing can be very complicated. Your midwife will arrange with you to meet with a genetic counselor to go over your personal medical history and family history if this is something you are interested in. Your midwife will also explain the test in further detail. Talk with your midwife about any questions or concerns and she can help you make an informed decision.

Resources

1. http://www.acog.org/Patients/FAQs/Prenatal-Genetic-Testing-Chart-Infographic
2. http://onlinelibrary.wiley.com/store/10.1111/j.1542-2011.2004.tb04230.x/asset/j.1542-2011.2004.tb04230.x.pdf;jsessionid=B7955F37EF7FAC74B5FE590A4DF0744F.f03t04?v=1&t=iz6m1fz3&s=50efbb46e8997a87d8c5a93318fd377bdde06326
3. http://onlinelibrary.wiley.com/store/10.1111/jmwh.12026/asset/jmwh12026.pdf?v=1&t=iz6m2qq9&s=8b6fd1bc2e2e6913b2cf107b99651d72a5a63919

Good news! Sex is perfectly safe during pregnancy, unless your midwife has told you otherwise. There are some pregnancy complications that can arise, i.e., placenta previa that your midwife may recommend to avoid sexual intercourse but for the most part, sex is perfectly safe. In fact, orgasm is actually good for the developing fetus; those feelings of closeness and affection are good for you, your partner, and your baby. So don’t worry, your baby is safe!

Many women worry that their partner’s penis might “poke” the baby. Well I am here to tell you loud and clear that the penis does NOT go past the vagina. It doesn’t go into the cervix and doesn’t touch the uterus. So don’t worry your baby is perfectly safe in there. Many women actually report that sex is more enjoyable during pregnancy; this could be attributed to the increase in hormones.

As your pregnancy progresses it might be a good idea to try different positions. As that cute little baby grows, your abdomen grows larger making some positions very uncomfortable. Alternate positions are listed below.

• Missionary position
• You on top
• Side-by-side, from behind
• From behind, doggy style
• Side-by-side, at an angle
• On a chair
• Edge of the bed

It’s also important to note that orgasm can cause mild contractions and in some cases spotting of blood. The cramps should disappear soon after your finished and the spotting should be minimal so no need to worry.

Sex during the end of your pregnancy can be very helpful to induce labor. There are prostaglandins in semen that can cause your cervix to soften and contractions to begin. So relax, loosen up, and enjoy the last little while your baby is in your womb. The good news is you are creating a beautiful life and on a positive note, you don’t have to worry about getting pregnant:).

It’s no doubt you have seen hundreds of baby items that are advertised as “must haves” for mom and baby. In all honesty, a breastfeeding baby really doesn’t need much to survive outside of the womb. Besides diapers of course:). So before you start your registry or go overboard on shopping consider the following top 10 items that were voted as the 2016 “must have” for or mom and baby [1]. These are good ideas for shower gifts that you can add to your registry.

• Baby sling or carrier
• Swaddling blankets
• Boppy pillow
• Nursing cover
• Nipple cream/nursing pads
• Breast pump
• Burp clothes
• Mylicon (Gas Drops)
• White noise machine 
• Bouncy chairs and baby swings

Some other items that many women love and recommend to add to that list include the Boon Grass countertop drying rack, click here. A nursing cover that can be used as a car seat canopy, a grocery cart cover, scarf, or a nursing cover, click here. In addition, a baby item that gives some piece of mind while your in your car, a car mirror, click here. Also, there is a large variety of baby video monitors that have been life savers for some, click here. Last but not least, a diaper bag that has the ability to convert to a bag pack; those babies grow fast and before you know it you will need two hands to carry around that car seat. Here are some top rated bags that range in price.

Pic 1, Click here

Pic 2, Click here

Pic 3, Click here 

Pic 4, Click here

Resources

1. http://www.consumerreports.org/babies-kids/

Travel

Traveling can be perfectly safe during your pregnancy. You should probably mention this to your midwife but flying on an airplane and riding in a car is all OK to do during your pregnancy. Just remember to wear your seatbelt and take the same precautions you normally would. If you are going to be sitting for long periods of time it’s a good idea to get up every 2 hours and walk around to prevent blood clots. You can also purchase some compression stockings to wear, click here. Some airline companies require that you bring a note from your midwife if you are traveling late in your pregnancy.

Dental Care

It is perfectly safe to get your teeth cleaned during pregnancy. Some studies have shown that poor oral health can lead to preterm birth. It is recommend to discuss this with your midwife. You should always tell your dentist that you are pregnant before he begins any procedures. You can get dental x-rays done as long as your wear a protective apron over your pregnant abdomen.

Cats

Do you have a cat? It’s ok if you have a cat but during pregnancy it is recommended that you have someone else change the kitty litter box. A rare microbe can be inhaled by you from the cat litter called “toxoplasmosis.” This microbe can be harmful to you and your baby. Please let your midwife know if you have a cat.

Bathing

Bathing daily is not harmful to your baby, this is actually encouraged! Warm baths can feel good during pregnancy and be very relaxing. Just make sure your bath tub is nice and clean. Hot tubs should be avoided in early pregnancy, but can actually be used later in pregnancy as long as the hot tub is clean and you don’t stay in for a long period of time. If you experience discomfort get out, listen to your body, it might be too hot.