Nutrition During Pregnancy and Preconception Care | Exercise in Pregnancy | Medication use during pregnancy | Food Guidelines | VBAC | When To Call Your Doctor
Nutrition during pregnancy
The single most important thing that you can do for your baby is to eat a healthy, well-balanced diet. A well-balanced diet is one that includes foods from all food groups in appropriate amounts, so as to ensure proper nutrition. Proper nutrition ensures that all essential nutrients (carbohydrates, fats, protein, vitamins, minerals and water) are supplied to the body to maintain optimal health and well-being. Good nutrition is essential for normal organ development and functioning; normal reproduction, growth and maintenance; for resistance to infection and disease; and for the ability to repair bodily damage or injury. While pregnancy is a normal condition for the female body, it is stressful, and all nutritional needs are increased in order to meet the needs of the pregnancy.
The World Health Organization recommends that a pregnant woman eat a minimum of 75 grams of protein per day, obtained from a wide variety of whole food sources. While the government’s plan, myplate, is a good example of a well-balanced diet, pregnant women need more protein and calories in general. This means including:
- 2 to 3 servings of meat, fish, nuts or legumes, and tofu
- 2 to 3 servings of dairy (milk, eggs, yogurt, cheese)
- 3 servings of vegetables (predominantly green vegetables)
- 3 servings of fruit
- 3 servings of whole grain breads, cereals, or other complex carbohydrates
- at least 8 glasses of water each day
For information about specific foods and nutrients during pregnancy, visit: http://www.acog.org/Patients/FAQs/Nutrition-During-Pregnancy
If you are planning to become pregnant, it is a good idea to have a preconception care checkup. During this visit, your health care provider will ask about your diet and lifestyle, your medical and family history, medications you take, and any past pregnancies. Identifying these factors before pregnancy allows you to take steps that can increase the chances of having a healthy pregnancy and a healthy baby. The first 8 weeks of pregnancy are key for the baby growing inside you. Most of the baby’s major organs and body systems have begun to form. Your health and nutrition can affect your baby’s growth and development in these early weeks.
For more information, visit: http://www.acog.org/Patients/FAQs/Good-Health-Before-Pregnancy-Preconception-Care
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Exercise in Pregnancy
Becoming active and exercising at least 30 minutes on most, if not all, days of the week can benefit your health during pregnancy in the following ways:
- Helps reduce backaches, constipation, bloating, and swelling
- May help prevent or treat gestational diabetes
- Increases your energy
- Improves your mood
- Improves your posture
- Promotes muscle tone, strength, and endurance
- Helps you sleep better
Regular activity also helps keep you fit during pregnancy and may improve your ability to cope with labor
The hormones produced during pregnancy cause the ligaments that support your joints to become relaxed. This makes the joints more mobile and more at risk of injury. The extra weight in the front of your body during pregnancy shifts your center of gravity and places stress on joints and muscles, especially those in the pelvis and lower back. This can make you less stable, cause back pain, and make you more likely to lose your balance and fall, especially in later pregnancy. The extra weight you are carrying will make your body work harder than before you were pregnant.
Certain sports are safe during pregnancy, even for beginners. Walking, swimming, and cycling are all beneficial. Yoga and aerobics can also be done, often with some slight modifications for the expanding abdomen. If you were a runner before you became pregnant, you often can keep running during pregnancy, although you may have to modify your routine.
What forms of exercise should be avoided?
In general, activities in which there is a high risk of falling, such as gymnastics, water skiing, and horseback riding, should be avoided. Some racquet sports also increase the risk of falling because of your changing balance. Other sports to avoid include the following:
- Downhill snow skiing—Your change in balance may put you at greater risk of injuries and falls. Also, you may be at risk of altitude sickness, an illness caused by breathing air that contains less oxygen.
- Contact sports, such as hockey, basketball, and soccer—These sports can result in harm to you and your baby.
- Scuba diving—Scuba diving can put your baby at risk of decompression sickness, a serious illness that results from changes in the pressure surrounding the body.
For more information, visit: http://www.acog.org/Patients/FAQs/Exercise-During-Pregnancy
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Medication use during pregnancy
Many over-the-counter and prescription medications are safe to take during pregnancy. However, some are not safe for pregnant women. Prior to pregnancy, you should discuss any medication use with your provider to determine if any should be changed or discontinued. If you find out you are pregnant and have concerns about medication use, make an appointment to discuss the situation with your provider right away - in some cases, abrupt discontinuation of medication can also be harmful. Some medications that are safe during pregnancy are not recommended in breast-feeding mothers, so if you are planning to breastfeed, make sure to have a discussion with your provider about any changes that need to be made after delivery.
For a list of over-the-counter medications that are safe to use during pregnancy, click here:
All pregnant women (unless specifically instructed by a provider) should take a prenatal vitamin daily. There are many over-the-counter options as well as prescription vitamins - the choice of which one to take is very individual and should be determined by several factors such as tolerability and affordability. Prenatal vitamins typically contain more folic acid and iron than traditional multivitamins, as well as supplemental DHA. These vitamins should be continued during breast-feeding and often beyond, in anticipation of another future pregnancy or as an alternative to a daily multivitamin.
Unlike prescription drugs, herbs and vitamin supplements do not go through the same scrutiny and evaluation process by the FDA. As a result, the quality and strength of an herbal supplement can vary between two batches of the same product and between products from different manufacturers. Consumers have little way of knowing if a product will do what the label claims and how safe the product may be. Reliable information about the product may be hard to find, which makes researching these products’ effectiveness more challenging. Although herbs are natural, not all herbs are safe to take during pregnancy. The FDA urges pregnant women not to take any herbal products without talking to their health care provider first. Women are urged to consult a trained and experienced herbalist (or other professional who is trained to work with herbs) if they want to take herbs during their pregnancies. Some herbal products may contain agents that are contraindicated in pregnancy. Herbs may contain substances that can cause miscarriage, premature birth, uterine contractions, or injury to the fetus. Few studies have been done to measure the effects of various herbs on pregnant women or a developing fetus.
The following herbs are considered Likely Unsafe or Unsafe during pregnancy and should be avoided:
- Saw Palmetto – when used orally, has hormonal activity
- Goldenseal - when used orally, may cross the placenta
- Dong Quai – when used orally, due to uterine stimulant and relaxant effects
- Ephedra - when used orally
- Yohimbe - when used orally
- Pay D’ Arco – when used orally in large doses
- Passion Flower - when used orally
- Black Cohosh – when used orally
- Blue Cohosh – when used orally; uterine stimulant and can induce labor
- Roman Chamomile – when used orally in medicinal amounts
- Pennyroyal – when used orally or topically
The following herbs have been rated Likely Safe or Possibly Safe for use during pregnancy:
- Red Raspberry Leaf – Rich in iron, this herb is used to increase milk production, decrease nausea, and ease labor pains. Pregnancy teas that are often made from red raspberry leaf to help promote uterine health during pregnancy. There is some controversy about whether this should be used throughout pregnancy or just in the second and third trimester, so many health care providers remain cautious and only recommend using it after the first trimester.
- Peppermint Leaf – Helpful in relieving nausea/morning sickness and flatulence
- Ginger root - Helps relieve nausea and vomiting – shop for tea
- Slippery Elm Bark - (when the inner bark is used orally in amounts used in foods) Used to help relieve nausea, heartburn, and vaginal irritations
- Oats & Oat Straw – Rich in calcium and magnesium; helps relieve anxiety, restlessness, and irritated skin – shop for tea
For more information, visit: https://nccih.nih.gov/health or http://www.herbmed.org/
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From the FDA: “Fish and shellfish are an important part of a healthy diet. Fish and shellfish contain high-quality protein and other essential nutrients, are low in saturated fat, and contain omega-3 fatty acids. A well-balanced diet that includes a variety of fish and shellfish can contribute to heart health and children's proper growth and development. So, women and young children in particular should include fish or shellfish in their diets due to the many nutritional benefits.
However, nearly all fish and shellfish contain traces of mercury. For most people, the risk from mercury by eating fish and shellfish is not a health concern. Yet, some fish and shellfish contain higher levels of mercury that may harm an unborn baby or young child's developing nervous system. The risks from mercury in fish and shellfish depend on the amount eaten and the levels of mercury in the fish and shellfish. Therefore, the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) are advising women who may become pregnant, pregnant women, nursing mothers, and young children to avoid some types of fish and eat fish and shellfish that are lower in mercury.”
Do not eat fish containing high levels of mercury:
- King Mackerel
Eat 2 meals a week of a variety of fish and shellfish that are lower in mercury, such as:
- Canned light tuna
Check local advisories about the safety of fish caught by family and friends in your local lakes, rivers, and coastal areas. If no advice is available, eat up to 6 ounces (one average meal) per week of fish you catch from local waters, but don't consume any other fish during that week.
What is mercury?
Mercury occurs naturally in the environment and can also be released into the air through industrial pollution. Mercury falls from the air and can accumulate in streams and oceans and is turned into methylmercury in the water. It is this type of mercury that can be harmful to your unborn baby and young child. Fish absorb the methylmercury as they feed in these waters and so it may build up in them. It builds up more in some types of fish and shellfish than others, depending on what the fish eat, which is why the levels in the fish vary.
I'm a woman who could have children but I'm not pregnant - so why should I be concerned about methylmercury?
If you regularly eat types of fish that are high in methylmercury, it can accumulate in your blood stream over time. Methylmercury is removed from the body naturally, but it may take over a year for the levels to drop significantly. Thus, it may be present in a woman even before she becomes pregnant. This is the reason why women who are trying to become pregnant should also avoid eating certain types of fish.
Is there methylmercury in all fish and shellfish?
Nearly all fish and shellfish contain traces of methylmercury. However, larger fish that have lived longer have the highest levels of methylmercury because they've had more time to accumulate it. These large fish (swordfish, shark, king mackerel and tilefish) pose the greatest risk. Other types of fish and shellfish may be eaten in the amounts recommended by FDA and EPA.
What about fish sticks and fast food sandwiches?
Fish sticks and "fast-food" sandwiches are commonly made from fish that are low in mercury.
The advice about canned tuna is in the advisory, but what's the advice about tuna steaks?
Because tuna steak generally contains higher levels of mercury than canned light tuna, when choosing your two meals of fish and shellfish, you may eat up to 6 ounces (one average meal) of tuna steak per week.
What if I eat more than the recommended amount of fish and shellfish in a week?
One week's consumption of fish does not change the level of methylmercury in the body much at all. If you eat a lot of fish one week, you can cut back for the next week or two. Just make sure you average the recommended amount per week.
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Our providers support vaginal birth after cesarean section if desired and when appropriate. If you are interested please discuss with your provider. We will review the circumstances around your delivery by cesarean section and look at other risk factors to provide you our best prediction for your likelihood for success. In most incidences, this option is available to women who have had only 1 cesarean section.
We will need to review your dictated operative note from your prior delivery, so please bring a copy or the name and address of the hospital where your cesarean section was performed. As our office is adjacent to Overland Park Regional, we prefer to do these deliveries at OPR, so we can be more available.
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When To Call Your Doctor
If you experience any of the following before 37 weeks:
- Persistent vomiting
- Six or more contractions in one hour
- Leaking of fluid or sudden gush from vagina
- Any vaginal spotting or bleeding
- Unusual or severe discomfort
- Fever greater than 100.6 degrees C, especially if associated with abdominal pain
- Rhythmic back pain or pelvic pressure, low dull backache, menstrual-like cramps, abdominal or pelvic cramping
- A noticeable decrease in fetal movement. (28 weeks or beyond) (Less than 4 movements per hour or less than 10 movements in 2 hours)
- Swelling of hands, face, legs, and feet
- Painful urination
If you experience any of the following 37 weeks or beyond:
- Regular, painful contractions, every 3 to 5 minutes apart (1st time mothers). If this is not your first child, call when your contractions are 5 minutes apart, lasting 60 seconds. If you have a history of very rapid labors, discuss this with your healthcare provider
- Leaking of fluid, regardless of the presence or absence of contractions
- Any significant amount of vaginal bleeding. A small amount of mucous, bloody show is normal. (If bleeding is like a menstrual cycle or heavier or wearing a maxi paid is required then please contact our office)
- Fever greater than 100.6 degrees, especially if associated with abdominal pain
- A noticeable decrease in fetal movement. It is a wives tale that decreased fetal movement is normal right before the onset of labor. Call for any noticeable decrease in fetal movement. (Remember, the baby can be more difficult to feel as you get closer to your due date. Make sure you are in a quiet place, free of distractions when trying to assess the amount of movement)
- Visual disturbances: Dizziness, double vision, spots before eyes
- Severe headache
- Swelling of hands, face, legs, and feet
- Painful urination
- Fever greater than 100.6 degrees, especially if associated with abdominal pain or increased bleeding or breast pain
- Bleeding that consistently gets heavier instead of lighter
- Worsening abdominal or episiotomy site pain
- Foul smelling vaginal discharge
- Unusual pain or redness of the breast(s)
- Pain or difficulty with breast-feeding
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