Congratulations on Your Pregnancy and Welcome to:

1813 W Harvard Ave – Suite 542 – Roseburg, OR - 97471(541) 464-6464

Mary E. Powell, MD William T. Hollander, MD Amy N. Zastrow, MD Physician and Surgeon Physician and Surgeon Physician and Surgeon

Karen M. Roberson, NMNP, CNM

1813 W Harvard Ave – Suite 542 – Roseburg, OR - 97471(541) 464-6464

What to Expect at Your Prenatal Visits

Prenatal visits will be:

Initial apt. is an extensive interview that you can expect to last about an hour Every 4 weeks for the first two trimesters (week 28) Every 2 weeks until about week 35 Weekly from week 36 until delivery

At each appointment we will:

Collect urine sample: o Looking for protein, ketones, glucose, blood, leukocytes. This gives us an indication of overall

health and may alert us to urinary infections or other concerns. Check weight and blood pressure Measure growth of the baby Listen to heart tones Answer any questions or concerns

Labs, ultrasound, and other tests to be done:

Initial Apt: OB Panel (blood type & Rh, CBC, H&H, Rubella), HIV, urine toxicity, urinalysis with culture, cystic fibrosis (optional). Pap & cultures may be done if necessary

6-8 wks: initial dating ultrasoundo This is a limited ultrasound done to determine fetal measurements and confirm due date

16-20 wks: Quad Screen (optional blood test screening for birth defects) 20-24 wks: Complete anatomical ultrasound (assessment of organ development)

o Sex of the baby can usually be determined at this ultrasound 24-28 wks: 1 hr glucose (2 hrs fasting prior to test)

3 hr glucose if necessary 28 wks: Rhogam injection (if necessary) 35-36 wks: Group Beta Strep Culture 35 wks: Non Stress Test (NST) for gestational diabetics (weekly or biweekly)

o NST’s may also be done on an as needed basis 36-40 wks: OB Provider may do cervical exam

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Healthy Eating During Pregnancy

Good nutrition during pregnancy, and enough of it, is very important for your baby to grow and develop. Getting all the nutrients you need is easy by focusing on a variety of foods each day. Keep in mind that eating for two, doesn’t mean eating twice as much. Although you need more nutrients, you don’t need many more calories. In fact, you only need about 300 more calories a day than before you were pregnant.

10 goals for eating during pregnancy:

1. Eat a variety of food each day. Recommended daily servings include:

6-11 servings of breads and grains 2-4 servings of fruit 4 or more servings of vegetables 4 servings of dairy products 3 servings of protein (meat, poultry, fish, eggs or nuts) Use fats and sweets sparingly

2. Choose foods high in fiber that are enriched such as: Whole grain breads, cereals, pasta, rice, fruits and vegetables A high fiber diet helps reduce constipation, a common discomfort of pregnancy.

3. Take a prenatal vitamin each day to make sure you are continuously getting enough vitamins and minerals.

4. Eat and drink at least four servings of dairy products and calcium-rich foods each day to ensure that you are getting 1000-13000mg of calcium daily. Examples include:

Hard cheeses (1 ½ oz), Milk (1 cup), Cottage cheese (2 cups), Yogurt (1 cup) Calcium-added: soy cheeses (1 ½ oz), soy milk or soy yogurt (1 cup) Green veggies: broccoli, spinach, and greens (½ cup cooked) Tofu (9 oz), rice milk, orange juice (¾ cup) Seafood: salmon, sardines (3 oz)

5. Eat 3 servings of iron-rich foods to ensure at least 27 mg of iron daily. Examples include: Enriched grain products, lean meat, poultry, fish, leafy green vegetables, molasses Eat vitamin C and iron foods together since vitamin C helps your body absorb iron. Caffeine can block the absorption of iron. Take iron supplements 1-3 hours before or after

consuming any caffeine. Iron is needed to increase your blood volume and help deliver oxygen to you and your baby.

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6. Choose one good source of vitamin C to ensure at least 70 mg of vitamin C daily. Examples include: Oranges, grapefruits, strawberries, honeydew, papaya Broccoli, cauliflower, brussel sprouts, green peppers, tomatoes, mustard greens Vitamin C helps make the tissue that supports your baby’s

bones and muscles.7. Choose one good source of folic acid to ensure at least 0.4 mg of folic

acid daily. Examples include: Dark leafy greens (spinach, asparagus, turnip greens) Legumes (lima beans, black beans, black-eyed peas and

chickpeas) Getting enough folic acid reduces the risk of neural tube

defects, such as spina bifida.8. Choose one good source of Vitamin A every other day. Examples include:

Carrots, pumpkins, sweet potatoes, spinach, beet greens, apricots, cantaloupe. Vitamin A helps your baby’s cells grow. It also keeps your own skin smooth and clear. Getting vitamin A through food sources is best. Do not take vitamin A pills unless advised by your

healthcare provider. Too much vitamin A may affect your baby’s growth.9. Eat 3 servings of protein daily. You need 60-85 grams or 5.5 ounces of protein daily. Protein provides the

very important “building blocks” that go into making nearly every part of your baby. Examples include: Chicken, turkey, lean red meat, fish, lamb, pork (1 serving is approx 3 oz/ size of a deck of cards) Eggs (1 serving is one large egg) Peanuts or other nuts, pumpkin/sunflower seeds (½ oz), roasted soybeans (¼ cup) Soy milk or soy yogurt (1 cup) Split peas, lentils, dried beans such as pinto & garbanzo beans (¼ cup cooked)

Hummus (2 Tbsp), peanut or almond butter (1 Tbsp) Tofu (¼ cup), tempeh (1 oz), soy cheeses (2 oz)

10. Drink 8-12 eight ounce glasses of water daily. Your body needs water to increase your blood supply, carry nutrients from your food to your baby and to make amniotic fluid.

Remember: caffeinated beverages actually dehydrate you and do not count as water consumption.

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Foods to Avoid When Pregnant

1. Avoid alcohol during pregnancy. o Alcohol can cause premature delivery, mental retardation, birth defects, and low birth weight

babies.2. Limit caffeine to no more than 300 mg per day. Caffeine content does vary depending on how it was

prepared. o An 8-ounce cup of coffee has about 150 mg of caffeine on averageo Black tea has about 80 mg. o A 12-ounce glass of caffeinated soda contains anywhere from 30-60 mg of caffeine. o Chocolate -- the amount of caffeine in a chocolate bar is equal to 1/4 cup of coffee.

3. Avoid saccharin. It can cross the placenta and may remain in fetal tissues. In moderation, other artificial sweeteners have been approved by the FDA. These include:

o aspartame (Equal or NutraSweet), acesulfame-K (Sunett), and sucralose (Splenda).4. Decrease the total amount of fat you eat to 30% or less of your total daily calories. For a person eating

2000 calories a day, this would be 65 grams of fat or less per day.5. Limit cholesterol intake to 300 mg or less per day.6. Avoid seafood known to contain high levels of mercury. These are

o Shark, swordfish, king mackerel, or tilefish (white snapper)7. Avoid unpasteurized soft cheeses because they may cause Listeria infection.

o Not okay to eat- Feta, Brie, Camembert, blue-veined, and Mexican-style cheeseo Ok to eat- Hard cheese, processed cheese, cream cheese, cottage cheese, & yogurt.

8. Avoid raw fish, especially shellfish like oysters and clams.9. Heat all lunch meats and hot dogs to steaming before eating. Eating these without heating first also poses a risk for Listeria infection.

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How much weight should I gain?

Your healthcare provider may tell you how much weight gain would be healthy for you. This depends, in part, on your weight before getting pregnant:

If your weight was normal you may want to gain 25-35 pounds If you were underweight, your healthcare provider may suggest gaining 28-40 pounds If you were overweight, keeping weight gain to 15-20 pounds might be best.

Aim for HealthA slow, steady rate of gain is often best. After the first trimester, you may gain about a pound a week. But keep in mind that every woman gains weight differently. Don’t worry too much about pounds. Instead, aim

for feeling healthy.

Where does all the extra weight go during pregnancy?

Baby: 8 pounds Placenta: 2-3 pounds Amniotic fluid: 2-3 pounds Breast tissue: 2-3 pounds Blood supply: 4 pounds Fat stores for delivery and breastfeeding: 5-9 pounds Uterus increase: 2-5 pounds Total: 25 to 35 pounds

Don’t Diet.

Now is not the time to diet. You might not get enough of the nutrients you and your baby need. Instead, learn how to be a healthy eater.

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Rev: 05/2016

Over the Counter Medications

Some over the counter medications are safe to take during pregnancy, but some are not. In general, do not take any medications unless they are truly necessary. Don’t take more than the recommended dose and, if possible, avoid taking anything during the first trimester when your developing baby is most vulnerable. If you have questions about a medicine, please call before taking it. The following medications have no known harmful effects during pregnancy when taken according to package directions.

Condition MedicationAllergy Benadryl (Diphenhydramine), Claritin, ZyrtecCold/Cough and Flu Tylenol (acetaminophen) or Tylenol Cold

Warm saltwater gargle (1 tsp. salt in 1 cup warm water)Vicks Vapo-RubSaline nasal drops or sprayCough drops and throat lozengesSudafed (pseudophedrine), Actifed, Dristan, Neosynephrine*,DayQuil, NyQuilRobitussin DM, Trind-DM, Vicks Cough Syrup, Romilar**Do not take the “SA” (sustained action) forms of these drugs or the “Multi-Symptom” forms of these drugs

Cold Sores Orajel, Herpecin 6 cold soreConstipation Metamucil or Citrucil, Fiberall/Fibercon

Colace, Senekot, Milk of Magnesia, MiralaxDiarrhea Use only for 24 hours, only after 12 weeks of pregnancy

Immodium, KaopectateHeadache Tylenol (acetaminophen)Heartburn Tums, Maalox or Mylanta

Prilosec OTC one daily, Pepcid AC, Zantac 150 mg twice dailyHemorrhoids Tucks pads, Witch Hazel

Preparation H, AnusolNasal Sprays Nasal Moist Solution, Ocean Nasal Mist, Saline Nasal MistNausea & Vomiting Vitamin B6 100 mg daily

Prilosec OTC one daily, Zantac 150 mg twice daily, DramamineRashes Hydrocortisone cream or ointment

Benadryl cream or gel, Caladryl cream or lotionOatmeal bath (Aveeno)

Sleep Unisom, Tylenol PM, BenadrylSore Throat Regular cough drops or throat lozenges with Zinc

Mentho-Lyptus cough dropsChloraseptic, Cepacol , SucretsVicks Vapo-Rub

Yeast Infections Monistat or TerazolDo not insert applicator too far

Please note: No Drug can be considered 100% safe to use during pregnancy.

Colds and upper respiratory infections are usually caused by a virus. Antibiotics are only for bacterial infections. There is no effective medical treatment that will make a cold go away more quickly than it would on its own. Adequate rest is very important, as is staying well hydrated by drinking plenty of liquids.

Some simple home remedies to help with chest and nasal congestion include hot showers or baths, eating spicy foods or putting salt water drops or spray in your nose. You can buy nasal sprays or make your own by mixing 1tsp salt in quart of warm water and using an eye dropper to put drops into your nose.

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Although you have a lot to think about during this time, oral health is important during pregnancy and should not be neglected. In fact, scientists have discovered that women with gum problem are over three times more likely to give birth ahead of time as compared to moms-to-be with good oral health. They also experienced a one in four chance of delivering before 35 weeks.

See a dentist as soon as you know you are pregnant. Due to hormonal changes, gum disease can be worse during pregnancy, leading to red, sore and bleeding gums. Having your teeth cleaned early in your pregnancy may help prevent most gum problems.

Daily brushing and flossing: Brush your teeth and gums two times a day using a soft toothbrush and toothpaste with fluoride in it. Floss your teeth daily.

Healthy diet and limited sweet snacking: Dental problems also can be caused by snacking more often. Limit snacking on pop, sweets, and starchy snacks like potato chips.

X-rays of your teeth may be necessary if you need emergency dental care. Always be sure to remind your dental care professional of your pregnancy. Care should be taken to limit or avoid nitrous oxide, some prescribed antibiotics and some pain medications. Your dentist can contact your obstetrician with any questions.

Baby’s teeth begin to form in the fourth month of prenatal development. Be sure to get plenty of calcium. Calcium is needed for the baby’s teeth and bones. Good calcium sources include milk, cheese, dried beans, and leafy green vegetables.

The study publicized at the Annual Meeting of the American Association for Dental Research in Washington

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Dental Health During Pregnancy

Common Discomforts of Pregnancy

Your body is constantly changing now that you are pregnant, which may cause discomfort. Some pregnancy discomforts may occur in the early weeks, while others occur only as you get closer to delivery. Every woman's pregnancy is unique and you may never experience some of the discomforts described below. This is normal and usually does not mean something is wrong. Discuss any concerns you are having with your health care provider.

REMEMBER: Your body often knows best and tries to tell you if there is a problem. Pregnancy is generally a very healthy time for most women. Pregnancy lasts such a short time; relax and enjoy! There is nothing as wonderful as feeling a live person inside you!

Symptom What to do

Abdominal Pain or Shooting Pain Down Legs

Sharp, shooting pains on either side of your stomach may result from stretching ligaments supporting your growing uterus. These pains may also travel down your thigh and into your legs.

Change your position or activity until you are comfortable; avoid sharp turns or movements.

If you have a sudden pain in your abdomen, lean forward until it goes away.

Do pelvic rocks. Apply heat, take a warm bath or shower, or try massage. Take Tylenol (acetaminophen), occasionally. Contact your health care provider if the pain is severe or

constant or if you are less than 36 weeks pregnant and you have signs of labor.

Backaches

Backaches are usually caused by the strain put on the back muscles, changing hormone levels, and changes in your posture.

Wear low-heeled (but not flat) shoes. Don't stand for long periods of time. If unavoidable, place

one foot on a stool for support. Sit in a chair with good back support, or place a small

pillow behind your lower back. Place your feet on a footrest or stool to keep your knees higher than your hips.

Check that your bed is firm. If needed, put a board between the mattress and box spring.

Sleep on your left or right side with a pillow between your legs for support.

Apply heat, take a warm bath or shower, or try massage. Try pelvic rocking which tones muscles and improves

posture. Maintain good posture. Standing up straight will ease the

strain on your back. Contact your health care provider if you have a low

backache that goes around your stomach and does not go away within one hour after you change position or rest. This might be a sign of premature labor.

Bleeding and Swollen Gums

The increase in your circulation and supply of certain hormones may cause tenderness, swelling and bleeding of gums.

Use a soft toothbrush and brush gently Increase your intake of Vitamin C (oranges, broccoli, etc.) Take proper care of your teeth and gums. Brush and floss

regularly. Get a dental checkup early in your pregnancy to make sure

your teeth and mouth are healthy.

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Symptom What to do

Braxton-Hicks Contractions

The muscles in your uterus will contract (tighten) as early as the 2nd trimester of pregnancy as a pre-labor warm up. Irregular, infrequent contractions are called Braxton-Hicks contractions (also known as "false labor pains"). These are normal during pregnancy.

Try to rest. Reach arms over your head as far as possible (stretch). Change your position and your activity. If it is true labor, it

will not stop. True labor contractions will become more regular and

closer together. If your uterus hardens 5-6 times in 1 hour regularly before

36 wks of pregnancy contact your healthcare provider.

Constipation

Your hormones as well as vitamins and iron supplements may cause constipation (difficulty passing stool or infrequent passage of hard stools). Pressure on your rectum from your uterus may also cause constipation.

Add more fiber (such as whole grain foods, fresh fruits, and vegetables) to your diet.

Drink more fluids (at least 6-8 glasses of water and 1-2 glasses of fruit or prune juice daily).

A cup of hot water three times a day may help. Exercise daily. Walking is very good. Avoid straining when having a bowel movement. May use Colace Stool Softener (100 mg daily).

Difficulty Sleeping

Finding a comfortable resting position can become difficult later in pregnancy.

Do not eat just before sleep Cut out coffee, soda, etc. Try drinking warm milk at bedtime. Try taking a warm shower or bath before bedtime or

practice relaxation exercises. Use extra pillows for support while sleeping. Lying on your

side, place a pillow under your head, abdomen, behind your back and between your knees to prevent muscle strain and help you get the rest you need.

Dizziness (Feeling Faint)

Dizziness can occur anytime middle to late pregnancy. The pregnancy hormone progesterone dilates blood vessels so blood tends to pool in the legs. In addition, more blood is going to your growing uterus. This can cause a decrease in blood pressure, especially when changing positions, resulting in dizziness. Faintness and dizziness can also be affected by poor eating habits. When your blood sugar levels are too low, you may feel faint.

Move around often when standing for long periods of time. Change your position slowly. Get up slowly after you have been lying down. Eat regular meals to prevent low blood sugar. Do not stay in the sun Report any dizziness to your health care provider.

Fatigue

Your growing baby requires extra energy, which may make you feel tired. Fatigue is common early and late in pregnancy.

Get plenty of rest; go to bed early at night and take naps during the day.

If working, try to cut down on hours. Exercise daily to increase your energy level. You could be anemic (low iron in the blood). Have your

health care provider test for this.

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Symptom What to do

Frequent Urination

During the first trimester, your growing uterus and growing baby press against your bladder, causing a frequent need to urinate. This will happen again in the third trimester when the baby's head drops into the pelvis before birth.

Avoid tight-fitting underwear, pants, or pantyhose. Contact your health care provider if your urine burns or

stings. This can be a sign of a urinary tract infection and should be treated right away.

Limit fluids before bedtime.

Headaches

Headaches can be caused by tension, congestion, constipation, or in some cases, preeclampsia . They can occur anytime during pregnancy.

Apply an ice pack to your forehead or the back of your neck.

Rest, sit, or lie quietly in a low-lit room. Close your eyes and try to release the tension in your back, neck, shoulders and face.

Try Tylenol (acetaminophen) occasionally. Ask your health care provider before taking any other medications for your headaches.

Contact your health care provider if you have nausea with your headaches, if your headache is severe and does not go away, or if you have blurry vision, double vision, or blind spots.

Heartburn or Indigestion

Heartburn (indigestion) is a burning feeling that starts in the stomach and seems to rise to the throat. It occurs during pregnancy because your digestive system works more slowly due to changing hormone levels. Also, your enlarged uterus can crowd your stomach, pushing stomach acids upward.

Try more frequent meals, eat slower, and chew your food well.

Drink warm liquids such as herbal tea. Avoid soda. Avoid fried, spicy, or rich foods, or any foods that seem to

give you indigestion. Don't lie down directly after eating. Elevate the head of the bed (with pillows) while sleeping. Don't mix fatty foods with sweets in one meal and try to

separate liquids and solids at meals. Try heartburn relievers such as Tums, Maalox or Mylanta.

Hemorrhoids

Hemorrhoids are swollen veins that appear as painful lumps on the anus. They may form as a result of increased circulation and pressure on the rectum and vagina from your growing baby.

Try to avoid constipation which can cause hemorrhoids and make them more painful.

Drink plenty of fluids, increase fiber and fruits in diet. Try to avoid sitting or standing for long periods of time. Make an effort not to strain during a bowel movement. Sitz baths. Kegel exercises.

Leg Cramps

Pressure from your growing uterus can cause leg cramps or sharp pains down your legs.

Be sure to eat and drink foods and beverages rich in calcium (such as milk, broccoli or cheese).

Exercise daily. Stretch your legs before going to bed. Avoid lying on your back, since the weight of your body

and the pressure of your enlarged uterus can slow the circulation in your legs, causing cramps.

Gently stretch any muscle that becomes cramped by 12

Symptom What to do

Leg Cramps con.

straightening your leg, flexing your foot, and pulling your toes toward you.

Try massaging the cramp, or apply heat to the sore area.

Nasal Congestion

You may have a "stuffy nose" or feel like you have a cold. Pregnancy hormones sometimes dry out the lining in your nose, making it inflamed and swollen.

Apply a warm, wet washcloth to your cheeks, eyes, and nose to reduce congestion.

Don't use nose sprays; they can aggravate your symptoms. Drink plenty of fluids (at least 6-8 glasses of fluids a day) to

thin mucus. Elevate your head with pillows while sleeping to prevent

mucus from blocking your throat. Use a humidifier or vaporizer to add moisture to the air. If you have a cold, may use Acetaminophen for fever and

muscle aches. Rest.

Nausea or Vomiting

An upset stomach is one of the most common discomforts during pregnancy. Nausea is a result of hormonal changes and most often occurs early in pregnancy until your body adjusts to the increased production of hormones.

If nausea is a problem in the morning, eat dry foods like cereal, toast or crackers before getting out of bed. Or, try eating a high-protein snack such as lean meat or cheese before going to bed (protein takes longer to digest).

Eat small meals or snacks every 2-3 hours rather than three large meals.

Sip on fluids throughout the day. Avoid large amounts of fluids at one time. Try cool, clear fruit juices, such as apple or grape juice.

Avoid spicy, fried, or greasy foods. If you are bothered by strong smells, eat foods cold or at

room temperature and avoid odors that bother you. Talk to your doctor about taking vitamin B6 or other

treatments. Contact your health care provider if your vomiting is

constant or so severe that you can't keep fluids or foods down. This can cause dehydration and should be treated right away.

Shortness of Breath

Shortness of breath can occur due to increased upward pressure of the uterus

When walking, slow down and rest a few moments. Raise your arms over your head (this lifts your rib cage and

allows you to breathe in more air). Avoid lying flat on your back, and try sleeping with your

head elevated.

Stretch MarksStretch marks are a type of scar tissue that forms when the skin's normal elasticity is not enough for the stretching required during pregnancy. They usually appear on the abdomen and can also appear on the breasts, buttocks or thighs. While they won't disappear completely, stretch marks will fade after delivery. Stretch marks affect the surface under the skin and are usually not preventable.

Be sure that your diet contains enough sources of the nutrients needed for healthy skin (especially vitamins C and E).

Apply Vitamin E, lotion or cocoa butter to your skin daily. Best done when skin is wet.

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Symptom What to do

Swelling in the Feet and Legs

Pressure from the growing uterus on the blood vessels carrying blood from the lower body causes fluid retention that results in swelling (edema) in the legs and feet.

Try not to stay on your feet for long periods of time. Avoid standing in one place.

Drink plenty of fluids (at least 6-8 glasses of fluids a day). Avoid foods high in salt (sodium). Elevate your legs and feet while sitting. Avoid crossing

your legs. Wear loose clothing; tight clothing can slow circulation and

increase fluid retention. Don't wear tight shoes; choose supportive shoes with low,

wide heels. Eat three servings of protein daily; too little protein can

cause fluid retention. Rest on your side during the day to help increase blood

flow to your kidneys. Notify your health care provider if your hands or face

swell. This may be a warning sign of preeclampsia.

Tender Breasts

Most pregnant women will feel some changes in their breasts. Your breasts will increase in size as your milk glands enlarge and the fat tissue increases, causing breast firmness and tenderness in the first and last few months of pregnancy.

Wear a bra that provides firm support. Try wearing a bra during the day and night to ease discomfort and maintain support.

Apply heat Increase your bra size as your breasts become larger. Your

bra should fit well without irritating your nipples.

Vaginal Discharge

Increased blood supply and hormones cause your vagina to increase normal secretions. Normal vaginal discharge is white or clear, non irritating, odorless and may look yellow when dry on your underwear or panty liners.

Choose cotton underwear or brands made from other natural fibers.

Avoid tight-fitting jeans or pants. Do not douche. It’s possible to introduce air into your

circulatory system or break your bag of waters in later pregnancy.

Clean the vaginal area often with soap and water. Attention to cleanliness – always wipe from front to back. Contact your health care provider if you have burning,

itching, irritation or swelling, bad odor, bloody discharge, or bright yellow or green discharge (these symptoms could be a sign of infection).

Varicose Veins

An increased volume of blood and the pressure of your growing uterus can slow your circulation, sometimes causing the veins in your legs to become larger or swollen.

Avoid standing or sitting in one place for long periods. It's important to get up and move around often.

Wear support hose but avoid any leg wear that is too tight. Elevate your legs and feet while sitting. Do not cross your

legs. Exercise regularly. Pelvic rocks.

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Common Questions about Morning Sickness

Why am I feeling nauseated all day long? There is no single explanation for why you’re feeling sick. Some combination of the many physical changes taking place in your body is probably responsible. Those changes include rapidly increasing estrogen levels, an enhanced sense of smell, excess stomach acids, and increased fatigue. Some researchers theorize that stress and emotions may also play a role in morning sickness.

Although it won’t alleviate your nausea, it may be reassuring to know that you’re not alone. Sixty to 90 percent of moms-to-be find the early weeks of pregnancy feel like one long, sickening ride on a mega-roller coaster. What’s worse, this morning sickness can strike morning, noon, or night.

How long will the nausea last? No two pregnancies are alike, and the same goes for bouts of morning sickness. The nausea you’re feeling can last anywhere from a few weeks to a few months – or longer, although that’s rare. By the end of the third month, most women stop feeling outright nauseated. Unfortunately, queasiness or mild nausea can come and go throughout pregnancy. It’s often triggered by certain smells, which vary from woman to woman. For example, one mom-to-be survived three months of vomiting during her pregnancy, but the smell of potatoes made her feel sick right up to the day she delivered her daughter.

What happens if I vomit so often I can’t keep anything down? Talk to your healthcare provider. You should also ask for help if you don’t feel like eating at all. Thankfully, this syndrome, called hyperemesis gravidarum (literally “excessive vomiting in pregnancy”), is rare. And frightening as it sounds, it can be treated.

If left untreated, excessive vomiting can lead to malnutrition, dehydration, and other complications for you and your baby. Your doctor or midwife can help you avoid reaching a crisis state by prescribing certain anti-nausea drugs (such as Zofran or Phenergan), recommending a special diet, putting you on bedrest, or even checking you into the hospital.

If you’re diagnosed with dehydration, you may be hospitalized so you can receive intravenous hydration with fluids, glucose, and electrolytes. You may also be given medication to decrease your nausea and vomiting and help you keep food down.

Will my nausea affect my baby? The mild nausea commonly associated with morning sickness won’t threaten your baby’s well-being as long as you’re able to keep food down, eat a well-balanced diet, and drink plenty of fluids.

Most women with morning sickness figure out pretty quickly what they can and cannot stomach, and how many times they need to eat throughout the day.

If you find prenatal vitamins hard to swallow, try taking them with food – it may be a little easier on your stomach. If you still can’t stomach then, consider eating a vitamin-fortified cereal every morning (Total is one good example). And be extra certain to eat a diet that’s high in all the vitamins you and your baby need.

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Ways to Cope with Morning Sickness

Keep simple snacks, such as crackers, by your bedside. When you first wake up, nibble a few crackers and then rest for 20-30 minutes before getting out of bed.

Eat small frequent meals or snacks throughout the day. Aim for bland foods that are high in protein or carbohydrates, as both can help fight nausea. Good choices include crackers, animal crackers or yogurt.

Try taking 50 mg of vitamin B6 twice a day, with your doctor’s consent. Prenatal vitamins higher in B6 and B12 can also be prescribed. B6 helps the body metabolize certain amino acids (proteins), which may somehow reduce nausea, although no one knows exactly why this works. You may also try eating foods which are high in B vitamins.

You may stop taking your prenatal vitamins temporarily and take only a folic acid supplement (1 mg daily). If the nausea improves, give yourself a few days and then reintroduce the vitamins.

Since iron can be hard on your digestive system, stop taking iron supplements for the first trimester unless you are anemic.

Avoid rich, spicy, acidic, and fried foods, and eat less fat in general.

Though it’s important to keep yourself well hydrated, try drinking fluids only between meals, and limit them during meals.

Sniff lemons. The smell of a cut lemon may help your nausea. Put slices in your iced tea or sparkling water.

Drink ginger ale or ginger tea. Ginger is known to settle the stomach and help queasiness. But make sure the beverage you choose in made with real ginger – many sodas aren’t. (Ask your doctor before taking ginger supplements since some experts believe they may increase risk of miscarriage.)

Give yourself time to relax. Talking things over with another mother-to-be can be a nice way to relieve stress. Some researchers theorize that stress and emotions may also play a role in morning sickness.

Try acupressure bands. You can find these soft cotton wristbands at drugstores. This simple device designed to ward off seasickness, has also helped many pregnant women through morning sickness. Strap it on so that the plastic button pushes against an acupressure point in the underside of your wrist and you may begin feeling some relief.

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Reasons to Quit Smoking for Baby’s Sake1. There is a link between smoking and an increase in

Sudden Infant Death Syndrome (SIDS).2. Women who smoke and are pregnant are more likely to

have babies:a. Who are low birth weightb. Who are born prematurelyc. Who die within the first year

3. Low birth weight babies:a. Are 20 times more likely to die than normal weight babies.b. Are more likely to suffer from learning disabilities, epilepsy, and hearing or

vision problems.c. Are harder to care for, and account for 23% of child abuse incidents in babies

under 1 year.4. Nicotine is a poison and is found in the breast milk of mothers who

smoke.5. Children whose parents smoke have more allergies,

hospitalizations and respiratory infections than children whose parents don’t smoke.

The good news about quitting:1. Within 20 minutes of last cigarette:

a. Blood pressure drops to normalb. Pulse rate drops to normal ratec. Body temperature of hands and feet increase to normal

2. 8 Hoursa. Carbon monoxide level in blood drops to normalb. Oxygen level in blood increases to normal

3. 24 hoursa. Chance of heart attack decreases

4. 48 hoursa. Nerve endings start regrowingb. Ability to smell and to taste things enhances

5. 72 hoursa. Bronchial tubes relax, making breathing easierb. Lung capacity increases

6. 1 – 9 monthsa. Coughing, sinus congestion, fatigue, shortness of breath decreaseb. Cilia regrow in lungs, increasing ability to handle mucus, clean the lungs, reduce

infection7. 5 years

a. Lung cancer death rate for average smoker drops to 12 deaths/100,000 – almost the rate of nonsmokers

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b. Precancerous cells are replacedc. Other cancers – such as those of mouth, larynx, esophagus, bladder, kidney and

pancreas – decrease. (There are 30 chemicals in tobacco smoke that cause cancer.)

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Common Laboratory Tests During Your Pregnancy

CBC (Complete Blood Count) The CBC will detect disorders, infections, and anemia, which impacts the oxygen carrying ability of the blood. In most cases standard medication can correct any problems.

Urine TestUrinary tract infections may occur during your pregnancy. Many occur without symptoms. All urinary tract infections must be treated. By frequently testing your urine, your care provider can detect kidney problems, abnormal levels of glucose which may indicate a diabetic problem, persisting infections, and pre-toxemic changes that could affect your baby’s health.

Blood Type and Rh ScreenYour blood will be drawn, tested, and typed for a blood group (A,B,AB, or O) and for Rh factor. Rh factor is a blood cell component that is either “positive” or “negative”. If your blood is Rh negative and your baby’s blood is Rh positive, your body’s immune system may attempt to defend itself by creating proteins that may harm baby’s red blood cells. In most cases, your practitioner can prevent problems by giving you a Rhogam injection at 28 weeks and again post partum.

Rh Antibody TiterIf you are Rh negative, the provider will also test for Rh antibodies. Antibodies are part of the body’s defense mechanism. The blood test is done in early pregnancy and is often repeated at 28 weeks. This double check is done to make sure your body has not already developed any defenses against the Rh positive factor since the initial Rh screening.

Hepatitis BHepatitis B is a virus that infects the liver. If a pregnant woman has hepatitis B, in most cases, her baby can get treatment at birth to prevent infection.

HIVHIV is a virus that weakens the body’s defense against disease and causes AIDS. IF a woman has HIV, she can pass it to her baby during pregnancy, during labor, or through breastfeeding. If an HIV infection is found before a woman gives birth, doctors can treat her with drugs that fight HIV. These drugs greatly reduce the risk of the baby being infected. The earlier in pregnancy that treatment begins, the smaller the chance that the baby will be infected with HIV.

Rubella (German Measles) ImmunityTesting for rubella (German measles) is also required by the state. Rubella can cause birth defects if you contract the disease during the first three months of your pregnancy. If you have never had German measles or have not been vaccinated for rubella, you should take care to avoid children with measles during your pregnancy. Pregnant women who are not immune can get the vaccine after their baby is born to keep them from getting rubella in the future.

RPRThis test screens for syphilis (a sexually transmitted bacterial disease) that can be transmitted to your unborn baby. It may not cause symptoms at first, but can progress and harm many parts of the body. Treating syphilis early in pregnancy is the best way to keep baby from getting it. If left untreated, it can cause a dangerous condition called congenital syphilis in the baby that leads to bone and tooth deformity, nerve damage, or brain damage.

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QUAD MARKER SCREEN

What is the Quad Marker Screen?The quad marker screen is an optional screening test to determine if a woman is at higher or lower risk of

carrying a baby with Down Syndrome or neural tube defects such as spina bifida. The test is usually performed during weeks 16-18 of your pregnancy. Because this is a screening test it means that some women with healthy babies will have screening results indicating a possible problem (and will be offered appropriate follow-up testing) while some women whose babies have birth defects will go undetected.

What Happens During the Quad Marker Screen?

During the quad screen, a sample of blood is taken from your vein. Substances in the blood sample are measured to screen for:

Problems in the development of the fetus's brain and spinal cord, called open neural tube defects. The quad marker screen can predict approximately 75-80% of open neural tube defects.

Genetic disorders such as Down syndrome, a chromosomal abnormality. The quad marker screen can predict approximately 75% of Down syndrome cases in women under age 35 and over 80% of Down syndrome cases in women age 35 years and older.

What Substances Are Measured During a Quad Marker Screen?

The blood sample is sent to a laboratory and tested for the presence of the following four substances, which are normally found in the baby's blood, brain, spinal fluid, and amniotic fluid:

Alpha-fetoprotein (AFP): A protein produced by the baby's liver. Unconjugated Estriol (UE): A protein produced in the placenta and in the baby's liver. Human Chorionic Gonadotropin (hCG): A hormone produced by the placenta. Inhibin-A: A hormone produced by the placenta.

The expected amount of these substances normally found in the mother's bloodstream changes each week of pregnancy, so it is important to tell your health care providers how far along you are in your pregnancy. High AFP levels may indicate that the baby has an open neural tube defect. High AFP levels may also indicate that the fetus is older than was thought or that the woman is expecting twins. Lower than normal AFP levels could indicate that a woman is at higher risk for having a baby with Down syndrome.

Levels of hCG and Inhibin-A are higher than normal when a woman has an increased risk of having a baby with Down syndrome. Lower than normal levels of Estriol may also indicate that a woman is at high risk for having a baby with Down syndrome.

Is the Quad Marker Screen Safe?Yes. The quad marker screen is a safe and useful screening test for families concerned about birth defects or genetic diseases. It is a test that carries no risk to the baby, since a blood sample is taken only from the mother.

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What Does It Mean if the Quad Marker Screen Results Are Normal?Normal levels of AFP, estriol, hCG, and Inhibin-A strongly indicate that you have a healthy pregnancy and a healthy baby. In over 98% of pregnancies, normal quad marker screen results predict healthy babies and births without major complications. However, there are no prenatal tests that can guarantee your baby and pregnancy will be completely healthy or without complications.

What Does It Mean if the Quad Marker Screen Results Are Abnormal?Quad marker screen results that are not in the normal range do not necessarily mean there is a problem in your pregnancy.

The quad marker screen is used for screening only, which means it can only assess your risk of having a baby with a certain birth defect (it is not used to diagnose the particular problem that may be present). If the quad marker screen results are not in the normal range, further tests such as an ultrasound or amniocentesis may be necessary.

Out of 1,000 pregnant women, approximately 50 will have quad marker screen results that indicate an increased risk for having a baby with a birth defect. Of those 50 women, only one or two will actually have a baby with an open neural tube defect. About 40 women will have quad marker screen results that show an increased risk for having a baby with Down syndrome and one or two will actually have a baby with Down syndrome.

Should I Have the Quad Marker Screen?

It is your decision whether or not to have the test. However, if you have any of the following risk factors, you may strongly want to consider having the test:

You are age 35 or older when the baby is due. Your family has a history of birth defects. You've had a child with a previous birth defect. You were diagnosed with type 1 diabetes prior to your pregnancy.

If you have any concerns about the test, talk to your doctor or health care provider. He or she may be able to answer your questions and alleviate concerns.i

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CYSTIC FIBROSIS (CF)

CF carrier testing is an optional blood test to see if parents-to-be have (carry) the abnormal gene that causes CF and are therefore at increased risk of having a child with CF.

The only way to get CF is to have two genes that cause CF—one from the mother and one from the father. This means that both parents are CF carriers. A CF carrier has only one CF gene and has no CF symptoms. You could inherit the CF gene from one of your parents and never even know it.

If only one parent from a couple is a CF carrier, none of the children will have CF. But there is a 50-50 chance that each child will be a symptomless carrier.

When both parents carry the CF gene, there is a 25% chance (1 in 4) that their child will have CF. There is a 50-50 chance that the child will be a carrier like the parents. And there is a 25% chance that the baby will not have the gene—not a carrier and not have the disease.

If test results show that both parents are CF carriers, your health care provider can test the baby in utero. If the baby has CF, parents can take time before delivery to learn more about the disease and find appropriate specialists.ii

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i The March of Dimes.; Deborah A. Driscoll, MD, "Second trimester maternal serum screening for fetal open neural tube defects and aneuploidy." American College of Medical Genetics, 2004.; Reviewed by Mikio A. Nihira, MD on December 20, 2009; © 2010 WebMD, LLC. All rights reserved.

ii March 2006© 2010 March of Dimes Foundation.