FAQs for our Moms-to-be

What Medications are Safe in Pregnancy?

You've got all seven dwarfs: Sneezy, Sleepy, Snotty, Pukey, Runny, Coughy, and All-Stopped-Up, but what is safer for you and your baby? Here is a partial list, and please ask if you're not sure!

Pain

  1. Tylenol or ES Tylenol (stay away from Motrin, Advil, Ibuprofen, Aspirin, Goody's, BC, and Aleve)
  2. Heating pad on medium setting for muscle/joint/back pain

Cold, Upper Respiratory Symptoms, and Allergies

  1. Sudafed
  2. Tylenol Sinus or Tylenol Cold and Allergy
  3. Tavist D
  4. Claritin or Alevert or Zyrtec or Benadryl
  5. Robitussin plain or DM
  6. Mucinex (guaifenesin)
  7. Saline Nasal Spray (Ocean Mist)
  8. Ricola or Halls Cough Drops

Nausea and Vomiting

  1. Vitamin B6 50mg 2X a day and Unisom at bedtime (we really like this one)
  2. Ginger capsules, ginger ale, or ginger beer (obviously this is not alcoholic, sorry)
  3. Emetrol

Diarrhea

  1. Kaopectate
  2. Immodium

Constipation

  1. FiberCon or Citrucel and lots of water
  2. Metamucil and lots of water
  3. Milk of Magnesia and lots of water
  4. Colace and lots of water
  5. Fleets Enema (only once) and we don't even have to say it, do we?

Gas

  1. GasX
  2. Phazyme

Heartburn

  1. Tums (only use the recommended daily dose)
  2. Mylanta or Maalox
  3. Pepcid AC or Complete

Yeast Infection

  1. Monistat 1 or 3
  2. Sitz bath

Hemorrhoids

  1. Anusol HC
  2. Preparation H
  3. Tucks Pads

Sleep

  1. Benadryl 25-50mg or Tylenol PM
  2. Chelated or Glycinated Magnesium 400-800mg (available at Fairhope Health Food Store)

Can I paint?

Avoid exposure to lead and oil-based paints. If you paint, use only latex paint and be sure the room is well ventilated. Avoid exposures to paint removers, thinners, and paint brush cleaning solutions. If your home was built prior to 1979, check for lead-based paint. A test kit can be found at many hardware stores.

Can I have my hair colored during pregnancy?

Sometimes permanents and hair color do not take very well during pregnancy because of the hormonal changes in your body although it is currently thought to be safe.

What about caffeine?

Caffeine is found in coffee, tea, soft drinks, cocoa and chocolate products. The short and long-term effects of caffeine are unclear. Caffeine intake may decrease the absorption of some vitamins. Limit your intake to one or two (6 oz.) caffeinated drinks per day and in very high intake amounts may increase your risk of miscarriage in early pregnancy.

Can I drink alcohol during pregnancy?

No. No one knows how much alcohol is safe during pregnancy. The March of Dimes recommendation is no alcohol, even in moderation, during pregnancy.

Is smoking really dangerous to my unborn baby?

First and second hand smoke can cause prenatal complications and reduced birth weight because of carbon monoxide poisoning and reduced oxygen to your baby. We strongly recommend no smoking and avoiding exposure to second hand smoke.

Can I exercise during pregnancy?

We recommend 30-45 minutes of exercise 4-5 times a week. Walking, biking, and swimming are safe during pregnancy and usually continuing any exercise program you were comfortably doing before you became pregnant is fine.

Does a hot tub, sauna, electric blanket or steam room affect my pregnancy?

We recommend you avoid exposure to these items, especially in the first trimester. They may raise your core body temperature and may be potentially dangerous to the developing embryo or fetus. Temperature should not be more than the regular body temperature of 98.7 degrees.

What is toxoplasmosis and what about my cat?

Toxoplasmosis is a rare disease caused by a parasite that lives in some mammals, such as cats. Toxoplasmosis infections during pregnancy may also infect the baby. Prevention includes: making sure meat is thoroughly cooked, daily cat litter box changing by someone other than you, washing your hands well with soap and water after touching soiled or uncooked meat or vegetables, wearing gloves while gardening, and not allowing your cats to walk on areas where food is prepared or eaten.

How much weight should I gain?

If you are the appropriate weight for your height and body build, you should gain between 25-35 pounds. During the first 12-14 weeks of pregnancy, you should gain no more than 2-6 pounds; thereafter, you should gain 1/2 to 1 pound per week.

Should I have genetic counseling and/or testing?

If you are 35 years of age or over, or if you have a family history of birth defects, mental retardation, or certain medical conditions, we offer referral to genetic counseling and genetic testing. Your health care provider can furnish you with more information regarding these tests.

What is a Quad Screen?

A Quad Screen is a blood test offered during pregnancy to identify women who are at increased risk of having a baby with Down Syndrome. It also permits screening for open neural tube defects, such as open spina bifida and the identification of pregnancies at high risk for trisomy 18.

When should I feel my baby move?

Movements of the baby are usually first felt between the 4th and 5th months (18-20 weeks).

What is a "sugar" screen and when should it be done?

This test detects diabetes of pregnancy. We recommend testing at 24-28 weeks gestation. Fasting is not required. Testing can be done at any time during the day. The test involves drinking a sweet liquid and having a blood sugar test performed one hour later. If this test is abnormal, you will need a more extensive three-hour glucose tolerance test.

What is GBS (Group B Streptococcus) and when will I be tested?

GBS is a type of bacteria found in the vagina or the urinary tract as part of a woman's normal "mix" of bacteria. This bacteria, although not an infection in you, can be passed to a baby and may cause infections in the newborn (less than 2 percent). We recommend GBS testing at 35-37 weeks of pregnancy. If the test indicates the presence of GBS, we recommend treatment with IV antibiotics during labor.

Am I in labor?

If your pregnancy is uncomplicated, come to Labor & Delivery at night or call the office during the day when you've been having contractions that last for about a minute each, coming very regularly at least every five minutes for about an hour. (You time a contraction from the beginning of one to the beginning of the next one.) If you're high-risk, we may want to hear from you earlier in labor and we will have already discussed parameters for you.

We can tell a lot by the sound of your voice, so verbal communication helps. We'll want to know how close together your contractions are, how long each one lasts, how strong they are (you can't usually hold a conversation through a real labor contraction), and any other symptoms you may have.

Finally, whether or not your pregnancy has been problem-free up to now, and whether or not you think you might be in labor, be sure to call us immediately (or head for the hospital; check in through the emergency room and they will roll you upstairs to the Birth Center) in the following situations:

  • Your water breaks or you suspect that you're leaking amniotic fluid. Tell your practitioner if it's yellow, brown, or greenish, because this signals the presence of meconium, your baby's first stool, which is sometimes a sign of fetal stress. It's also important to let us know if the fluid looks bloody.
  • You notice that your baby is suddenly less active (see our "When to Call" sheet).
  • You have vaginal bleeding (unless it's just bloody show, mucus with a spot or streak of blood), constant severe abdominal pain, or fever.
  • You consistently have more than 4 contractions per hour before 37 weeks.
  • You have severe or persistent headaches, vision changes, intense pain or tenderness in your upper abdomen, sudden increase in swelling in your hands, feet, or face. This may be pre-eclampsia or what used to be called "toxemia" of pregnancy.

How Can I Treat Hemorrhoids at Home?

Hemorrhoids are varicose veins or blood vessels that have become unusually swollen, hat show up in the rectal area. Hemorrhoids typically range from the size of a raisin to the size of a grape. They can be merely itchy or downright painful, and sometimes they can even cause rectal bleeding, especially during a bowel movement. Sometimes the enlarged veins protrude through the anus. When this happens, you'll feel a soft, swollen mass.

Hemorrhoids are relatively common during pregnancy and after because the weight of that growing babe slows blood return form the lower half of your body. In effect, you get a "traffic jam" of blood and those veins back up. Some women get them for the first time while they're pregnant, and if you've had them before pregnancy, you're quite likely to have them again now. They may also develop while you're pushing during delivery. Either way, they often go away on their own, or with the help of some simple measures mentioned below.

  • Apply an ice pack (with a soft covering) to the affected area several times a day. Ice may help decrease swelling and discomfort. You may find cold compresses saturated with witch hazel (available by the bottle at any pharmacy)to be soothing.
  • Soak your bottom in warm water, in a tub or a sitz bath. A sitz bath is small plastic basin that you fill with water and position over your toilet, allowing you to submerge your rectal area simply by sitting down (also available at any pharmacy).
  • Try alternating cold and warm treatments. Start with an ice pack followed by a warm sitz bath.
  • Gently but thoroughly clean the affected area after each bowel movement using soft, unscented, white toilet tissue. Moistening the tissue can help, too. Many women find using pre-moistened wipes more comfortable than using toilet tissue. You can buy medicated wipes (such as Tucks) made specifically for people with hemorrhoids.
  • Stay very well hydrated and keep your fiber intake up in your diet to avoid constipation. See our "Safer Medications and Treatments" sheet for constipation treatments.
  • The best over the counter treatment we've found is to insert Preparation H or Anusol suppository with a dollop of Preparation or Anusol cream (the suppositories and creams contain two different medications) 4 times a day. Use this for a short course of treatment only (a week or less).

When should I call, and what should I do?

How do you know whether that sudden ache is normal or warrants a call? Here's a rundown of symptoms that should set off your warning bells. But even if you don't see your symptom on this list, it's better to err on the side of caution and make that call than to agonize for days, wondering whether you've pulled a ligament or gone into preterm labor. We're always happy to work you into the office schedule. Our office number is 990-1950. If you come to the hospital after hours, come through the emergency room and they will bring you to the birth center.

Some of these symptoms may be more or less urgent depending on your particular situation or health history and on how far along you are.

  • Your baby is suddenly moving or kicking less than usual (once he begins moving regularly). As your baby grows and has less room, somersaults and cartwheels will turn into wiggles and squirms, but frequency of movement should remain about the same. Fetuses go through cycles of sleeping and waking just like already-born babies, but the sudden change in pattern is the key.
  • Severe or persistent abdominal pain or tenderness especially with nausea and vomiting.
  • Vaginal bleeding. It is normal to spot a little after any kind of vaginal exam or after sex. If the spotting persists or there is more than spotting, please call.
  • A sudden change in vaginal discharge or a change in the type of discharge - that is, if it becomes watery, mucousy, or bloody (even if it's only pink or blood-tinged). Note: After 37 weeks, an increase in mucus discharge is normal and you may even pass what looks like a snot ball (that's your mucus plug) and it can be quite alarming. Passing your mucus plug does not mean immediate labor, unfortunately.
  • If you have a gush or a trickle of clear, odorless fluid that continues to gush or trickle. Believe it or not, late in pregnancy you may not be able to tell the difference between leaking a little urine and your water breaking. Leaking urine stops after a bit, broken water continues to leak (because your baby continues to make more). Call for the continued leaking or if you're unsure.
  • Pelvic pressure (a feeling that your baby is pushing down), lower back pain (especially if it's a new problem for you), menstrual-like cramping or abdominal pain, or more than four contractions in an hour (even if they don't hurt) before 37 weeks.
  • Painful or burning urination. If it is during the week, you can be seen in the office the next day so we can check your urine for a bladder infection so call us first thing in the morning.
  • Severe or persistent vomiting, or any vomiting accompanied by pain or fever.
  • Chills or fever of 100 degrees Fahrenheit or higher.
  • Visual disturbances such as double vision, blurring, dimming, flashing lights, or "floaters" (spots in your field of vision).
  • Persistent or severe headache, or any headache accompanied by blurred vision, slurred speech, or numbness.
  • We're all a little puffy when we're pregnant, but call for severe and sudden swelling of your feet, ankles, hands, face, or a rapid weight gain (more than 4 pounds in a week).
  • A persistent or severe leg cramp, or calf pain that doesn't ease up when you flex your ankle and point your toes toward your nose or when you walk around, or one leg being significantly more swollen than the other.
  • Trauma to the abdomen.
  • Fainting, frequent dizziness, a rapid heartbeat, or heart palpitations.
  • Difficulty breathing, coughing up blood, or chest pain.
  • Severe constipation accompanied by abdominal pain or severe diarrhea that lasts more than 24 hours; we need to see you in the office
  • Persistent intense itching of your torso, arms, legs, palms, or soles, or a feeling of itchiness all over your body.
  • Any health problem that you'd ordinarily call your doctor about even if it's not pregnancy related (like worsening asthma or a cold that gets worse rather than better). Just call a little sooner than you would normally.

Goodness gracious! After reading that list you may be amazed to know that the vast majority of pregnancies are not complicated by any problems; however, your body is changing so rapidly that it's hard to know whether what you're experiencing is "normal."

If you're not sure whether a symptom is serious, you don't feel like yourself, or you're uneasy, trust your instincts and call us. If there's a problem, you'll get help right away. If nothing's wrong, you'll be reassured.

Finally, if you're near your due date, check out the "Am I in labor?" FAQ so you'll know when it's time to take the show live . . .

May I travel?

You may travel up to 35-36 weeks of your pregnancy. However, please check with your doctor prior to traveling to discuss the risks associated with travel and if you are later in your pregnancy, please request a short copy of your records to take with you. If you travel by car, get out of the car every 1-2 hours. Drink plenty of fluids and WEAR A SEATBELT!!! Most airlines will allow you to fly until 32 weeks and if you fly, an aisle seat may be more convenient. Be sure to walk about the cabin every 2 hours. Check with your insurance coverage on travel limitations.

What about dental appointments?

We recommend a dental cleaning during pregnancy - notify your dentist you are pregnant. Dental x-rays are OK if abdomen is shielded. Novacaine without Epinephrine may be used for dental work - no nitrous oxide!!

Is intercourse OK?

Intercourse is safe throughout your pregnancy unless you are experiencing spotting, bleeding, contractions, ruptured membranes, or if you've been told by us that you have a placenta previa.

What vaccines are safe during pregnancy?

Hepatitis B, Tetanus, Pneumonia, Flu (seasonal and H1N1), and TB skin test.

What about mercury in fish and shellfish?

Fish and shellfish are an important part of a healthy diet. A well balanced diet that includes a variety of fish and shellfish can contribute to heart health and baby's proper growth and development. However, nearly all fish and shellfish contain traces of mercury that accumulate in streams and oceans as they feed. Some fish are not a health concern. Yet, some fish and shellfish contain higher levels of mercury that may harm an unborn baby's developing nervous system. Larger fish that have lived longer (swordfish, shark, king mackerel and tile fish) have the highest level of mercury because they've had more time to accumulate it. The risks depend on the amount of fish and shellfish eaten and the levels contained. 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 only eat fish and shellfish that are low in mercury. Fish sticks and "fast food" sandwiches are commonly made from fish that are low in mercury. Tuna steaks generally contain 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 per week. If you eat a lot of fish one week, you can cut back for the next week or two since one week's consumption of fish does not change the level of mercury in the body at all. Just make sure you average the recommended amount per week.

By following the three (3) recommendations for selecting and eating fish or shellfish, women and young children will receive benefits and be confident that they have reduced their exposure to the harmful effects of mercury:

  • Do not eat: shark, swordfish, king mackerel or tilefish

  • Eat up to 12 ounces (two average meals) a week of a variety of fish and shellfish that are lower in mercury such as shrimp, canned light (albacore white tuna has more mercury than canned light tuna), tuna salmon, Pollock and catfish.
  • Check local advisors (your local Health Department) about the safety of fish caught by family and friends in your local lakes, rivers and coastal areas.

Is Swelling Normal?

A certain amount of swelling (called edema) is normal during pregnancy. It occurs most often in the legs. Elevating the legs usually makes the swelling less by the next morning. Swelling can begin during the last few months of pregnancy, and it may occur more often in the summer. Let your doctor or nurse know if you have sudden swelling in your hands or face, because this may be a sign of another problem. A clue that your hands are swollen is that your rings are too tight. Never take medications (water pills) for swelling unless they have been prescribed to you.

  • Elevate you legs when possible.
  • Rest in bed on your side.
  • Lie down with your legs raised on a small footstool or several pillows.
  • Do not wear stockings or socks that have a tight band of elastic around the legs.
  • If you must sit a lot on the job, stand up and move around from time to time.
  • Try not to stand still for long periods of time.

Can I take herbal remedies during pregnancy?

There is very little known about herbal medicine and nontraditional medications during pregnancy. Many women don't consider herbal remedies to be medicine and when pregnant women don't report their use of these substances to their obstetricians, this is worrisome because even "herbs or vitamin supplements" can have side effects or interactions with other medications.

Herbal medications are not regulated by the Food and Drug Administration (FDA), therefore there is no good control over these products. In some cases, herbal remedies may not even contain the substance that is listed on the bottle. It may contain the concentration stated in the label or it may have a higher or lower level of the substance.

What is a bloody show?

A bloody show is a small amount of bloody mucous seen at anytime in the final month of pregnancy. It may be anything from just mucous (plug) to pink discharge to a bloody red discharge. Although it is a good sign that your cervix may be softening in preparation for dilation it does not always mean you are going into labor. It may occur from 3 weeks to 1 hour before delivery and may not come out all at once (or at all before labor) and thus gives us no idea of when labor may occur. It may also occur within 24 hours after a pelvic examination. If this occurs you do not have to go to the hospital. Just watch for any other signs of labor. Heavy vaginal bleeding is never a simple bloody show and should be evaluated in the hospital immediately.

What are "Braxton-Hicks" contractions?

Braxton-Hicks contractions are very mild, irregular contractions that may feel like menstrual cramps. They can occur at any time in the late 2nd trimester and 3rd trimester (26 - 40 weeks). If you are less than 36 weeks and these mild cramps become uncomfortable or are accompanied by a mucous or bloody discharge, you should call the office or come to be evaluated at the hospital. Otherwise, they are common and normal.

Could it be Round Ligament Pain?

Round ligament pain generally refers to a brief, sharp, stabbing pain or a longer-lasting dull ache that pregnant women commonly feel in the lower abdomen or groin, starting around 14 weeks. You may feel the pain starting from deep inside your groin, moving upward and outward on either side to the top of your hips. The pain is internal, but if you were to trace it on your skin, it would follow the bikini line on a very high-cut bathing suit.

You may feel round ligament pain as a short jabbing sensation if you suddenly change position, such as when you're getting out of bed or out of a chair or when you cough, roll over in bed, or get out of the bathtub. You may feel it as a dull ache after a particularly active day; when you've been walking a lot or doing some other physical activity.

The round ligaments that attach your uterus to your pelvis have the same function as the ligaments in, for example, your knees; they provide support and stability. As your uterus grows during pregnancy, the ligaments stretch and thicken to accommodate and support it. These changes can sometimes cause pain on one or both sides of your abdomen.

When you should call

The sharp, jabbing type of round ligament pain shouldn't last longer than the few moments in which you're changing position or getting up, but the ache may come and go your entire second trimester. Don't hesitate to call us any time sharp abdominal pain continues after a short rest or are accompanied by:

  • Severe pain or cramping, or more than four contractions in an hour (even if they don't hurt)
  • Low back pain, especially if you didn't previously have back pain, or an increase in pressure in the pelvic area (a feeling that your baby is pushing down)
  • Bleeding, spotting, or a change in the type, amount, or odor of vaginal discharge
  • Fever, chills, faintness, or nausea/vomiting. If you already have "morning sickness", then if you have a sudden increase in nausea/vomiting with pain
  • Pain or burning when you urinate

What you can do at home

If you've been reassured by your practitioner that what you're feeling is round ligament pain, sit down and try to relax when the pain strikes. Resting comfortably should alleviate your symptoms. You can also try flexing your knees toward your abdomen to get some relief or lying on your side with a pillow under your belly for support and another one between your legs. A warm bath may help or a heating pad set no higher than on medium heat. Tylenol is also fine, 1-2 every 6 hours as needed.

Listen to your quickly-changing body. If you find that you're more prone to round ligament pain when you're particularly active, cut back to see if that helps. Then, if you feel fine, you can gradually increase your activity until you find the level of exertion that's comfortable for you.

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