Questions and Answers About Pregnancy
Questions and Answers About Pregnancy
Q: I consumed some alcohol before I knew I was pregnant. Should I take any special precautions or have any extra tests?
A: This is not an unusual situation. Because we know alcohol enters the unborn baby’s circulation, many pregnant women worry that they may have caused harm to the baby because they drank before realizing they were pregnant. Effects of alcohol are dose-related to some extent. If you drank very heavily and often before you discovered you were pregnant, the effects on the baby are potentially greater than if you drank too much on one occasion or drank lightly on several occasions.
There are no extra tests during pregnancy that can tell you if your baby is affected. The usual observations made by your doctor or midwife (such as height measurements, heart rate monitoring, and possibly ultrasound) can detect some problems, such as growth retardation, that are sometimes associated with alcohol use. Observations of the baby after birth will allow a clearer assessment of the baby’s condition.
The two best things for you to do during pregnancy are to stop drinking alcohol (because the baby receives alcohol in his or her bloodstream whenever you drink) and to try not to worry (which, I realize, is easier said than done). Babies are resilient and not all babies whose mothers drank have apparent alcohol-related problems. Discuss your concerns with your doctor, and maintain a healthy lifestyle.
Q: Is it true that I should not clean my cat’s litter box while I am pregnant? Why?
A: Kitty litter carries the potential for spreading toxoplasmosis, a mild infection that may cause coldlike symptoms under normal circumstances. If you are pregnant, however, toxoplasmosis can cause serious malformations or even death of the unborn baby.
Cats, especially outdoor cats that eat rats or mice, often carry the organism that causes toxoplasmosis. You can get toxoplasmosis by petting a “carrier cat,” changing its litter box, or gardening in soil where cats have passed feces. You can also get toxoplasmosis from eating raw or undercooked meat and eating unwashed vegetables that have grown underground, such as potatoes or carrots.
It is quite likely that if you have had an outdoor cat in the past, you have had toxoplasmosis. Once you have had the disease, you are immune to it in the future. The problem is that most people do not know whether they have had it or not. If you have a cat and are concerned, you can be tested for antibodies to toxoplasmosis (which indicate that you have had the disease and are now immune to it). An absence of antibodies indicates that you are at risk. To prevent catching toxoplasmosis during pregnancy, take the following precautions:
* Cook your meat thoroughly.
* Wash your vegetables thoroughly.
* Wash your hands after you pet or handle a cat.
* Have someone else clean the litter box.
* Avoid soil and sandboxes where cats pass feces.
Q: What are the benefits of folic acid for pregnant women?
A: Folic acid supplements should be taken a month or more before conception and continued through early pregnancy. Most prenatal vitamin supplements contain the recommended daily amount of folic acid (400 micrograms).
The main benefits of folic acid are the prevention of particular birth defects, such as cleft lip, cleft palate, and neural tube defects (abnormalities in the development of the brain and spinal cord, such as spina bifida and anencephaly, the absence of a large portion of the brain). These defects occur in about 1 in 1,000 newborns but are dramatically reduced when women take folic acid before and during early pregnancy.
Folic acid is present in foods such as liver, leafy green vegetables, and yeast. It is difficult for many women to get enough folic acid through their diets. For this reason folic acid is added to prenatal vitamin preparations.
Because women with unplanned pregnancies might not get enough folic acid before pregnancy, nutritionists and maternity caregivers recommend that all fertile women take a folic acid supplement every day, whether planning pregnancy or not.
Q: Is it safe for me to get a massage during pregnancy?
A: Yes, it is safe and very helpful as well. You should, however, see a licensed massage therapist (LMT) who has had additional training in pregnancy massage. She or he will know how to safely modify massage techniques to accommodate for bodily changes that occur during pregnancy (for example, avoiding having you lie on your back or your abdomen after about four to five months of pregnancy and checking for varicose veins, excessive swelling, carpal tunnel syndrome, and other conditions).
Many massage therapists have specially designed massage tables that allow you to lie on your abdomen without putting undue pressure on your abdomen or breasts. Ask your doctor, midwife, childbirth educator, or doula for referrals.
Q: Do midwives assist only with home births?
A: No, most midwives practice in hospitals or out-of-hospital birth centers because those are the locations where most women give birth. It is true, however, that almost all home births are attended by midwives, who are experts in normal birth.
In all countries outside North and South America, midwives provide most of the maternity care, but in the United States less than 10 percent of all births are attended by midwives. The percentage is growing rapidly, however, because midwifery care is highly satisfying to women and has an excellent track record in terms of safety and cost.
Q: I was wondering when a woman can get pregnant. What are the days in the menstrual cycle that you are most likely to get pregnant? How do you determine when you are fertile in your own menstrual cycle?
A: There are only a few days before and after you ovulate when you are able to become pregnant. These days come roughly in midcycle, but timing of ovulation varies from woman to woman. There are several ways that you can determine when you ovulate, including observing changes in the mucus in your vagina (cervical mucus) and recording your temperature before rising each morning.
An excellent book on the subject is Taking Charge of Your Fertility, by Toni Weschler (HarperPerennial, 2001). It provides complete and very helpful information on this subject and many others.
Q: What effects does stress have on pregnancy and what are the symptoms?
A: Stress during pregnancy may be related to a woman’s relationship to family and friends. Major life-changes, such as a death in the family, change in marital status, serious illness, or moving also play a significant role in stress levels. Financial situation and job or career demands are other common sources of stress.
Whatever its cause, stress can manifest itself as anxiety, exhaustion, fear, sadness, anger, or grief. Such emotions can lead to physiological changes, such as increased release of stress hormones and increased blood pressure. These effects of stress may cause premature labor or hypertension (high blood pressure). Both conditions can present problems for the baby, such as causing the baby to be small in size or immature in development.
Pregnancy adds stress to the lives of women who are already stressed. The right caregiver (midwife, doctor, or clinic) may be able to refer such women to appropriate services that can ease some of their stress.
Stress management techniques are also helpful. Many women find that yoga, meditation, and relaxation techniques help reduce stress. Self-help methods or counseling can help a woman learn how to avoid, eliminate, or better respond to stressful circumstances. The most important thing is practical and emotional support from loved ones and friends.
One important note: A pregnant woman in stressful circumstances must be careful not to blame her baby. Doing so may lead to inappropriate treatment of her innocent baby. Rather, she should address the real causes of her stress and reserve love and concern for her baby.
Q: Is it okay for me to eat sushi with raw fish while I am pregnant?
A: You should not eat sushi with raw fish because it sometimes contains parasites such as tapeworms. These parasites can make anyone sick, whether pregnant or not. The added risk during pregnancy is that your unborn baby could be deprived of necessary nutrients if your illness lasts for a long time.
When you are pregnant, cook fish well so as to kill any parasites, rather than follow the current trend of lightly searing the fish. Cook fish until it flakes when you insert a fork and twist it. Follow preparation directions in a good cookbook to determine cooking times for various kinds of shellfish. Freezing fresh seafood also kills parasites.
Today another concern regarding seafood is industrial pollution, which contaminates seafood in some geographical areas with chemicals or PCBs (polychlorinated biphenyls). Cooking does not destroy these substances. You should check with your community health department for information on the safety of local seafood.
Q: What vitamin supplements should I take during pregnancy?
A: Your best source of vitamins is nutritious food from all the food groups: grains; vegetables; fruits; calcium foods such as dairy products; protein foods such as meat, fish, poultry, eggs, dried beans, and nuts; and fats, oils, and sweets. Most doctors and midwives recommend a good diet plus prenatal vitamins for extra insurance. Prenatal vitamins are preferable to ordinary multipurpose vitamins because they are designed to meet the added nutritional demands of pregnancy.
It is also important to have your diet evaluated by a nutritionist. If you lack certain nutrients due to food allergies, intolerance, or dislike, additional amounts of specific supplements (such as calcium, iron, and others) may be recommended. A nutritionist can help you plan a diet that is in line with your taste preferences and consistent with your ethnic or religious background.
As for the decision on the specific choice of the brand and formula for your prenatal vitamins, there are numerous ones available. You and your doctor or midwife should make the choice jointly.
It is not wise or safe to take large doses of any vitamins, or to design your own supplementation program, without professional guidance. Vitamins have potential side effects on your unborn baby. One example is vitamin C, which, if taken in large quantities over several weeks or months (in hopes of preventing colds), creates a higher than usual requirement in the unborn baby, which continues after birth, causing temporary symptoms of vitamin C deficiency. Vitamins should be considered a form of medicine and taken with caution and knowledge.
Q: About how much weight should I gain during pregnancy?
A: If you are of normal weight before pregnancy, you should probably gain between 20 and 35 pounds. This weight gain includes the growing baby, as well as many of the changes your body undergoes to support the baby. The breakdown typically looks something like this:
Baby 6 to 9 pounds
Placenta 1 to 2 pounds
Uterus 2 pounds
Amniotic fluid 2 to 3 pounds
Added breast weight 1 to 2 pounds
Added blood volume 2 to 3 pounds
Added tissue fluid 4 to 6 pounds
Fat 5 to 8 pounds
Total weight gain 23 to 35 pounds
If you were underweight or overweight before pregnancy, you may benefit from gaining more or less than the recommendations for women of normal weight. Ultimately, the quality of your diet is more important than the number of pounds you gain during pregnancy.
Q: What is a doula, and why do women use doulas for assistance during childbirth?
A: A doula is a woman (or occasionally a man) who is trained and experienced in helping with childbirth. She accompanies women and their partners through the entire birth process, providing emotional support, physical comfort, and nonclinical advice. She also helps them get the information they need to make good decisions.
Women and their partners choose doulas for a number of reasons:
* The doula puts the parents’ interests first.
* The doula is knowledgeable and caring.
* The doula can help parents have the kind of birth they want and make adjustments if problems arise and unexpected interventions are needed for safety.
* The doula does not leave for a break or shift change. (Doulas take breaks only when the woman is asleep or when labor is unusually long and a backup doula is present.)
* Women who are anxious or fearful about birth or hospitals appreciate the support and reassurance a doula gives.
* Partners often feel overwhelmed by their responsibilities and want help and advice in carrying out their roles. They also appreciate being able to take a nap during a long labor without leaving the mother with no support.
* Expectant parents are impressed by research findings from numerous studies that prove that a doula’s support often results in shorter labors, fewer requests for epidural blocks, fewer cesarean births, fewer deliveries by forceps and vacuum extractor, and less postpartum depression.
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