Baby Plans
So you and your partner are thinking about having a baby. The thought will undoubtedly bring about many different emotions. Fear may be one of the greatest, but hopefully excitement and curiosity are not far behind. Bringing a child into this world is a miracle in its own, but it is also a tremendous responsibility. Not to be taken lightly, it is something that deserves some planning.
First of all, are you and your partner ready? Being ready not only means the desire to have a child, but also the financial and physical ability to have a child and raise a child. I’ll leave the financial part to your own wisdom and reflection. However, the physical ability to have a child is a very important topic of discussion.
While we definitely need the male component for your future baby, his physical condition is a minor concern compared the desire to have a healthy mom to carry and nurture the baby. In fact, some future moms are bypassing the male interaction and simply checking the world wide web to “order” the necessary material to conceive a child. While it can be nice to have a “partner” to support you, help you, and encourage you through your pregnancy, it isn’t always necessary. For now, we will focus on the very important female portion of the equation.
Prior to getting pregnant, the future mom should strive to be the healthiest and fittest that she can achieve. This includes the control and improvement in any pre-existing health conditions, as well as doing whatever she can to be in the best shape possible before getting pregnant.
Health conditions such as diabetes, high blood pressures, and obesity are a few of the more common ailments that women may already have when deciding to have a child. Ideally, prior to getting pregnant, each of these conditions should be under control. We are definitely more strict regarding sugar control during pregnancy than when not pregnant. In fact, women with diabetes under poor control prior to getting pregnant and in the first trimester are at a higher risk of having miscarriages and/or children with birth defects. Any women with diabetes who plans to get pregnant should strive to keep her sugars in the low hundreds and ideally have a screening test done called a hemoglobin A1C proving that their control has been normal for at least the past thirty days. They should also make sure that their medications are appropriate for the first trimester of pregnancy. While many treatments for diabetes have been found to be safe in pregnancy, there is still some concern for the pill form of treatment. For this reason, we recommend that anyone who needs medicine to treat their diabetes use insulin to control their sugars in the first trimester. While there are definitely women who inadvertently took the pill form of treatment for diabetes in the first trimester and had healthy children, there is definitely more experience and support for insulin use in pregnancy. Once further into the second and third trimester of a pregnancy, you and your doctor can determine if switching to pills is an option for you.
If you have troubles with high blood pressure even before getting pregnant, it is again very important that you get it under control. This does not mean better than usual, it means normal. Even blood pressure that is normal sometimes, but at other times out of control can cause devastating problems with pregnancies. While making sure that your physical condition is the best possible is a major step towards controlling your blood pressure, for many of us it is not enough. Many medications for high blood pressure are safe in pregnancy, but there are definitely those that may cause problems for the baby. For this reason, make sure that you let your doctor, either your general physician or your ob/gyn, know that you plan a pregnancy. It would be much safer to change your medication before getting pregnant than when you may already be weeks into your first trimester.
One of the common elements of both diabetic control and treatment of high blood pressure is your diet. Diabetes is not simply the control of sugar in you diet. Sugar may be the ultimate culprit in the bad things that happen to diabetics, but it hides in many different forms. Be sure to review what is good and bad for your diabetes in your diet. Simple things like breads, pastas, cream based soups, and dairy products may hide different forms of sugars. The same goes for the control of high blood pressure. Salts are notorious for causing water retention and increased blood pressure. Many are hidden in our everyday diets. Sodas and soups are examples of items full of sodium.
Asthma is more unpredictable in pregnancy. Many women get better with their asthma while they’re pregnant, while others get worse. To complicate in even more, some stay the same. The most important thing to remember is to avoid the triggers that seem to make your asthma worse. Things like exercise induced asthma, allergic reactions, and infections are some of the most common causes of attacks. While it would be great to be able to avoid these things, reality tells us different. To that end, it is most important to know what you can do if you feel an attack coming. For the most part, asthma medications are safe in pregnancy. Some of the newer treatments like singulair and advair are less known, but albuterol, theophylline, ventolin have much more experience. In the event that you have an attack, using an inhaler and/or an SVN machine are completely acceptable in any trimester. The use of steroids in pill form or inhaler are also safe. Cromolyn is another option for some asthmatics and should be used if part of your normal treatment. Obviously keeping your asthma doctor informed of your problems is important also.
Fortunately most women who plan pregnancies are young and healthy. Unfortunately many pregnancies are surprises and the future moms are forced to play catch up with regards to their health and changing their lifestyles. The most obvious first steps are to stop anything that has even the smallest possibility of affecting your baby. If you are already pregnant, smoking, drug use, alcohol use, and exposure to possible toxic conditions should be eliminated immediately. While the perfect solution is stopping immediately, it is not always the easiest thing to do. Smoking is a perfect example. Not only do men and women become addicted to the chemical portion of smoking, there is always a mental addiction as well. We find that the easiest way to reduce the risks to your baby are to gradually reduce your use of tobacco. First try to reduce the number of cigarettes that you use on a daily basis one at a time. If this means one less cigarette for every month of your pregnancy or, better yet, one less cigarette every week, it reduces the exposure to your baby. Stopping everything immediately is great, but unfortunately commonly ends in failure. Getting your partner to quit smoking too will make the odds of your success even better. Not to mention the second hand smoke that you and your baby will get from him. Nicotine products like the gum and patches hold their own risks to your baby, but when compared to the additional risks of the cancer causing elements of cigarettes to you, they are the lesser of two evils. In general, stopping tobacco use with good old fashion will power is the best choice.
The treatment of alcohol and drug use is less flexible. These both have strong histories of causing problems for mothers and their babies. For this reason, both should be stopped as soon as you find out you’re pregnant. In some literature, alcohol use is cited as the number one reason for mental impairment in this country. Any mother who drinks consistently through pregnancy may have a healthy appearing child, but will always have to wonder if that child would have done better in school or achieved more in life if she hadn’t consumed alcohol during her pregnancy. Drug use holds some of the same concerns, but carries an even more ominous risk for your unborn child. Drugs can kill you and can kill your unborn child. Most drugs that are abused are those that cause some type of stimulation. Any stimulation will undoubtedly cause some changes in the very circulation that supports your baby. These changes can kill. Other drugs have more of a sedative effect and can be addictive to the mother and the baby. Unmonitored withdrawal from these drugs and/or overuse of these drugs can cause death of the mother and the baby. Growth issues with your baby and preterm labor are only a few of the other complications that can arise from drug use in pregnancy.
Drug use that we do recommend in pregnancy is Folic Acid. For decades now we have known that the use of folic acid (folate) is beneficial to babies from their very beginnings. We know from many studies that the use of folic acid before getting pregnant, ideally for more than a month, will reduce the risk of certain birth defects. While these birth defects are uncommon in this country, any reduction in the rare time that they do occur is fantastic. More recent research has shown that folic acid may even be beneficial in preventing preterm labor. The use of folic acid for months and, even better, a year before getting pregnant has shown a reduction in the preterm deliveries of very small babies. Fortunately folic acid is found in many common diet items and is likely consumed in adequate amounts by simply eating a diet rich in grain products. To be safe, though, it is advisable in so many ways to simply take a good multivitamin every day. There are benefits to your health even if you’re not trying to get pregnant. Options for vitamins and their availability should make it easy to comply with this recommendation. Even vitamins available without prescriptions at discount stores and “big box” stores are acceptable. Vitamins are vitamins. They are definitely good for both you and your baby. Many patients ask us about what vitamins are best. In general, all vitamins are the same. Vitamin is vitamin A whether it’s in a tablet or a gummi bear or green leafy vegetables. Some may argue about which is absorbed better and gets into your system better, but in general they all do some good. Therefore, some countries will advocate a simple diet plan to include all the necessary vitamins (i.e. Japan) while others don’t have enough confidence in their people (i.e. USA), so they advocate supplements. Whatever your choice, it doesn’t do you any good unless it gets into your system. Therefore, if it’s in the form of chewable children vitamins or smoothie shakes with added vitamins or prenatal vitamins over the counter or a prescription vitamin, it’s all good.
The only concern about how much of any vitamin that you might get or, more importantly, how much is too much is with Vitamin A. This is the only vitamin that holds some toxicity if too much is ingested. In general the amounts found in traditional vitamins are fine. You would have to take four prescription prenatal vitamins in one day and keep doing it before you would cause problems. The only other issue with any of the supplements is the potential of constipation with iron usage. While iron is recommended in pregnancy, it can cause some stomach upset and difficulty with bowel movements. In general, we recommend treating the constipation and/or stomach upset rather than stopping the iron. Treatments such as Mylanta, Maalox, Tums, Rolaids, Zantac, etc. are fine any time in pregnancy. Food items that contain iron and may be better tolerated are spinach and liver.
At no time should you ever worry that you are “starving” your baby or that you have done any harm by neglecting a certain item in your diet. While we would love to have you get all the necessary nutrients in your diet that we recommend for a healthy baby, in reality your body treats your baby as “number one” and you get leftovers. In other words, you baby will get calcium to form bones and teeth even if you never eat or take in any calcium throughout your pregnancy. Anything your baby needs, your baby takes. As what might be a hint for the future, your baby gets what he or she wants and mom “suffers”.
For all the reasons and recommendations above, it can be and should be a very good idea to find your maternity professional even before getting pregnant. This person can be physician or midwife in most cases. While certain conditions will warrant a more specialized medical professional, most pregnancies can be cared for by either a doctor or a midwife. The vast knowledge of either is a treasure trove of information for you to plan your pregnancy. The best way to find a maternity professional is by not just picking one from your insurance book or the telephone book or the internet. You want a more personal recommendation. Some of the best referrals will come from friends that have had children. Ask many people, even strangers. Pay attention to repeating names of doctors or midwives. Even call the hospital where these doctors or midwives work and ask the labor and delivery nurses their recommendations. Check the Board of Medicine by phone or on the internet to see if any concerns are listed. Check the Board of Nursing for Midwives. When you have a professional or two, don’t hesitate to see if they are available for interviews or if their office has any type of informal get to know the practice meetings. Finally, remember that you are never stuck with any medical provider. In the event that you find yourself with a practice that doesn’t quite fit what you wanted, look again and move on to another practice. Your records are your property and at no charge for copies, you can move on to another provider very smoothly.
Simply said, just do your best. Try to be in the best shape that you can reasonably maintain and try to eat healthy. Don’t do anything that may affect your baby in a bad way and do whatever you can to help give your baby the best first “building blocks” that you can.
As for exercise, pregnancy is probably the first and maybe the greatest challenge that a woman’s body may face. Both the creation of a human being within their body and strain of carrying the pregnancy for most of a year will tax even the most in shape of all women. In fact, many an aerobics expert will complain about the difficulties of carrying a baby. For this reason, it would be ideal if a woman was in “great” shape before getting pregnant. While this is not always possible, maintaining some sort of exercise through pregnancy has many benefits. We don’t recommend starting any type of aggressive workout program when already pregnant, but maintaining or starting a cardio based program would be great. Such things as long walks, treadmills, stationary bicycles, stair steppers, swimming, and elliptical machines are great forms of exercise while pregnant. Low impact aerobics or water aerobics are also beneficial. Anything to build stamina, burn calories and not traumatize joints or cause excessive pelvic thrusting will help you get through the pregnancy with minimal weight gain and even more energy. Exercise will do so much for your body image, weight control, energy level, and sense of well being. The only thing better would be if you could get your partner to exercise with you!
Limitations for exercise are rather limited. In general, cardio is fine as long as you keep you heart beat less the one hundred and forty (140). Using machines that allow you to monitor your heart rate or learning how to check your heart rate would be best. In the event that your heart rate gets above this recommended level, it doesn’t mean that you must stop your exercise. It only means that you should slow down or rest until your pulse comes down to an acceptable level. You may continue to exercise as long as you would like using this one parameter. Remember to stay hydrated by drinking while you exercise. Weight restrictions are more controversial. Most textbooks give a limit for lifting of twenty five pounds. However, there are many women who are used to lifting more than twenty five pounds just with their other children. Rather than giving a patient a limit of a certain weight, the more rationale recommendation is to limit the amount of weight that you lift to something that doesn’t require effort. In essence, do not strain. We simply don’t want you to push down or strain against your pelvis too much.
Even more simplistically, listen to your body. In any activity that you do, if it causes you discomfort, cramping, and/or bleeding, don’t do it. This can apply to exercise, working, traveling, or, even, intercourse. If you suffer any of these when doing a certain activity, you owe it to your baby to find out why and whether it’s a problem before doing it anymore. To steal a phrase from the drug companies, consult your doctor.
So now you’ve decided that you’re definitely going to try and get pregnant. You’ve stopped all bad habits (e.g. smoking, drinking, drugs) and started good ones (e.g. regular exercise, healthy diet, prenatal vitamins, Omega 3 fatty acids). You’ve made sure that any pre-existing medical problems that you might have are under control and that any medicines that you are taking are safe for your future pregnancy. Now for your homework.
While most pregnancies are not this planned out, you are going to be the exception. We all know the couples that had the unplanned pregnancy and how easy it was for them to get pregnant when they really didn’t want to. In reality, it seems that when couples really want to get pregnant, it just doesn’t happen like they want. While sometimes we’ll have couples come in and state that they thought it would take longer to get pregnant and they got pregnant faster than they planned, it’s more common that patients are concerned that it’s not happening fast enough. For most young healthy couples, it takes an average of five months for fifty percent of couples to get pregnant. In other words, half of all couples trying to get pregnant are still trying after five months. It’s not until a year of trying that we consider it too long.
So don’t get discouraged. Don’t stress over it. Many a couple will realize their fertility when they don’t realize their fertility. Just do your homework and don’t fixate on it. While fifteen percent of couples will still be trying at a year, there are many wonderful options available to the rare couple that is having trouble getting pregnant.
Pregnancy Folklore
Through the centuries of women having babies, it was inevitable that many stories and anecdotes would be created and passed down through time. These so-called “wife’s tales” are mostly based on rumor and are rarely true. Some of the more common stories that you might hear are the following:
Heart burn
a. Very common in pregnancy
b. Not related to the amount of hair the baby has
c. Treated with antacids safely
Stretch marks
d. Cannot be prevented
e. Not all women get them
f. Moisturizing creams work best
g. Staying hydrated keeps your skin more flexible
Fetal movements
h. Usually not felt until around twenty weeks
i. Unpredictable
j. Should be consistent in the third trimester
- - Dr. Plimpton
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Spring Is Here
As the season changes and the beautiful flowers and plants emerge from their winter slumber, we all must face the reality of new infections and new pollens in the air. If you’re lucky, you’ve developed a resistance to many of these assailants as you’ve lived here in the Valley. Unfortunately, even the longest of residents, even natives, can succumb to the sneezes and runny noses that most of us get. Pregnant women are no different.
For this reason, it’s important to know what you can and can’t take while you are pregnant. The following is a short list of some of the more common medications that you can take while pregnant. Each is divided into the type of benefit you may expect from the medicine, but many patients will need to take more than just one type of medication to feel better. There are no prescription medications listed in this summary. Any medication that requires a prescription should be discussed with your doctor before being used, especially your obstetrician or midwife.
Most importantly, DO NOT TAKE MEDICATIONS GIVEN TO SOMEONE ELSE! USE THE MEDICATION ONLY AS PRESCRIBED OR WRITTEN ON THE PACKAGE. A common mistake is to take the medication only when you feel bad. Take the medication to prevent feeling bad! If it says to take Pseudofed every 8 hours, then take it every 8 hours.
ALLERGIES
Common symptoms: runny nose, itchy eyes, congestion
Appropriate medications: benadryl, pseudofed, Actifed, Contac, Allerest
COUGH
Appropriate medications: Robitussin, any generic cough syrup with no alchol
SORE THROAT
Appropriate medications: any lozenge, Choroseptic spray
ACHES, FEVER, HEADACHES
Appropriate medications: Tylenol or its generic (any dosage)
FLU SYMPTOMS
Appropriate medications: Theraflu, Robitussin, Dayquil, Tylenol Cold
I’ve always thought that it was easier to let people know what NOT to take. In general, stay away from cold and allergy medications that contain ALCHOL, like Nyquil. Try to avoid ibuprofen, Motrin, Advil, and anything containing Aspirin. An isolated exposure to these medications is not dangerous to your baby, but we try to avoid them in pregnancy. In general, the best rule of thumb is to avoid any and all risks to your baby when there are perfectly good options that are not a problem.
Finally, most flus, colds, and/or allergies are short in duration. For this reason, if you don’t feel better after doing the best that you can with REST, PUSHING FLUIDS, and these MEDICATIONS in 48 to 72 hours, then let your health care provider know right away. If you feel worse even before that timeframe, let them know sooner. If you already have a problem like Asthma or other lung condition, let them know even sooner.
While most pregnant women will not fight infections as good as non-pregnant women, you should feel better with treatment. Those in your household may get the same infection and be better in a few days, BUT you take a WEEK to get better. The point is YOU GET BETTER!
Finally, the powers that be have made the womb a very special place. You can be a pretty sick person, but your baby is having a great time inside. It’s extremely rare that any infection that you get will ever go to your baby. So, that’s one less thing to worry about. Remember, your baby lives off of you! Keep yourself healthy and do what you can to get yourself better when you are sick and your baby will follow right along. REST, FLUIDS, VITAMINS, and APPROPRIATE MEDICATIONS will go a long way.
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