Obstetrics
Welcome to Modern Women’s Care
Compassionate Care for Your Pregnancy Journey
Congratulations on your pregnancy!
We are honored you have chosen Modern Women’s Care to accompany you through this remarkable chapter of your life. Whether you’re expecting your first child or adding to your growing family, our dedicated team is here to provide you with personalized, comprehensive care every step of the way. At Modern Women’s Care, we believe every pregnancy is unique and deserves individualized attention. Our experienced healthcare professionals are committed to supporting your physical health and emotional well-being, ensuring you feel informed, comfortable, and confident throughout your prenatal journey.
Together, Dr. Allen and Bujor will create a nurturing environment where you and your baby can thrive. Thank you for entrusting us with your care. We look forward to being a part of your incredible journey into motherhood.
Weight Gain During Pregnancy
Appropriate weight gain depends on your pre-pregnancy weight, or Body Mass Index (BMI). Generally, it is best to gain between 6-10 pounds during the first half of your pregnancy, then ½-1 pound per week thereafter.
| Body Mass Index before pregnancy Weight gain | Recommended |
| Underweight (BMI < 18.5) | 28-40 pounds. |
| Ideal Weight (BMI 18.5-24.9): | 25-35 pounds. |
| Overweight (BMI 25-29.9): | 15-25 pounds. |
| Obese (BMI 30 or higher): | 11-20 pounds |
“***Caloric intake should increase by ~300 calories per day during pregnancy
Exercise
If you are healthy and your pregnancy is normal, it is safe to continue or start regular physical activity. Ideally, pregnant women should get at least 150 minutes of moderate-intensity aerobic activity every week. You can divide the 150 minutes into 30-minute workouts on 5 days of the week or into smaller 10-minute workouts throughout each day. With exercise you should not let yourself get overheated or out of breath and stay hydrated. Do not push yourself to the point of being lightheaded or unable to hold a conversation. Listen to your body and stop if you have pain or discomfort.
Recommended exercises: walking, swimming, stationary bicycling, modified yoga modified pilates, pregnancy fitness classes, and low impact aerobics. Avoid lying on your back as much as possible particularly after 20 weeks. If you are new to exercise, start out slowly and gradually increase your activity. If you were already exercising regularly before your pregnancy, you can usually continue your exercise program with the aforementioned modifications.
Exercises you should avoid: contact sports and sports that put you at risk of getting hit in the abdomen, scuba diving, skydiving, and activities that might result in a fall such as snow skiing, water skiing, surfing and horseback riding. Avoid “hot yoga” or “hot Pilates,” which may cause you to become overheated, as well as Jacuzzis/hot tubs.
Sex
Sexual intercourse and/or orgasm during pregnancy are safe unless specifically prohibited by your doctor. As pregnancy progresses, alternative positions for intercourse may be necessary for your comfort. Your doctor may advise you do not have intercourse if:
- You have abnormal bleeding at any point during the pregnancy
- You have abnormal placenta location (placenta previa)
- You are at risk of preterm labor
- You have rupture of amniotic membranes
Travel
Traveling by car, bus, or airplane is generally safe for healthy low-risk pregnant women, however, keep in mind that many complications of pregnancy occur without warning. The best time to travel is mid-pregnancy (14 to 28 weeks). During these weeks, your energy has returned, morning sickness is improved or gone, and you are still able to get around easily. We usually suggest you discontinue elective travel between 28-32 weeks. Wear your seat belt. Long flights can put a woman at an increased risk of forming a blood clot in her legs. Wear compression socks on airplane or long car rides. Plan to get up and walk around every 2 hours and stay hydrated. If you are planning a trip, particularly a long distance one, discuss it with your Ob-Gyn.
Nausea
Although some women feel worse in the morning, the symptoms can occur anytime or all day long. There are certain things you can do to decrease your symptoms. Eat small, frequent meals (every 2-3 hours). Try not to drink with meals, instead sip fluids between meals. Eat a few crackers or dry toast before getting out of the bed, wait 5-10 minutes, then get up slowly. In general, try to eat bland, easy to digest foods such as broiled chicken, cut up fruit such as watermelon or cantaloupe, crackers, peanut butter, pudding, baked potato etc. Try taking your prenatal vitamin before bed. Avoid greasy, fried foods, carbonated beverages, liquids with high sugar content, and caffeine. If you need something with flavor, try mixing equal parts of water and juice to lower the sugar content or sugar free Gatorade. Sit upright after meals and avoid using straws to drink liquids. You may also want to try sea bands.
If none of the above is helpful, there are over the counter medications which may help:
- Unisom 25mg at bedtime or 12.5mg 2x/day
- Vitamin B6 10-25mg 3x/day
- Benadryl 25mg every 6 hours
- Dramamine 50-100mg every 4-6 hours (max 400mg/day)
- Ginger capsules 250mg 4x/day
- Chlor-Trimeton 8-12mg once daily
- Emetrol as directed (AVOID if you are diabetic)
Constipation
Eat more raw fruits and vegetables; try dried fruits, prunes/prune juice, apricots. Increase bran and fiber in your diet and drink adequate fluids (8-12 glasses daily). Try a glass of warm water as soon as you get up. Exercise regularly. Take 2 tablespoons of Milk of Magnesia or Colace (stool softener) 1-2 tablets,1-2 times a day.
Heartburn
Eat 5-6 small meals a day. Limit fatty and fried foods. Avoid spicy foods, citrus and tomato-based foods. Remain upright at least 2 hours after eating.
Bleeding or Spotting in Early Pregnancy
It is always alarming to see any bleeding when you are pregnant. In the first trimester light bleeding or spotting can occur for several reasons such as during implantation (when the fertilized egg attaches to the uterine lining), due to hormonal changes, a friable cervix (one that is prone to bleeding), infection, or a cervical polyp. If this occurs, stop any strenuous activity, rest and give the office a call. When bleeding is heavy and/or associated with cramping or lower abdominal pain, call your doctor as soon as possible or go to the ER. This type of bleeding or pain might be an indication the pregnancy is miscarrying or possibly an ectopic pregnancy (the pregnancy has implanted outside of the uterus i.e. the fallopian tubes).
When Should You Sleep on Your Side
It is recommended to stop sleeping on your back after 20 weeks. As your uterus grows, it can compress the vena cava, a large vein that carries blood from your lower body to your heart. This compression can reduce blood flow to the baby. Compression of the vena cava can also lead to reduced blood flow to the mom, potentially causing symptoms such as dizziness and nausea. Sleeping on your side, either the left or the right, is best. You can place pillows under your belly, between your knees, and behind your back for support and comfort.
Coloring Your Hair
We recommend waiting until after the 1st trimester to dye your hair or use a plant-based alternative.
If you choose to dye your hair, ensure the area is well-ventilated, wear gloves, and consider highlights to minimize contact with your scalp.
Jacuzzi/Sauna
We recommend avoid using hot tubs, saunas, and steam baths during pregnancy. Prolonged exposure to high temperatures can cause overheating and potentially harm the developing baby, especially in the first trimester.
Cat Litter and Soil
These may contain toxoplasma, a harmful parasite. Your cat is safe, but the poop may not be. Do not change cat litter while pregnant. When gardening, wear rubber or leather gloves.
Avoid NSAIDs
Motrin, Ibuprofen, Aleve, Advil, Naproxen: Use of these medications during pregnancy may lead to low amniotic fluid, fetal renal dysfunction and premature closure of the fetal ductus arteriosus, a blood vessel that is essential for fetal circulation.
Herbal Supplements
There is a lack of adequate studies that assess the risk and/or benefit of most herbs during pregnancy. There are many herbs that can be harmful to the developing baby as well as the mother; some can cause unintended side effects such as contractions leading to miscarriage or premature birth. This is a partial list of herbs to avoid: black/blue cohosh, buckthorn, cascara, ephedra, feverfew, mandrake, mugwort, tansy, and yarrow. Consult with your doctor before using any herbs.
Smoking and Recreational Drugs
These can increase the risk of miscarriage, bleeding, placental separation, smaller babies, premature babies, developmental delays, and other serious complications. Once you know you are pregnant, it is best to stop them completely. Talk to your healthcare provider if you need help.
Kick Counts
It is generally recommended to start counting fetal movements beginning at 28 weeks. This is when fetal movements become more consistent and predictable making it easier to track changes in their activity. Fetal movements can be kicks, flutters, swishes or rolls. The baby should move at least 3-5 times in one hour or 10 movements in 2 hours. If it does not, please contact your doctor or go to labor and delivery immediately.
Circumcision
The American Academy of Pediatrics found the health benefits of newborn circumcision (reduced risk of UTIs, HIV and penile cancer) outweigh the risks; while the benefits are significant, they are not sufficient to recommend routine circumcision for all newborns. They say the final decision on whether to circumcise should be left to the parents to make in the context of their religious, cultural, and personal preferences.
Newborn Stem Cell Preservation (Cord blood and cord tissue banking)
Stem cells are cells with the potential to develop into many different types of cells in the body. Your baby’s umbilical cord contains an abundance of stem cells that can be privately stored for potential future use in the treatment of blood disorders, immune deficiencies, genetic diseases, medical disorders, and cancers. Collecting the umbilical cord blood is a safe, painless procedure done after the baby is born and before the placenta is delivered. You have the option to privately store your child’s stem cells (for a fee) or have them discarded along with the placenta.
It is important to have a nutritious, well balanced diet during pregnancy. Good protein sources such as fish, poultry or lean meats together with fresh fruits, vegetables, grains, and milk products will provide you with the basics for good nutrition. Try to not skip meals. Avoid eating excessive sweets and “junk foods” such as sodas, candy, pastries, potato chips, French fries, pizza, etc.; limit these foods and save them for special occasions.
Your protein intake may need to increase during pregnancy, aim for 70-100 mg per day. You should drink 8 to 12 cups (64-96 oz) of fluids each day, plain water is the best source of hydration.
Foods To Avoid When You’re Pregnant
Fish that may contain mercury or other contaminants: Shark, swordfish, king mackerel, orange roughy and tilefish are high in mercury. Avoid fish from contaminated local lakes and rivers that may be exposed to high levels of polychlorinated biphenyls. These fish include striped bass, bluefish, salmon, trout, pike and walleye.
Low mercury fish choices include salmon (choose wild-caught over farmed, wild-caught may have lower levels of PCBs), tilapia, cod, shrimp, Pollock tuna (light canned), and catfish. Many types of shellfish are low in mercury such as oysters, clams, scallops, shrimp, crab and mussels; if cooked properly, are okay to eat. During pregnancy it is recommended to not have more than 2 servings of low mercury fish or shellfish (or 12 ounces) per week. Limit Albacore tuna to 6 oz per week
Smoked Seafood
Refrigerated, smoked seafood often labeled as lox, nova style, kippered or jerky should be avoided because it could be contaminated with listeria. These are safe to eat when they are in an ingredient in a meal that has been cooked, like a casserole. Canned or shelf-safe smoked seafood is usually ok to eat.
Soft Cheese
Avoid soft, unpasteurized cheeses to minimize the risk of Listeriosis. Soft cheeses like Brie, Camembert, Feta, Roquefort, Blue, Goat, Gorgonzola and Mexican style cheeses that include queso blanco, queso fresco and queso Panela can be more susceptible to harboring harmful bacteria, including listeria. Listeria can lead to complications like miscarriage, premature birth, or severe illness in the newborn.
Raw Egg
Raw eggs or any foods that contain raw eggs should be avoided because of the potential exposure to salmonella.
Unpasteurized Milk
Unpasteurized milk may contain a bacteria called listeria which can cause miscarriage, premature birth or severe illness to the baby.
Pâté
Refrigerated pâté or meat spreads should be avoided because they may contain the bacteria listeria. Canned pâté or shelf-safe meat spreads can be eaten.
Unwashed Vegetables
It is essential to make sure you wash vegetables before consuming to avoid potential exposure to toxoplasmosis and other bacteria. Toxoplasmosis may contaminate the soil where the vegetables were grown.
Raw Vegetable Sprouts
Do not eat raw sprouts including alfalfa, clover, radish and mung bean sprouts; they can contain listeria, E. coli and salmonella. Bacteria can get into the sprout seeds and are “nearly impossible” to wash out. It is OK to eat thoroughly cooked sprouts.
Raw or Undercooked Food of Animal Origin
Undercooked animal foods such as rare meat, raw oysters, sashimi, ceviche may contain an array of bacteria, viruses, and parasites. To reduce your risk of foodborne illness, have your meats cooked well done, test the doneness of meat, poultry and fish with a food thermometer, cook eggs until they are no longer runny, and follow baking instructions.
Hot Dogs and Luncheon Meats
Avoid hot dogs and deli meats including ham or turkey, bologna, and salami unless it’s been heated until steaming hot. This is because deli meats can harbor listeria bacteria, which can be harmful to both the mother and the developing baby. Listeriosis, the infection caused by listeria, can lead to serious complications during pregnancy, including preterm labor, stillbirth, and infection of the newborn.
Unpasteurized Juices
Unpasteurized juices are more susceptible to harboring bacteria, including E. coli.
Caffeine
The American College of Obstetricians and Gynecologists (ACOG) recommends limiting caffeine intake during pregnancy to less than 200 milligrams per day. This is equivalent to about one to two 8 oz cups of brewed coffee.
Alcohol
There is no level of alcohol consumption that’s known to be safe at any time during the pregnancy. The American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant women avoid alcohol completely.
Artificial Sweeteners
Artificial sweeteners are generally considered to be safe for use in moderation during pregnancy. However, some individuals, particularly those with phenylketonuria (PKU), a metabolic disorder, should avoid aspartame. Additionally, while saccharin is generally considered safe, some recommend avoiding it due to concerns about placental transfer and unknown long-term effects on the baby. Try to avoid using saccharin due to concerns about placental transfer and potentially impacting the baby’s development.
Vaccines
*Flu (Influenza) Vaccine: Recommended if you are pregnant during flu season; if possible, it is best to get the flu shot by the end of October. Safe to receive during any trimester of pregnancy. During your pregnancy, your immune system will not be as strong; getting the vaccine can reduce the chance of having a severe flu illness and possible hospitalization.
The flu vaccine creates antibodies that are passed to a fetus, which protect against the flu until a baby can get the flu vaccine at age 6 months.
*Tdap (Whooping Cough) Vaccine: Recommended between 27 weeks and 36 weeks of each pregnancy. The Tdap vaccine creates antibodies that are passed to a fetus, which protect against whooping cough until a baby can get a whooping cough vaccine at age 2 months. Babies younger than 3 months have the highest risk of severe disease and death from whooping cough. The best way to protect your newborn is by getting the Tdap shot during pregnancy.
Other close contacts of the newborn should also be vaccinated before the baby is brought home from the hospital. Only the patient needs a Tdap booster with each pregnancy, family members are required to receive a booster every 5-10 years.
*Covid-19 Vaccine: the Covid-19 vaccine is being offered to pregnant and nursing mothers and is safe to receive in any trimester. The vaccine helps to prevent severe illness from Covid-19.
The COVID-19 vaccine creates antibodies that are passed to a fetus, which may protect against COVID-19 until a baby can get a COVID-19 vaccine at age 6 months.
*The RSV Vaccine: RSV (Respiratory Syncytial virus) is the leading cause of hospitalization in newborns in the United States. RSV is a common virus that can cause severe respiratory infections in infants, particularly those under 6 months old or born prematurely.
There are two ways to protect your baby from getting very sick with RSV. If you are between 32 and 36 weeks of pregnancy during RSV season (September through January), you can get the RSV vaccine or your baby if less than 8 months old, can get an RSV immunization during their first RSV season. If a baby is born during RSV season, it is recommended the baby receive the RSV vaccine within the first week of life, if mom was not vaccinated.
When given to the mother, the RSV vaccine creates antibodies that are passed to a fetus, which protect against RSV for the first 6 months after birth.
For information on vaccines during pregnancy please go to acog.org or cdc.gov
When to Go to the Hospital
*Decreased Fetal Movement – If your baby is not as active as usual or you notice a sudden decrease in movement, go to labor and delivery.
*Leaking of Amniotic Fluid/Rupture of Membranes – Some women will break their bag of water prior to the onset of contractions. This may be a painless gush of fluid from the vagina or a continuous trickle of fluid that cannot be controlled. If this should happen, go to Labor and Delivery regardless of whether or not you feel contractions or discomfort.
*Contractions – Should you experience regular contractions (painful tightening of the uterus, often radiating to the back as well) every 10 minutes or 6 or more contractions in an hour and your pregnancy is less than 37 weeks, call your doctor or go directly to the hospital. If your pregnancy is over 37 weeks: when your contractions are regular, occurring every 5-7 minutes for at least an hour, and lasting 40-60 seconds each, it is time to go to the hospital.
*Bleeding – At term you may notice a mucus discharge that is blood tinged; this is your “bloody show” and is completely normal. This may happen as you go into labor, but it may also occur several days or weeks prior to the onset of labor. You should go to Labor and Delivery if you are bleeding like a menstrual period, passing clots or the bleeding is associated with pain.
It is not necessary to go to the hospital with the onset of losing your mucus plug if you are over 37 weeks.
WARNING SIGNS
If you have any of the signs or symptoms listed below, please contact your doctor immediately!
Preterm Labor
- 6 or more contractions in one hour before 36 weeks
- Rhythmic cramping in the lower back or abdomen
- Increased pelvic pressure associated with increased vaginal discharge
- Loss of mucus plug before 36 weeks
- Vaginal spotting or bleeding
- Leaking of fluid from vagina
Urinary Tract Infection
- Pain or burning with urination
- Flank (back) pain on one side with fever
- Bloody or malodorous urine
Pre-Eclampsia or Toxemia of Pregnancy
- An at-home blood pressure reading of 140/90 or higher on two separate occasions, taken at least 15 minutes apart, and either the top (systolic) or bottom (diastolic) is elevated
- Persistent headaches unrelieved by Tylenol
- New onset of blurry vison or other visual changes
- Increased swelling of the face and hands
- Upper abdominal pain not relieved by antacids
Decreased Fetal Movement
- If you think baby is not moving normally, eat or drink something cold with sugar in it such as orange juice, then lie down on your left and concentrate on feeling the baby move. The baby should move at least 3-5 times in one hour or 10 movements in 2 hours. If baby does not move, please call us or go to Labor & Delivery for evaluation immediately!
Acne
- Benzoyl Peroxide
- Topical Erythromycin or Clindamycin
Avoid:
- Accutane
- Minocycline
- Tetracycline
- Retin-A
Allergies
- Benadryl
- Claritin/Claritin-D
- Flonase
- Tylenol Allergy/Sinus
- Zyrtec
Avoid:
- Claritin-D if you have High BP
Antibiotics
- Amoxicillin/Ampicillin
- Azithromycin
- Bactrim
- Clindamycin
- Erythromycin
- Keflex
- Macrobid/Nitrofurantoin
- Penicillin
Avoid:
- Ciprofloxacin/Levofloxacin
- Minocycline/Doxycycline
Cold / Sinuses / Congestion
- Breathe Right Strips
- Mucinex
- Saline Nasal Spray
- Sudafed
- Tylenol Cold
- Afrin
Avoid:
- Sudafed if you have High BP
Constipation
- Citrucel
- Colace
- Fiberall/Fibercon/Benefiber
- Metamucil
- Milk of Magnesia
- Miralax
- Natural Calm
- Senokot
Cough
- Robitussin DM
- Dextromethorphan
- Vicks VapoRub (on chest)
- Halls or Ricola cough drops
Diarrhea
- Immodium
Avoid:
- Pepto Bismol
- Kaopectate
Gas
- Gas X
- Mylicon
- Simethicone
Headache / Pain / Fever
- Aspirin-Free Excedrin Migraine
- Cold Compress
- Tylenol (Regular and Extra Strength)
Avoid:
- Aleve
- Advil, Ibuprofen, Motrin
- Naproxen
Hemorrhoids
- Anusol HC
- Colace or Docusate Sodium
- Preparation H
- Tucks Pads or Witch Hazel Wipes
- Sitz Bath
Indigestion / Upset Stomach
- Maalox
- Mylanta
- Tums/Rolaids
Avoid:
- Pepto Bismol
Insomnia
- Benadryl
- Tylenol PM
- Unisom
Nausea
- Benadryl (25–50mg every 6 hrs as needed)
- Dramamine (25–50mg every 4–6 hrs as needed)
- Emetrol (as directed)
- Unisom (25mg at bedtime)
- Vitamin B6 (25mg 3x/day)
Avoid:
- Emetrol if diabetic
Skin Rash / Itching
- Benadryl
- Benadryl lotion
- Hydrocortisone Cream
- Zyrtec/Claritin
Sore Throat
- Cepacol lozenges
- Chloraseptic spray
- Ricola cough drops
- Salt water gargle
Yeast Infection
- Miconazole or Clotrimazole
- Monistat (3-day or 7-day)
Avoid:
- Diflucan
The American College of OB/GYN (ACOG) affirms the safe use of acetaminophen in pregnancy. High quality studies, including a 24 year long Swedish study, have found no causal link between Tylenol use and autism or ADHD. In fact, while autism cases have increased in the general population, Tylenol usage in pregnancy has decreased. It is well known that fever and pain pose great risks to pregnancy. Untreated fever can lead to miscarriage, fetal cleft lip and palate, heart defects, and abdominal wall defects. The benefit of Tylenol usage in prevention of these health issues cannot be understated.
While we recommend that all pregnant patients continue to be cautious about using any medication during pregnancy, the data supports continued judicious use of Tylenol/acetaminophen for fever/pain.
Please refer to ACOG “FAQ on acetaminophen use in pregnancy” for further information. You may also contact us directly for any questions you might have.
1st Trimester:
From 1 to 13 weeks
Common Symptoms
- Common symptoms include nausea, vomiting, breast tenderness, fatigue, frequent urination, food cravings or aversions, bloating, and constipation.
- Vaginal spotting can often occur and may be nothing of concern but it can sometimes be the start of an impending miscarriage or ectopic pregnancy
* Remember to take your prenatal vitamin daily
* Eat small, healthy snacks or smaller meals more frequently
* Drink at least 6 glasses of water per day
Daily Supplements:
- Prenatal Vitamin (PNV): With 400-1,000mcg of Folic Acid. Folic Acid is important to reduce the risk of neural tube defects.
- DHA (omega-3 fatty acid): Helps in the development of the fetal brain. Recommended dose is 200-400 mg.
-
Calcium: Needed for bone development. Recommended dose 1200 mg/day during pregnancy. Most Prenatal vitamins have about 200 mg of Calcium, thus you would need to get an additional 1000 mg/day from a food and a calcium supplement. Calcium is hard to absorb therefore it is recommended to take it in divided doses, 500-600 mg twice per day. (Tums are a source of calcium; if you are taking it for heartburn you may not need any extra calcium).
-
Iron: If needed for anemia. Your blood test will check for anemia at the 1st visit and again in the 2nd trimester when we screen for gestational diabetes.
Important Tests:
- Prenatal blood tests: check for anemia, blood type, immunizations, infection, thyroid disorder, diabetes, and vitamin D.
- Early ultrasound: confirm the pregnancy and establish an estimated due date.
- NT (nuchal translucency) ultrasound: performed between 11-14 weeks, measures the fluid filled space behind the fetal neck to assess the risk for Down’s Syndrome and other chromosomal abnormalities as well as congenital heart defects.
Optional Testing:
- Maternal genetic carrier testing: to determine if the mother is a carrier of certain genetic conditions such as Cystic Fibrosis, Fragile X, and Spinal Muscular Atrophy (SMA). If you are found to be a carrier, then your partner is also screened for the same disorder. Most of these conditions are recessive, meaning the baby is not at risk for having the disease unless both parents are carriers of the defective gene. If both parents are carriers, there is a 25% chance the fetus will develop the disorder and a 50% chance the fetus will be a carrier (meaning asymptomatic). In addition to the three listed here, there are many other gene defects that can be screened for and screening more extensively may be available if interested.
- NIPT (Non-invasive prenatal testing): drawn as early as 10 weeks, this blood test analyzes fetal DNA circulating in maternal blood to assess the risk of Down Syndrome, Trisomy 13 and 18 with an accuracy over 99%. The NIPT can also determine the baby’s gender.
2nd Trimester:
From 14 to 27 weeks
Common Symptoms
- Quickening: the first time a pregnant woman feels the baby’s movements. It usually occurs between 18-23 weeks, although it can happen earlier.
- Round Ligament Pain: A common discomfort during pregnancy caused by the stretching of the ligaments that support the uterus as it grows. It’s often described as a sharp, sudden or pulling sensation in the lower abdomen or groin. Most episodes of round ligament pain are brief, lasting only a few seconds to minutes. If the pain is severe or lasts for more than a few minutes, seek medical advice.
- Back Pain: Weight gain, changes in posture and a growing uterus can contribute to back pain.
- Skin Changes: Hormone changes during pregnancy cause you to have more cells with pigment, called melanin, in your skin. You may have brown or grayish-brown patches on your face, also known as melasma. You can also develop a dark line down your belly called a linea nigra; this fades after delivery. You might also see reddish-brown, black, silver or purple lines on your belly, breasts, buttocks or thighs; these are called stretch marks. Another skin change may be small, thin web-like veins on the skin’s surface known as spider veins as well as larger, bulging, twisted blue or purple twisted veins known as varicose veins.
- Nosebleeds/Nasal Congestion: Saline drops or a saline rinse as well as moisture, may help with this. Stay hydrated. Using a humidifier or putting petroleum jelly around the edges of the nostrils can help the skin stay moist. If you’re experiencing nosebleeds multiple times per week, contact your provider. If the blood flow is excessive, doesn’t stop after a few minutes of applying pressure or is associated with a headache, seek immediate medical attention.
- Swollen and Bleeding Gums: Bleeding gums during pregnancy, while common, should not be ignored. Brush at least twice a day with a soft-bristled toothbrush and floss daily. See your dentist for regular cleanings and to monitor for gum disease. Rinsing with salt water can help reduce inflammation.
- Vaginal Discharge: It is common to experience increased vaginal discharge during pregnancy. Generally normal discharge is thin, clear, milky white and is odorless. If you notice any changes in color, consistency, or odor or have other symptoms such as burning, itching, pain please contact your provider.
If you experience a sudden gush or continuous trickle of clear or yellowish fluid, it could be amniotic fluid and requires immediate attention.
Important Tests:
- AFP: A blood test drawn between 15-20 weeks to screen for neural tube defects
- Level 2 Ultrasound (Anatomy Scan): This is typically performed between 18-22 weeks gestation and is aimed at assessing fetal anatomy (brain, limbs, heart, stomach, kidneys) and detecting fetal anomalies.
- Gestational Diabetes Screening: Between 24-28 weeks, a 1-hour glucose tolerance test is performed, However, women at higher risk may be screened earlier.
Additional Information:
After the 20th week of pregnancy, you should avoid sleeping on your back and switch to sleeping on your side. This position allows for optimal blood flow to the baby.
Consider starting pelvic floor physical therapy in your 2nd trimester. Pelvic floor therapy can aid in alleviating pain and discomfort in your lower back and pelvic region, improve posture and strength, help with birth preparation and enhance postpartum recovery
3rd Trimester:
From 28 to 40 weeks
Common Symptoms:
- Fatigue and Insomnia: Discomfort from the growing belly, frequent urination, and the baby’s activity can make it difficult to sleep.
- Swelling and Varicose Veins: Elevate your legs and increase your water intake. Wearing comfortable shoes and compression stockings can help. Gentle exercise such as swimming and walking can improve circulation. Avoid prolonged standing and crossing your legs when sitting. If the swelling is severe, discuss with your provider.
- Low Back Pain and Sciatica: You can try wearing a maternity support belt or abdominal support garment. Regular physical activity and stretching can be of help. Practice good posture and lift properly by squatting down with a wide stance and bending at the knees. Wear low heeled shoes with good arch support, avoid flat or high heels. Physical therapy may help as well as seeing a chiropractor; discuss with your provider first.
- Heartburn: Try antacids such as Tums or Pepcid AC and eating smaller meals more frequently. Wait at least 2 hours after eating before lying down. Foods and beverages to avoid if you are experiencing heartburn: chocolate, caffeine, spicy or fatty foods, citrus fruits, tomato products and carbonated beverages.
- Constipation and Hemorrhoids: If you are constipated, drink plenty of fluids and eat fiber-rich foods such as fresh or dried fruit, raw vegetables, and whole-grain cereals. Stool softeners may help as well, discuss other treatment options with your provider.
Soaking in warm water or a sitz bath, using witch hazel pads, Preparation H or Anusol can aid in treating hemorrhoids. Consult your doctor if you experience severe pain or rectal bleeding.
- Leg Cramps: May occur at night when you’re trying to sleep. To help relax the muscle, try stretching your calf muscle or gently massaging the area, apply heat using a heating pad or warm compress or place an ice pack on the cramping muscle which can reduce the pain. Tips to reduce the occurrence of leg cramps: drink plenty of fluids, daily calcium intake of 1,000-1,200mg, eat magnesium rich foods such as whole grains, beans, dried fruit, nuts, and seeds or take a magnesium supplement not to exceed 400mg/day, as well as eat potassium rich foods such as bananas.
- Tingling or Numbness in Hands: May indicate carpal tunnel syndrome. Try wrist splints to keep your wrists straight and discuss with your provider.
- Braxton Hicks: Braxton Hicks contractions are a tightening in your abdomen that comes and goes; it’s uncomfortable but not painful. They feel a little like menstrual cramps and are felt in the front of your abdomen, but not in your back. These contractions don’t get closer together, don’t increase in how long they last or how often they occur and don’t feel stronger over time. They often stop with rest and/or hydration and you are able to talk, walk and go about your normal activities during Braxton Hicks contractions.
Additional Information:
- TDAP Vaccine: One dose of Tdap vaccine is recommended during each pregnancy. Getting the Tdap vaccine during pregnancy helps protect your newborn from whooping cough, also called pertussis. Aim to get the vaccine between 27 and 36 weeks of pregnancy.
- Rhogam: An injection given to Rh-negative mothers during pregnancy to prevent the development of antibodies that could harm a future Rh-positive baby. Rhogam is typically administered at 28 weeks of pregnancy.
- Ultrasound: A follow up ultrasound is often done in the 3rd trimester between 32-36 weeks to check for fetal growth and position.
- RSV vaccine: The CDC recommends that pregnant women receive the RSV vaccine during weeks 32 through 36 weeks of pregnancy, administered between September 1st through January 31st. RSV is a respiratory virus that is highly contagious and can cause a range of illnesses, from mild colds to more serious conditions like pneumonia and bronchiolitis; it is the leading cause of infant hospitalization in the U.S.
- GBS: Group B Strep is a type of bacteria that can be found in the vagina and rectum. It can be a part of the normal flora and is not a sexually transmitted infection. About 1 in 4 pregnant women carry GBS but can be unaware since it does not usually cause any symptoms. It can be passed from mother to baby during labor and delivery. Untreated GBS infection in newborns can lead to serious illnesses like sepsis, pneumonia, or meningitis. A culture to test for GBS is done between 36 and 38 weeks of pregnancy. If the results show that GBS is present, intravenous antibiotics will be administered during labor to help protect the fetus from being infected.
To Do List:
- Kick counts: Generally recommended to start counting fetal movements beginning at 28 weeks. This is when fetal movements become more consistent and predictable making it easier to track changes in their activity. Fetal movements can be kicks, flutters, swishes or rolls. The baby should move at least 3-5 times in one hour or 10 movements in 2 hours. If it does not, please contact your doctor or go to labor and delivery immediately.
- Sign up for childbirth classes and schedule a hospital tour.
- Complete hospital registration and select a pediatrician.
- Discuss your birth preferences with your doctor and if having a male infant, whether or not you would like a circumcision performed.
- Cord Blood Banking: Talk to your doctor about the option of storing stem cells from your baby’s umbilical cord. Stem cells can be privately stored for potential future use in the treatment of blood disorders, immune system deficiencies, genetic diseases, medical disorders, and some cancers. The process involves collecting the left over blood in the umbilical cord and placenta and a piece of the umbilical cord itself after the baby is born and before the placenta is delivered. The collection process is simple, safe, and painless for both mom and baby.
- Placenta Donation: After delivery, you have the option to take your placenta home, have it discarded as medical waste or donate it. Tissue from the placenta can be used to create medical products that can help heal wounds, diabetic ulcers, burns, and assist in reconstructive surgeries. If you choose to donate, the process is safe, easy and of no cost to you or your insurance. You simply inform your doctor you would like to donate your placenta, sign a consent that allows for the acquisition of the placenta and your doctor and hospital staff will do the rest.