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Q: I know I’m supposed to take Folic Acid, should I just start taking a Prenatal Vitamin?
A: The recommended dose of folic acid is 0.4 mg (400micrograms). If you’re taking a regular multivitamin, it many only contain 0.2 mg (200 mcg) so check the label. You can also purchase folic acid by itself; again read the label as it’s available in doses ranging from 0.2 mg to 1.0 mg. Most prenatal vitamins actually have 1.0 mg which is fine. See Before Pregnancy: Folic Acid.
Q: My partner and I having been trying to get pregnant for six months and still haven’t conceived. Should I be examined for infertility?
A: 85% of all couples will get pregnant within one year of having unprotected intercourse...some get pregnant in the first month and some get pregnant in the last month, all of which is normal. There are things you can do to increase your chances of conceiving. Time your unprotected intercourse every couple of days before/during/after you ovulate (length of your cycle in days minus 14 equals day of ovulation). For example: 30 day cycle minus 14 equals ovulation around day 16 from the first day of your period. Avoid any artificial lubricants (some have anti-sperm properties). If after one year of trying you still have not conceived, consult your family doctor.
Q: What can I do for allergies?
A: It's always best, whether you're pregnant or not, to try to avoid the allergens that you know you react to. With that said, it's hard to do. There is plenty of data on the traditional antihistamines (eg. Benadryl) that demonstrats they are safe and we certainly use them in pregnancy for other reasons. Newer allergy medications (such as Claritin or Reactin) are also felt to be safe. Intranasal or topic steroids could also be considered. When in doubt, consult your health care provider and or pharmacist for more information on what is right for you.
Q: What can I do for a cold?
A: Pregnancy is a somewhat immune suppressed state so while you're not necessarily more likely to get a cold, it always seems to take forever to get rid of it! First of all, having a cold has no effect on the baby so this is really about you. Traditional things like acetominophen for aches/pains/fever, fluids and more rest is still the mainstay. The options at the Pharmacy don't make your cold go away any faster, they just make it more tolerable.
Lozenges (ie. Hall's) and vic's are safe. Most over-the-counter (OTC) cold medications contain five medications and it's always worth reading the label: For Analgesics, it's best to look for acetominophen and avoid ones with non-steroidal antiinflammatories such as ibuprophen or Acetylsalicylic acid (ASA). Cough Suppressants (DM or Dextromethorphan) are safe during pregnancy. Decongestants (Pseudoephedrine and phenylephrine) are the most common and appear to be safe but may be worth avoiding in the 1st trimester of pregnancy. Decongestants that you squirt into your nose also appear to be safe but use only for a very short period of time as you can get a rebound effect when you stop if you've been using them too long.
Antihistamines (Diphenhydramine and chlorpheniramine) are the most commonly used antihistamines and are safe in pregnancy but can cause drowsiness and Expectorants (most common is Guaifenesin that is safe). The "Non-Drowsy" formulas also tend to include large doses of caffeine so you might want to avoid these. Always read the label and when in doubt, consult your health care provider or pharmacist for more information on what is right for you.
Q: I had an episode at work where I felt light headed all of a sudden and had to sit down. I felt very shaky afterwards. Is this something I should be concerned about?
A: It sounds like you probably experienced a drop in blood pressure. It’s a very common complaint in pregnancy and is the reason we tell women not to lie flat on their backs. As your uterus expands, it pushes on the big blood vessel (Vena Cava) that brings blood back to your heart from your legs and lower body. When this happens, your blood pressure drops and your body tries to get you to faint - it’s easier to pump blood from your heart to your head if you are lying horizontal compared when you are standing upright.
When your blood pressure drops, the body does a number of things simultaneously to increase the blood pressure, including the release of adrenaline...that is what gives you a shaky feeling that can last for a period of time. In addition to feeling dizzy and shaky you might also feel sweaty. None of this usually has an impact on the baby but don’t fight it - because you can’t. If you feel faint, lie down (preferably on your left side) or sit down and put your head between your legs until you feel better. If you wake up at night and you are flat on your back but otherwise feel fine, don’t worry about it. If you were having a problem with low blood pressure your body would wake you up and you would feel dizzy, shaky and sweaty. Roll over on your left side until the feeling passes.
Q: I rolled over in bed and got a sudden sharp stabbing pain in my side?
A: Sounds like you’ve strained an abdominal muscle. As the uterus grows, it causes the muscles of your abdomen to stretch. Some women find that certain movements that cause further stretching or contract the abdominal muscles results in pain that can be felt anywhere in your abdomen. This type of pain does not last and has no impact on your pregnancy.
Q: How do I recognize the baby’s first movements?
A: Ultrasound exams show that the baby actually starts to move very early on in pregnancy but women do not feel these early movements. Quickening (see Fetal Movements), or the perception of movements, usually occurs between 18-22 weeks gestation. Women who have had previous pregnancies often feel fetal movements a little earlier (16-18 weeks) because they know what to expect. Sometimes the location of the placenta (the afterbirth) will affect when you first feel the baby moving. Most women describe fetal movements as a fluttering sensation, which can be hard to differentiate from gas. However, at some point when you’re sitting/lying quietly you will feel something - whether it is a flutter or more like the baby is rolling - that you will definitely recognize as a movement.
Q: My partner and I had sex last night and I noticed some bleeding afterwards...should I be concerned?
A: Probably not, but I bet it caused a lot of anxiety! Vaginal spotting/bleeding can come from different sources. The most common source as it relates to intercourse is from the cervix. Pregnancy causes changes to the cervix that make it more sensitive and more likely to bleed. A little bit of spotting is not a concern, but if you experience more than spotting - regardless of whether you were doing anything or not before hand - you need to see your doctor immediately, or head to the hospital to ensure that all is well. (See Sex in Pregnancy)
Q: The past 3 nights I've been up continuously with extremely itchy feet and hands. I did not sleep at all last night and I am exhausted. I’ve tried ice water, baking soda in a cool bath, Benadryl, moisturisers but nothing seems to work. Do you have any suggestions?
A: There are many things that can cause itchiness in pregnancy, but there are only a few pregnancy-specific conditions. The two that we see most commonly are Intrahepatic Cholestatis of Pregnancy (ICP) and Pruritic Uriticarial Papules and Plaques of Pregnancy (PUPPPS). ICP is relatively common, especially in some ethnic groups. It typically starts in the third trimester involving primarily the palms and soles of the feet; it can then spread to the rest of the body. Some women may also develop jaundice. The itchiness (and jaundice) will resolve spontaneously following delivery. Treatment includes antihistamines, topic preparations, Ursodiol and sometimes steroids (topically or by mouth). A small but significant increased risk of stillbirth has been reported with ICP. As such, we tend to monitor babies closely and often recommend early delivery.
PUPPPS almost always starts on stretch marks on the abdomen but can spread to involve thighs, buttocks, breasts and arms. It usually consists of wheals or small vesicles. Apart from being very itchy and annoying, it is otherwise harmless for the mother and/or baby and will resolve spontaneously within one to two weeks of delivery. High and low-dose topical steroid creams are usually effective. Sometimes a course of steroid pills is required. Antihistamines (like Benadryl) are less helpful but may be useful at night to help you sleep.
Q: My baby is only a day old but my milk still hasn’t come in. Is this normal and if so, is there something I can do to make it come in quicker?
A: There is nothing that causes more anxiety and guilt for new mothers than breast feeding. The hormone that causes you to produce milk is called prolactin. Prolactin levels are very high during pregnancy, but you don’t produce any milk (only a little colostrum) because the placenta produces blocker hormones that prevent the prolactin from working. After your baby is born and the placenta is delivered, it takes about three or four days for the placental hormones to clear from your system and for the prolactin to start to work. This is a normal physiologic process and there is nothing you can do to make your milk come in any faster. What you can do is take this time with your baby and learn about breastfeeding. The little bit of colostrum that is in your breasts now is essential nourishment as it has antibodies and protein that the baby needs. Babies may loose weight as they wait for their mothers’s milk to come in. Babies can loose up to 10% of their birth weight before we would consider supplementing them. Breast fed babies don’t get back to their birth weight until about two weeks after delivery. See After Pregnancy: Breastfeeding
Q: It’s been a week since my delivery and I’m still bleeding, is this normal?
A: It can be. Everyone is different but we expect that most women, whether they had a vaginal delivery or caesarean section, will have vaginal bleeding that may be as heavy as a heavy period in the first few days but every day it should get lighter. It will eventually taper off completely in about 2 to 4 weeks. If you are still experiencing bleeding four weeks after delivery, or if at anytime the bleeding starts to get heavier, you should speak to your doctor. It may be that everything is fine, but there is a chance you have a little bit of placental tissue still inside the uterus. This prevents the uterus from contracting down completely and you will continue to bleed until it comes out. Sometimes an ultrasound is ordered to see if there is anything still in the uterus, though it can be hard to distinguish between some placental tissue and a blood clot. If there is some tissue still there, your doctor may talk to you about the need to have a surgical procedure called a D&C (dilatation and curettage) to remove it. The term we use is “Retained Products of Conception”. It does increase the chance of getting an infection in the uterus, the most typical symptom of which is increased bleeding.