ASK THE OB/GYN
ONE THING MORE THAN ANYTHING ELSE DEFINES YOUR FORTY WEEKS OF PREGNANCY:
QUESTIONS. WE COMPILED A LIST OF THE BEST ONES WRITTEN BY READERS LIKE YOU AND
HANDED THEM OVER TO OUR ON-CALL EXPERT RANDY A. FINK, MD FACOG, FOR THE REAL
DEAL
ON EVERYTHING FROM FOOD CRAVING AND C-SECTIONS TO VAGINAL ELASTICITY,
GESTATIONAL DIABETES AND MORE.
THE FAMILY GROOVE: Do food cravings mean that I am deficient in certain vitamins or minerals?
Should
I give into them?
Dr. Randy A. Fink: Occasionally, anemia due to iron deficiency (common in pregnancy) can result in a
strong craving for certain non-nutritive substances. This is called “pica”, pronounced pie-cuh. The most common cravings are those for ice, corn starch, and sometimes even dirt. However, most cravings in pregnancy are pretty routine. Cravings for fruit, milk, chocolate, salty and sour snacks are the most common. They are probably hormone related, and may reflect some of the physiologic changes in the mom-to-be. For most women, these are not true deficiencies. Should you “give in?” Everything in moderation and enjoy!
TFG: How do I know if I am having Braxton Hicks contractions?
RF: Braxton-Hicks contractions are “practice contractions.” The uterus is a muscle built to do one thing: to squeeze the baby out. Until it learns how to do this for labor, it needs some practice. This is usually experienced as tightening in the belly that occurs irregularly. Tightening that occurs in regular intervals, especially if they are persistent and start to become painful, should warrant a call to your doctor.
TFG: Can I choose to have a C-section?
RF: Yes, in many places, c-section by choice is now an option. A good understanding of the risks and benefits is important, so talk to your obstetrician.
TFG: Many women who have had the AFP blood test have had false positives. What exactly is the test and should I take it even though so many come back with incorrect information?
RF: The AFP-quad is a screening test for Down Syndrome and other chromosomal abnormalities, as well as for open neural tube defects (called spina bifida). It is a non-invasive blood test from mom, performed between 16 to 20 weeks. It will pick up about 80% of abnormalities and has a false positive rate of about 5%. A better test is called the Integrated Screen and it is rapidly becoming the standard of care. This is also a non-invasive test: at about 12 weeks of gestation, mom has a blood test and an ultrasound that measures the thickness of the baby’s neck. This test, combined with a blood test performed at about 16 weeks, gives a result with a sensitivity of up to 95%, with a false positive rate as low as 1%. Sadly, though, there is no perfect test.
TFG: If I eat too much sugar, can I develop gestational diabetes?
RF: Women who are overweight are at an increased risk for gestational diabetes. So, eating sugar alone is not considered a risk factor. Being over 110% of your ideal body weight is a risk. So, the sugar consumed over the years leading up to pregnancy is more of a risk than that specifically consumed during pregnancy.
TFG: During my first pregnancy, I retained a lot water. I am newly pregnant again and don't want to go through the next seven-and-a-half months bloated. Is there a way to combat the water retention or is this just how I am doomed to be during my pregnancy?
RF: Water retention is a normal part of pregnancy and generally there is little a mom can do, proactively, to effect how bloated she will get or feel. However, minimizing the consumption of excess salt may play a role. Be aware that even if you consume a totally salt-free diet, though, you will still be swollen. When sitting, try to keep your feet elevated as much as possible. Long periods of standing may result in increased edema. Wearing good support stockings can decrease this somewhat. Support stockings are also helpful if your work requires standing.
TFG: Is it safe to dye or bleach your hair while pregnant?
RF: There is no good evidence to support one it way or the other. Most obstetricians agree that highlighting is generally safe, but that coloring and bleaching be avoided. Either way, wait until after the first trimester.
TFG: Are there any chemical cleaners or beauty products I should stay away from while pregnant?
RF: Cleaning products can generally be used with safety, remembering certain safeguards. Always clean in a well-ventilated area and, if in doubt about the effects on your skin, wear gloves. (A simple barrier will help you feel much better about interacting with the chemicals in your environment.) Understand that no beauty product has been tested on pregnant women, so there is never a guarantee of safety. However, there is probably negligible or minimal risk to using most common products.
TFG: Do I have to avoid soft cheeses altogether or just ones that aren't pasteurized?
RF: Listeria is a bacterial infection that can cause serious pregnancy complications. Soft cheeses (i.e. brie, feta, Camembert) are often made from unpasteurized milk. Pasteurization is a heat treatment that kills many types of bacteria. Soft cheeses should be avoided unless the label states they have been made from pasteurized milk.
TFG: How quickly into labor can I get an epidural? Do I have to wait until I am dialated a certain amount or my contractions are a certain time apart?
RF: An epidural can be given when you are in active labor (painful contractions that cause your cervix to dilate). The evidence shows that women in labor should not be required to wait until an arbitrary time (i.e., You must be for centimeters dilated first) before receiving an epidural. Early epidurals may increase your need for having your labor stimulated with pitocin, but epidural use does not increase cesarean section rate.
TFG: Does the vagina stretch out more and more with each vaginal childbirth, leaving the opening bigger each time?
RF: The walls and opening of the vagina may stretch and may lose some elasticity with childbirth. Additionally, tears to the skin at the vaginal opening may cause the opening itself to be larger. However, there is a maximum stretch that will differ for each woman. Some women will be maximally stretched with the first delivery and will not stretch more. The vagina heals remarkably well after delivery. So, no, once it reaches its max, the vaginal does not tend to get larger and larger.
TFG: In addition to a good prenatal vitamin, can pregnant women take other supplements like omega 3, 6, 9 pills and acidophilus?
RF: Some prescription prenatal vitamins now contain the complete range of the essential fatty acids and I’d recommend them over taking a standard prenatal vitamin and multiple other supplements. The safety of acidophilus has not been studied well enough in pregnancy to encourage its use.
TFG: Are there any vitamins to avoid taking while pregnant?
RF: A good prenatal vitamin should help meet your nutritional needs during pregnancy. Some clinicians recommend calcium supplementation, but otherwise you should not need any other supplements.
TFG: Is it okay for pregnant women to do sit-ups?
RF: In an otherwise normal pregnancy, there is no reason you can’t do sit-ups. However, by 20 to 24 weeks of gestation, your pregnant tummy gets in the way, making sit-ups impractical. As long as your clinician agrees, consider crunches instead.
TFG: Is there something I can do while pregnant that will ease any impending postpartum depression?
RF: Women who exercise are less prone to postpartum depression. Additionally, since women with a history of depression are at high risk for postpartum depression, early intervention with counseling (before delivery) can be very helpful in its prevention.
TFG: Are episiotomies necessary? Is it bad if you have to have one?
RF: The best available evidence tells us that routine episiotomies are not necessary. An older way of practicing was that everyone got an episiotomy, thinking that a surgical incision would heal better than an uneven tear. But careful study has shown that an episiotomy for everyone is not indicated. However, some people need an episiotomy. My rule of thumb is: if in labor it appears that your bottom is about to explode, you need an episiotomy. Episiotomy or not, your bottom will be sore. And since most first-time deliveries will result in a tear, there is a good likelihood that even without an episiotomy you will still need stitches.
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