During Pregnancy

Please call any time; someone is always available by phone. Have your provider's phone number close at hand throughout your pregnancy.

Additionally, please call your doctor, nurse or midwife if you have any of the following:

• Severe nausea and vomiting (not able to keep anything down for a whole day)
• Bleeding from your vagina
• Discharge from the vagina that smells bad, itches, or causes pain
• Pain or burning on urination
• Pain in the lower abdomen
• Severe headache not relieved by Tylenol (acetaminophen)
• Fever of more than 100 degrees
• You think you have been exposed to a contagious disease
• If you fall, or if you've been in a motor vehicle accident
• Feeling extremely sad or hopeless
• Feeling unsafe

Download and print the above list to keep on-hand throughout your pregnancy.

Changes You May Experience During Pregnancy

Although many weeks may pass before there are outward signs of pregnancy, tremendous changes are taking place in your body. You may feel a wide range of physical and emotional reactions. Even if you've been pregnant before, you may well find that no two pregnancies are the same, and that you have a different set of reactions and feelings to this particular pregnancy.

Here are some of the things that commonly occur, and some ideas on how to manage so you feel your best. Please ask your obstetric provider about any concerns you may have related to the changes in your body, your emotions, and your life during this special time.

For more information on all of these topics, download our Feeling Pregnant information sheet.

Feeling tired

You may feel more tired than usual in the first weeks of pregnancy. This is normal as your body adjusts to meeting the needs of your growing baby.

Nausea, vomiting, or heartburn

Pregnancy hormones affect the way your stomach works. They also affect your sense of smell and appetite. In some cases, this leads to nausea. Some women find that strong odors or spicy foods make nausea worse. Hormones can also affect the acid in your stomach, leading to classic symptoms of heartburn or indigestion.

Food cravings, food aversions, and hunger

Many patients experience food cravings during pregnancy. In general, this does not pose a problem. If you crave sweets such as ice cream, it's okay to indulge occasionally. But try to limit your intake of foods high in fats and sugars. Cravings for more nutritious foods can almost always be satisfied without worry. You may also suddenly find that you can't stand the thought of a food you once adored. Food aversions are also common now, and should not worry you as long as you continue to eat a wide variety of healthy foods.

Headaches

Pregnancy hormones can trigger headaches in some patients. This may be especially true if you were prone to headaches before you got pregnant. Some patients have headaches related to vision changes during pregnancy. In these cases, adjusting the eyeglass prescription may help.

Frequent urination, leaking urine when you laugh or cough

Early in pregnancy, hormones can cause you to urinate more frequently than usual. Later, your baby's weight puts pressure on the bladder, which can also cause frequency and leakage. Don't be concerned about going to the bathroom a lot, unless there is pain or burning when you use the bathroom. If this happens, be sure to call for advice — you could have an infection.

Breast tenderness or leaking fluid from the breasts

Hormones cause your breasts to get larger during pregnancy, and can also sometimes cause fluid to leak from your breasts. Wear a support bra in the right size. Make sure the bra fits well.

Vaginal discharge

Your body naturally increases the secretions in your vagina during pregnancy. The secretions help prevent bacteria from entering the uterus, and should be white or very pale yellow. They should not be bloody, smell bad, or cause pain or itching; tell your provider if they are.

Gas, constipation, hemorrhoids

Early in pregnancy, hormone changes affect your stomach and bowels, causing more gas and, in some women, constipation. Later, the pressure of the baby on your intestines can interfere with moving the bowels. All the usual diet and exercise remedies for these problems also help when you are pregnant. Drink plenty of fluids, get enough exercise, and make sure you have fiber in your diet. Hormones cause the walls of the blood vessels in your rectum to relax, which can lead to hemorrhoids. Later, the pressure of the baby can make the problem worse. Constipation can also worsen hemorrhoids.

Changes in your legs

The weight of your baby can have an effect on the blood vessels in your legs. For some, varicose veins become an issue during pregnancy. For others, swelling of the ankles and feet is a problem. For mild swelling, elevating your feet and legs whenever you can is the best treatment. For more severe swelling, or to treat swollen veins in your legs (varicose veins), you may want to try compression stockings.

Emotional changes

Most people are aware of how hormones can affect mood and emotions. The hormone changes of pregnancy will probably have some effect on how you feel. In addition, just being pregnant is bound to cause strong emotions, which vary depending on whether the pregnancy was planned, whether you have people around you to provide support, and how much stress you feel in your daily life. While "mood swings" are normal to a certain extent, some women are prone to develop problems such as depression during this time. Be sure to talk with your obstetric provider about any feelings that are causing you concern.

Changes in relationships

Pregnancy is a time when relationships shift and change in new ways. Some partners pull together as they prepare for the birth of their baby. However, pregnancy can also increase the stress or tension in a relationship. Now more than ever, it is important that you make sure you feel safe at home. For more information, or to talk with someone further about these issues, please call the Center for Violence Prevention and Recovery at Beth Israel Deaconess Medical Center at 617-667-8141.

Your body will go through a great deal of change as your baby grows. Here are some things you can do to make sure you feel your best and to avoid some of the discomforts that sometimes occur. For more information on all of these topics, download our Staying Fit information sheet.

Pay attention to posture

As the weight in the front of your body increases, it will be important to pay attention to your posture. This will help prevent backaches and fatigue.

Be aware of changes in balance

You also may find that the changes in weight make you feel awkward or even clumsy. If so, you are not alone. Accidents such as slips and falls are common in pregnancy. This is because the new weight in your belly changes your body's center of gravity. Although you will naturally make adjustments in how you move in order to stay balanced, be aware that your sense of balance is changing.

Get regular exercise

If you've been working out regularly for a long while, there is usually no need to stop during pregnancy. Talk with your obstetric provider about the kind of exercise you may do, and about what level of exertion is okay for you. You should not exercise to the point where you become exhausted.

If you haven't been active before pregnancy, now is not the time to begin a vigorous exercise program. But there are safe, easy exercises you can do to help you feel better and maintain your health and stamina. Walking and swimming, for example, can be done throughout most of your pregnancy, even if you are not used to exercising. Start slowly and work at a pace that is comfortable for you.

Strengthen your pelvic floor

The pelvic floor refers to the muscles in your genital area. It includes the muscles around your vagina, urethra (urinary opening), and anus (bowel opening). Doing exercises, called Kegels, to strengthen these muscles helps support the area under the weight of your baby. Doing Kegels may help you keep control of your bladder during and after pregnancy, and can also help prepare you for labor.

Good eating habits during pregnancy will help make sure both you and your baby are as healthy as possible. Download our Eating Well information sheet to learn what foods you need for healthy eating and how much of each food is recommended each day. If you have special concerns or needs regarding nutrition, ask about a referral to a dietitian.

How much weight should I gain?

Check with your obstetric provider about the amount of weight gain that is right for you. In general, it's not the number of pounds you gain that is important — it's whether you are eating well and whether your baby is growing as it should.

What precautions must I follow regarding foods or drinks?

There are some precautions you must take regarding what you eat and drink. Some foods may contain bacteria or other organisms that could be harmful to you or your baby. Others foods or drinks have toxic materials that could have harmful effects on your baby's growth and development. Review food precautions and recommendations in our Eating Well information sheet.

What is WIC?

If you find that buying enough nutritious food is difficult on your budget, the WIC program may be able to help. WIC stands for “Women, Infants, and Children.” It is a nationally-funded program that helps ensure that those who are pregnant or breastfeeding, and their children, get the nutrition they need. There are income guidelines for WIC enrollment.

If you are interested in this program, your obstetric provider can fill out a referral form for you. Call 1-800-WIC-1007 to find out where there is a WIC office near you, or visit the Massachusetts WIC Office website. You will need to make an appointment at the WIC office to be enrolled in the program.

Please don’t take any medication that is not on this list unless it has been approved by your provider. In some cases, common brand names are given in parentheses. It is okay to use generic versions or other brands of the same medication.

• Heartburn: Famotidine (Pepcid), Maalox, Mylanta, Tums, Rolaids.
• Headache and pain remedies: Acetaminophen (Tylenol) only.
• Constipation: Docusate sodium (Colace), fiber laxatives (Metamucil).
• Vitamins: Prenatal vitamins. Please take only the recommended dose. Do not take additional vitamins or supplements unless prescribed by your obstetric provider.
• Colds: You may use any brand of cough drop or saline nasal spray. Certain cough and cold remedies are okay; some should be avoided, especially in the third trimester. Please call your provider’s office for advice about a particular product.

Ultrasound examinations are an important diagnostic test for women who are pregnant. They are commonly used to date a pregnancy, view the placenta, amniotic fluid, and rule out or confirm the presence of twins. Specifically, the Full Fetal Survey ultrasound scan provides an opportunity to look closely at your developing baby.

About the Procedure

By use of the sound waves transmitted throughout the uterine wall, an image of the baby is projected onto a screen. Through that image a maternal-fetal medicine specialist can examine fetal structure such as the heart, spine, and kidneys. Normal growth and development can be assessed through fetal measurements. It is also possible to view the placenta as well as evaluate the amount of amniotic fluid.

This procedure is generally performed around 18 weeks of pregnancy or during the second trimester. It is not considered a painful procedure; however, you may feel some discomfort due to a full bladder. The need for a full bladder will vary depending upon your gestational age and the person performing your ultrasound.

It is important to know that a normal ultrasound does not promise a healthy baby. There are many abnormalities that cannot be determined using ultrasound alone, including Down syndrome.

An ultrasound exam may be a part of your routine obstetrical care during your pregnancy or may be done if there is some clinical indication, such as having previously had a child with a specific birth defect.

There are currently no known fetal or maternal risks associated with ultrasound use in pregnancy.

In order to address the possibility of risk factors for your offspring, we recommend that you contact one of our genetic counselors to review any family history concerns, and whether or not it is appropriate for you to consider prenatal diagnosis. It is important to remember that there is no one test or combination of tests that will rule out the presence of all fetal birth defects, mental retardation or genetic disease.

For more information, please call the Division of Genetics at Beth Israel Deaconess Medical Center at 617-667-7110.

The two-hour glucose test helps to measure how your body is using sugar during your pregnancy. This test is important to do because pregnancy hormones can cause the level of sugar in your body to be too high. High levels of sugar are not good for you or your baby. If your sugar levels are high, they can be treated.

This test will tell your doctor if you have gestational diabetes (diabetes during pregnancy). If you do have gestational diabetes, this can be treated. Your doctor will talk with you more about this once the test results are back.

How do I prepare for this test?

• You should have nothing to eat or drink after midnight the night prior to your test.
• You should NOT change your diet at all before this test. Please eat as you normally would.

What will happen on the day of my test?

• You will need to be at the office for two hours for this test.
• You should report to Shapiro 8 at the time you were given. You will check in at the phlebotomy lab.
• You will have your blood taken for the first time.
• You will be given a sweet liquid called GLUCOLA to drink which you will need to drink entirely in about 5 minutes.
• You will need to tell the phlebotomist what time you finished drinking the GLUCOLA.
• Your blood will be drawn again one and two hours after you have finished drinking the GLUCOLA.
• You may drink ONLY WATER during this test. You may eat and drink as usual once the third blood test has been done.

How will I know the results?

Your health care provider will have the results the day after the test and will discuss them with you.

When picking a pediatrician there are a number of things you need to think about.

What kind of practice?

• Solo practitioner
• Partnership
• Group practice
• Practice that has a pediatric nurse practitioner

Is this the right doctor for you?

• Hospital Affiliations – Where the pediatrician admits patients to.
• Credentials – Board-certified by the American Academy of Pediatrics?
• Office location – Is the office someplace easily accessible to you?
• Office hours – Are the hours convenient for your schedule?
• Atmosphere – Is the staff responsive to their patients?
• Decor – Look for an area that will make waiting more comfortable for you and your baby. Are sick children separated from those that are seen for well visits?
• Waiting Time – Find out from the receptionist how long the wait times are for patients and reconcile this with your schedule.
• Protocol for taking phone queries – How does your doctor handle phone calls? For example, some may have a call-in time during which they answer questions.
• How are emergencies handled? – Exactly how does the doctor handles emergencies? Some have you go straight to the emergency room, others instruct you to come to their office.
• Financial Matters – Different offices offer different forms for payment. Some may bill you and some may expect payment at the time of the visit. If you have insurance, check to see whether or not this physician accepts your plan.
• Style – You need to find a provider who fits your style. Do you want someone who is easygoing and laid back or one who is very formal? One who welcomes your input or one who takes charge?
• Philosophy – You should find a provider who agrees with you on the major issues such as breastfeeding, preventative medicine, circumcision and feeding schedules

Once you settle on a doctor you should call, many physicians offer a courtesy prenatal interview. Some insurance also cover a prenatal visit to the pediatrician. You need to call your insurance provider to see what the protocol is. While we don't endorse any one practice, here is a list of some providers in the community that may be helpful: Pediatrician List (PDF).

We understand that whether this is your first baby or your last, the right time to call about coming to the hospital may seem unclear. The following are guidelines to help you decide. In some cases, your doctor will give you more individualized instructions. Call if you experience the following symptoms:

What is normal?

• Contractions that are irregular are normal at the end of pregnancy.
• A mucousy or bloody show can occur up to several days before the onset of true labor.
• There is nothing to do if either of these things occur.

If it's your first baby

• Your water breaks or
• Contractions are regular – Occurring every 5 minutes and lasting approximately 45 - 60 seconds for 1 hour
• The contractions should be strong and require effort in coping. This means that you have difficulty reading or having a conversation or performing tasks because of the discomfort.

Before 24 Weeks

• Bleeding
• Ruptured membranes or leakage of fluid vaginally
• Fever over 100°F that persists despite the use of Tylenol (Acetaminophen)
• Abdominal pain that is severe or prolonged
• Persistent vomiting or diarrhea
• Feeling threatened or being harmed either physically or sexually

24 - 37 Weeks

• Experiencing more than four contractions in a one hour period
• A decrease in fetal movements from your baby's baseline, or less than 10 movements in 10 hours
• Unusual, severe or prolonged headache
• Changes in vision such as blurred or partial vision
• Bleeding
• Ruptured membranes or leakage of fluid vaginally
• Fever over 100°F
• Abdominal pain that is severe or prolonged
• Persistent vomiting or diarrhea
• Feeling threatened or being harmed either physically or sexually

After 37 Weeks

• Heavy bleeding which soaks a pad (light bleeding or spotting is normal after vaginal exams)
• Regular painful contractions at 5 minutes apart which is persist for an hour
• Ruptured membranes or leakage of fluid vaginally
• Severe abdominal pain
• A decrease in fetal movements from your baby's baseline, or less than 10 movements in 10 hours
• Fever over 100°F
• Unusual, severe or prolonged headache
• Changes in vision such as blurred or partial vision
• Persistent vomiting or diarrhea
• Feeling threatened or being harmed either physically or sexually

Cesarean birth is sometimes needed to ensure the health of you or your baby.

Sometimes a Cesarean section is planned in advance because of certain issues that have arisen during the pregnancy, such as:

• breech presentation
• placenta previa (a complication of pregnancy in which the placenta grows in the lowest part of the womb [uterus] and covers all or part of the opening to the cervix)
• prior Cesarean sections of a special kind
• multiple gestations
• active herpes infection
• an exceptionally large baby

Other times, Cesareans are not planned and the decision is made together with you during labor. For example:

• A baby may be too large to pass through the pelvis
• Cervical dilation or descent of the baby's head stops during labor. This may be called "cephalopelvic disproportion"
• At other times, babies do not tolerate labor or show concerning changes in their fetal heart rate. In these cases, a Cesarean may be necessary.

Cesarean birth is a major surgery and requires anesthesia. Once you and your physician have decided that a Cesarean is necessary, you will speak with the anesthesiologist to discuss your options. Depending on how quickly the Cesarean has to be performed; you will be given either a spinal, an epidural or general anesthesia. You may feel some pressure during the surgery but you should not feel pain. Your support person should be able to stay with you in the operating room if you have a spinal or epidural anesthesia. If you need general anesthesia, then your support person will have to wait in the recovery room.

Infection is a possibility anytime a person has surgery. There are several important steps that we take together with you in order to prevent infection that may follow a Cesarean. First, please do not remove hair from the area around your planned incision (this includes your groin and stomach area) for about a week prior to surgery. Second, you will also be given instructions to use a special anti-bacterial soap to shower with the night before and morning of planned surgery. This should be used only on your body, not your scalp or face. Lastly, we give all women undergoing Cesarean birth antibiotics to prevent infection; it is important to let your health care providers know of any allergies to antibiotics that you have experienced in the past.