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We understand that pregnancy can be a time of excitement as well as apprehension. Each pregnancy is different, and we hope to help you have the most positive experience that you can. There are many questions and concerns that are common to pregnancy and we have provided information on some of these topics here, including ideas for relieving some of the most frequent discomforts. Of course, we are always available to answer your questions in the office.

What can I do about nausea?

Nausea and vomiting in early pregnancy is not always limited to "morning" sickness. Eat small, frequent meals starting first thing in the morning. Avoid greasy and spicy foods. Make sure you are taking in plenty of fluids. Try sucking on peppermint or sour hard candy. Consider sipping on a carbonated drink. "Sea Bands" motion-sickness wrist pressure bands are available at drug stores and may be helpful. You may also try Vitamin B6 supplements, 100mg/day. Prescription medications may be recommended in some cases. Please contact the office if you are unable to keep down food and liquids for more than 12 hours.
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Can I exercise?

Exercise in pregnancy is healthy and may help you to feel better and stronger. Most moderate intensity exercise routines can be safely continued in pregnancy. Recommended activities include walking, swimming, stationary bicycle, low impact aerobics, yoga, and free weights. Avoid activities requiring extended time flat on your back or standing still in one position. You may find that your balance is not as good during pregnancy. Drink plenty of fluids during your workouts, and discontinue any activity which causes abdominal pain, cramping, or back strain. Your physician will counsel you if any obstetrical/health reason arises requiring you to modify your routine.
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What should I be eating?

A healthy balanced diet is very important during your pregnancy. The key to good nutrition is including a wide variety of foods including proteins, carbohydrates, fats, and minerals. 
Things to avoid include raw or undercooked meat, alcohol, predatory fish (shark, swordfish, king mackeral, and tile fish), unpasteurized milk and soft cheeses. Reheat deli meats until they are steaming hot. Limit consumption of fish from local rivers, lakes or ponds to no more than one 6 oz serving per week. Limit other fresh or canned ocean fish (salmon, tuna, flounder) or seafood (shrimp, oysters, clams) to no more than 12 oz per week.
Make sure to wash all fruits and vegetables thoroughly. It is also recommended that you take a daily prenatal vitamin containing at least 1mg of folic acid to reduce the risk of birth defects and to ensure you are getting the extra nutrients that you need.
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How do I know if my baby is moving enough?

Every baby has periods of sleep and of activity through the day. You may start to feel occasional fetal movements starting around 17-21 weeks. By 24-26 weeks, you should feel several active periods of movement everyday. If you feel at some time (after 26 weeks) that your baby is not moving adequately, perform a kick count. To do this, lie on your left side away from any distractions. Count all of the movements that you feel. When you get to 5, you may stop. If you do not feel at least 5 movements in an hour, call the office right away.
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What is the AFP/Quad Screen?

This is an optional blood test offered to low risk patients in the 16th-17th week of pregnancy to assess the risk of chromosome abnormalities (such as Down's syndrome) and birth defects (such as spina bifida). This screen cannot diagnose these problems or completely rule them out. It can only indicate an increased or reduced risk. Additional testing would be offered should your test results return abnormal. 
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What tests do I need if I'm over 35 years old?

We know that due to physical changes in the body, the risk of certain pregnancy complications increases as the pregnant mother ages. These include risks of chromosome abnormalities such as Down's syndrome. All women who will be 35 or older at delivery are offered prenatal testing. These tests are always optional. The risk for carrying a pregnancy affected by a chromosome problem is 1/132 at 35yo and increases to 1/40 by age 40. Options for definitive diagnosis include second trimester amniocentesis (extraction of a small amount of amniotic fluid through the mother's abdomen) and chorionic villus sampling (CVS) in which the placenta is sampled between 10-14 weeks. Both tests carry a small miscarriage risk. Noninvasive testing is also available which can provide some additional risk information. A first trimester ultrasound measurement of the fetal nuchal skin fold combined with a blood test can identify up to 90% of Down's syndrome cases. Some women over 35 prefer to have no specialized testing.
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When is it necessary to have a cesarean section?

A cesarean delivery may be indicated for many different reasons including the position of the baby, inability of the baby to fit through the pelvis, abnormalities of the placenta, and fetal stress with labor. Women will also elect to have a repeat cesarean section if they have undergone a cesarean delivery in the past.
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What are the risks of smoking in pregnancy?

Cigarette smoking in pregnancy has been associated with increased risk of miscarriage, preterm delivery, low birth weight, placental abruption, and perinatal mortality. Following delivery, an increase in cases of respiratory and ear infections and of sudden infant death syndrome is observed in the infants of parents who smoke. Your doctors strongly encourage you to stop smoking and to ask for help if you need it. 
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What if I develop gestational diabetes?

All patients will be screened for diabetes of pregnancy in the second trimester. If results are elevated, a second confirmatory test will be ordered. Gestational diabetes affects 2-5% of pregnancies. Management includes consultation with an endocrinologist or a high-risk obstetric specialist, home blood sugar monitoring, and dietary changes to control blood glucose levels. Good control is necessary to promote normal growth of the baby and healthy development. Occasionally insulin is required to maintain desired blood sugar levels. If this is the case, you would be counseled regarding additional monitoring of the baby and any special considerations for delivery.
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Is swelling normal?

Swollen feet can be very common, especially late in pregnancy and in the warm weather months. This can be a sign of toxemia/preeclampsia, so if your blood pressure has been high or your swelling is associated with headaches, blurry vision, or nausea, you should contact the office. Most swelling is not related to toxemia. Limiting salt intake and drinking 8-10 glasses per day of water may help. Elevate your feet when you are able and consider using support panty hose.
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Can I paint?

You may paint while you are pregnant. Make sure you use water-based paint only and work in a well-ventilated area. Limit painting to only 2 hours at a time and avoid sleeping in a recently painted room until the fumes are gone.
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Can I travel?

If you are experiencing a normal pregnancy without complications, you may travel by car or air up until the 36th week. We recommend that you stretch your legs while traveling at least every 2 hours and increase your fluid intake to avoid dehydration.
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What if my baby is breech?

Your baby may change position frequently. By approximately 36 weeks, the majority of babies have settled into the head-down position. About 3% of healthy babies at term will present with the feet or bottom in the lowest part of the uterus--considered breech. Because of potential serious risks, a vaginal delivery is not recommended if the baby remains breech. If the situation is appropriate, you may elect to undergo a version procedure to attempt to turn the baby and increase the chances that you will have a vaginal delivery. The physician uses pressure on the mother's abdomen to roll the baby into a head-down position. If the procedure is not successful or if you decide against a version attempt, then a cesarean delivery would be scheduled.
You can also try to encourage the baby to turn by using the following described positions. Place a supportive board or ramp against a couch at a 45° angle and lie on the board - head down and feet at the top for 5-10 minutes twice a day. You can also use pillows instead of a board to raise the pelvis off of the floor. These exercises may allow gravity to dislodge the baby's breech from the pelvis, allowing him/her to turn.
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How will I know when I am in labor?

You may have intermittent contractions through much of the pregnancy. These are called Braxton-Hicks contractions and they may or may not be painful. Labor occurs when the uterus tightens with contractions regularly every few minutes with increasing intensity. Other signs that labor may be approaching include a bloody or thick mucous discharge, increasing pelvic pressure, or loose stools. Your water may break during your labor or before it even starts. Or the physician may break the water to help encourage labor in the hospital. Call the office/answering service when your contractions are strong and regular, about every 5 minutes, for about one hour. You should also call if you believe your water is broken, if you have a large amount of vaginal bleeding, or if your baby is not moving.
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How long could I go past my due date?

A full term delivery may occur as early as 37 weeks or as late as 42 weeks (2 weeks past the due date). Allowing a pregnancy to continue beyond 42 weeks may increase the risks of harm to the baby and is not recommended. If you remain pregnant significantly past your due date, you will be assessed to see if the cervix is "ready." Special tests may be done to make sure the baby remains healthy. Induction of labor would then be scheduled for between 41-42 weeks in most cases.

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