Q&A with OB/GYNs from the Childbirth Center at Missouri Baptist
|John Appelbaum, MD, OB/GYN
Q. What are some things an expectant mom can do to ensure a healthy pregnancy?
A. First, be sure to address any medical issues prior to conception. For example, controlling blood pressure, optimizing blood sugars, and managing any clinical medical conditions before pregnancy leads to a healthier pregnancy outcome.
It sounds cliché, but diet and exercise are critical to getting pregnant and having a healthy pregnancy and baby. It can also help to minimize pregnancy discomfort such as nausea and constipation. Here is a guide to building a healthy diet:
- Three daily servings of vegetables – broccoli, carrots, tomatoes and leafy greens
- Two to three daily servings of fruits – apples, oranges, berries and bananas
- Six to eight daily servings of grains (ideally whole grains) – oatmeal, quinoa, popcorn, whole-wheat pasta and bread, barley and brown rice are some examples of whole grains
- Six to eight daily servings of lean protein – skinless poultry, fish (twice per week), eggs, beans, peas, soy products, nuts and seeds
- Three daily servings of dairy – low-fat milk, yogurt or cheese
- Limit processed foods, sweets and fats
- Also, drink plenty of water and limit sugary drinks like soda and decadent coffees
In addition to a healthy diet, low-impact exercise such as walking, swimming and yoga – for 30 minutes every day – can help prevent excessive weight gain, improve and maintain fitness, reduce stress, boost mood, and regulate blood pressure and glucose levels. However, speak with your provider before starting any exercise programs while pregnant.
Q. Are there any pregnancy-related symptoms that expectant moms should be wary of?
A. Certain pregnancy symptoms, such as nausea, fatigue and weight gain are fairly common. However, other symptoms can be a sign of trouble. For instance, bleeding with abdominal pain could be a sign of a miscarriage or tubal pregnancy. If you’re dealing with round-the-clock nausea and vomiting beyond the first trimester and are unable to keep anything down, you may be suffering from hyperemesis gravidarum (HG). Although rare, HG can lead to malnutrition and dehydration, which can be harmful for the baby.
After 20 weeks, if you experience a persistent severe headache, visual disturbances and swelling, you may be suffering form preeclampsia – a serious condition for both moms and babies. If left undiagnosed, preeclampsia can lead to eclampsia, which includes seizures and a less than
optimal pregnancy outcome.
If you ever experience any unusual symptoms throughout the course of your pregnancy, don’t hesitate to call your provider. It’s better to be safe than sorry.
Q. What causes morning sickness?
A. Most women in early pregnancy experience some form of morning sickness, which may be caused by a number of things. First, in early pregnancy, the fetus and ovaries produce elevated levels of estrogen and progesterone that a newly pregnant woman is simply not used to, and these hormones can cause nausea.
Second, the pattern of contractions in the stomach is the same for both nausea and hunger. For many women, the trigger for morning sickness is hunger. Once they eat something, the nausea gets better, which leads me to believe that the hunger pains we normally associate with hunger are now interpreted as nausea by an expectant mom.
Third, in early pregnancy, there is a heightened awareness of odors, motion, sound and other sensations, which can be somewhat disorienting and may result in nausea.
Finally, another potential cause of morning sickness is HCG (human chorionic gonadotropin), a hormone produced by the fetal placenta. HCG is produced in very large amounts in early pregnancy, about the same time that morning sickness is at its worst. This hormone also interacts with the thyroid gland and, in a small percentage of women, may cause nausea by increasing the activity of the thyroid gland.
Q. What can I do to minimize that sick feeling?
A. Most women find some relief from that icky sick feeling by eating or drinking something – a cracker or slice of fruit, a sip of water or soda, and then a distraction for a few minutes will often bring relief. Once the nausea is relieved, eating and drinking additional food and fluids will help keep this feeling away. Subsequent snacking on an item – hard candies or a cold soda – may also help keep that feeling away.
Unfortunately, for some women, these solutions may not provide the relief they need. In those cases, there is a prescription medication that combines vitamin B6 (pyridoxine HCl) and doxylamine to help relieve morning sickness. Applying continuous pressure on the mid-wrist with a seasickness band has also been helpful for some women.
Finally, if the feeling of nausea is pervasive and your morning sickness is causing dehydration and weight loss, then there are several potent, yet safe anti-nausea medications that may be prescribed by your obstetrician.
Q. How soon after I find out that I’m pregnant should I see an obstetrician?
A. After the exhilaration of a positive pregnancy test, we encourage you to make an appointment for a visit and an ultrasound to help determine how far along you are in the pregnancy. We also screen for medical issues that need an immediate evaluation and/or treatment. Ideally, we would like to start prenatal care by about two months after your last menstrual period.
Generally, we encourage our patients to schedule an appointment prior to conception in order to identify potential medical problems and conditions that may affect pregnancy. We also suggest that you begin taking prenatal vitamins and make certain lifestyle changes (e.g. no smoking or excessive drinking) prior to conceiving to help make your pregnancy positive, successful and healthy.
Q. What should I look for when selecting an obstetrician?
A. Choosing an OB/GYN (obstetrician/gynecologist) is an important task and personal decision. You should select an OB/GYN you can easily talk to and who takes the time to answer your questions. He or she should be able to sit down with you during your visit to address any issues and/or concerns.
The following are some key questions to ask prospective OB/GYNs:
- Which hospital(s) the OB/GYN regularly performs deliveries?
- How often he or she will be the physician at your birth?
- If your OB/GYN is unavailable, who will cover for him or her?
- How accessible is your OB/GYN if you have questions after-hours?
Q. Is spotting during pregnancy a sign that something is wrong?
A. This is a difficult question to answer. Light vaginal bleeding or spotting can be completely harmless or may be an important clue to a problem with the pregnancy. Fortunately, most of the time, spotting is caused by the maturing placenta or irritation of the cervix during sexual activity. Unfortunately, even an experienced clinician is rarely able to determine the cause of spotting through conversation. Therefore, an office visit with an exam may be necessary to determine the cause of the spotting.
For more information on pregnancy changes and/or concerns, consult your physician or call MoBap at (314) 996-5433 or toll-free (800) 392-0936, or email us.