Q&A with OB/GYNs from the Childbirth Center at Missouri Baptist

Dr. Appelbaum, OB/GYN at MoBap
John Appelbaum, MD, OB/GYN

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:

  1. Which hospital(s) the OB/GYN regularly performs deliveries?
  2. How often he or she will be the physician at your birth?
  3. If your OB/GYN is unavailable, who will cover for him or her?
  4. How accessible is your OB/GYN if you have questions after-hours?

Q. Why do I need to take prenatal vitamins?

A. Prenatal vitamins have long been used as a safety net for those who might be missing some of their vitamins and minerals in their less than perfect diets. In the 1990s, however, it was found that folic acid, a major component of prenatal vitamins, reduces the risk of neural tube defects in the fetus by a factor of three, from 15/10,000 to 5/10,000. By simply taking your prenatal vitamins, you can significantly decrease the risk of a complicated birth defect.

Additionally, DHA – another supplement now found in prenatal vitamin supplementation – supports the fetus’ growth and brain development. Your prenatal vitamin complements your diet and assists you in providing your fetus with the building blocks needed to ensure good growth and development.  We suggest you start prenatal vitamins at least one month (or more) prior to conception and continue until you are no longer breastfeeding.

Q. Prenatal Vitamins: Over-the-Counter or Prescription?

A. At your first visit, you’ll receive various prenatal vitamin samples. We suggest that you try each one to see how it affects you. If you prefer one more than another, then you should take the preferred tablet. However, if you don’t prefer a specific brand, then a generic over-the-counter brand can provide you with the advantage of taking prenatal vitamins at a fraction of the cost. Just be sure to choose a brand that contains DHA. Whether you choose over-the-counter or prescription prenatal vitamins, you can rest assured that all prenatal vitamins contain folic acid.

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.