Barb's Daily Dose

Pregnant and Worried About Swine Flu

I am getting a lot of calls and emails from pregnant women who are worried about the swine flu.  As most of us know, during pregnancy a woman’s immune system changes to allow her body to carry the baby who her body would normally not be so accepting of.

That’s why pregnant women are much more susceptible to colds, and the seasonal flu as well as H1N1 or swine flu.  It’s the same reason, we advise pregnant women not to eat raw fish and avoid soft cheeses, pregnant women are more susceptible to serious complications from viral and bacterial infections.

Spotting in Pregnancy

Here's a question from a mom who's pregnant and spotting.

I’m about 16 weeks pregnant and I just starting seeing some spotting. I don’t feel any cramping or pain, but I’m wondering what could cause this and what I should do?  It’s so scary to see any blood when you’re pregnant.

Here's what I advised her:

The best thing to do whenever you see any spotting or bleeding is to be in touch with your health care provider. Often they will want to see you and check the baby. Often, they’ll order an ultrasound, do some lab tests, and may recommend bedrest, no exercise and/or no sex.

It’s estimated that about 10-15% of all normal, healthy pregnancies will have some unexpected bleeding or spotting, with or without cramping. Most of the times, the bleeding doesn’t pose any risk to the baby and just stops on it’s own. It’s best to be checked though, because there are many reasons why bleeding may be occurring.

If a woman is Rh negative, and she has bleeding, she may need to have a Rhogam injection to prevent her body from making antibodies that can harm the baby.

Spotting may also be a sign of an infection.  Your provider will probably want to evaluate that too. Sometimes spotting starts after sex, which can be very scary, and cause couples to think twice about snuggling together.  Ask your health care provider what precautions, if any, you should take.  Good luck.

Pregnancy After Miscarriage

I was recently asked by a reader what I thought she should know now that she's pregnant again after 2 miscarriages.

Here's what I told her:

Congratulations! I’m guessing that after the 2 miscarriages that you’re probably more than a little worried. I’d recommend that you give your doctor a call right away. Sometimes a provider may want to check a mom’s progesterone level if she’s had more than 1 miscarriage. We like to see the progesterone level at about 20 to 30 ng/ml. If yours is low, then you might need more progesterone.  I recommend Endometrin, which many fertility experts also prescribe. 

Many moms have experienced the tragedy of one or more miscarriages. It’s scary to think about getting back on the emotional roller coaster again until you know that everything is ok.

Your provider may want you to have an ultrasound as early as 5 ½ to 6 weeks after the 1st day of your  last menstrual period. That’s as early as we can see a heart beat. Some may want to see you at 8 -9 weeks, that’s about the earliest that most providers can hear a heartbeat. In any case, be sure to take your prenatal vitamin each day and we’ll keep our fingers crossed for you. 

If you have an underlying health problem, such as diabetes or high blood pressure, then you'll need to be monitored more closely. Many providers will likewise order other lab tests to rule out Lupus or other auto-immune disorders.

In any case, you'll want to take your prenatal vitamins every day, get your lab tests, see your health care provider regularly and try to enjoy your pregnancy as much as possible.

Good luck.

Ultrasounds

Should I be worried about having too many ultrasounds during my pregnancy? Will it affect my baby in any negative way? And how many ultrasounds are normal to have? I wondered about this when I was in my training and learning how to do ultrasounds. The good news is that we’ve had ultrasound technology for over 25 years and there have been no reports of any negative side effects on babies or on children who’ve had ultrasounds. Literally millions of children and people have had at least one ultrasound while they were in their mom’s tummies. Many have had more than 3 and some more than 5 ultrasounds. Depending on whether it’s a high risk pregnancy, a pregnant mom may need 5, 8 or even more ultrasounds. I have some high-risk patients who have had 10 ultrasounds, because toward the end of the pregnancy we needed to look at the baby and the amount of fluid every week. So rest assured, ultraounds are a safe way to look at your baby and for health care providers to evaluate their growth, development and health.

Jumping While Pregnant

I just found out I am pregnant and I am already 7 weeks along. Before I knew I was pregnant, I was jumping up and down inside one of those big air jumpers for kids (for about 5 minutes). I didn’t feel any pain, but now I’m worried: Is jumping bad for the baby?

You sound like you’re going to be a fun mom! Rest assured that the jumping you did shouldn’t have any effect on your baby. Jumping in those air jumpers provided your legs and ankles lots of cushioning. As long as you didn’t have any spotting or bleeding after the jumping, you and the baby should be just fine.

In general with any exercise, we advise moms not to exercise in ways that have a risk of falling, such as skiing, rock climbing, parachuting, and other risky sports like horse back riding. It’s not that jumping is bad, it’s just that it’s not an exercise that is recommended, because as a pregnancy continues, a woman’s center of gravity will shift, putting her at more risk for falling. I hope you’ll find other fun ways to get some exercise.

Pregancy After 40

Is it Safe for a Woman to Conceive After 40?

This question comes up all the time.  Depending on the woman's circumstances, if she is healthy, and without other medical problems, then the answer is Absolutely YES, a woman can safely conceive after 40.

The Risks

We've all heard that the risks of delivering a baby with a genetic disorder are increased after 40, but it's important to keep these "risks" in perspective and understand what it might mean for an individual woman.  Even at 40, the risk of delivering a baby with a genetic disorder are still quite small.

Questions of the Week

Question 1

Is there any other treatment for Lichen Sclerosus other than steroid creams?

Lichen Sclerosis is a chronic skin condition that can affect men and women. We don’t know what causes it.  It can cause a white patch of skin near the genitals or rectal area. Often there is intense itching and eventually the skin can become thicker and can tear easily.

Unfortunately right now, the best treatment for Lichen Sclerosis is steroid cream. I'd advise you to talk to your dermatologist or rheumatologist.  Many women find that they use a medium to high potency cream or ointment for a short time 2 times/day to get it under control and then can move to a lower dosage and use it 1-2 times/week.

Question 2

I am in my 21st week of pregnancy. When I check my breasts, milk comes out. Is this normal.  It's not unusual for a pregnant woman to already see some milk from her breasts.  It's normal and please don't worry.  I would advise you not to keep checking as any nipple stimulation can cause contractions and early labor.  It’s also perfectly normal not to see any milk, until after you deliver the baby.

Help I Need to Know Exactly When I Conceived

Frequently Asked Questions

I recently found out that I was pregnant. The doctor said that I was 5 weeks and 3 days. My question is can you tell me about what day my conception occurred?

This is a question that comes up frequently and I wish that I could give you an exact answer about the date of conception. Many women need to know this information for a variety of important reasons.

The trouble is that even with very sophisticated technology like Ultrasounds that can give us a fairly accurate idea of how far along a woman is, these can be off by as much as 3-7 days in the first 12 weeks of pregnancy.

A Nurse's Favorite Birth Plan

A Birth Plan That Works For Everyone   

Even if you've read every book on childbirth preparation, spent hours reading and scanning pregnancy websites and watched every episode of Deliver Me, the idea of actually giving birth to your own child, may be, well a little overwhelming....and scary.

Is your mom, sister or best friend a Labor & Delivery Nurse?  Or maybe you have a Doula Lined up?  Perhaps, you have the best Midwife or Doctor ready to answer every question and explain in detail how they make decisions when the unexpected happens...Yet still there may be a little feeling of apprehension as your due date approaches.  What to do?

Even though women have been giving birth since the beginning of time, absolutely anything can happen. Let me repeat that, anything can happen.  If you've been listening to your friends, family or perfect strangers tell their stories, you've probably heard quite a few variations on the same theme.  Each woman is unique as is her baby's birth. 

Everyone has the same goal, a healthy mom and a healthy baby. And though it’s a natural process, every woman’s experience is different. So what do you do to try to prepare?  Two words:  Birth Plan.

Why This Location Really Matters to Your Baby

Many times, my pregnant patients tell me that they never knew that there was so much to worry about until they became pregnant and started reading.

It's so true!  Before pregnancy, who knew that there were so many tests to decide on, or that during an ultrasound, the doctor would need to look at the position of the placenta. This is one aspect of pregnancy that people rarely mention, unless there's a problem.

Location, Location, Location

"I just had an ultrasound, and my doctor told me that I have a low-lying placenta. He didn't say much else, what does this mean?  I'm 18 weeks pregnant."