A Guide for Expecting Parents

In Preparation: A Guide for Expecting Parents

Introduction Congratulations on your exciting new adventure.

Pregnancy is one of life’s’ most wondrous experiences. The Women’s Clinic of Northern Colorado would like to thank you for allowing us to share in this life transition. We are dedicated to ensuring that your pregnancy and birth are healthy and positive experiences.

Education is one of the most important parts of the pregnancy experience. Pregnancy is a wonderful time to make healthy lifestyle changes that you can maintain far beyond delivery.

Over the years the doctors and midwives of The Women’s Clinic of Northern Colorado have delivered more than 40,000 babies. All of our experience has taught us something very valuable: each and every pregnancy is unique.

So even though this e-book answers many of the most common questions, it is by no means intended to replace your health care professional.

We are completely committed to the highest quality of care for you and your baby during this special time. We are here to help you, 24 hours a day. We encourage you to call any time you need us.

Acknowledgements This book is an expression of our commitment to provide you, the patient, with the highest quality of care possible.

A very special thanks to those people whose enthusiasm and interest made this book possible, especially Nicole D. Ferreri, BS., for compiling the 2019 e-book version of In Preparation. Nicole’s expertise in Health and Exercise Science, Sports Medicine, and evidence-based input was invaluable as we strive to meet the goal of providing our patients with the most up to date prenatal care advice possible.

Physicians

Certified Nurse Midwives

Ransey L. Jeffery, MD, FACOG Gary A. Ludwin, MD, FACOG Beverley A. Donnelley, MD, FACOG Warren K. James, MD, FACOG Susan Haney, MD, FACOG Elizabeth K. Serniak, MD, FACOG Kara L. Micetich, MD, FACOG Audrey L. Tool, MD, FACOG Kevin J. Tool, MD, FACOG Angela K. King, MD, FACOG Phil N. Priebe, MD, FACOG Michelle L. Tollefson, MD Darla E. Eisenhauer, MD

Patricia Fredericks, RN, CNM Stesh Irons-Kahl, RN, MSN, CNM Terri Leiser-Gross, RN, MSN, CNM Lani Nielson, RN, MSN, CNM Educators Karon Montgomery, MS, CGC Kristin Glenn, MBA, CBE, CLC Jennifer Hoover, BS, IBCLC

Table of Contents The Pregnancy Experience The First Trimester Symptoms and tips for coping with the discomforts ………….… 7 The developing fetus …….....………………………………….……......10

The Second Trimester Symptoms and tips for coping with the discomforts ………..…..11 The developing fetus ……………………………………………………..14

The Third Trimester Symptoms and tips for coping with the discomforts ……..……….15 The developing fetus ……………………………………………….……....18

Healthy Weight Gain Why maintaining a healthy weight is important …………………19 Healthy weight gain throughout pregnancy ……….………………19 Suggestions for maintaining a healthy weight ..............................21

What to Avoid Smoking, Alcohol, Marijuana, and Recreational Drugs..................22 Radiation ……………………………………………………………………....22 Hot Tubs and Saunas ……………………………………………………….22

Sexual Intercourse Throughout Pregnancy ……………..............23 Common Illnesses …………………………………………………….............23 Possible Complications Miscarriage ………………………………………………………………. ......25 Other possible complications …………………………………….………26

Warning Symptoms ……………………………………………………….....28

Nutrition Why is proper nutrition important?

Benefits of proper nutrition ……………………………………………….30 Eating for Two ………………………………………………………………..30

What should you eat?

Nutrition recommendations…………………………………….............31 General nutrient requirements ………………...…..........................33 Vitamins and Minerals …………………………………..….……………...33

Nutrition tips………………………………………………………............……………35 What should you limit/eat in moderation? …………………………...……36 What shouldn’t you eat? ……………………………………………………………. 36

Exercise Why is exercise important?

Benefits of exercise for the mother ……………………………………….…….38 Benefits of exercise for the fetus …………………………………………..........38 Fetal responses to exercise ……………………………………………..............39 Dispelling exercise myths ……………………………………………..…………39

Barriers to exercise and finding motivation ………………………………...40 Exercise recommendations General exercise recommendations ……………………….…………………40 Safe and unsafe activities …………………………………………………...........41 Warning

signs

to

discontinue

exercise ……………………………42

Contraindications …………………………………………………..…………...... 42

Exxercises for Increased Comfort Pelvic floor exercises ………………………………………………………………….. 43 Core exercises ………………………………………………………………………..….. 43 Hip exercises ……………………………………………………………….…………….. 46

Exercise during the postpartum period ………………...……………………….. 51

Stress Management Why is stress management important? ………………………………………….. 52 Common stressors during pregnancy …………………………...……………….. 53 Tips for coping with stress Resilience and optimism …………………………………………………………….. 54 Social support ………………………………………………………..………………….. 54 Meditation ………………………………………………………………….…………….. 55 Yoga ……………………………………………………………………………………...….. 56

Postpartum depression and anxiety ……………………………………………….. 57

Partner Support Tips on how to be a supportive partner ………………………….……………….. 58

Breastfeeding ……………………………………………………………….……………….. 59 Conclusion and Resources ………………………….………………………….. 61

The Pregnancy Experience Pregnancy is a very exciting and occasionally stressful time in a woman’s life. The body undergoes many rapid hormonal and structural changes as the baby grows and develops in the uterus.

This section contains information about normal changes that occur during pregnancy, when to expect them, how to alleviate any discomforts you may experience, and how to have an overall healthy pregnancy. Remember, we are always available and happy to answer any questions or concerns that arise throughout your journey. 10 •

Pregnancy Experience

The First Trimester (Weeks 1 -12)

The first sign of pregnancy is usually the missed menstrual period. It is normal to experience light bleeding, also called spotting, at the usual time of the menstrual period throughout the first two to three months of pregnancy. It is also natural to feel stressed about the additional responsibility and lifestyle changes that pregnancy will bring. Mood swings may become more extreme, and some women may feel as though they are laughing or crying at seemingly insignificant events. Below are some common symptoms you may feel during the first trimester, why they occur, and tips for alleviating your discomforts. 10

It is important to note that symptoms occurring in one trimester may also continue to occur throughout all three trimesters.

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Pregnancy Experience

Fatigue Fatigue occurs because your body requires more physical and emotional energy to undergo the rapid changes that accompany pregnancy. Your body simply needs more rest to adjust to the pregnancy.

Coping with Fatigue • • •

Do not feel guilty about getting extra rest during the day!

Take short naps throughout the day when you feel fatigued.

Go to bed earlier at night. 10

Swollen or Engorged Breasts The breasts may feel swollen or engorged during the first few months of pregnancy, which is a result of the growing milk-secreting glands in the breasts. Wear comfortable, nonrestrictive clothing to help. 10

Increased Vaginal Secretions Increased vaginal secretions are normal during pregnancy and are not a concern unless irritation develops. If irritation does develop, contact your health care provider. 10

Frequent Urination Frequent urination often occurs because the uterus rotates forward and may put additional pressure on the bladder, which limits the amount of urine the bladder can comfortably hold.

Coping with Frequent Urination •

• • •

This symptom usually subsides after the 1st trimester, but may return during the last few weeks of pregnancy when the baby begins to push on the bladder. It is not abnormal, however, for frequent urination to persist throughout the entire pregnancy.

Make sure to drink plenty of water and stay adequately hydrated!

Know where all the bathrooms are located!

If these symptoms are accompanied by pain or burning, contact your health care provider. 10

Uterus

Bladder

As you can see, the growing uterus is located directly above the bladder and will put additional pressure on the bladder. No wonder women experience frequent urination during pregnancy!

8

Pregnancy Experience

Nausea and Vomiting This is often called morning sickness, although symptoms can occur at any time of day. Nausea may be caused by the increased amount of hormones (commonly progesterone) that interfere with the stomach and intestines or from low blood sugar levels. 10

Coping with Nausea and Vomiting •

•

• • •

• •

•

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Remember that nausea won’t last forever; it usually subsides after the first trimester!

Keep a quick snack at your bedside to eat before getting up to raise blood sugar levels in the morning. Keep crackers in your bag to eat throughout the day if the nausea persists.

Try to eat right at the onset of hunger sensations.

Eat slowly and chew thoroughly.

Avoid an empty stomach. Eat small amounts of high protein foods frequently throughout the day and just before you go to bed.

If nausea occurs at a specific time, eat 30 minutes before that time.

If you are currently taking iron pills, take these pills after the nausea has gone away.

Avoid dehydration and drink fluids between meals to help with digestion.

•

•

•

•

•

•

Avoid any foods, odors, or activities that make you sick. Avoiding strong smells and flavors, spicy foods, and greasy foods may help.

Eat bland foods such as rice, mashed potatoes, vanilla milkshakes, bananas, and applesauce Eat foods higher in Vitamin B6 such as bananas, salmon, mackerel, chicken, sunflower seeds, halibut, tuna, broccoli, and filberts Eat ginger cookies, sip natural ginger ale in small amounts, or sip tea in small amounts.

Avoid fatigue whenever possible.

Increase your rest, avoid sudden changes in posture, decrease the amount of time you stand during the day, and avoid sudden movements when getting out of bed.

Speak with your health care provider if nausea and vomiting are becoming extreme. 10

Pregnancy Experience

The Developing Fetus: The First Trimester Weeks 4-5: The baby is a cluster of cells and is considered an embryo.

• The brain and spinal cord have started to form • The heart begins to form • There are buds where the arms and legs will eventually form • The placenta begins to form • The embryo is 1/25 of an inch long – about the size of a sesame seed

Week 8

Weeks 6-8: The baby is now considered a fetus and many structures begin to form.

• The heart beats rhythmically and circulates blood through the fetus. The heartbeat can be detected by ultrasound at about 6 weeks of pregnancy • Major organs and body systems have begun to form • The arms and legs continue to form • Eyelids begin to form • The fetus is about ½ inch long, and weighs less than 1/4 of an ounce – about the size of an almond

Week 12

Weeks 9-12: • • • • • • •

The nervous and muscular systems begin to develop and the bones and muscles begin to grow Fingers and toes begin to form The skin is thin and transparent The external sex organs develop Facial features have begun to develop Arm and leg movements can be seen, but are often not yet felt by the mother The fetus is about 2 inches long and weighs almost ½ ounce – about the size of a plum 19, 23, 24

* These images were taken from ultrasounds completed by sonographers at the Women’s Clinic of Northern Colorado

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Pregnancy Experience

The Second Trimester (Weeks 13 -28) The second trimester is often the most comfortable trimester. The baby and uterus grow rapidly during this time and the pregnancy will begin to show. During the second trimester, you will begin to feel the movements of your baby and you can feel stronger and more frequent kicking.

With first pregnancies, these movements usually aren’t noticed until around 18-20 weeks. Movements are usually felt 2-4 weeks earlier with subsequent pregnancies. Below are some common symptoms you may feel during the second trimester, why they occur, and tips for alleviating your discomforts. 10

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•

•

•

The circulatory system experiences significant changes during pregnancy.

Your blood volume and heart rate are going to increase to accommodate the needs of the fetus.

Nutrients are passed from the mother to the growing fetus through the placenta.

The nutritional needs of the fetus may cause your blood sugar levels to drop significantly, so try to eat frequent healthy snacks throughout the day.

The fetus also requires more oxygen, so you may experience an increase in your breathing frequency to accommodate this. 5

Pregnancy Experience

Constipation and Hemorrhoids Hemorrhoids occur when the veins in the rectal area become dilated and thin out. Hormonal changes, the pressure of the growing baby on your intestines, and natural slowing of your body’s functions are all causes of constipation and hemorrhoids during pregnancy.

Coping with Constipation and Hemorrhoids • • •

•

•

•

Drink 6-8 glasses of water per day.

Exercise regularly.

Increase the fiber content of your diet. Foods high in fiber include many fruits and vegetables, high fiber bread and pasta, brown rice, oatmeal, and many types of nuts.

Avoid cleansing with a dry tissue when hemorrhoids occur; use Tucks or moistened cotton balls to avoid further irritation.

If natural methods fail to alleviate constipation, you can obtain nonprescription stool softeners such as Colace, Surfax, Metamucil, or Milk of Magnesia.

For hemorrhoids, it is safe to use Dermoplast, Preparation H or HC, and Witch Hazel. 10

Stretch Marks and Other Skin Changes Heredity is the major cause of stretch marks and they usually occur when the skin is stretched until its connective tissues break.

These marks may appear as red or pink streaks on the abdomen, thighs, or breasts. Also, the change in circulating hormones during pregnancy can cause the pigment-containing cells in your skin to become darker. A dark vertical line may develop under your navel and your nipples may also darken. These skin changes may fade to normal skin tone after delivery, but they may remain visible. 10

“If you crave pickles and ice cream you are not weird – just pregnant!”

Nosebleeds, Nasal Congestion, and Bleeding Gums The increase in blood volume causes blood vessels to swell, which may put pressure on the mucus membranes of the nose and sinuses and cause nasal congestion and increased sinus pressure. Nosebleeds and bleeding gums may also occur due to enlarged blood vessels.

Coping with Nosebleeds, Nasal Congestion, and Bleeding Gums

Food Cravings

•

It is normal to experience cravings for specific or unusual food combinations. If you crave pickles and ice cream you are not weird – just pregnant! Indulge your food cravings as long as it does not interfere with the good nutrition that your growing baby requires. 10

• •

Use a humidifier in your home to prevent nosebleeds.

Brush and floss your teeth carefully and frequently to help with bleeding gums.

Taking more vitamin C may also help bleeding gums. Oranges and other citrus fruits, broccoli, kale, and Brussels sprouts are great sources of vitamin C. 10

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Pregnancy Experience

Round Ligament Pain (Pain in the Lower Abdomen or Groin) Round ligament pain can feel like a pulling or tightening in the groin area because the round ligaments extend from the top of the uterus to the groin. Certain movements may cause the uterus to shift and cause sharp pains. The pains usually only last a few seconds. Slowly shift positions to avoid pain. 10

Blurry Vision The increased fluid in the body may cause the cells that cover the eyes to swell, resulting in a slight blurring of vision. It may be uncomfortable to wear contacts during this time, so it is best not to change your prescription or purchase contact lenses while you are pregnant. 10

Heartburn, Indigestion, and Increased Bowel Gas Heartburn and indigestion occur when the growing uterus presses on the muscle at the top

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of the stomach and causes this muscle to relax.

Food contents may regurgitate backwards and cause a burning sensation.

Coping with Heartburn, Indigestion, and Increased Bowel Gas • • • • • •

•

Symptoms may be worse at night when you go to lie down, so go to sleep in a semireclining position.

When heartburn strikes, trying eating yogurt or milk.

Avoid overfilling the stomach by having several small meals throughout the day instead of a few large meals.

Eat meals slowly.

Avoid drinking a lot of fluids in the evening before bedtime.

Avoid gas-forming foods such as beans, cabbage, cauliflower, broccoli, and very spicy foods. Avoid fried and fatty foods as well.

If natural methods fail to relieve your symptoms of heartburn, you can obtain medications such as Gaviscon, Pepcid, Zantac, Tagamet, Tums, or Prilosec.

Simethicone may help with excess gas. 10

Pregnancy Experience

The Developing Fetus: The Second Trimester Weeks 13-16: • • • • • • • •

Week 16

Eyebrows, eyelashes, fingernails, and toenails have all formed The placenta is fully formed Your baby’s muscles and bones continue to develop and the skeleton looks more complete The baby can hear and swallow Skin begins to form The intestinal tract develops and the baby has its first bowel movement The baby’s kidneys are functioning and begin to produce urine The fetus is 6-7 inches long and weighs about 5 ounces – about the size of a small grapefruit

Weeks 17-20: • • • •

The baby becomes more active and you may be able to feel movements and kicks from your baby Your baby sleeps and wakes regularly It may be possible to determine the sex of the baby using an ultrasound The fetus is about 10 inches long and weighs about ½ - 1 pound – about the size of a banana

Week 20

Week 21-24: • • • •

Bone marrow has formed and begins to make red blood cells Fingerprints and footprints have formed Hair begins to grow on the baby’s head The lungs have formed, although they do not work to help your baby breathe yet

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Pregnancy Experience

Week 26 • • •

The baby can store fat and gains weight more rapidly The brain is rapidly developing The fetus is about 12 inches long, and weighs a little over 1 pound

Weeks 25-28: • • • •

The baby’s eyes can open and close The fetus can kick, stretch, and make grasping motions The baby can hear and respond to sounds The fetus is about 14 inches long and weighs 2 – 2 ½ pounds 19, 23, 24 * These images were taken from ultrasounds completed by sonographers at the Women’s Clinic of Northern Colorado

The Third Trimester (Weeks 29 -40)

During the final three months of your pregnancy the uterus continues to grow until it reaches the level of the breastbone. In this trimester you may also experience a nesting instinct and begin to prepare a place in your home for your new baby. The breasts continue to grow, as they get ready to produce milk for your baby. It is common to notice clear fluid leaking from your nipples during the third trimester. It is also common to experience a slight increase in body temperature and many women find they perspire more during this time. Below are some common symptoms you may experience during the third trimester, why they occur, and tips for alleviating your discomforts. 10

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Pregnancy Experience

Low Back Pain Increased weight gain causes a shift in the center of gravity and may interfere with balance. This change also causes the low back curvature to become more exaggerated and may increase the forces across the joints and the spine during weight-bearing activities. Low back pain is a common symptom of pregnancy, experienced by about 60% of women.

Coping with Low Back Pain •

• • •

Exercises that strengthen the core muscles are a great way to alleviate low back pain – specific information is contained in the “exercise” section of this booklet.

Apply heat to the lower back.

Maintain good posture and avoid wearing high-heeled shoes.

Ask your partner to massage your back, or consider professional pregnancy massage therapy. 10

Coping with Shortness of Breath • • •

Pelvic Pressure The growing baby causes the uterus to expand in all directions, increasing the pressure on the vessels and nerves in your lower abdomen and pelvis. You may notice a return of the frequency of urination if the baby is resting on your bladder. 10

Swollen Ankles Swollen ankles often occur as the pregnancy progresses and are caused by increased fluid retention.

Joint Laxity (Looseness) The hormone relaxin causes a softening of the ligaments that hold your joints together, especially the joints that hold the pelvis together. This may cause a feeling of instability while walking and exercising. Joint laxity (looseness) can increase your susceptibility to joint or muscle injury, so modify movements and move slowly, especially when exercising. 10

Avoid lying flat on your back.

When sitting, be conscious of sitting up straight and try not to slouch forward.

Use pillows to elevate your head when sleeping 10

Coping with Swollen Ankles • • • •

Rest frequently on your side during the day and sleep on your side at night.

Avoid excess salt.

Drink more fluids.

Make sure you are getting enough protein in your diet. 10

Shortness of Breath Shortness of breath occurs because the uterus begins to press on the diaphragm, which can interfere with breathing. This is a normal symptom and usually improves when the baby’s head begins to settle in the pelvis.

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Pregnancy Experience

Varicose Veins During pregnancy, vein walls stretch and thin out, which can cause varicose veins. For some people, this can also be hereditary. The pressure of the uterus on blood vessels in your abdomen may interfere with the return of blood from your legs.

Coping with Varicose Veins • • •

Avoid constrictive clothing.

Avoid standing or sitting for long periods of time to prevent the pooling of blood in the legs and feet.

Take frequent rest periods throughout the day and lay on your side with your legs level with your heart. 10

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Leg Cramps The exact cause of leg cramps is not known, but it may be related to a need for more calcium.

Coping with Leg Cramps • • • •

Drink plenty of water.

Drink low-fat milk or eat low-fat dairy products.

Reduce your intake of processed foods and sodas.

Be sure to eat plenty of fruits and vegetables. 10

Pregnancy Experience

The Developing Fetus: The Third Trimester Weeks 29-32: • The skeleton is fully formed. The bones harden, but the skull remains soft.

• Taste buds form on the baby’s tongue • The baby kicks more forcefully • The fetus can hiccup • The lungs are not quite fully developed, but the baby begins practicing breathing movements • The baby’s body begins to store needed vitamins and minerals • The baby gains weight more rapidly • The baby is about 18 inches long and weighs 4.5 – 5 pounds Week 33-36: • The baby continues to grow more rapidly • The baby’s movements become more restricted because there is less space in the uterus to move around • The brain continues to develop • Sleeping patterns develop • The baby is about 20 inches long and weighs 6 – 7 pounds Week 37-40: • The baby is considered full term at 39 weeks • As the due date becomes closer, the baby will drop lower into the pelvis and will rotate so that it’s head is facing downward, in preparation for birth • The baby gains about ½ pound per week during the last month • At birth babies usually range between 6 pounds 2 ounces and 9 pounds 2 ounces, but babies can range beyond this and still be considered healthy • Babies are usually 19 – 21 inches long at birth, but babies can range beyond this and still be considered healthy 19, 23, 24

Week 32

Week 40 (Full Term)

* These images were taken from ultrasounds completed by sonographers at the Women’s Clinic of Northern 18 Colorado

Pregnancy Experience

Healthy Weight Gain Healthy weight gain during pregnancy is very important. Above all, it is most important to maintain proper nutrition and a healthy exercise program throughout your pregnancy.

Maintaining proper diet and exercise will help ensure that you gain a healthy amount of weight throughout your pregnancy. The amount of weight gained should be appropriate for promoting the normal growth and additional needs of your baby, but should not promote excessive weight retention after delivery. Paying attention to healthy weight gain during pregnancy will make it much easier to return to a healthy weight during the postpartum period.

Excessive weight gain during pregnancy can cause your baby to be larger than what is considered a normal birth weight, and insufficient weight gain during pregnancy can cause your baby to weigh less than what is considered normal birth weight. 6, 10

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Suggested weight gain throughout pregnancy is based on your pre-pregnancy weight. The body mass index, which is a number that accounts for an individual’s height and weight, is used to estimate weight gain.

Body mass index (BMI) is a number that is calculated from your height and your weight. A chart is provided for you to determine your BMI from your height and pre-pregnancy weight.

Find your height and weight on the chart – where they meet, drag your finger up and stop at the listed BMI value. 6

Pregnancy Experience

Source: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi_tbl.pdf

Compare the pre-pregnancy BMI that you obtained from the above chart to the table for recommended weight gain below to estimate the amount of weight that is healthy for you to gain throughout your pregnancy.

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Pregnancy Experience

This table contains the Institute of Medicine’s recommendations for weight gain during pregnancy, based on pre-pregnancy BMI values. 6

Body Mass Index

Recommended Weight Gain (pounds)

Less than 18.5 18.5 – 24.9 25 – 29.9 Greater than 30

28 – 40 25 – 35 15 – 25 11 – 20

Amount of Weight to Gain Each Week, Beginning in the 4th Month 1 ½ pounds 1 pound 2/3 pound ½ pound

Below are some tips if you are gaining weight too quickly or if you are having trouble gaining weight.

If you are gaining weight too quickly: •

• • • • •

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Decrease fried foods, refined or processed grains, and snacks such as chips, cake, pie, candy, cookies, and donuts.

Eat fresh fruits and vegetables, lowfat yogurt, or cottage cheese for snacks.

Prepare food with healthy fats and oils.

Eat baked, broiled, or roasted foods instead of fried foods.

Decrease intake of soda and fruit juices and increase water.

Do more physical activity throughout the day, especially if you sit frequently. Walking is a great form of exercise for controlling weight gain.

If you are having trouble gaining weight: •

• •

• • •

Keep healthy foods like almonds, cashews, sunflower seeds and dried fruit on hand to snack on in small amounts.

Eat healthy snacks; substitute avocado or nut butters for jam on whole grain toast.

Stay well hydrated and avoid high sugar beverages. Ginger, peppermint and lemon balm teas are generally considered safe to drink during pregnancy.

Eat two servings of whole fat dairy per day.

Eat healthy proteins like chicken, bison and salmon and eggs.

Talk with your provider if you have special dietary concerns.

Pregnancy Experience

What to Avoid There are certain activities and substances that you should avoid while pregnant as they can be harmful to your developing baby. The health and proper development of your baby should be a priority during this time.

Smoking, Alcohol, Marijuana, and Recreational Drugs Smoking, alcohol, marijuana, and recreational drugs should not be used while you are pregnant. Smoking during pregnancy increases the chances of miscarriage or premature birth.

Smoking mothers tend to have low birth weight babies who are at a greater risk for death or disability than normal weight infants. If you currently smoke, we strongly recommend that you quit smoking before you become pregnant, or as soon as you know that you are pregnant.

alcohol. These drugs include marijuana, cocaine, heroin, methamphetamine, prescription painkillers, and any other illicit drugs.

We would be happy to discuss a plan with you to quit smoking, drinking alcohol, and using recreational drugs, but it is ultimately up to you to make the decision for your child. 10, 20

â€œâ€Ś it is ultimately up to you to make the decision for your child.â€?

Alcohol quickly reaches the fetus if the mother decides to drink. Alcohol produces both physical and mental defects in babies, including growth deficiency, malformed facial features, low birth weight, premature birth, seizures, poor coordination, feeding problems, and deficient mental development. In the mother, drug and alcohol use may cause hemorrhage, high blood pressure, stroke, infection, and dental problems.

Both marijuana and other recreational drugs should be avoided during pregnancy, because they can have serious developmental effects on your baby similar to the effects of

Radiation

Radiation, such as routine x-rays for dental diagnosis, may be performed as long as the abdomen is protected. It is especially important to avoid radiation during the first trimester. If an x-ray is necessary, we recommend that you consult with your health care provider to determine if the benefits outweigh the potential risks for your baby. 10

Hot Tubs and Saunas Elevated body temperatures may be associated with birth defects or other pregnancy complications. It is best to avoid exposure to excessively high temperatures while you are pregnant, therefore you should avoid hot tubs and saunas. 10

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Pregnancy Experience

Sexual Intercourse Throughout Pregnancy It is perfectly fine to have sexual intercourse throughout pregnancy as long as it remains comfortable and as long as your health care provider has not directed you otherwise. By the third trimester, the enlargement of the uterus may make you feel awkward and unattractive, decreasing your sexual drive. In some women, the extra blood going to the pelvis may actually increase sexual drive. Especially during the last trimester, you may

need to experiment with a variety of positions in order to have comfortable intercourse. Many women may find that orgasms cause the uterus to contract, although it is very rare for an orgasm to initiate labor. Close physical contact such as massaging may provide a satisfactory alternative if intercourse is uncomfortable. If you have specific questions or concerns about sexual intercourse throughout your pregnancy ask your health care provider.

Common Illnesses Common illnesses such as headaches, colds, and the flu may occur during pregnancy. Below are some helpful tips and medications that are safe to take while you are pregnant if you are experiencing any of these illnesses. If you have specific questions about your symptoms or a medication, or if your symptoms become more severe and do not go away, contact your health care provider. 10

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Pregnancy Experience

Symptom

Tips

Headaches

• •

Nasal Congestion

• • • •

Coughing

•

Sip on a mixture of equal parts honey and lemon juice in water

•

You may want to come by the office and get a culture to make sure that you do not have a strep infection.

Mixing warm water and ½ teaspoon of salt makes a soothing gargle for your throat.

Monitor your temperature by taking it twice a day for ten days.

If you have a fever greater than 100°F contact your doctor for an examination.

It may be best to come into the clinic as soon as you suspect it is the flu.

As soon as your symptoms occur, stop eating solid foods and start drinking small amounts of liquids frequently.

Water, broth, tea sweetened with honey, de-carbonated soda, and JellO are all acceptable fluids.

Avoid milk and milk products.

UTIs are more common during pregnancy.

If you are experiencing burning with urination, feeling and urgency to urinate, blood in the urine, a onesided backache, a fever, or chills, contact your health care provider.

If you experience persistent allergy symptoms, you may use any of the tips listed above or these specified medications.

Sore Throat •

• Fever

•

• • Flu • • • Urinary Tract Infections (UTI)

•

• Allergies

Rest and relax Place a cold or hot compress on your forehead or the back of your neck Massage the neck and shoulders Drink more fluids Run a cool mist vaporizer Rest

•

Safe Medications to Take

Tylenol Benadryl Mucinex Sudafed EmergenC Robitussin Plain EmergenC

EmergenC

Tylenol

Kaopectate Imodium

Your doctor may prescribe a medication.

Claritin Zyrtec Chlortrimeton Benadryl Rhinocort 10

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Pregnancy Experience

Possible Complications Although most pregnancies proceed normally, we are always alert to possible complications, and we put an emphasis on the prevention and early detection of complications. Below we have listed some possible conditions that may be encountered during pregnancy and also the warning signs that would warrant immediate discussion with your health care provider.

Miscarriage About 30% of pregnant women will experience some bleeding during the first trimester of pregnancy. Many of the causes of

What can cause a miscarriage?

•

• • • •

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About ½ of miscarriages are caused by chromosomal abnormalities in the mother’s egg or the father’s sperm. Most of the time these abnormalities occur by chance and have nothing to do with the health status of the mother or father.

Women over the age of 40 are more likely to have a miscarriage.

Abnormalities in the uterus or cervix Infections, hormonal irregularities, or diseases present in the mother Smoking, drinking alcohol, drug use, certain medications, and exposure to high levels of radiation can all cause a miscarriage.

this bleeding are completely harmless. Light bleeding may occur during the time you would normally have your menstrual period, however the bleeding usually only lasts for a few days and then disappears. Occasionally, the growing placenta or sexual intercourse may cause light bleeding.

Miscarriages are more likely to occur in the first trimester of pregnancy. Symptoms of a miscarriage may include heavy and persistent bleeding that lasts more than a few days, severe lower abdominal cramping, abdominal pain, and mild to severe low back pain. If you experience any of these symptoms, contact your health care provider. 12

What does NOT cause a miscarriage?

•

Physical activity and exercise

•

Stress

•

Sexual activity

•

It is important to recognize that you should not think that something you did or failed to do caused a miscarriage. Most of the time these occur by chance and from natural causes out of your control. 12

Pregnancy Experience

Other Possible Complications Preeclampsia Preeclampsia is a condition that occurs only during pregnancy and resolves after delivery. It is characterized by: • • •

High blood pressure Excessive fluid accumulation – especially in the hands and face Proteins in the urine

The serious nature of preeclampsia is often underestimated, but if the condition is not controlled, it could cause seizures, coma, or death.

Signs and Symptoms It is difficult to notice the initial symptoms of preeclampsia when it first develops, but you should contact your doctor immediately if you experience: • • • • • • •

A rise in blood pressure Excessive or unusual swelling in the face and hands A sudden gain of weight Severe and persistent headaches Blurry vision or temporary loss of sight Severe upper abdominal pain Nausea or vomiting Prevention

• • • •

Rest on your left side periodically throughout the day Eat an adequate amount of protein Avoid excessive amounts of salt in your diet Drink plenty of water 10, 16

Placenta Previa The placenta is a structure inside the uterus that supplies nutrients and oxygen to a developing fetus. The placenta is usually

located at the top or the side of the uterus, but when the placenta partially or completely covers the mother’s cervix, this is known as placenta previa.

Signs and Symptoms • • • •

Vaginal bleeding during the second or third trimester – usually a bright red color Some women will have contractions If diagnosed early in the pregnancy, it may resolve naturally If it does not resolve naturally, your doctor will closely monitor this and take necessary action Prevention

• •

Since the cause of placenta previa is unknown, there are no certain ways to prevent it.

Remember to recognize what is normal for you and talk to your health care provider if you notice anything abnormal. 13

Preterm Birth Preterm birth refers to births that occur between the 20th and 36th week of pregnancy.

Babies born during this period require special care to help the baby eat, breathe, and maintain body temperature. The following may increase your likelihood of preterm birth: • • •

• • •

Previous preterm labor or delivery The current pregnancy is twins, triplets, etc.

Abnormally shaped uterus or DES (Diethylstilbestrol) exposure Severe UTIs or kidney infections Incompetent cervix, previous cone biopsy of the cervix, or a fibroid tumor Smoking

26

Pregnancy Experience

Signs and Symptoms Contractions are normal throughout pregnancy and often occur because of changes in position or a full bladder. Contractions of preterm labor may be painless, but they often have a pattern.

Contact your health care provider if you are experiencing any of these symptoms, because you may be going into preterm labor: • • • • •

4 or more regular contractions per hour – they will last from 20-120 seconds and occur every 15 minutes or less Rhythmic lower abdominal cramps and pelvic pressure A low, dull backache that feels different than you normally experience A large amount of mucus or water leaking from the vagina Pink or brown vaginal discharge Prevention

• • • • •

Stress management – this will be discussed in more detail later in this booklet Do not lift heavy loads Empty your bladder as often as you need to Drink plenty of water If you are having contractions, lie down with a pillow behind your back so you are slightly tilted to your left side. If your uterus becomes tight and feels hard, you are having a contraction. Monitor your contractions by recording their length and frequency. Come into the clinic if they become frequent and rhythmic. 10

Prolonged Pregnancy Prolonged pregnancy is when the pregnancy extends more than 2 weeks past the due date.

Although 13% of all pregnancies extend 42 weeks beyond the last menstrual period, many of the pregnancies are not actually overdue.

This may be because conception was

27

delayed, which is why we pay such close attention to determining the first day of the last menstrual period, the conception date, and the date that fetal heart tones were detected.

Prolonged pregnancy could be a problem because the aging placenta may fail to supply the baby with proper nutrients and oxygen, there may be a decrease in amniotic fluid, staining of the amniotic fluid due to the baby’s bowel movements, loss of the baby’s fat, decreased tolerance to contractions during labor, and occasionally death of the baby in the uterus.

When a pregnancy extends beyond 42 weeks, we consider inducing labor. If the cervix is not favorable for induction, tests of fetal well-being will be performed. If there is fetal well-being, it is generally considered safe to wait until the cervix does become favorable for induction.

Careful monitoring of the baby’s heart rate during labor is essential if the baby is overdue.

There are no certain ways to prevent prolonged pregnancy, but remember that we will carefully monitor your progress throughout your pregnancy and we will take action if necessary.

10

Pregnancy Experience

Warning Symptoms If any of these symptoms occur, you should immediately talk to your doctor. These symptoms may not be normal parts of pregnancy.

• • • • • • • • • • • •

Sudden or excessive swelling of the face, hands, and feet Painful or burning urination Fever higher than 100°F and chills Irritating vaginal discharge Frequent dizzy spells Marked decrease in fetal movement Vaginal bleeding like a period or heavier Loss of fluid from the vagina Severe and prolonged abdominal pain Severe and persistent headaches Disturbances in vision such as dimness, blurring vision, or flashes of light Severe and persistent vomiting 10

28

Nutrition

Nutrition

Why is Proper Nutrition Important During Pregnancy?

Nutrients that the baby needs to grow are transferred from the mother to the fetus through the placenta. Proper nutrition is the best way to ensure that you have a healthy pregnancy and a healthy baby. If you have specific questions about your diet during pregnancy, consult with a Registered Dietician.

Proper nutrition is important because: ♦ It can reduce the risk for gestational diabetes and preeclampsia: Proper nutrition can help keep your blood sugar at a healthy level and also help you avoid high blood pressure and unhealthy fluid retention. ♦ It can help ensure that your baby will grow and develop properly: Research shows that babies that are deprived of proper nutrition in the womb may have impaired growth. Babies that were malnourished in the womb are more likely to develop heart disease, type II diabetes, high blood pressure, and other diseases later in life. Proper nutrition helps ensure that your baby will be of a healthy weight, decreasing the risk of developing these diseases later in life. ♦ It can help the mother have an easier delivery and post-partum experience ♦ It can be an important component of healthy weight gain: Focusing on proper nutrition is a great way to prevent excessive weight gain and ensure that you are maintaining healthy weight gain throughout your pregnancy.

♦ Nutritional habits can carry on past pregnancy: Making healthy nutritional changes during pregnancy will encourage you and your child to maintain a healthier lifestyle well beyond pregnancy and delivery. 1, 7, 10

Eating for Two “Eating for two” is a very common phrase used to describe nutrition during pregnancy.

Although you are making nutritional choices that will impact both you and your child, this does not mean that you should eat twice the amount of food you normally would.

You need around an additional 300 calories each day (especially during the second and third trimesters when the baby grows more rapidly). Healthy weight women should eat about:

“Proper nutrition is the best way to ensure that you have a healthy pregnancy and a healthy baby.”

• • •

1,800 calories per day during the first trimester 2,200 calories per day during the second trimester 2,400 calories per day during the third trimester – nutrition is most important during the final trimester when your baby is growing quickly

These numbers should serve as guidelines for you to follow throughout your pregnancy.

What is most important is to focus on proper nutrition to ensure that your baby will grow properly and healthily. Try not to put too much emphasis on the overall number of calories that you consume. Instead, focus on eating a well balanced diet and you will be able to maintain healthy weight gain and healthy growth of your baby. 5

30

Nutrition

What Should You Eat? It is important to maintain a well-balanced and nutritious diet throughout your pregnancy. The USDA recommends these nutritional habits for optimal health. Let this list serve as a guideline for your daily diet throughout your pregnancy.

Each source suggestion is equivalent to one serving.

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Nutrition Food Category Breads, cereals, pasta, rice (Carbohydrates)

Amount

At least 6 servings per day

Sources • •

• Milk, yogurt, cheese

Meat, poultry, fish, beans, eggs, nuts

At least 3-4 servings per day

•

• • At least 3 servings per day

•

Vegetables

At least 4-5 servings per day

•

1 serving = 1 cup raw, ½ cup cooked, ½ cup juice

•

• At least 3-4 servings per day Fruits 1 serving = 1 cup raw, ½ cup cooked, ½ cup juice

• •

• Fats and Oils

Very small amounts – try to limit these in your diet •

Try to pick whole grain options 1 slice of bread, ¾ cup cold cereal, ½ an English muffin or bagel, 1 six-inch tortilla, 4-5 crackers, ½ cup rice or pasta Choose low-fat options when possible 1 cup milk (skim, 2%, whole), 1 cup yogurt, ½ cup cottage cheese, 2 ounces cheese Choose lean meats when possible 3 ounces cooked meat, fish, or poultry, 2 tablespoons peanut butter, 1 egg, ½ cup dried peas or beans (cooked), 1 cup tofu, ½ cup tuna At least 2 servings should come from green leafy vegetables Choose fresh vegetables when you can (instead of canned) because these tend to have a higher nutritional value Green beans, beets, carrots, peppers, spinach, broccoli, kale, cauliflower, peas, lettuce Try to avoid fruit juices – they tend to have a lot of added sugar Choose fresh fruits when possible – these will have a higher nutritional value Apples, bananas, tomatoes (or tomato juice), grapes, peaches, cherries, strawberries, cantaloupe, watermelon, oranges, mangoes, grapefruit Limit unhealthy fats and oils such as desserts, soft drinks, chips, butter or margarine, bacon, etc.

Healthy fats include avocado, oily fish, nuts, seeds, olive oil, vegetable oils 5, 7, 10

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Nutrition

General Nutrient Requirements Water It is important that you drink plenty of water each day because it can be very easy to become dehydrated, especially since you have a higher blood volume and more fluid in your body during pregnancy. Try to drink at least seven to eight full glasses of water per day. This number may increase if you are at a higher altitude or during the hot summer months. If you’re thirsty, this is a good indication that you are dehydrated and need to drink more water.

Carry a water bottle with you and drink constantly throughout the day. 7, 10

Carbohydrates and fiber Carbohydrates are going to be an important fuel source for the mother and for fetal growth.

The quality of carbohydrates in your diet matters, so try to pick whole grain options when possible. Fiber is especially important because it may help the mother’s digestive system and help with constipation symptoms. Sources of fiber include whole grains, brown rice, oatmeal, bran cereal, beans and lentils, and broccoli. 7

Protein Protein is one of the most important nutrients to help ensure a healthy pregnancy. Protein is essential for proper growth and

33

development of the baby, and it helps your body support the changes it experiences as your baby grows. Protein will be especially important in the second and third trimesters, when the baby is growing most rapidly.

Usually, the average diet of a woman in the United States provides more than enough protein, and consumption does not need to be increased during pregnancy. Good sources of protein will be lean meats, beans, eggs, fish, peanut butter, and other foods. If you are vegetarian or vegan, speak with a Registered Dietician to find appropriate alternatives to ensure that you get enough protein to support the growth of your baby. 7, 10

Vitamins and Minerals There are certain vitamins and minerals that your body may need more of during pregnancy. Most vitamins and minerals can be obtained from dietary sources and supplementation is not necessary, but you will likely need to take an iron and folic acid supplement since your diet may not be able to meet these needs. Your doctor will prescribe a prenatal vitamin that will have proper amounts of each. 7, 10, 21 Listed below are some important vitamins and minerals and where to get them from your diet.

Nutrition Vitamin or Mineral

Why it’s important •

Iron (27 mg per day)

• • •

Folic acid

•

(400 – 600 micrograms per day)

• Calcium (1,000 – 1,200 mg per day)

• •

•

Iron is an important component of blood It is required for proper fetal development It is needed for the growth of the placenta It is also needed to increase the number of maternal red blood cells, which will help with the increase in blood volume associated with pregnancy Folic acid can prevent neural tube defects in the developing fetus. Neural tube defects would interfere with the proper development of the baby’s brain, spine, and spinal cord.

Calcium is essential for the proper development of your baby’s skeleton Calcium can also maintain the strength of the mother’s bones It can also reduce the development of high blood pressure disorders in the mother Vitamin C may help protect and strengthen membranes in the mother’s body

Vitamin C

Sources • • • • • • • • • • • • • •

• • • •

• Vitamin D (600 international units (IU) per day)

•

Vitamin D is required for immune system and nervous system function Vitamin D also helps with the proper development and growth of your baby’s skeleton

• • • • •

Iron-fortified breakfast cereals – drink the milk after you eat the cereal Cream of wheat and oatmeal Spinach Dried beans and refried beans Meats, including fish and poultry Dried fruits Prune juice Legumes such as beans, peas, lentils, and peanuts Orange juice Fortified breakfast cereals – drink the milk after you are finished eating the cereal Leafy green vegetables Low-fat milk and yogurt are great sources of calcium Cheese and crackers Spinach or kale

Oranges, tangerines, or orange juice Grapefruit or grapefruit juice Strawberries, pineapples, watermelon, cantaloupe, kiwis, tomatoes Brussels sprouts, broccoli, kale, cauliflower, red and green peppers, potatoes Low fat milk and yogurt Eggs Cheese Fortified breakfast cereals – drink the milk after you are finished 34 Fish 7, 10, 21

Nutrition

Nutrition Tips ♦ Eat small meals and nutritious snacks throughout the day. Small meals will be easier for you to digest, and eating often will keep both you and your baby supplied with a steady stream of nutrients ♦ Remember to take your daily multivitamin/mineral supplement if your health care provider prescribes one. Be sure to take these with food to avoid nausea. ♦ Eat a variety of foods from all the food groups. If you crave one certain food, talk to a Registered Dietitian about it so she/he can suggest a way to balance the food you crave with other foods. ♦ Eat fresh foods instead of processed or packaged ones 10

35

Nutrition

What Should You Limit / Eat in Moderation? ♦ Caffeine: Consuming too much caffeine could put extra stress on your baby during pregnancy, so it is important to limit your consumption to equal to or less than 200 mg per day. 200 mg of caffeine is equivalent to about one 12-ounce cup of coffee. Other foods that contain caffeine include caffeinated tea, dark chocolate, and soda. ♦ Foods high in sugar and fat: It is best to limit or avoid foods that are high in sugar and fat. These would include desserts such as cake and cookies, soda, fruit juices, “junk food” such as chips and candy, and any other processed foods. Try to eat fresh foods as much as possible and find healthy alternatives for junk food. 7

What Shouldn’t You Eat? Although pregnancy does not increase your risk for developing certain food-borne illnesses, it is more dangerous if you contract one of these illnesses while you are pregnant, as it can be very harmful to your developing baby. Foodborne illnesses such as listeriosis, salmonella, and toxoplasmosis are of concern during pregnancy. It is best to avoid: ♦ Unpasteurized milk, cheese, or paté • Avoid soft cheeses and cheeses made with unpasteurized milk such as feta and Brie • Hard cheeses made with pasteurized milk such as cheddar or Swiss should be safe to eat ♦ Raw eggs or raw meat ♦ Raw fish (sushi) or raw shellfish such as oysters and clams

♦ Limit fish consumption to 2 times per week • Avoid fish such as swordfish, king mackerel, marlin, orange roughy, shark, tilefish, and big eye tuna as these fish contain high levels of mercury that could be harmful to your baby • Choose fish lower in mercury such as salmon, tilapia, or trout ♦ Undercooked meat • All meats, including fish, should be cooked to 145° F ♦ Contaminated vegetables or other foods ♦ Deli meat • Avoid consuming raw deli meat. If you choose to eat deli meat, make sure you are getting it from a reliable source where it is properly handled.

Also, it is important that you never eat something that is not food such as starch, clay, dirt, or other non-food items. A craving for one of these items is often an indication that your body needs a particular vitamin or nutrient from a healthy food. Consult your health care provider if you are craving any non-food items.

3, 7, 10

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Exercise Many women often wonder if exercise is safe during pregnancy. When done properly, not only is it safe, but highly encouraged. Exercise does not increase your risk of miscarriage and there are many wonderful benefits that can come from maintaining a regularly active routine.

Remember that it’s never too late to start an exercise routine, even if you decide to start during pregnancy. Before you start or continue an exercise program, meet with your health care provider to create an appropriate exercise plan and to confirm that it is a safe option for you.

Exercise

Why is Exercise Important During Pregnancy?

Not only does exercise have wonderful effects on your health, it can have many positive impacts on your baby’s health, both in and out of the womb. Below, we have listed some reasons why exercise is important and beneficial for both you and your growing baby.

Benefits of exercise for the mother Exercise can:

“lose the baby weight” more quickly if you exercise during and after pregnancy. You may also recover faster after giving birth. Ø Reduce low back pain Ø Shorten labor: Research shows that women who exercised during pregnancy had a shortened first stage of labor. Ø Reduce your risk of a C-section 1, 2

Benefits of exercise for the fetus

Ø Improve or maintain your physical fitness: Whether you currently exercise regularly or Exercise can: you decide to start exercising during pregnancy, it is possible to maintain or even Ø Increase the likelihood that you will have a healthy weight baby: Studies have shown improve your physical fitness level. that exercising during pregnancy may Ø Improve your decrease your psychological “Not only does exercise have likelihood of having a well-being: large for gestational wonderful effects on your Exercising may age (high weight) make you feel health, it can have many baby. As babies of better about positive impacts on your baby’s exercising mothers yourself and grow, they may be reduce stress. health…” leaner and grow to a Ø Decrease your healthy weight. risk for Ø Protect your baby against diseases later in gestational diabetes: Gestational diabetes life: Research has shown that maternal is characterized by any abnormal rise in exercise may provide some protection blood sugar levels during pregnancy. against atherosclerosis (buildup of plaque Exercise can help you maintain healthy in the arteries) later in your child’s life. blood sugar levels, lowering your risk of Studies have also shown that if your baby is developing gestational diabetes. a healthy weight, they may be at a Ø Help you maintain a healthy blood decreased risk of developing heart disease, pressure type II diabetes, high blood pressure, and Ø Help you maintain healthy weight gain other diseases later in life. throughout pregnancy: Women who Ø Possibly improve development of the exercise during pregnancy gain less weight brain and spinal cord: Some research and are more likely to maintain healthy indicates that maternal exercise may weight gain. improve development of the fetus’ brain Ø Improve your recovery time in the and spinal cord (neurodevelopment). 1, 2 postpartum period: You may be able to

38

Exercise

Fetal Responses to Exercise Light to moderate intensity exercise should be well tolerated by the fetus. The fetal heart rate increases during or after light to moderate exercise, but will return to baseline soon after exercise stops. If you wish to engage in strenuous or vigorous exercise, consult your health care provider, as vigorous exercise should be approached with caution. 22

Dispelling Exercise Myths Ø Exercise does not cause miscarriages Ø Exercise does not increase your risk of having an early delivery or a low birth weight baby Ø Normal exercise does not increase your core temperature enough to be harmful to your baby Ø Depending on age and pre-pregnancy fitness

level, for healthy individuals it can be safe for the heart rate to go above 140 beats per minute.

Determining your exercise intensity using the talk test or rating of perceived exertion (explained below) are more appropriate ways to gauge your level of exertion. 22

39

Exercise

Barriers to Exercise and Finding Motivation It may be difficult to find motivation to exercise during pregnancy. Many women feel like they have no time or energy to exercise regularly.

Some women may also say they feel pain or discomfort when moving or that that there is no need to worry about weight management during pregnancy.

It is important not to let these barriers stop you from being physically active throughout your pregnancy. This is a great time to continue or start exercising because it can have many benefits for you and your baby. Also, this is a time when you have access to frequent medical care, so you are in a safe environment to be active. We are always here to answer any questions that you may have.

Below are some suggestions if you are having trouble finding motivation to exercise: • • • • •

Even a little something is better than nothing. What about a short walk around the neighborhood?

Keep an exercise journal to track your progress Exercise with friends Pick activities you enjoy Remember that exercise can actually reduce low back pain and other discomforts 2, 15

Exercise Recommendations The American College of Obstetrics and Gynecology (ACOG) makes the following recommendations for exercise during pregnancy: •

• • •

•

• • •

•

•

If you are not experiencing any complications and you do not have any contraindications, it is safe to exercise.

Get at least 20-30 minutes of moderateintensity exercise most or all days of the week.

Avoid motionless postures because blood can pool in the legs and feet Avoid lying on your back (especially in the second and third trimesters). Lying on your back can put pressure on the vein that returns blood to your heart, which can lower your blood pressure and decrease the amount of blood reaching the fetus.

Stay hydrated! Make sure to take frequent water breaks throughout your exercise session Avoid exercising in hot and humid environments Wear loose-fitting clothing to avoid over heating Wearing a sports bra that gives you plenty of support may increase your comfort during exercise. A belly support belt may also increase your comfort.

Increased fluid retention and increased joint laxity may make you more susceptible to muscle and joint injuries. Avoid jerky, bouncy, or high-impact motions to help prevent injury. Modify exercises when necessary and make sure you have an adequate warm up before any kind of activity.

The extra weight that the baby puts in the front of your body can shift your center of gravity forward, making you

40

Exercise

•

•

• •

less stable. Because of this, you are more likely to lose your balance and you are at a higher risk of falling. Be aware of your balance and stability and make modifications to your exercise routine if you are feeling unstable.

You will experience an increase in blood volume, heart rate, and breathing frequency during pregnancy because your growing fetus requires plenty of oxygen.

These changes may make it more difficult to engage in strenuous exercise, so modify your exercise routine accordingly.

If you have not been active before, progressively increase your exercise routine. Start slow and then add to your routine when you are ready.

Avoid prolonged exercise sessions above 60 minutes Eat something small before you exercise. If your workout is going to last

The following activities are safe to begin or continue: • • • • • • • •

Walking Swimming Stationary biking Low-impact aerobics Yoga or Pilates – modify positions when needed Running or jogging Strength training – modify when needed Racquet sports

*If an activity that you would like to participate in does not appear on this list, ask your health care provider if they believe it is safe for you to engage in.

41

more than 45 minutes, bring a quick snack (such as fruit, vegetables, or crackers) that you can eat during your exercise session to ensure that your blood sugar stays at a healthy level. 8, 22

Determining exercise intensity Commonly we assess exercise intensity using the “talk test” or rating of perceived exertion (RPE). The “talk test”: If you can still carry on a conversation during exercise, you are not overexerting yourself and it is safe to continue exercising at that intensity. RPE: RPE is assessed on a scale of 6 – 20. While you are exercising, think about where you would fall on this scale. Moderate intensity exercise is a 13 or 14 on this scale and is appropriate to continue.

The following activities should be avoided: • •

• • •

Contact sports – such as hockey, boxing, soccer, basketball, etc.

Activities with a high risk of falling – such as downhill skiing, water skiing, surfing, off-road biking, gymnastics, horseback riding, etc.

Scuba diving Sky diving “Hot yoga” or “hot Pilates”

*Speak with your health care provider if you are unsure about the safety of an activity that you wish to engage in. 8, 22

Exercise

Warning Signs to Discontinue Exercise

Relative and Absolute Contraindications

If you experience any of the following, you should stop exercising immediately and consult your health care provider.

The ACOG identifies contraindications for exercising during pregnancy. Relative contraindications refer to conditions that may require you to use caution while exercising, or they may indicate that it is unsafe for you to exercise. If you have any relative contraindications discuss with your health care provider if exercise will be safe for you.

Vaginal bleeding Regular painful contractions Amniotic (watery) fluid leakage Difficult or labored breathing before or during exercise exertion Dizziness Severe headache Chest pain Muscle weakness that affects balance Calf pain or swelling Fatigue, flushness or paleness, shakiness, dizziness, hunger, or irritability. These may be signs of low blood sugar. 22

• • • • • • • • • •

• • • • • • • •

• • • • •

Relative Contraindications to Exercise Anemia Maternal cardiac arrhythmia – The mother has an irregular heartbeat Chronic bronchitis Poorly controlled type I diabetes Extreme obesity Extreme underweight (BMI less than 12) History of an extremely sedentary lifestyle Intrauterine growth restriction – the baby is not growing properly because of insufficient nutrients or growth restriction Poorly controlled hypertension (high blood pressure) Orthopedic conditions – injuries to the joints or muscles Poorly controlled seizure disorder Poorly controlled hyperthyroidism – over activity of the thyroid gland Heavy smoker

Absolute contraindications refer to conditions that will not allow you to exercise. If you have any absolute contraindications, it is not safe to exercise during pregnancy.

It is important to tell your health care provider if you have ever been diagnosed with any of these conditions. It is up to you and your health care provider to evaluate any conditions that you may have and assess whether it is safe for you to engage in exercise during pregnancy. 22 Absolute Contraindications to Exercise • Hemodynamically significant heart disease • Restrictive lung disease • Incompetent cervix or cerclage – the cervix is weak • Multiple gestation (twins, triplets, etc.) at risk of premature labor • Persistent vaginal bleeding in the 2nd or 3rd trimester • Placenta previa after 26 weeks • Premature labor during the current pregnancy • Ruptured membranes • Preeclampsia or pregnancy-induced hypertension • Severe anemia 22

42

Exercise

Exercises for Increased Comfort Exercise during pregnancy is important because it helps ensure an easier delivery as well as a more rapid recovery; not to mention exercise can be fun! The following tips and exercises may help you maintain comfort throughout your pregnancy as well as strengthen the muscles that you will use during labor and delivery.

Pelvic Floor Exercises Pelvic floor exercises, more commonly known as Kegels, can help improve and maintain muscle tone, strength, and elasticity of the pelvic floor muscles. This exercise can also help you achieve voluntary control of these muscles, which can help in the ease of “pushing” during labor and delivery.

Increasing blood flow to the pelvic floor muscles using Kegels will also promote healing of the pelvic floor during the postpartum period. Kegel exercises will help prevent the sagging of the uterus, bladder, or bowel and will help prevent the loss of control of the urethral (which prevents leakage of urine) or anal sphincters.

The simplest way to create an awareness of your pelvic floor muscles is to act like you are stopping and starting the flow of urine. You can perform basic Kegel exercises by:

• • • • • •

Firmly contract your pelvic floor muscles by pulling the muscles upward and inward Hold this position for several seconds (5-10 seconds) Relax and then repeat this process 10 times Work up to 50 Kegels per day by repeating this series five times per day Remember to breathe normally as you do these exercises You can do Kegel exercises in any position (sitting, lying down, standing) and in any location (home, work, at the grocery store, while driving) and no one will ever know you are doing it!

Core Exercises The core muscles, especially the lower abdominal muscles, need to be strengthened during pregnancy so they can better support your growing uterus and baby. Strengthening your core muscles will also help provide adequate support to your low back, helping to prevent lower backaches. Below are some core strengthening exercises that may be beneficial to perform.

43

Exercise

Pelvic tilt: The purpose of this exercise is to strengthen and tone your low abdominal muscles, relieve back discomfort, and improve or maintain good posture. This exercise can be performed lying on your back (consult with your health care provider before you do this exercise on your back during the second or third trimesters), on your hands and knees, standing, or sitting. This is a great exercise to do repeatedly throughout the day.

• • •

• •

Lie on your back with your knees bent, feet flat on the floor You may put your hands on your pelvis and lower abdominals in order to monitor the positioning of your pelvis Tighten your abdominal muscles and tuck in your bottom, flattening the small of your back against the floor. Feel your pelvis rotate so that it moves closer to your ribs.

Relax and repeat You may also perform this exercise on your hands and knees with your arms directly below your shoulders and knees below your hips, sitting in a chair, or standing

1. Start with your pelvis in a neutral position

2. Pelvic tilt

Cat/Cow: This exercise can help strengthen the abdominal and low back muscles, can increase mobility in your hips and low back, and can increase circulation to these areas. This exercise is also beneficial for relieving pressure and tension in your low back and pelvis, may improve your digestion, and open up the pelvis and birth canal.

• • • • •

Begin on your hands and knees Relax your lower back, allowing your pelvis to tilt and your abdominals to comfortably sag Then round your lower back and contract your abdominal muscles Alternate between slowly sagging and rounding your low back several times You can repeat this exercise frequently throughout the day, and it may be relaxing to perform before bed time

44

Exercise

1. Start with your pelvis in neutral position

3. Round your back and contract your abdominal muscles

2. Allow the abdominals to comfortably sag

Modified Side Plank: This exercise is beneficial for strengthening your oblique muscles, which are located on either side of your central abdominal muscles.

Strengthening these muscles can improve the strength and stability of your entire core, which can help prevent low back pain. Strengthening your oblique muscles is also important for helping you move when your central abdominal muscles stretch out.

• • •

45

Lie on your side with your knees bent to a 90° angle Bend your elbow directly under your shoulder and place your other hand on your hip Lift your torso up until you have aligned your body and created a straight line from your head to your knees

• • •

Try holding this position for 30-60 seconds.

You may need to work up to this number.

Repeat this exercise several times.

Make sure to perform this exercise lying on your right and your left sides.

Exercise

Hip Exercises Since low back pain is a common discomfort during pregnancy, the following exercises may strengthen your hip muscles, which will help prevent further discomfort to your low back. These exercises may help strengthen your core and open up your hips and birth canal for labor and delivery. They may also help stabilize your core, back, and hips.

Bridging: This exercise will strengthen your buttock muscles, which can help support your back, prevent low back pain, and stabilize your hips.

Consult your healthcare provider if you are in the second or third trimester before performing this exercise.

• • • •

•

Lie on your back with your knees bent, feet flat on the floor Perform a pelvic tilt by tucking your pelvis Squeeze your buttock muscles Slowly raise your hips up off the floor, keeping your back straight and your abdominal muscles tight. Lift your hips as high as you comfortably can. You should try to form a straight line from your knees to your chest.

Relax and repeat several times

1. Lie on your back with your knees bent

2. Bridge

46

Exercise

Tailor Sitting: This is a simple exercise that encourages your uterus to move forward, increases circulation to your pelvis and leg muscles, and stretches your inner thighs. This is a great exercise to repeat several times a day, every day of the week.

• • •

Sit crossed-legged on the floor with your back relaxed, but not sagging Feel free to move around in this position, finding places that provide a comfortable stretch Straighten and shake out your legs periodically to avoid cramps and decreased circulation

Clamshells: This exercise helps strengthen your buttock muscles and the muscles of your hips.

• • •

• •

47

Lie on your side with your knees slightly in front of you and bent to a 90° angle Place one arm under your head and the other on your hip to monitor your pelvis for movement Tighten your buttock muscles, and then lift your top knee up and out, keeping your feet together. Do not let your pelvis rock back, keep your hips and core as stable as you can Do this exercise slowly and repeat several times Make sure to perform this exercise on both the right and left sides

1. Lie on your side

2. Clamshell

Exercise

Sidelying Hip Abduction: This exercise will help strengthen your outer hip and leg muscles.

• • •

• •

•

Lie on your side with your bottom leg bent and your top leg straightened Place one hand on the ground in front of you to help stabilize you during this exercise Tighten the muscles of your outer hip and, keeping your knee straight, lift your top leg about 1 foot off of the ground and keep your toes pointing forward. Remember do not lift your top leg too high, this exercise will provide benefits for you even if you have barely lifted your leg Lower your leg and repeat this several times – make sure to perform this exercise slowly It may be helpful to perform this exercise with your back against a wall, to make sure that your top leg does not travel behind you. Make sure your leg stays in line with your body.

Remember to perform this exercise on both your right and left sides

1. Lie on your side with your bottom leg bent and top leg extended

2. Lift your top leg off the ground

Standing Hip Abduction: You can also perform hip abduction in a standing position if that is more comfortable for you.

• • •

Hold on to a stationary object for support Tighten the muscles of your outer hip Keeping your hips level, extend one leg out to the side, keeping both knees straight.

Make sure that your leg stays in line with your body.

•

•

Bring your leg back to a standing position, then repeat this several times, making sure to perform this exercise slowly Make sure to perform this exercise with both your right and left legs

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Exercise

2. Extend your leg out to the side

1. Hold onto a stationary object for support

Figure-Four Stretch: This is a great position to stretch your buttock muscles as well as your low back. This exercise may help provide some relief to your lower back and hips.

•

• • •

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Lie on your back with your knees bent (consult with your health care provider before you do this exercise on your back during the second or third trimesters) Cross one of your legs on top of the other, placing the foot on top of your opposite knee Pull your other knee toward your chest slowly and gently until you feel a stretch in your buttock and hip muscles Hold this position for about 30 seconds or as long as it is comfortable

• •

Feel free to do this stretch as many times as you need throughout the day Make sure to perform this exercise with both the right and left legs

Exercise

Standing Hip Flexor Stretch: This exercise will stretch the front of your hips, which may help relieve some tension you may feel in your hips.

• • •

• •

Stand with one foot several inches in front of the other Place your hands on your hips With both knees slightly bent, push your pelvis forward, keeping your buttock muscles tight until you feel a stretch in the front of your hip Hold this position for a few seconds or as long as is comfortable Make sure to perform this stretch with both the right and left leg

Plié Squat: This exercise will improve the strength of your buttock muscles and also allow for greater mobility of your hips. This position can be important for preparing your body for labor and delivery. This is also a great position to practice squatting to lift objects rather than bending over to lift objects.

• • • •

•

•

Stand with your legs shoulder width apart or slightly wider Turn your toes slightly outward Slightly bend your knees and perform a pelvic tilt to support your low back Continue bending your knees and sit backwards in your hips and squat down as low as you comfortably can. Keep your heels on the ground and do not let your knees go forward beyond your toes.

To come up from this position, first come up halfway, then place the hands on the legs to push yourself the rest of the way up to a standing position – this will help relieve any pressure on your low back As you become more comfortable with this exercise, you can hold the squatting position for longer periods of time and you can perform this exercise more frequently throughout the day

1. Stand with legs apart and toes slightly outward

2. Squat as far as you can comfortably go

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Exercise

Exercise During the Postpartum Period It is important to continue engaging in a healthy lifestyle after delivery. Exercise and proper nutrition should remain important parts of your daily routine. As soon as it is medically safe after delivery, exercise can be gradually resumed. Start small and slow and gradually progress your routine, as you feel ready and as long as your health care provider has cleared you to do so.

Exercising while you are breastfeeding is perfectly fine. It will improve your fitness level and help you lose excess weight after delivery. Exercise does not affect milk production, the composition of milk, or the growth of your baby. Feed your baby before you exercise to avoid breast discomfort. 22 At the Women’s Clinic, we offer Mom and Baby Yoga classes to help you continue exercising in the postpartum period. For more information, visit https://fcwc.com/classes/

“Exercise and proper nutrition should remain important parts of your daily routine.”

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Stress Management While exercise and nutrition are important parts of your physical health, stress management is essential for your psychological health. Stress management can come in many forms and contributes to your overall health and well-being during pregnancy. This section will provide some important information and tips for coping with stress during and after pregnancy.

Stress Management

Why is Stress Management Important During Pregnancy?

Research shows that women who have relatively moderate to low levels of stress and those who effectively deal with their stress are less likely to deliver preterm and low birth weight babies.

Extremely high levels of stress should be avoided whenever possible to help ensure that your baby has the healthiest outcome. High levels of stress could result from traumatic or highly significant events in your life, or this stress could result from the cumulative effects of small stresses.

It is normal to feel stressed, especially during a life-changing event such as pregnancy.

Learning how to properly deal with stress during your pregnancy will promote your wellbeing and the optimal health of your baby. 4

“Remember that you are not alone if you experience stress and anxiety during pregnancy.�

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Common Stressors During Pregnancy Remember that you are not alone if you experience stress and anxiety during pregnancy. Women often encounter stress related to financial concerns, work, strain on personal or intimate relationships, or other daily challenges. Pregnancy can bring about other concerns such as stress about labor and delivery, the well-being of your child, hospital and health care experiences, expenses, the postpartum period, parenting, and various others. Although you may be feeling stressed, there are many ways to cope with your stress and take care of your physical and mental health. 4

Stress Management

Tips for Coping with Stress Eliminating a stressor from your life is not always possible, so it is important to choose methods or activities that best help you cope with stressors. Often, activities that you enjoy will be great stress-relievers. Try the different methods listed below and find what you like best. Some ways will work better for you than they will for others.

Here are some tips that may help you cope with stress: v Practice resilience and optimism • Resilience means maintaining a good attitude despite facing adversity or stressful events.

• Working on resilience will make it easier for you to recover from and continue functioning during stressful times in your life.

• Practice resilience by: 1. Building your relationships with family and close friends. Accept help from those people when they offer it and be honest with them when you are struggling.

2. Accept that change is part of life and be open to new experiences.

3. Develop realistic goals and make a plan to pursue them. Make one attainable goal to achieve every day that will help you work toward a larger goal.

4. Keep your stressors in perspective.

Try not to let little stressors become bigger than they are.

5. Build a positive view of yourself. Be confident in yourself and your abilities. Carrying a child is an amazing process and you should feel proud of yourself!

6. Take care of your needs. Take time when you need it and carve out time to do activities that you enjoy.

7. Be flexible. Stressors are sometimes unexpected, but take them as they come and be confident in your ability to deal with them effectively.

• •

Practicing optimism means believing that the outcomes of your pregnancy will be positive.

Sometimes just believing that you can bounce back from adverse events and being positive about the outcomes of stressful times will help you more effectively cope with stress. 4, 17

v Build your social support • In times of stress, seek support from your family and friends • Grab lunch or go shopping with a friend • Make dinner with your partner • Watch a movie and relax with your partner or friends • Encourage your partner to adopt healthy lifestyle changes with you. This will help you feel like you are not alone in this and this support may give you strength to continue being healthy.

• Find someone to confide in or seek out a support group and share your feelings of stress or anxiety with them.

• Seek support from your health care provider if you are overwhelmed and feel as though you cannot effectively cope. 4

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Stress Management v Practice mindfulness • “Mindfulness based interventions” refer to activities or methods that you can use to reduce feelings of stress, anxiety, or depression. These activities focus on centering and connecting your mind and body in a calm environment.

• Mindfulness based interventions may also improve the quality of your sleep • The most common mindfulness techniques to use are meditation and yoga. 18

Meditation What is meditation?

• •

Meditation is a practice meant to connect the mind and body It may involve deep breathing or deep relaxation

How do I perform basic meditation?

• • • •

Find a quiet place with as few distractions as possible Find a comfortable position – this could include sitting, lying down, lying in a reclining position, walking, or any other positions that are generally comfortable for you Focus your attention on something that is meaningful to you – this could be a specific word, phrase, or an object. You could also try to focus your attention on the rhythm of your breathing.

Keep an open mind and attitude – allow distractions and stressors to come and go, without letting them affect you

Why is meditation important?

•

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Meditation may help you feel more calm and relaxed, both physically and mentally 11

Yoga

Stress Management

Why is yoga beneficial?

• • • • • •

Yoga can be thought of as a combination of exercise and meditation – so it gives you an opportunity to be active and to actively improve your psychological well-being Yoga can lower your stress, feelings of anxiety, and depression Yoga can help you maintain healthy weight gain Yoga can improve labor and delivery outcomes: it may shorten the duration of the first stage of labor and you may experience less pain during labor Yoga may lower blood pressure and improve low back or pelvic pain Yoga may lower your risk of developing high blood pressure and preeclampsia

What kind of yoga should I do?

•

Yoga that involves deep breathing or deep relaxation may be more beneficial for stress reduction

Where can I do yoga?

•

The Women’s Clinic offers prenatal yoga classes that focus on breathing techniques, guided relaxation, and yoga poses that are especially beneficial during pregnancy. These classes are taught by a certified yoga instructor who specializes in prenatal yoga. Join us!

For more information, visit https://fcwc.com/classes/ 9, 18

* Talk with your health care provider if you decide you would like to do yoga during pregnancy to ensure that this is a safe activity for you.

“Yoga can lower your stress, feelings of anxiety, and depression”

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Stress Management

Postpartum Depression and Anxiety What is postpartum depression?

Postpartum depression can be defined as feelings of extreme sadness or depression, anxiety, and/or exhaustion after childbirth that may interfere with a woman’s ability to accomplish daily activities and take care of her family Postpartum depression occurs in about 20% of women after they have a baby

•

•

What causes postpartum depression?

There is no single cause of postpartum depression and it often arises because of a combination of physical and psychological factors It is important to remember that nothing you did or did not do increased your likelihood of developing postpartum depression – most of these factors are out of your control

•

•

• • • • • • • • • • • •

Feeling anxious or worrying Moodiness, irritability, or restlessness Abnormal sleeping patterns – this could be sleeping more than usual or not being able to fall asleep Trouble with concentrating, remembering details, or making decisions Experiencing anger or rage Loss of interest in activities that were once enjoyable Withdrawing from family and friends Frequent muscle aches, stomach pains, or headaches Eating more or less than usual Trouble with bonding or finding an emotional attachment with your baby Doubting your ability to properly care for your baby Thinking about harming yourself or your baby

Symptoms of postpartum depression • • •

Feelings of sadness, hopelessness, or emptiness Feeling extremely overwhelmed Crying more often than usual or for no apparent reason

What do I do if I am experiencing any of these symptoms?

•

•

•

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The most important thing to do if you are experiencing any of these symptoms is to contact your health care provider right away. They can help you distinguish between feelings that are normal and what may be symptoms of postpartum depression.

Remember that you are not alone! Many women experience symptoms of postpartum depression and this is nothing to be ashamed of.

Discuss treatment options with your health care provider. Postpartum depression is treatable and it may be managed using counseling or medication. 14

Partner Support

Partner Support Supporting your partner throughout every step of her pregnancy is a very important part of the pregnancy journey. Although you are not the one carrying the baby, you can still play a very active role in ensuring that she has the healthiest pregnancy possible, promoting the well-being of your child. Here are a few simple tips that will help you be supportive to your partner through this process.

• • • • • • • •

Encourage your partner to rest when she feels fatigued Massage her back and feet when she is feeling sore Instead of gaining “sympathy weight” with your partner, promote good nutrition by adopting a healthy diet with her Attend as many medical appointments and check-ups as possible Make dinner for or with your partner Go on a walk with her Exercise with her Attend educational classes with her. It is important that you are educated about pregnancy, labor, and delivery alongside her.

• •

• •

Indulge her cravings as long as they don’t interfere with the good nutrition that your growing baby needs Be there for her. Supporting your partner and spending time with her is one of the most important parts of this process. When she feels supported, she will feel less stressed and be more likely to adhere to a healthy lifestyle.

Remember that you are an important part of this team!

Attend one of our classes! At the Women’s Clinic, we offer several classes to prepare you and your support partner for pregnancy and beyond. For more information, visit https://fcwc.com/classes/

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Breastfeeding

Breastfeeding The Decision to Breastfeed Breastfeeding is a natural part of motherhood and making the choice to breastfeed can be beneficial for several reasons. You can make the decision to breastfeed at any point during pregnancy.

Breastfeeding can: Decrease your child’s risk of developing allergies, asthma, ear infections, obesity, type II diabetes, and childhood cancers Reduce your risk of developing breast and ovarian cancer, type II diabetes, and cardiovascular disease Be an important part of bonding with your baby

• •

•

Common Concerns When making the decision to breastfeed, women often have concerns about their ability to produce enough milk, returning to work, and their partner’s attitude toward breastfeeding.

Remember that breastfeeding is a normal part of maternal biology, but it doesn’t always come naturally to every person. It is important to educate yourself and seek family and social support when you are initiating or continuing to breastfeed.

Set Goals Make individual breastfeeding goals with your family and support partner. The Women’s Clinic supports your breastfeeding journey and we are happy to provide prenatal counseling, assistance with breast pump selection, breastfeeding education, and postpartum lactation support. We encourage you to make a

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prenatal lactation appointment and sign up for a breastfeeding class with your partner or other support person. For more information, visit https://fcwc.com/classes/

6 Tips to Prepare for Breastfeeding 1. Stay healthy. Staying healthy can minimize the risk of premature birth. Babies born before 39 weeks of pregnancy have more difficulties with breastfeeding than fullterm babies. Care for yourself and your baby by eating nutritious meals and engaging in a regular exercise routine. Try your best to manage your stress, stay hydrated, and rest when you feel fatigued.

2. Discuss breastfeeding with your partner. Partners can make a significant positive impact on the decision to breastfeed as well as the duration of breastfeeding. Take time to discuss your desire to breastfeed and how you imagine your partner supporting you, especially in the early weeks after birth.

3. Meet with a lactation consultant. The Women’s Clinic has board-certified lactation consultants on staff to assist our breastfeeding families. Prior to delivery, discuss your health history, previous breast surgeries, or specific concerns about breastfeeding with your consultant.

Schedule an appointment with a lactation consultant between the 24th and 36th week of your pregnancy so that you will have a breastfeeding plan and support ready after your baby is born. For more information about meeting with a lactation consultant at The Women’s Clinic, call (970) 493-7442 ext.

3951 or email hooverj@fcwc.com

Breastfeeding 4. Take a breastfeeding class. Women who learn how to breastfeed during pregnancy are more likely to breastfeed than those who do not. Breastfeeding classes offer the opportunity to prepare, ask questions, dispel breastfeeding myths, and understand how breastfeeding works from birth to 6 months. The Women’s Clinic offers breastfeeding classes separately or as part of childbirth classes. For more information, visit https://fcwc.com/classes/ 5. Order your breast pump. During your prenatal lactation appointment, you can discuss which pumps are covered by your health insurance. Your lactation consultant will help you choose a pump that will best

meet your needs when you return to work, school, or begin pumping milk to use in a bottle. Your 20-week paperwork includes a prescription so that you may obtain your pump via your health insurance.

6. Attend a breastfeeding support group.

Babies have instinctive breastfeeding behaviors that guide them after birth.

However, women learn to breastfeed through observing and learning from other breastfeeding people. You can attend breastfeeding support groups and begin to learn and create a strong social support network for after your baby is born. Social support has a positive impact on breastfeeding and mood in the postpartum year.

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Conclusion and Resources

Conclusions and Resources Here at The Women’s Clinic, we also offer a variety of classes for women and their support partner to feel more confident during their transition into parenthood. We offer childbirth, breastfeeding, and parenting classes. To receive more information about our classes and to sign up, visit our website here.

Below are some reliable online resources that may supplement information that you learned from this booklet:

General Pregnancy Guidelines: American College of Obstetricians and Gynecologists American College of Nurse-Midwives American Academy of Pediatrics Evidence-based practice Web MD Centers for Disease Control

Smoking Cessation: Smoke Free Families

Medication Safety in Pregnancy: Infant Risk Approved Over the Counter Medications During Pregnancy

Exercise During Pregnancy: Web MD: Pregnancy Fitness

Nutrition in Pregnancy: Food and Health

Breastfeeding: La Leche League International Breastfeeding Online Breastfeeding Basics Baby Center

Multiples: Multiples of America

Why take Childbirth Preparation Classes?

NCBI Childbirth Education

What’s the Best Class for Us? American Pregnancy

Pertussis Vaccination Information: CDC Vaccines

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Conclusion and Resources

We hope that this guide has provided you with some tools and helpful information to assist you in adopting healthy lifestyle changes throughout your pregnancy. Thank you for choosing the Women’s Clinic of Northern Colorado and the University of Colorado Health System Hospitals for the birth of your baby. Congratulations on your pregnancy!

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References 1. Barker, D JP. “The Developmental Origins of Adult Disease.” Journal of the American College of Nutrition, vol. 23, no. sup6, 2004, pp. 588S–595S., doi:zx10.1080/07315724.2004.10719428.

2. Blaize, A Nicole, et al. “Impact of Maternal Exercise during Pregnancy on Offspring Chronic Disease Susceptibility.” Exercise and Sport Sciences Reviews, vol. 43, no. 4, Oct. 2015, pp. 198–203., doi:10.1249/JES.0000000000000058.

3. “Checklist of Foods to Avoid During Pregnancy.” FoodSafety.gov, U.S. Department of Health and Human Services, 28 Jan. 2010, www.foodsafety.gov/risk/pregnant/chklist_pregnancy.html.

4. Dunkel Schetter, Christine. “Psychological Science on Pregnancy: Stress Processes, Biopsychosocial Models, and Emerging Research Issues.” Annual Review of Psychology, vol. 62, 2011, pp. 531–558., doi:10.1146/annurev.psych.031809.130727.

5. “Eating Right during Pregnancy.” MedlinePlus Medical Encyclopedia, US National Library of Medicine , 7 Feb. 2018, medlineplus.gov/ency/patientinstructions/000584.htm.

6. Gregg, Vanessa H, and James E Ferguson II. “Exercise in Pregnancy.” Clinics in Sports Medicine, vol. 36, 2017, pp. 741–752., doi:10.1016/j.csm.2017.05.005.

7. Ho, Alison, et al. “Nutrition in Pregnancy.” Obstetrics, Gynaecology and Reproductive Medicine, vol. 26, no. 9, 2016, pp. 259–264.

8. “Hypoglycemia.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 16 Feb. 2018, www.mayoclinic.org/diseases-conditions/hypoglycemia/symptomscauses/syc-20373685.

9. Jiang, Qinxian, et al. “Effects of Yoga Intervention during Pregnancy: A Review for Current Status.” American Journal of Perinatology, vol. 32, no. 06, 2014, pp.

503–514., doi:10.1055/s-0034-1396701.

10. Jeffrey, R L, et al. In Preparation: A Guide for Expecting Parents. The Women’s Clinic of Northern Colorado, 2006.

11. “Meditation: In Depth.” National Center for Complementary and Integrative Health, U.S. Department of Health and Human Services, 7 Sept. 2017, nccih.nih.gov/health/meditation/overview.htm.

12. “Miscarriage Symptoms, Causes & Treatment.” Cleveland Clinic, Cleveland Clinic, 2017, my.clevelandclinic.org/health/diseases/9688-miscarriage.

13. “Placenta Previa.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 17 May 2017, www.mayoclinic.org/diseases-conditions/placentaprevia/symptoms-causes/syc-20352768.

14. “Postpartum Depression Facts.” National Institute of Mental Health, U.S. Department of Health and Human Services, www.nimh.nih.gov/health/publications/postpartumdepression-facts/index.shtml.

15. Prather, Heidi, et al. “Benefits of Exercise During Pregnancy.” American Academy of Physical Medicine & Rehabilitation , vol. 4, no. 11, 2012, pp. 845–850., doi:10.1016/j.pmrj.2012.07.012.

16. “Preeclampsia.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 21 Apr. 2017, www.mayoclinic.org/diseases-conditions/preeclampsia/symptomscauses/syc-20355745.

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17. “The Road to Resilience.” American Psychological Association, American Psychological Association, 2018, www.apa.org/helpcenter/road-resilience.aspx.

18. Shi, Zhenrong, and Angus Macbeth. “The Effectiveness of Mindfulness-Based Interventions on Maternal Perinatal Mental Health Outcomes: a Systematic Review.” Mindfulness, vol. 8, no. 4, Aug. 2017, pp. 823–847., doi:10.1007/s12671-016-0673-y.

19. “Stages of Pregnancy.” Womenshealth.gov, US Department of Health and Human Services, 20 Dec. 2017, www.womenshealth.gov/pregnancy/youre-pregnant-nowwhat/stages-pregnancy.

20. UCHealth. Drug and Alcohol Use during Pregnancy. Drug and Alcohol Use during Pregnancy, UCHealth, 2016.

21. “Women's Health Care Physicians.” Nutrition During Pregnancy - ACOG, American College of Obstetricians and Gynecologists, Feb. 2018, www.acog.org/Patients/FAQs/Nutrition-During-Pregnancy#and.

22. “Women's Health Care Physicians.” Physical Activity and Exercise During Pregnancy and the Postpartum Period, American Congress of Obstetricians and Gynecologists, Dec. 2015, www.acog.org/Resources-And Publications/CommitteeOpinions/Committee-on-Obstetric-Practice/PhysicalActivity-and-Exercise-During-Pregnancy-and-the-Postpartum-Period.

23. “Women's Health Care Physicians.” Prenatal Development: How Your Baby Grows During Pregnancy - ACOG, American College of Obstetricians and Gynecologists, June 2015, www.acog.org/Patients/FAQs/Prenatal-DevelopmentHow-Your-Baby-Grows-During-Pregnancy.

24. “Your Pregnancy Week-by-Week.” Johns Hopkins Medicine, Johns Hopkins All Children's Hospital, 2018, www.hopkinsallchildrens.org/community/fit4allmoms/yourpregnancy-week-by- week.

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