This document about Pregnancy and Labor and Delivery of a baby was written by Darren Salinger, M.D., OB/GYN with answers to questions frequently asked by patents during his more than 20 years of practice.
What to expect during Pregnancy
The changes that take place during the short span of human pregnancy are profound.
Many of these changes occur soon after fertilization and continue throughout the entire pregnancy. Most of these incredible adaptations are in response to the growing fetus and the hormonal changes the fetus produces in its mother.
Changes…Start at 4-5 Weeks of Pregnancy
Most people will notice subtle changes as early as four to five weeks of pregnancy.
The first changes to be noticed are:
- Breast tenderness (sometimes with nipple discharge);
- Heightened sense of smell (your favorite food or perfume may be intolerable);
- Nausea with or without vomiting (this is called morning sickness, but often this problem can occur throughout the day);
- Increased frequency of headaches;
- Increased frequency of heartburn; and
- Pelvic cramping or tenderness.
Usually these conditions go away spontaneously at around 14 to 16 weeks of pregnancy.
Q. Should I listen to what my friends and family say about my pregnancy?
Most pregnant people are given more information than they care to hear from family and friends during the entire course of the pregnancy.
Many statements often told are not true and only serve to heighten anxiety and stress.
Just because a family member has a bad story about a complication does not mean that it is going to happen to you.
Each Pregnancy Is Individual
Each pregnancy is individual. Even if you have had a problem during a previous pregnancy, that does not necessarily mean it will happen again.
Q. Is it common to get sick during Pregnancy?
During pregnancy, people get common colds, flus and are more prone to:
- Body aches and pains
What to do about Constipation During Pregnancy
- Drink more water.
- For constipation during pregnancy, most over-the-counter remedies are safe to use.
Examples of products that can be used for constipation during pregnancy are:
Hemorrhoids During Pregnancy
Hemorrhoidal problems are very common during pregnancy. A person’s entire venous circulation changes in the pregnant state.
The large uterus can compress veins which return blood from the legs and rectum, promoting swelling and increasing risk factors for hemorrhoids.
Also labor and delivery of a baby generates tremendous stress on existing hemorrhoids or can cause hemorrhoids to occur.
It is best to manage hemorrhoids before labor and delivery and make sure to take care after you have your baby.
What to do about Hemorrhoids During Pregnancy
When you are vertical (standing or sitting), the pressure on your hemorrhoids increases; and they tend to swell more. Periods of rest — sitting and lying down — can be beneficial if possible.
Consider a “Gamer Chair” during pregnancy
Use of a “gamer” chair — which is designed to tilt the sitter back and allows sitting individuals to put their feet up — can give you chances to take periods of rest lying down and can be very beneficial if you are suffering with hemorrhoids.
Use a Buttpillow® to take pressure off hemorrhoids
Use of an ergonomic cushion that elevates the peri-anal area, such as the Buttpillow®-Prego or Buttpillow®-Executive, can be very beneficial to minimize external pressure on your peri-anal area or hemorrhoids.
Q. Am I eating for two during Pregnancy?
One of the most common statements heard is the need to eat for two. This is not true.
During early pregnancy, many people find it difficult to eat or want to eat certain foods like salad or fruit.
There is no problem with light eating habits during pregnancy; and it is also okay if you lose a few pounds in the first trimester.
Pre-Pregnancy Nutritional Status is Important
The important factor for maternal and fetal wellbeing is pre-pregnancy nutritional status.
The way you ensure that your body is prepared for pregnancy is to eat a well-balanced diet and take a multivitamin with folic acid.
Heartburn During Pregnancy
Large Fatty Meals Cause Heartburn
In addition, eating larger meals — especially if the meal contains a lot of fat, such as fried foods — may cause terrible heartburn and even pressure in the chest. This happens because the hormones of pregnancy make the stomach empty its contents slower.
To help prevent this heartburn problem, eat more frequent smaller meals; and limit the amount of fatty foods and milk products.
What to do about Heartburn During Pregnancy
Heartburn is very common during pregnancy.
Most over-the-counter medications are safe for heartburn relief.
Tums is a tablet antacid and is a good first choice.
If tablet antacids are not strong enough, liquid antacids are recommended such as Mylanta and Maalox.
Don’t Take Heartburn Medicine Containing Aspirin During Pregnancy
It is important to note that some heartburn medications contain aspirin, which is not recommended during pregnancy.
Two common medications that contain aspirin and should NOT be taken during pregnancy are Pepto-Bismol and Alka-Seltzer.
Body Aches During Pregnancy
Back Pain During Pregnancy
Most people will experience some degree of low back pain during pregnancy. Back pain usually starts after the fifth month and can be mild with minimal lifestyle changes needed to relieve the pain (exercise, decreased work hours, physical therapy).
Q. What causes back pain during pregnancy?
Back pain is caused by the heavy uterus pulling the spine forward increasing the normal lumbar curve of the spine, called lumbar lordosis.
Other causes of back pain during pregnancy include:
- Kidney stones,
- Kidney infections, and
- Muscle strain from activity.
Q. Can I do anything to prevent back pain during pregnancy?
The best way to prevent back pain is to begin strengthening and stretching the back muscles early in pregnancy and even prior to pregnancy.
Q. Is bed rest or normal activity better for back pain during pregnancy?
Once back pain begins, most people feel like they should rest and lie down in bed. While this can help in the short term, it has been shown that maintenance of normal daily activities and back exercises can keep the back muscles more limber than bed rest and inactivity.
Potential Relief and Prevention of Pain During Pregnancy
The following may help relieve and prevent pain during pregnancy:
- Heating pads;
- Warm baths; and
- Massage therapy;
- Cushion to elevate the peri-anal area for individuals suffering with hemorrhoids;
- Cushion or chair to tilt the pregnant person back to help maintain the natural curve of the lumbar curve, especially during the third trimester;
- Shoes to minimize back pain during pregnancy.
Cushion to Restore Natural Lumbar Curve – Lumbar Lordosis
It is beneficial to sit on a chair that can tilt the pelvis slightly backwards to decrease the extra curvature of the lumbar spine that occurs during pregnancy. The increased lumbar curve commonly occurs during the third trimester of pregnancy.
A cushion with a rear-ward tilt, such as the Buttpillow®-Prego (4 degree rearward tilt) or the Buttpillow®- Executive (2 degree rearward tilt) can be used to help maintain normal lumbar lordosis while sitting.
Shoes to Wear to Minimize Back Pain During Pregnancy
While standing during pregnancy, wearing shoes with a small heel can also help relieve and prevent back pain by changing a person’s center of gravity slightly.
Some people will find shoes with small heels more comfortable than sneakers.
Pelvic Pain During Pregnancy
Pelvic pain and cramping are two other common conditions during pregnancy. The uterus places rapidly increasing weight on the bones and ligaments of the pelvis. There are also parts of the pelvis that stretch to accommodate the growing fetus which can cause pain.
Tilting the pelvis slightly backwards (while seated or while laying down) may help relieve this pain by cradling the uterus and changing the weight distribution of the uterus.
Q. Should I tilt my bed backwards to minimize pelvic pain during pregnancy?
Some experts recommend placing blocks or objects, such as wood or books, under the feet of the bed to tilt the head of the bed down a little bit to relieve pelvic pressure and pain during pregnancy.
Food Additives During Pregnancy
There is much discussion about many food additives and their safety during pregnancy. A common additive is artificial sugar.
These products with artificial sugar have been theorized to cause birth defects but medical literature has never proven this relationship. Use these products in moderation.
Do Not Diet During Pregnancy
Pregnancy is not the time to begin a diet. A good approach to this topic is to drink plenty of water instead of diet sodas.
Treat yourself with a regular soda or a beverage sweetened with real sugar as a treat. The key is to make water your main drink and make everything else a treat.
There are people who do not tolerate water, so drink sugar-free and caffeine-free beverages instead.
Q. What about caffeine during Pregnancy?
There is some theoretical risk of birth defects with caffeine. It has been shown that coffee, sodas and other foods and drinks with caffeine in moderation present little risk. As a general rule, during pregnancy do not drink more than two caffeinated beverages a day.
Take a Multivitamin Before and During Pregnancy
Sometimes people are told to avoid all medications during pregnancy. A prenatal multivitamin is a good idea especially during the first 12 weeks (1st trimester) and also for at least three months before pregnancy.
Medications during Pregnancy
Medications to Avoid
The main group of medications to avoid while pregnant is aspirin and other aspirin-like products such as:
- Ibuprofen (avoid during pregnancy);
- Motrin (avoid during pregnancy);
- Aleve (avoid during pregnancy).
Medications that are safe in Pregnancy
It is safe to use acetaminophen (Tylenol), regular or extra-strength, two pills every six hours with a maximum of eight pills in a 24 hour period.
Sudafed is safe for Nasal or Sinus Congestion. Most cough medications are safe in pregnancy, such as:
- Robitussin DM and
- Vicks 44.
Labor and Delivery — What to Expect
Tips on Pushing While Delivering a Baby
These are tips for pushing to effect a natural delivery. Sometimes even after a long time of pushing, a person may need a cesarean delivery.
Two ways to deliver a baby:
- A natural delivery, or
- Cesarean section.
Tips on how to push while delivering a baby:
There are a few steps to remember to make pushing more effective, which means less time in labour.
- Have confidence that you can do this.
- Positive thinking is important.
- Your body knows what it needs to do.
Three steps for pushing when a contraction begins:
- First, take a deep breath like you are going under water. This step gives you power.
- Second, hold your breath and curl up around your baby while lying on your back with your head at a comfortable elevation.
This means bring your chin forward to your chest and bring your knees back toward your chest. Note: This is when people (at the hospital where you are delivering) may help hold the bottoms of your feet.
- Third, bear down like a bowel movement.
To repeat these three steps while pushing:
- Take a deep breath and hold it.
- Curl up.
- Push down.
Counting and pushing during a contraction:
Some people like a slow steady count while pushing, such as when doing exercise. A steady push for three sets of counting from 1 to 10 is a common practice. Another method is to have someone time 10 seconds and let the person pushing down know when the time is up.
Some other considerations while pushing:
- Rest your shoulders;
- Rest your face;
- Try not to push with your legs;
- Try not to waste energy by hyperventilating, extra motion, extra sounds
Dealing with your support people while pushing:
Keep in mind people may say words such as:
- “Harder” or
- “Faster” or
- “Give more effort.”
Slow and steady pushing is best:
Don’t get frustrated. Keep your focus.
You do not need to push harder, or faster, or more.
Slow, steady, controlled pushing is the way to go.
Fear and Anxiety – push past the point of fear
There comes a time when people worry that if they continue pushing, they may hurt themselves.
Please remember this is what the body is made to do.
When you get to the time when this sensation is felt, push past the point of fear; and have confidence that you will not hurt yourself.
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