We had the chance to chat with one of our featured speakers, Lauren Hammer, MS, APRN-BC, Women’s Care Florida to learn more about pregnancy, labor and delivery.
How can I increase my chances of getting pregnancy?
Get your body baby ready! Being underweight or overweight can affect ovulation – causing irregular cycles, missed periods and no ovulation at all.
Know your BMI! If you are overweight, you are more likely to be “high-risk” and at increased risk for miscarriage, gestational diabetes and issues with high blood pressure which could lead to Preeclampsia. Eating healthy and exercising daily will help you have a healthier pregnancy (ideal BMI is considered 18.5-25).
Age does play a factor. Although many couples have babies into their 40s, delayed childbearing can decrease the probability of successful conception. Women in their late 30s are approximately 40 percent less fertile than those in their early 20s. Paternal age may also play a role, especially over the age of 50. So, take this into account in family planning, especially if you desire lots of babies!
Get a Preconception Check-Up. Visit your ob-gyn or midwife to discuss any health issues you may have, review any medications you are on, get up to date with immunizations, get tested for STDs and start a prenatal vitamin with adequate folic acid and DHA for prevention of neuro tube defects and benefit baby’s brain health.
If you smoke, you need to quit! Use of tobacco by the female AND possibly the male partner appears to be associated with subfertility. Good news is that studies suggest fertility is improved when smoking is stopped.
Skip Happy Hour! Moderate and heavy drinkers tend to take longer to achieve pregnancy. When it’s time to start trying to conceive, I recommend avoiding all alcohol as there is NO known safe level of prenatal alcohol consumption and could put a developing baby at risk.
Don’t stress and have fun! Daily and timed intercourse can be stressful. Instead, have intercourse two to three times per week from soon after you have stopped your period through the day of ovulation which ensures that semen quality is optimal during the most fertile period – typically two days before you ovulate and on the day of ovulation.
Skip the expensive ovulation test kits! You can predict the time of ovulation by tracking changes in your cervical mucous. Ovulation produces slippery clear mucus that enhances sperm motility. Also, many Apps on your phone do a very good job of tracking your cycles and predict when you may ovulate. For couples with irregular cycles or those who have intercourse less often, an inexpensive home ovulation test kit may decrease the time to conception.
Choose the right lubrication! Some lubricants have been found to inhibit sperm mobility including KY Jelly, Astroglide, Touch, Replens, Olive Oil and saliva to name a few. Lubricants that do not inhibit sperm motility include Pre-Seed, Mineral oil and canola oil if lubrication is needed.
What should I look for when choosing my ob-gyn?
Is your ob-gyn covered by your insurance? Start with checking for providers available through your insurance plan to minimize any out-of-pocket expenses. For many women, expenses are their number one concern and this may help narrow the search for a provider.
Determining whether you are at risk for complications during a pregnancy is important and may determine where you deliver your baby, thus narrowing down who is available to take care of you. For instance, if you have a medical history of diabetes, high blood pressure, obesity, heart problems or a history of a previous high-risk pregnancy like a low birth weight baby, preeclampsia or preterm birth, you may need to deliver at a hospital who specializes in caring for the high-risk mother. If your baby may need extra help at delivery, the hospital should have a neonatal intensive care unit. These factors may play a part in who cares for you prenatally and if they have access to a high-risk Labor and Delivery and NICU.
Decide on what qualities are the most important to you when choosing an ob-gyn. Do you prefer a female or male provider? Do you desire an intimate setting with a smaller group of ob-gyn providers, or a group with multiple offices and convenient services like on-site lab draws and ultrasound? Find out if they have convenient office hours or offer weekend appointments that will fit your schedule. Lastly, check their track record for their rate of primary cesarean sections and if they offer trial of labor after cesarean section.
How often should the baby kick?
Fetal movement is quite subjective early in pregnancy and varies depending on the time of day and gestational age. From 22-36 weeks on average, many moms perceive 10 movements within 25 minutes and from 37 weeks and beyond, 10 movements within 35 minutes.
Frequency of baby’s movements increases from morning to night with peak activity late at night. Transient decreases in baby’s movements can be due to fetal sleep states that can last up to 40 minutes, mom’s medications and smoking.
Sometimes moms perceive that baby is moving less depending on baby’s position, placental position (anterior placenta), early gestational age, sitting versus standing positions, too much or too little amniotic fluid or just being distracted. If you are ever concerned that your baby is not moving, call your provider ASAP.
As you get closer to term, you may be asked to perform “fetal kick counts” where you monitor baby’s movements once per day. We would expect baby to move at least 10 movements over 1 hour, (some providers say over 2 hours) while you are focused on counting with your hands on your belly.
How will I know if I’m in Labor?
You are in labor when your uterus contracts regularly to thin and dilate the cervix. “Real labor” contractions may be irregular at first but become regular, every 3-5 minutes apart, lasting 60 seconds. Labor contractions progressively get longer, stronger and closer together.
Another sign that you are truly in labor is that contraction frequency and intensity do not change much with position changes. For example, contractions typically get stronger when you walk and are in upright positions, but in “false labor” contractions may ease-up when you walk or even stop when you lie down or rest.
So labor has started, when do I go to labor and delivery? Remember 5-1-1: Contractions getting longer and stronger, every 5 minutes, lasting 1 full minute for 1 full hour. Of course, if you break your water, that is your golden ticket to L&D. Just call your provider on your way to the hospital.
How can my partner help me during pregnancy?
Patience, patience and more patience! From early pregnancy morning sickness (more like all-day nausea and vomiting), to fluctuating hormones, to lack of sleep and frequent trips to the bathroom, pregnancy wreaks havoc on the female’s body!
To help understand all the changes related to pregnancy, read books on pregnancy along with your partner to understand the “magic” that is happening and what to expect as the weeks go by, at times painstakingly slow. 40 weeks is term, yes, that is 10, not 9 months!
Attend prenatal appointments with your partner when you can. On average, prenatal visits occur every 4 weeks until 28 weeks, then visits increase to every 2 weeks until 36 weeks, then every week until she delivers.
Be a doer and not a burden! Try and reduce her stress as pregnancy can truly take a toll both physically and emotionally. For example, you can take over many of her chores and cooking. Give extra back and foot rubs. Tell her she is beautiful. Run a warm bath. Start stocking the freezer: grill extra meats and freeze what is left over for easy meal prep once the baby arrives. Most importantly, remind her how much you love her.
What food should I avoid during pregnancy?
Raw meat or seafood and high mercury fish – sorry sushi lovers, you need to avoid uncooked seafood and shellfish, beef or poultry due to risk of bacterial contamination. Fish with high levels of mercury include swordfish, mackerel, shark and tilefish. For other fish, limit consumption to twice weekly.
Unpasteurized milk and soft cheeses – these may contain listeria which can lead to miscarriage.
Trans fat and saturated fat – avoid the “bad fats” that are found in fast/processed food, baked goods, bacon, creamers and the like. These fats can inhibit the development of the baby’s brain and other organs.
Sugar-sweetened drinks – such as sodas, teas, juices, fruit drinks, energy drinks and sports drinks should be limited as they have no nutritional value and add unnecessary calories and weight gain.
Caffeine – small amount of caffeine, 2 small cups of coffee (less than 200mg per day) is usually okay. Anything more can increase heart rate, dehydration and irritability and is not recommended.
Can I work out during my pregnancy? Yes, exercise is recommended every day as long as you have an uncomplicated pregnancy. Exercises such as walking, jogging, yoga, swimming and even weight training are fine. Avoid exercises that have a high risk of falls or trauma to your belly like horseback riding, karate, kickboxing, etc. Also, avoid lying flat on your back after 20 weeks and be careful to avoid twisting exercises that could injure a knee. Stay well hydrated and rest frequently.
What are my pain management options during labor? There are many options to help you manage the discomforts of labor. Most importantly, keep an open mind and remember that every woman and every pregnancy is different! What you may have planned during the pregnancy to provide pain relief in labor may change depending on many factors once you are actually in labor. It’s a personal choice and we support whatever you choose!
Unmedicated Birth – This type of labor and birth is achieved without pain medication. Many women choose this and preparation is key. If you are planning on having this type of birth, consider a doula – a professional childbirth support person. Take childbirth classes like a labor prep, Lamaze or a Hypno-birth course. Practice deep relaxation and breathing techniques daily while listening to your favorite play list and creating affirmations for birth can be helpful. Practice, practice, practice!
Epidural – This is by far the most popular form of pain management in labor. This is anesthesia that is administered by an anesthetist who places a thin catheter in your back once you are in active labor. Medication is administered through this tube and often times, you can control how much is being given to you through a button you push to give you an extra boost of medication if needed. This relieves much of the pain, but often allows you to perceive pressure to push effectively. The tube is removed after you deliver and the effects of the medication wear off within 2 hours.
IV pain mediation – This is usually a type of narcotic that is given every 2-4 hours through the IV as needed to take the edge off the contraction pain. It can make you and the baby sleepy and is not given if delivery is near.
Nitrous Oxide – Yes, also known as “laughing gas” is a great, patient controlled pain management option where you place the mask over your nose and mouth just before and during a contraction and inhale the nitrous deeply. This allows temporary relief from contraction pain. It wears off as soon as the mask is removed and the effects are minimal to the baby.
Local Anesthesia – This is a small, local injection of medicine to numb the skin if stitches are needed. Lidocaine is usually the medication used and feels like a small bee sting for just a few seconds before it goes to work to numb the area.
What are Braxton Hicks? Braxton Hicks uterine contractions are named after an English doctor John Braxton Hicks in the 1800s. He identified them as pre-labor contractions that are mild, short-lived and do not dilate the cervix. They can occur anytime throughout the pregnancy, are unpredictable, infrequent, non-rhythmic and do not increase in intensity or frequency like labor or preterm labor contractions.
Am I allowed to take medications during pregnancy? Is anything off limits?
Many medications, both prescription and over the counter are safe during pregnancy.
The rule about taking any medications during pregnancy is simple, ask your doctor, NP or Midwife first. Typically at your first OB visit, you will receive a list of medications that are safe in pregnancy. If it approved and safe in pregnancy, follow the labels for dosage and follow directions.
Resources for evidence-based information about medications and other exposures during pregnancy and breastfeeding can be found at www.mothertobaby.org(866-626-6847 or text 855-999-3525), Reprotox (202-293-5137), Teratogenic Information System (206-543-2465).
Just as many meds are safe during pregnancy, many are not. Some are okay after the first trimester and beyond and some cannot be taken during the last trimester. This can be confusing, so again, check with your provider. Several are absolutely off limits during pregnancy including Accutane, Retin-A, Tetracyclines, Thalidomide, Fluoroquinolones and more.