IN THIS CHAPTER
Coping with changes in mind and body
Modifying your lifestyle for baby’s sake
Working while you’re pregnant
Even though you’re pregnant and your body is already undergoing miraculous changes, your day-to-day life goes on. How will you need to change your lifestyle to make your pregnancy go as smoothly as possible? What things in your life don’t need to change or need to be modified only slightly? You have a lot to consider: your job, the general level of stress in your life, and what to do about routine things like going to the dentist or hairdresser (among other things!). If you’re like most normally healthy women, you’ll probably find that for the most part, your life can go on largely as usual.
In this chapter, you find a general outline for how to plan your life during pregnancy, but all the issues covered are subjects for discussion with your practitioner. If you consider from the beginning how your daily habits and health practices interact with your pregnancy, you’re likely to have an easier time getting used to your new state of being.
Bracing for Emotional Changes
When you’re pregnant, you know you’re probably going to experience mood swings. Watch enough TV comedies featuring pregnant characters, and you’d begin to believe that every pregnant woman must become a raving lunatic at some point in her pregnancy. This section lets you know what you may be in for, without the laugh track. And because one of the most common worries pregnant women have is whether stress is harmful to either the pregnancy or their growing child, this section covers that, too.
Coping with mood swings
You’ve probably had mood swings before — just not with such intensity. Hormonal shifts affect mood, as most women — especially those who suffer from premenstrual syndrome (PMS) — already know. The hormonal fluctuations that support pregnancy are perhaps the most dramatic a woman experiences in her lifetime, so it’s hardly surprising that emotional ups and downs are commonplace. And the fatigue that goes along with pregnancy can easily make these ups and downs more severe. Add to this biochemical mix the normal anxieties that the average expectant mother has about whether the baby will be healthy and whether she’ll be a good mother, and you have plenty of fuel to produce good old-fashioned mood swings.
Your moodiness may be especially pronounced during the first trimester because your body is adjusting to its new condition. You may find yourself overreacting to little things: A mushy television commercial may leave you in tears; a careless grocery store clerk who smashes your bread may send you into a teeth-clenching rage. Don’t worry — you’re just pregnant. Take a few deep breaths, go out for a walk, or just close your eyes and take a short break. These feelings often pass as quickly as they arise.
If you feel that your mood swings are interfering with your daily life or if you have thoughts of harming yourself or someone else, let your healthcare provider know as soon as possible, or call 911 if you feel that it’s an emergency.
Experiencing stress
Many women wonder whether stress has any effect on pregnancy. That question is difficult to answer because stress is such an elusive concept. Everyone knows what stress is, but each woman seems to handle it in her own way, and no one can really measure its intensity. Chronic stress — unrelieved day after day — can increase the levels of stress hormones circulating in the bloodstream, and many doctors think that such elevated levels of stress hormones can promote preterm labor or blood pressure problems during pregnancy, but few studies have been able to prove this idea.
HELPING YOUR PARTNER COPE WITH EARLY SYMPTOMS
Early pregnancy brings extreme fatigue, the overwhelming desire to take a nap, food cravings, food aversions, nausea, vomiting, and a constant need to urinate — not to mention hormonal changes that cause pendulum-like mood swings, from crying to euphoria almost before you can ask what’s wrong.
Knowing the symptoms ahead of time helps you keep your cool when all around you seems to be falling to pieces. Following are some things you can do to help your partner through these first topsy-turvy months of pregnancy:
· Accept her limitations. Maybe you went out to eat several times a week and now the sight of restaurants makes her sick. Hang in there. By the second trimester, she’ll be eating everything in sight, and the Szechuan restaurant will still be there.
· Don’t take emotional outbursts seriously. Not letting her outbursts get to you is hard when they’re pointed at you and all your shortcomings, but listen to what she says, accept what may actually be true, and disregard the rest. Don’t forget to fix any shortcomings you can, though.
· Help her. Shoulder some of her chores, especially the ones that make her nauseated, such as cooking, garbage patrol, dishing out the dog food, and cleaning toilets. Remember that handling cat litter is strictly verboten for pregnant women, so that’s your job, too.
· Let her rest. Although sitting at home all weekend watching her take two naps a day may not seem like a whole lot of fun, use this time to get projects done around the house or catch up on your parenthood reading.
· Plan pit stops. If you’re the type of driver who doesn’t stop the car unless the road abruptly ends before you reach your destination, realize that pregnant women really do have to pee every five minutes; she’s not making up an excuse to go into the gas station shop for a frozen custard. Also, because blood volume increases during pregnancy, blood clots can develop if she doesn’t move her legs regularly. Let the woman get out of the car every few hours!
· Satisfy her cravings. Not that many pregnant women really want pickles and ice cream, but if your partner does, get some for her. Try not to gag as you watch her eat them; you may have to leave the room yourself.
Prepping for Physical Changes
When you’re pregnant, your body is undergoing a transformation. Pregnancy is a time of joy and excitement, but it can also be a time of some unpleasant and quite possibly embarrassing side effects. You may wonder at times what exactly has taken over inside your body. For example, you can go from feeling so nauseous you can’t even stand the smell of food one minute to feeling a burst of energy and a ferocious appetite the next. You may also pass gas, get stopped up, and be so tired you feel like a truck ran over you. But don’t worry; this, too, shall pass.
Morning, noon, or nighttime sickness
If you’re feeling a bit nauseous, you’re not alone! The majority of pregnant women experience nausea and vomiting at some point in their pregnancy, typically beginning in the first month of pregnancy and ending around 14 to 16 weeks (though some women do experience it longer). Nausea and vomiting may be due to low blood sugar and hormone fluctuations that occur in early pregnancy.
Even though pregnancy-induced nausea is called morning sickness, it can happen at any time of the day. A completely empty stomach contributes to feelings of nausea, so many women do feel it more in the morning. But nausea can strike at any time, even after you’re all ready for bed. To make matters worse, just the sight or smell of food can send a woman running to the bathroom to lose her lunch (or breakfast … or dinner). The good news is that nausea and occasional vomiting is not harmful to you or your baby.
No one likes to feel sick to her stomach. When you’re pregnant, you’re even more concerned because you’re now growing another life inside you. If you’re throwing up daily or several times a day, how is that affecting your ability to provide nutrients to your baby? Believe it or not, your baby doesn’t suffer from your occasional or even daily vomiting. Your body has reserves of nutrients and energy that the baby can use to grow and develop if food is unavailable in the short term. If you experience vomiting on a regular basis, try to stay hydrated and well-nourished when you’re feeling good. Doing so can help build up your fluid and nutrient stores.
The main risk of vomiting is dehydration. Mild dehydration can lead to fatigue and headaches, and severe dehydration can cause an imbalance in electrolytes, including sodium and potassium, which can be serious. To prevent either scenario from happening, sip on sports drinks to replenish sodium, potassium, and fluids. If sports drinks don’t appeal to you, simply drink water and eat salted crackers or pretzels and fresh, frozen, or dried fruit. And if your nausea is strong enough to interfere with your daily life, talk to your doctor about certain nausea-reducing medications that are safe to use during pregnancy.
Dealing with nausea
Feeling sick to your stomach is one of the worst feelings. Sometimes you wish you could throw up just to feel better, even if the relief is only temporary. If you’re experiencing even mild nausea, try these tips (which are in order of effectiveness) to feel better fast:
· Go bland early. Eat something bland (like plain toast or soda crackers) within 15 minutes of getting up in the morning. You may even want to have them on your bedside table to munch on before you get out of bed.
· Avoid having a completely empty stomach at any time of the day. When your stomach is empty, the acids in your stomach signal nauseous feelings to your brain. Keep snacks handy so you don’t find yourself hungry without something to munch on.
· Eat small portions. Just as you don’t want an empty stomach, you don’t want to get too full either. Limit portions at meals to only small amounts of food and follow those small meals with frequent snacks so you don’t get hungry.
· Eat foods that are low in fat and sugar. Avoid greasy, creamy, or high-sugar items. Fat takes a long time to digest, and sugar can cause a spike and subsequent drop in energy levels.
· Stay hydrated. Nausea can be a side effect of dehydration during pregnancy. To avoid becoming dehydrated, suck on ice chips or sip cold water to count toward your recommended 102 ounces of fluid per day. Why cold water? Not only is it refreshing, but it can also help decrease nauseous feelings and keep you hydrated after you vomit. (For additional tips on staying hydrated, flip to Book 3, Chapter 2.)
· Keep cool. Getting too warm or overheated can make nausea even worse! Keep cool in comfortable, loose-fitting clothing that doesn’t press on your stomach (stomach pressure can increase feelings of nausea).
· Relax and rest up. Get plenty of rest at night and nap throughout the day as needed and when possible. Sometimes sleep is the best escape from feeling nauseous because your body is worn down and needs the recovery.
· Take your vitamins at night. Prenatal vitamins have iron, which can aggravate nausea, but if you take yours at night, you may not experience any. Remember to have a small snack with the vitamin so you aren’t taking it on an empty stomach.
· Suck on lemon drops or sour candy. Sour foods can stimulate digestion, starting with saliva in the mouth and moving into the stomach.
The preceding tips are some of the standard ways of relieving nausea, but some women swear by less mainstream tactics, such as the following:
· Using ginger: People have used ginger to combat nausea for centuries. Scientists aren’t certain how it works, but it has something to do with the unique compounds found in ginger and their effect on the stomach. Look for lowfat gingersnap cookies, ginger tea, or ginger gum.
· Smelling lemon scents or eating lemon-flavored foods: Lemon is a refreshing scent, and many women report feeling less nauseous when eating, drinking, or even smelling lemon. Some companies have special lollipops, lemon drops, and gum just for pregnant women. But plain old lemon drops can do the trick without the premium price tag.
· Undergoing hypnosis or acupressure: These techniques can be beneficial for severe nausea in some women. Hypnosis works by training the unconscious mind to suppress the involuntary feelings of nausea. Acupressure has been used in traditional Chinese medicine to relieve nausea, and acupressure bands for the P6 pressure point on the wrist work for many pregnant women.
Food smells are often the worst offenders for setting off nausea. Ask someone to help you with food preparation if just smelling food prevents you from eating. Use fans and open windows in the house to get strong smells out as soon as possible. Also, stick with cold foods because they don’t have as much aroma as warm foods.
Determining when medical intervention is necessary
For a few women, vomiting becomes so excessive that it can harm them or their babies. This condition is called hyperemesis gravidarum. Typically, hyperemesis gravidarum is characterized by severe nausea, vomiting, weight loss of more than 5 percent, and evidence of dehydration. See Table 4-1 to recognize the difference between morning sickness and serious illness.
Table 4-1 Distinguishing between Morning Sickness and Serious Illness
|
Morning Sickness |
Serious Illness |
|
Your nausea goes away after 14–16 weeks. |
Your nausea doesn’t go away. |
|
Your nausea leads to occasional vomiting. |
Your nausea leads to severe vomiting (several times per day). |
|
Your vomiting doesn’t cause dehydration. |
Your vomiting causes severe dehydration. |
|
Your vomiting still allows you to keep some food down. |
Your vomiting doesn’t allow you to keep food down. |
|
Your nausea and vomiting are annoying. |
Your nausea and vomiting disrupt your life. |
|
You don’t experience any significant weight loss. |
You experience weight loss of more than 5% of your body weight. |
|
Nausea and some vomiting are your only symptoms. |
Dizziness, weakness, and fatigue accompany your vomiting. |
Treatment for severe nausea and vomiting can be as simple as taking antinausea medications prescribed by your doctor, getting enough fluids, and resting. If your symptoms become severe enough, you may have to be treated with intravenous fluids and electrolytes. Some serious cases require hospital stays and bed rest. When in doubt, call your doctor for advice on how to deal with your nausea and vomiting.
Even though some vomiting is normal during the first 14 weeks or so of pregnancy, other symptoms that sometimes accompany vomiting are not. Call your doctor or visit your local emergency room for immediate assistance if you
· Have a fever, diarrhea, and/or severe abdominal pain
· Experience prolonged vomiting and are also weak, dizzy, or faint
· Can’t keep liquids down for more than 24 hours
Dealing with your newly unruly digestive tract
As you may have already discovered for yourself, pregnant women are known to have problems with their digestive tracts. You can pretty much blame all your digestive tract woes on hormones — specifically progesterone and estrogen.
· Progesterone is one of the most important pregnancy hormones. Some of the side effects of increased levels of progesterone include water retention, sluggish digestion, and nausea. The result of these side effects is feeling bloated, gassy, and constipated.
· Estrogen is to blame for your expanding uterus, which, as the pregnancy goes on, also causes pressure on the digestive tract. This pressure can lead to heartburn and constipation.
Avoiding heartburn with the help of some nutrition tricks
Heartburn, or gastroesophageal reflux disease (GERD), is quite common during pregnancy and can happen at any time throughout your 40 weeks, although it often gets worse in the second and third trimesters.
Heartburn has two causes, and both are related to the sphincter muscle that connects the esophagus to your stomach. The progesterone your body produces relaxes that sphincter muscle, and your growing uterus presses on it. The result is that gastric acids, liquids, and food from the stomach travel back up your esophagus, leaving you uncomfortable. Heartburn typically worsens as your belly grows and puts more pressure on your stomach, causing the sphincter muscle to allow acid back into the esophagus (see Figure 4-1).
Illustration by Kathryn Born, MA
FIGURE 4-1: Your baby’s position in the uterus can lead to increased feelings of heartburn.
You can lessen the symptoms of heartburn by trying the following tips:
· Stop eating two to three hours before lying down for bedtime or a nap. The less you have in your stomach, the less likely you are to experience acid reflux.
· Sleep propped up to avoid lying flat. By elevating your upper body, gravity helps keep your stomach acids down. (If you’re past your first trimester, you shouldn’t lie flat, anyway, to avoid cutting off circulation to your baby and your legs. Lie on your left side for optimal circulation.)
· Practice good posture when sitting. When you slouch, you put more pressure on your esophagus, which can lead to heartburn.
· Avoid big meals. Eat small portions so that you don’t overfill the stomach and cause extra food to come back up the esophagus.
· Sip liquids with meals instead of drinking large amounts. Because you want to avoid having large amounts in your stomach at one time, drink small amounts at meals and stay hydrated by spreading your liquids out between meals.
· Avoid greasy or fatty foods. High-fat foods, specifically fried foods, tend to trigger heartburn because they don’t stimulate digestion but do take longer to digest (because they just sit in your stomach).
· Skip spicy and acidic foods. Acidic foods, like tomatoes, citrus, and peppers, can be problematic for many women. Onions and garlic are also on some women’s problem-foods list.
· Avoid caffeinated and carbonated beverages. These drinks have been known to cause acid reflux. Sorry to say, but chocolate can also irritate the esophagus, so you may want to avoid it, too.
· Take an antacid when you’re uncomfortable. Talk to your doctor about which one to choose or about a safe prescription medication if over-the-counter antacids don’t work for you.
Reducing gas with an antibloating diet
Burping and passing gas are two of the worst unmentionables of pregnancy. Who knew such an innocent-looking pregnant woman could produce so much gas? Again, you can blame this unpleasant side effect of pregnancy on the hormones.
Those fun pregnancy hormones combined with certain foods can cause your body to produce more gas, so you may want to adjust your lifestyle to avoid producing even more. Limit your consumption of the following if you find that they cause more gas:
· Cruciferous vegetables, such as broccoli, cauliflower, cabbage, Brussels sprouts, and bok choy
· Legumes and beans, such as pinto, kidney, black, cannellini, and garbanzo beans; black-eyed peas; and lentils
· Onions and garlic
· Soy and soy-containing foods
· Sugar-free items that contain sugar alcohols (avoid foods that have maltitol, xylitol, sorbitol, mannitol, and isomalt on the label)
· Inulin (a type of fiber added to many processed food products)
· Whole grains, nuts, and seeds
As you can see, most of these common gas-producing foods are good for you, so you still need to be able to enjoy them. To do so while reducing gas production, eat small portions of these (and really all) foods and spread out portions throughout the day. Also, eat slowly so you don’t swallow large amounts of air, and chew with your mouth closed.
One favorite gas-reducing trick is to take Beano, an over-the-counter supplement that contains an enzyme that helps you digest certain parts of carbohydrate-containing foods that cause gas. The trick is to take Beano at the start of the meal, not after you finish. To prevent gas from forming, the enzyme needs to be present in the stomach while you’re eating gas-inducing food. Beano is considered to be safe for pregnant women because it’s isolated to the digestive tract.
Preventing pregnancy constipation
The digestive tract becomes sluggish during pregnancy, causing the body to eliminate waste at a slower rate, which, in turn, can lead to constipation. If you’re anxious about your pregnancy, you don’t exercise at all, or you don’t eat healthy, high-fiber foods, pregnancy constipation can become a lot worse. Iron supplements or the iron found in prenatal vitamins may also be to blame for some of your constipation.
About half of women experience constipation during pregnancy, but you can definitely do something about it! Follow these tips to keep things moving in your body:
· Drink, drink, and drink more water. Stool needs water to keep it moving through the digestive tract.
· Eat lots of fiber. Choose whole grains, beans, and plenty of fruits and vegetables.
· Move your body to move your bowels. Exercise, even a low-key activity like yoga, has been shown to stimulate your digestive tract. Stay active throughout all phases of pregnancy. (Flip to Book 4 for some exercises that are safe to do while you’re pregnant.)
· Spread out your iron supplement throughout the day. Your prenatal pill has a high iron level, so cut it in half and take half in the morning and half in the evening. Your doctor may also be able to recommend an iron supplement that’s easier on the stomach.
· Consider taking over-the-counter fiber supplements or a stool softener. Turn to over-the-counter items only as a last resort, and talk to your doctor about which one is best for you before making a purchase.
· Get “good” bacteria from probiotics. Your digestive tract is full of bacteria, and some of the bacteria (commonly called probiotics) help support immune and digestive health. You can get probiotics by eating yogurt, drinking kefir (a type of fermented milk), or taking a probiotic supplement. Unlike stool softeners that you may take only as needed, probiotics are good to have on a daily basis.
Don’t take a laxative to relieve constipation, because doing so can cause uterine contractions and may also leave you dehydrated. Also, avoid taking mineral oils (which are natural laxatives), because they may inhibit absorption of some important nutrients during pregnancy.
Dealing with hemorrhoids
Hemorrhoids are essentially dilated, swollen veins in the rectum. The best way to prevent hemorrhoids is to avoid becoming constipated. Read through the recommendations in the preceding section to discover how to avoid constipation. If you find yourself with hard stools that don’t pass easily, don’t strain yourself trying to get them out. Simply drink lots of fluid and boost the fiber in your diet to 28 grams per day. Go for a walk to get things moving naturally, and avoid sitting for a long time, which puts additional pressure on the rectal area.
Nutritionally speaking, you can also prevent or deal with hemorrhoids by following the dietary guidelines for reducing swollen veins. Basically, these guidelines include the following:
· Limit the sodium in your diet to less than 2,300 milligrams per day.
· Avoid processed foods and high-salt condiments, like pickles, salad dressing, and soy sauce.
· Avoid adding salt to your food.
Hemorrhoids can bleed and be quite painful. If you have hemorrhoids already, take a warm bath with baking soda in the water to help soothe pain, reduce itching, and assist in healing. Witch hazel also helps reduce the swelling.
Visit your doctor if hemorrhoids become a concern. If you’re losing a lot of blood or if it’s too painful to have a bowel movement, you may need medical help.
Steering clear of urinary tract infections
Pregnancy puts you at an increased risk for another pesky problem: urinary tract infections (UTIs). In case you don’t remember anatomy and physiology from school, your urinary tract includes your kidneys, bladder, and the tubes that connect them.
During pregnancy, your kidneys work overtime to get rid of all your waste products and produce more urine. However, your bladder may not fully empty because your uterus is constantly pressing on it, leaving room for bacteria to multiply and grow until you have a full-blown UTI.
To reduce your chances of developing a UTI, follow these tips:
· Drink plenty of water to flush out the kidneys.
· Drink cranberry juice, especially if you’re prone to kidney infections.
· Eat fruits, vegetables, and whole grains to get plenty of antioxidants to boost your immune system.
· Eat yogurt, drink kefir, and look for other products with added probiotics (or take a probiotic supplement) to increase good bacteria in the urinary tract.
· Avoid caffeinated beverages, which act as a diuretic.
· Wear cotton underwear and avoid tight-fitting pants.
· Wipe front to back when using the bathroom to prevent bacteria from entering the urethra.
· Urinate when you first feel the need to do so instead of trying to hold it.
· Urinate before and after having intercourse.
UTIs are easy to treat with antibiotics that are safe during pregnancy, so don’t despair if you have any of the symptoms in the following list. Instead, call your doctor:
· Blood or mucus in the urine
· Pain or burning when urinating
· Feelings of urgency to urinate
· Fever or chills
· Urine that looks cloudy or has an unusual odor
· Pain or tenderness in the bladder
An untreated UTI is more likely to develop into a kidney infection in pregnant women. So if you have back pain, nausea, vomiting, fever, and chills, don’t wait to report these symptoms, all of which can signal a kidney infection.
Fighting fatigue
If you’re feeling unusually tired, you’re not alone. Most women don’t just feel a little bit tired when pregnant; they feel exhausted. It makes sense that in the third trimester, you’d be tired from the extra weight you’re carrying, but what could possibly make you feel so tired in the first trimester? Hormones! Between the surge of hormones and the increase in your blood supply, your body is going through a lot of changes. Your breasts and uterus are growing, and your baby is already getting a lot of your energy. The resulting fatigue is also your body’s way of telling you to slow down and get plenty of rest.
The good news is that the second trimester is well-known for bursts of energy. Many women find themselves cleaning and organizing in preparation of the baby’s arrival, even though their bodies are still working overtime. The third trimester brings some fatigue again, but this time it’s mostly because of your larger size. (Chapters 1, 2, and 3 in Book 2 take you on a full-blown road trip through the trimesters.)
Don’t listen to those well-intentioned people who say, “If you think you’re tired now, just wait until the baby comes!” Your fatigue right now comes from the physical drain on your body, and you need to take it seriously so that you take care of yourself properly. Follow these tips to beat fatigue:
· Take a nap when you need it. Even resting for 20 minutes without sleeping can make a world of difference.
· Ask for help. Don’t be a superwoman and try to do everything yourself. Ask your partner, friends, and family for assistance. Don’t be afraid to delegate!
· Move your body regularly. Exercise regularly (unless your doctor has told you not to). Women who exercise tend to have more energy and sleep better at night. See Book 4, Chapters 2 and 3 for recommendations on safe ways to get moving.
· Take your prenatal vitamin to ensure that you’re getting enough iron. Fatigue is a major symptom of iron deficiency because iron plays a role in transporting oxygen to the cells.
The most powerful ways to combat fatigue involve eating (specifically, paying attention to how and what you eat) and sleeping (as in getting the amount of sleep your body really needs). The following sections delve into the details of these two fatigue-fighting activities.
Eating for energy
What you eat and, even more important, when you eat it can make a big difference in your energy levels throughout the day. Changing just a few simple things in how you eat can help boost your energy levels.
· Eating small amounts: Eating small amounts rather than large meals has so many benefits in pregnancy. You can reduce your risk of getting heartburn, prevent excess weight gain, improve sleep, and decrease feelings of nausea, just to name a few. But the biggest benefit may be in the fact that you simply feel more energetic to face your day.
Eating large quantities can make you feel sleepy and lethargic, preventing you from having enough energy for you and your developing baby.
· Eating frequently throughout the day: When you eat smaller meals, you naturally have to eat more often, which really just means you get to enjoy some yummy snacks. Snacks act like a bridge between meals, preventing you from getting too hungry and making poor food choices. When the snacks you choose are also nutritious, you provide you and your baby with more nutrients to properly fuel your activities and your baby’s growth.
· Eating foods that provide lasting energy: Certain foods give your body sustained energy throughout the day, but some foods can cause a crash in energy. Avoid foods that are high in simple sugars and refined carbohydrates, like cookies and other sweets, many crackers, and regular soft drinks. Instead, choose foods that contain whole grains. Whole grains have more complex carbohydrates that take your body longer to digest than simple sugars, resulting in more lasting energy.
For lasting energy in a meal or snack, combine foods rich in complex carbohydrates with protein-rich foods. Aim to include protein, such as a piece of meat, poultry, fish, dairy, eggs, or a vegetarian alternative, at every meal. Protein keeps you feeling full for a longer period of time and prevents blood sugar from rising too quickly, which would lead to the inevitable crash of energy when it drops back down. Look for snacks that have either protein or fiber in them to prevent this type of energy crash at snack time.
Getting the sleep you need
Adults need between seven and nine hours of sleep per night, but you may find that your body needs more sleep while you’re pregnant. Plus, poor sleep can affect your labor when you’re ready to deliver. Some studies suggest that women who get six hours of sleep or less have longer labors and increased risk of C-section deliveries.
Many pregnant women face a variety of problems, like frequent urination, heartburn, and restless leg syndrome (RLS), that cause significant disruption to their sleep and therefore increase feelings of fatigue. (RLS causes discomfort in the legs when you’re lying down. You relieve the discomfort by moving your legs. To help minimize RLS, exercise regularly and be sure to stretch after exercise. Also, get checked for iron deficiency because it can sometimes contribute to RLS.)
Follow these tips to get a more restful night’s sleep:
· Drink liquids during the day and limit your intake three to four hours before bedtime. Limiting liquids later in the day may help cut down on the number of trips to the bathroom you need to make in the middle of the night.
· Develop a good bedtime routine. Take a warm bath, relax with a book, and dim the lights. Get the TV, computer, and phone out of your bedroom. Use the bedroom for sleep and sex only.
· Go to bed at approximately the same time each night. If possible, don’t set an alarm; allow your body to naturally wake up when you feel you’ve gotten the sleep you need.
· Sleep on your left side, especially after the first trimester. Use a body pillow or just a small pillow in between your knees or under your belly to get more comfortable.
· Sleep with your head elevated to keep stomach acids down, and avoid eating two to three hours prior to bedtime. Doing so helps minimize the possibility of heartburn.
Pregnant women, particularly those who are overweight at conception, may develop sleep apnea, a disorder in which breathing is repeatedly disrupted during sleep. Untreated sleep apnea is a serious medical condition and increases risk of gestational diabetes, preeclampsia, and having a low-birthweight baby. If your partner notices that you snore much louder or seem to have long pauses between breaths while asleep, alert your doctor.
AVOIDING BALLOON-LIKE FEET AND HANDS
Swelling happens because of the increase in fluid in your body. It can also lead to varicose veins and spider veins as your uterus puts pressure on the veins that send blood back up to your heart from your legs, feet, face, and hands. If you’re prone to swelling, follow these tips:
· Prop up your feet whenever you can.
· Limit your salt/sodium intake.
· Drink plenty of water and avoid alcohol.
· Avoid standing or sitting for too long. Take breaks if you have a job that requires you to sit or stand a lot.
· Sleep on your side and elevate your legs with pillows.
· Swim laps or join a water aerobics class to take the pressure off your legs. Or just enjoy being weightless while floating in the water.
· Wear medical-grade compression stockings. Get advice from your doctor on the right ones for you.
Remember: Call your doctor if swelling is severe or comes on suddenly. Dramatic or sudden swelling could be a sign of one of the more serious medical conditions.
Living through leg cramps
Leg cramps are a common annoyance of pregnancy, and they’re likely to become more frequent as the months go along. They’re due to a sudden tightening of the muscles. The muscles may tighten for many reasons, including lack of fluids, muscle strain, or staying in one position for too long. Doctors once thought that leg cramps were due to too little calcium or potassium in the diet, although that hasn’t been shown to be true. Some studies suggest that taking an oral magnesium supplement may reduce leg cramps.
To diminish leg cramps, try these suggestions:
· Apply heat to your calves.
· Drink plenty of fluids.
· Avoid staying in one position too long.
· Stretch and extend your legs and feet.
· Take a short walk.
· Ask your partner to give you a foot or leg massage.
Do your stretching nightly before bed. Point your toes up toward the ceiling to really stretch your calves out. Do this about ten times. In the morning, get in the habit of doing this stretching at least a couple of times, before you even open your eyes, if possible. To avoid triggering a spasm, try to avoid extending your feet when you first wake up.
Noticing vaginal discharge
During pregnancy, your vaginal discharge normally increases substantially. Some women find that they need to wear pantyliners every day. The discharge, which tends to be thin, white, and virtually odorless, is technically known as leucorrhea. Vaginal douches aren’t a good idea because they may alter your natural ability to fight off vaginal infections.
Pregnancy doesn’t prevent you from getting a vaginal infection, and the high levels of estrogen in your blood may predispose you to developing a yeast infection. A yeast infection usually produces a thick, white-yellow discharge, and it may cause itchiness or redness. Topical vaginal creams should solve the problem, and they pose no risk to the fetus. Most over-the-counter preparations come in 1-, 3-, and 7-day dosages and are completely safe for the baby. For hard-to-beat yeast infections, talk with your doctor about oral fluconazole, which may be used safely in pregnancy.
If your vaginal discharge takes on a brown, yellow, or green color, or if it develops a noxious odor or causes itching, let your practitioner know. (Be sure to use your judgment about how much of an emergency this is — it isn’t the sort of problem that requires a 3:00 a.m. phone call to her office.)
Putting up with backaches
Backaches, a common symptom during pregnancy, typically occur in the latter part of pregnancy, although they can occur earlier. The shift in your center of gravity can be one cause. Another can be the change in the curvature of your spine as the baby grows and the uterus enlarges. You may get some relief by getting off your feet when you can, applying mild local heat, and taking acetaminophen (Tylenol).
Some women experience pain extending from their lower back to their buttocks and down one leg or the other. This pain or, less commonly, numbness is known as sciatica, which is due to pressure on the sciatic nerve, a major nerve that branches from your back, through your pelvis, to your hips, and down your legs. You can relieve mild cases of sciatica with bed rest, warm baths, or heating pads. If you develop a severe case, you may need prolonged bed rest or special exercises.
Occasionally, preterm labor can present itself as low back pain. However, when it’s preterm labor, the pain is more cramp-like, and it comes and goes instead of being continuous.
Looking at Lifestyle Changes
Your lifestyle inevitably changes during your pregnancy. You may wonder whether it’s still okay to do some of the things you may have done on a regular basis before you were pregnant. This section provides information on activities such as whether you can safely color your hair while you’re pregnant, whether you can use saunas and hot tubs, and whether you can travel.
Pampering yourself with beauty treatments
When your friends and relatives hear that you’re pregnant, they’ll probably tell you how beautiful you look or what a lovely maternal glow you have. And you may feel more beautiful, too, although some women feel the exact opposite. You may find that you’re not happy with the physical changes that are happening to your body. Either way, you may wonder whether your customary beauty habits are safe to follow during pregnancy. This list goes over them one by one and shares possible risks:
· Massages: Massages are fine, and you’ll find that many massage therapists offer special pregnancy massages aimed at accommodating your pregnant belly. Some use special tables with the center cut out so that you can comfortably lie face-down, especially in the latter part of the pregnancy.
· Manicures and pedicures: A frequently asked question is “Can I have a manicure/pedicure or have nail tips or acrylic nails placed while I’m pregnant?” The answer is yes. Common sense suggests that you go to a reputable salon where the equipment is properly cleaned and the area is well-ventilated.
· Hair dyes: Many different types of chemicals are used in hair dyes, and manufacturers typically change their formulas frequently. Limited data is available on the safety of hair dye, because these chemicals are not usually studied during pregnancy. However, remember that only a fraction of any hair treatment chemicals get absorbed into a woman’s body through her skin, and this small amount is probably not enough to cause a problem for the developing baby. In addition, there’s absolutely no evidence that suggests that hair dyes cause birth defects or miscarriage. Semi-permanent dyes or highlights are even less controversial. With highlights, foil surrounds the strands of hair coated with the formula, so even less absorption through the skin occurs. Because of the limited hardcore scientific data available, your practitioner may tell you to stick to vegetable hair dyes during pregnancy, while your friend’s practitioner may tell her that dyeing her hair is fine.
· Permanents: No scientific evidence suggests that the chemicals in hair permanents are harmful to the developing baby. These preparations usually do contain significant amounts of ammonia, however, so for your own safety, use them in well-ventilated areas.
· Standard chemical straightening treatments: Several standard chemical treatments are available to women who want to have silky-straight locks. Such standard treatments usually include chemicals such as sodium hydroxide (lye), calcium hydroxide and guanidine carbonate (no lye), or thioglycolic acid salts (thio). Although the data is limited, it seems to show that these treatments are generally safe in pregnancy. One study showed no increase of preterm birth or low birth weight but did not look at risks of birth defects. Therefore, it may be best to use after the first trimester.
· Brazilian hair treatments: Brazilian or Brazilian keratin treatments are a popular method for straightening and smoothing the hair. Most of these treatments contain a chemical called formaldehyde, which can be absorbed through the skin or by breathing it in. Formaldehyde was used many years ago in hair dyes and was found to be carcinogenic (causing childhood cancers). Therefore, embrace your curls and avoid these products, or stick to blow-drying or flat irons for that super-straight look in pregnancy.
· Thermal reconditioning: Thermal reconditioning, also known as the Japanese straightening technique, is a fairly new method to permanently straighten hair. The process involves applying a variety of chemicals and conditioners to the hair and then using a flat iron to permanently straighten it. No scientific research has studied this technique in pregnancy. Some of the chemicals used are similar to those used for perming hair. The bottom line: Thermal reconditioning is likely okay during pregnancy, but no definitive data is available. If you want to play it as safe as possible, consider avoiding this treatment.
· Waxing: Waxing legs or the bikini line involves applying a heated wax preparation topically and then removing it along with the hair. Nothing in the wax preparations can lead to problems for the baby. So if you like, keep waxing away while you’re pregnant to help you remain carefree and hair-free.
· Laser hair removal: The laser used for hair removal works by transmitting heat to the hair follicle and stopping hair regrowth. Often, anesthetic creams are applied to the skin first to reduce pain. This therapy, which is applied locally, should not cause any problem to the baby.
· Facials: You may notice that your complexion has changed over the past few months. Sometimes pregnancy hormones can wreak havoc on your skin. Facials may or may not help. But go ahead and have one anyway, if only to enjoy the time to sit back and relax!
· Chemical peels: Alpha-hydroxy acids are the main ingredients in chemical peels. The chemicals work topically, but small amounts are absorbed into your system. Chemical peels are probably okay, but first discuss it with your practitioner.
· Wrinkle creams: The two most common antiwrinkle creams used today are Retin-A and Renova. Both of these preparations contain vitamin A derivatives. Substantial data suggests that oral medications containing vitamin A derivatives (for example, Accutane) can cause birth defects, but the information that’s available on topical preparations such as Retin-A and Renova doesn’t indicate a problem. Due to the significant effects of oral preparations, however, many practitioners discourage the use of any medications containing these compounds, oral or topical, to their patients.
· Botox: The safety of Botox therapy during pregnancy and breastfeeding is controversial, and the data, limited. In one study involving 16 pregnant women injected mostly in the first trimester, there were no reported birth defects. One patient suffered a miscarriage, although she’d had a miscarriage in a prior pregnancy. A few other studies with small numbers showed no untoward effects. To be on the safe side, consider enjoying the beauty from your pregnancy glow while you’re pregnant and wait until after you deliver for the Botox. If, however, there is a medical indication for Botox (severe migraines, severe cervical dystonia), it may be a reasonable option. Talk to your practitioner about it.
· Injectable fillers: Injectable skin fillers are used to smooth wrinkles and make lips fuller. Often they’re made with collagen or hyaluronic acid. No good data currently exists documenting the safety of fillers during pregnancy, so they’re probably best avoided until safety data is available. The good news is that the fluid retention of pregnancy may lessen the wrinkles anyway!
Relaxing in hot tubs, whirlpools, saunas, or steam rooms
A lot of women ask about just taking a nice, relaxing warm bath. In general, soaking in a warm, soothing bath is fine during pregnancy. Just make sure that the water temperature isn’t too high.
Using hot tubs, whirlpools, saunas, or steam rooms when you’re pregnant can be risky because of the high temperatures involved. In laboratory animals, exposure to high levels of heat during pregnancy has been known to cause birth defects or miscarriage. Studies involving humans suggest that pregnant women whose core body temperatures rise significantly during the early weeks of pregnancy may stand an increased risk of miscarriage or having babies with neural tube defects (spina bifida, for example). However, problems typically occur only if the mother’s core temperature rises above 102 degrees Fahrenheit (or about 39 degrees Celsius) for more than ten minutes during the first seven weeks of her pregnancy.
Common sense suggests that after the first trimester, occasionally using hot tubs, saunas, and steam rooms for less than ten minutes is probably okay. However, remember to drink plenty of fluids to avoid dehydration.
Traveling
The main potential problem with traveling during pregnancy is that it puts distance between you and your prenatal care provider. If you’re close to your due date or if your pregnancy is considered high-risk, you probably shouldn’t travel far from home. Your decision to travel, though, depends on what the risk factors actually are. If you have diabetes but it’s well controlled, going on a trip is probably okay. But if you’re pregnant with triplets, traveling to Timbuktu probably isn’t a good idea. If your pregnancy is uncomplicated, traveling during the first, second, and early third trimesters is usually fine.
Traveling by car poses no special risk, aside from requiring that you sit in one place for a long time. On long trips, stop every couple of hours to get out and walk around a bit. Wear your seat belt and shoulder strap; they keep you safe, and they won’t hurt the baby, even if you’re in an accident. The amniotic fluid surrounding the fetus serves as a cushion against any constriction from the lap belt. Not wearing restraints clearly poses a greater risk; studies show that the leading cause of fetal death in auto accidents is death of the mother.
Wear your seat belt below your abdomen, not above it, and keep the shoulder strap in its usual position.
Most airlines allow women to fly if they’re less than 36 weeks pregnant, but you may want to carry a note from your practitioner indicating that she sees no medical reason why you shouldn’t fly. Flying is perfectly safe, especially if you take a couple of precautions:
· Get up from your seat occasionally during longer flights and walk around the plane. Prolonged periods of sitting can cause blood to pool in your legs. Walking around keeps your circulation going.
· Carry a water bottle with you and drink water frequently. Airplane air is always very dry, and you can easily become dehydrated during long flights. In addition to keeping you hydrated, drinking extra water ensures that you get up frequently to go to the restroom, which keeps the blood from pooling in your legs.
You don’t need to worry about airport metal detectors — or any other metal detectors — because they don’t use ionizing radiation.
If you’re prone to air sickness and have found Dramamine helpful in the past, using it in normal doses while you’re pregnant is okay.
If you plan to visit tropical countries, where some diseases are particularly prevalent, you may want to be vaccinated before you go. But check with your doctor to see whether any vaccines you’re considering are safe to have during pregnancy. (For more information on vaccines, see Book 1, Chapter 2.)
Getting dental care
Pregnancy itself shouldn’t affect your dental health. You don’t want to avoid the dentist, because neglected cavities can become infected, which is all the more reason to see your dentist when you’re pregnant. Some recent studies have shown that pregnant women who suffer from periodontal disease, which is infection and inflammation of the gums, are at a higher risk for delivering small or premature babies. This finding is one more reason for making good oral hygiene a priority.
Pregnancy causes an increase in blood flow to the gums. In fact, about half of all pregnant women develop a condition called pregnancy gingivitis, which is simply a reddening of the gums caused by this increased blood flow. In this condition, gums have a tendency to bleed easily, so try to be gentle when you brush and floss your teeth.
For those of you who want whiter and brighter teeth, plenty of products are available, including whitening toothpastes and over-the-counter gels, strips, whitening systems, and trays. Although most are frequently used during pregnancy, no large studies document the safety of such treatments. Whitening toothpastes help remove surface stains without using bleach. There’s no reason to think they’re a problem.
Over-the-counter whitening strips, gels, and whitening systems are peroxide-based and haven’t been specifically studied in pregnancy. However, the safety of peroxide can be inferred from other studies. In one such study, pregnant rats were fed up to 10 percent hydrogen peroxide in their diets, and no problems were detected in their offspring. Similarly, when peroxide was tested as a component in hair dyes, it wasn’t found to cause birth defects. With in-office bleaching, the technician applies the whitening product to the teeth and uses heat and/or a laser to quicken the process. Many dentists don’t perform these procedures on pregnant women because they haven’t been well-studied. On the bright side, seeing your dentist for cleaning not only promotes good hygiene but also removes surface stains and leaves you with a brighter smile.
If you need routine dental work — cavities filled, teeth pulled, crowns placed — don’t worry. Local anesthesia and most pain medications are safe to use during pregnancy. Some dentists also recommend antibiotics during dental procedures, most of which are also safe during pregnancy, but you should check with your prenatal care provider to make sure. Even dental X-rays pose no significant problem for the fetus, as long as a lead apron or shield is placed over the abdomen.
Having sex
For most couples, having sex during pregnancy is perfectly safe. In fact, some couples find that sex during pregnancy is even better than before. However, you may have some issues to consider.
In the first half of pregnancy, sex can usually continue as before because your body hasn’t changed that noticeably. You may notice that your breasts are particularly sensitive to the touch or even tender. Later, as the uterus grows, some sexual positions become more difficult. You and your partner may find that you have to be a little creative to make things work. If you find that intercourse is too uncomfortable, other forms of sexual gratification may work better for you and your partner.
Many women ask us whether having sex at the end of pregnancy is okay, even if the cervix is a little bit dilated. Having sex then is perfectly fine as long as your membranes haven’t ruptured (your water hasn’t broken).
Avoid intercourse if you’re at a high risk for preterm labor (for example, you’ve been treated for preterm labor or have a cerclage in place), if you have placenta previa (see Book 6, Chapter 2) in the third trimester, or if you’ve had recent bleeding. Most practitioners suggest refraining from intercourse in these situations because intercourse has the potential to introduce an infection into the uterus, and semen contains substances that are known to make the uterus contract.
Another important aspect to consider is how each of you feels psychologically about having sex during pregnancy. Your libido or sex drive may increase. Often, you may find that you have vivid sexual dreams and that orgasm itself is heightened. On the other hand, you may find that your interest in sex is less than it was before you got pregnant. You may feel less attractive because of the physical changes that have taken place, which is perfectly normal. Your partner may also experience changes in his desire for sex because of the excitement and normal apprehension that go along with being a father and due to (unfounded) fears that intercourse will hurt the baby or that the baby will somehow know what Mom and Dad are up to.
Working during Pregnancy: A Different Type of Labor
Over the last half-century, the number of women who work outside the home has steadily increased. More than 75 percent of pregnant women work during the third trimester, and more than half work until within a few weeks of delivery. Many women find that working until the end of pregnancy keeps them happy and occupied and helps them not to focus on the discomforts. In addition, many women don’t have a choice; they may be the main income providers for their families, and their careers are high priority. Although most of the time, working throughout pregnancy doesn’t cause any problems for the baby, there can be some exceptions.
Stress in pregnancy, whether related to work or to home situations, isn’t well-studied. Some doctors believe that very high levels of stress may increase the risk of developing preeclampsia or preterm labor, although no study has confirmed this risk (both of these conditions are discussed in Book 6, Chapter 2). Unusual stress may increase your risk of postpartum depression. Too much stress obviously isn’t good for anyone. Do whatever you can to decrease the stress in your life, and talk with your practitioner if you find you’re becoming persistently blue or anxious.
Considering occupational hazards
Most jobs fall somewhere in between sedentary and demanding, but even then the amount of stress varies according to the individual. If your pregnancy proceeds without complications, you probably can continue to work right up until delivery. However, some complications that may arise during pregnancy may make reducing your workload or stopping work altogether advisable. For example, if you develop preterm labor, your practitioner will most likely advise you to stop working. Other conditions that may warrant a reduction in physical activity are hypertension or problems with the baby’s growth.
If you work at a computer terminal, you may wonder whether you’re being exposed to anything harmful. But you have no need to worry — no evidence suggests that the electromagnetic fields that computer terminals emit are a problem.
Occupations that are physically demanding can be problematic. Some studies suggest that women who have jobs associated with physically demanding responsibilities, such as heavy lifting, manual labor, or significant physical exertion, may be at a slightly higher risk of preterm birth, high blood pressure, preeclampsia, or small-for-gestational-age babies. On the other hand, long working hours haven’t been found to increase the chances for premature delivery. Other studies have also shown that jobs in which prolonged standing is required (more than eight hours a day) were associated with a greater chance for back and foot pain, circulatory problems, and a slightly increased risk of preterm birth. The good news: The use of support hose, although not particularly attractive, is helpful in decreasing varicose veins.
Some women believe that if they complain about certain symptoms or take time out from a busy schedule to eat or go to the restroom, they’ll garner the disapproval of their superiors at work. Don’t let yourself feel guilty about your special needs during this time, and don’t let work cause you to ignore any unusual symptoms. If you need time off to deal with complications, take it, and don’t feel bad about it. Remember that your health and your baby’s health are the highest priority.
Understanding pregnancy and the law
Take the time to understand your rights as they pertain to pregnancy. In the United States, the Pregnancy Discrimination Act, an amendment to Title VII of the Civil Rights Act of 1964, requires pregnant women to be treated in a manner equal to all employees or applicants. According to this act, employers can’t refuse to hire a woman because of her pregnancy-related condition, as long as she’s capable of performing the job’s major functions.
If an employee is temporarily unable to carry out her job due to the pregnancy, the employer must treat her the same as any other temporarily disabled employee, taking such actions as providing alternative tasks, disability leave, or leave without pay. A disability may arise due to the pregnancy itself, such as significant nausea and vomiting. A disability may also occur due to complications of pregnancy, such as bleeding, preterm labor, or high blood pressure, or it may occur due to hazardous job exposures. If your healthcare provider decides that your pregnancy is disabling, you can ask that she send a letter to your employer, verifying your disability.
In the U.S., most maternity leaves are from 6 to 8 weeks. You’re entitled to a 12-week leave in a one-year period under the Family and Medical Leave Act, although this may not be a paid leave.
Health insurance should cover expenses for pregnancy-related conditions in a way that’s similar to its coverage of other medical conditions, as long as obstetric services are covered. Health insurers are prohibited by law from considering pregnancy a preexisting condition, which means you cannot be denied coverage when you go from one job to another and switch health plans.