ZIKA VIRUS and PREGNANCY

Zika Virus: Answers for Pregnant Women

What is Zika virus?

Zika is a virus that’s been around for actually dozens of years; it generally causes a mild viral syndrome and is prevalent in the Tropics—South America, the Caribbean islands, and Pacific islands.

Zika virus is a mosquito-borne illness.  Most people who are infected with Zika virus have no symptoms. If they have symptoms, they are usually very mild such as fever, rash, red eyes, muscle pain or joint pain. People usually do not get sick enough to be hospitalized and they very rarely die.

Is there a link between the Zika virus and birth defects? Infection during pregnancy can be harmful to the fetus or the newborn. Zika virus has been associated with microcephaly, a birth defect in which the size of a baby’s head and brain is smaller than expected. This birth defect is associated with developmental delays including trouble speaking, problems with movement and balance, hearing loss, and vision problems.

How is Zika virus transmitted? Women can be infected with the Zika virus directly by mosquito bite in an area where there is active Zika transmission or by sexual transmission from an infected male partner.

How can I prevent catching the Zika virus? The Centers for Disease Control and Prevention (CDC) has recommended that pregnant women, or women who may potentially become pregnant, avoid travel to countries that have been affected by the virus, including a large number of countries in South America, the Caribbean and the Pacific Islands. Check the CDC website http://www.cdc.gov/travel/page/zika-travel-information for a complete list of affected countries. Both pregnant women and their partners should avoid mosquito bites, particularly if traveling to a country that has been affected by Zika. If your sexual partner has recently visited an area with the Zika virus or is infected with the Zika virus, abstain from sex or use condoms throughout the pregnancy.

 If I am going to travel to an affected area, what should I do to prevent catching the virus? Travel to an affected area is not recommended for pregnant women. If travel is completely unavoidable, talk to your healthcare provider and take precautions to avoid mosquito bites. This should include use of EPA-registered insect repellents, wearing long-sleeved shirts, long pants, and hats to cover exposed skin, and maximizing time spent indoors in air-conditioned or screened rooms.

The recommendations for people contemplating pregnancy are a little bit different. If the woman has been exposed to Zika and gotten sick—meaning she has flu-like symptoms, runny nose, sore throat, low-grade fever, red or itchy eyes—it is possible that it is due to the Zika virus and, currently for people who have symptoms that have been exposed, they can be tested to see if that is true.

For a woman who has been exposed and been sick from Zika, it is recommended  waiting 8 weeks before tyring to conceive. There’s concern for men that the virus can remain in their bodies and be spread through sexual contact. And so for a man who has been sick from Zika, again, been exposed, been in an area and had a viral syndrome, the man can now be tested and, if he’s been sick or tested positive, the current recommendation is that he not have unprotected intercourse with a pregnant woman or try to conceive for 6 months.

If I catch the Zika virus before my pregnancy, is my baby at risk? We do not yet have recommendations about the safe period between infection and conception. However, once the virus is cleared from the blood, prior Zika infection is not thought to affect future pregnancies.

For more information about Zika virus, visit www.ChildrensNational.org/Zika

If you are concerned that you have been exposed to the Zika virus, please talk to your doctor. The Fetal Medicine Institute at Children’s National can work with your doctors directly.

http://childrensnational.org/departments/fetal-medicine-institute

Phone number:  202-476-7409

*SOURCES: Information provided by Children’s National Health System Centers for Disease Control and Prevention

*Excerpts from The Zika Virus and Getting Pregnant, Eric A. Widra, Medical Director,  Shady Grove Fertility

The Benefits of Red Raspberry Tea

Red Raspberry leaf tea is one of the safest and commonly used tonic herbs for women wanting to get pregnant or for women who are already pregnant. Red Raspberry Leaf (Rubus idaeus) tones the uterus, improves contractions and decreases constipation. Most tonics need to be used regularly, for a tonic is to the cells much like exercise is to the muscles; it is not much help when done irregularly . But you will still  benefit even from occasional use of tonics during pregnancy, since they contain nourishing factors. The herb comes in forms of leaves to make teas or tonics as well as pill like capsules you can swallow. Most of the benefits given to regular use of Red Raspberry leaf tea throughout pregnancy can be traced to the strengthening power of fragrine, an alkaloid which gives tone to the muscles of the pelvic region, including the uterus itself; and to the nourishing power of the vitamins and minerals found in this plant. There is rich concentration of Vitamin C, the presence of Vitamin E and the easily assimilated calcium and iron. Raspberry leaves also contain vitamins A and B complex and many minerals, including phosphorus and potassium.

When to use: There are two basic points of view on the subject. There is agreement among many
clinicians that in the 3rd trimester frequent (2- 3 cups per day of tea or 1 – 2 cups per day of infusion) is
beneficial to the uterine and pelvic muscles.

The more radical point of view is that drinking one cup of tea per day in the 1st trimester and 2 cups in the 2nd trimester and switching to the infusion in the 3rd trimester ensures a strong uterus, is good for you nutritionally and prevents miscarriage. Some say it is advised to not use it in the first trimester, particularly if you have a history of miscarriage. If a mother is prone to miscarriages she may feel safer avoiding raspberry until the third trimester. This is an herb with centuries of safe use behind it, there is usually little cause for concern, but check with your healthcare provider before using.

According to Susun Weed, author of “Wise Woman, Herbal for the Childbearing Year,” the benefits
listed below for drinking a Raspberry leaf brew before and throughout pregnancy are as follows:

• Increasing fertility in both men and women. Red Raspberry leaf is an excellent fertility herb when
  combined with Red Clover.
•  Preventing miscarriage and hemorrhage. Raspberry leaf tones the uterus and helps prevent
  miscarriage and postpartum hemorrhage from a relaxed or atonic uterus.
• Use raspberry leaf infusion to help facilitate placenta delivery. Chips of frozen raspberry leaf infusion
  sucked throughout labor help keep the uterus working strongly and smoothly.
•  Easing of morning sickness. Many women attest to raspberry leaves’ gentle relief of nausea and
  stomach distress throughout pregnancy. Drink a cup or two of raspberry leaf tea or infusion each day.
  Sipping the infusion before getting up or sucking on ice cubes made from the infusion increases the
  strength of this remedy.
•  Reducing pain during labor and after birth. By toning the muscles used during labor and birth,
  Raspberry leaf eliminates many of the reasons for a painful birth and prolonged recovery. It does not
  counter the pain of dilation of the cervix.
• Red Raspberry Leaves do not start or encourage labor. It can help the contractions to be productive
  once true labor has begun because it strengthens the uterine and pelvic muscles but it is not an oxytonic
  herb (one that would induce labor). That being said, it’s important to talk with your midwife,
  obstetrician or herbalist before beginning drinking red raspberry leaf tea or taking a supplement. Some
  will recommend you wait until you are 36 weeks along before incorporating the tea into your health
  regime while others may encourage you to begin right away. Each situation and pregnancy is different
  so it’s best to get other’s opinions before beginning red raspberry leaf tea.

Tea recipe: To make a tea, pour 1 cup boiling water over 2 teaspoons of herb and steep for ten minutes. Strain. During the first two trimesters, drink 1 cup per day. During the final trimester, drink 2-3 cups per day.

Excerpts from Weed, Susun. “Wise Woman Herbal Childbearing Year.”http://www.motherandchildhealth.com/Prenatal/raspberry.html

Presented by Angel J. Miller, MSN, CNM

www.midwiferycareassociates.com

https://www.linkedin.com/in/angeljmiller

What is a Perinatal Mood Disorder?

Recently, the media has reported several stories relating to perinatal mood disorders (more commonly considered to be post-partum depression, but are not limited to depression). Guidelines around who should get screened and when have taken center stage. Despite this attention, many don’t realize what perinatal mood disorders are or whether or not they are at risk for one.

Quite simply, a perinatal mood disorder is a mental health concern that occurs either during pregnancy or post-partum. This can include depression, anxiety, obsessive thoughts, paranoid thinking, and thoughts to harm yourself or your baby. While these concerns exist prior to pregnancy for individuals, they can be exacerbated during pregnancy and after for several environmental reasons: changes in hormones and lack of sleep are two prevalent factors. Of course, not everyone who has a baby experiences changes in mood, and certainly, some people seem to be more resilient during this transition.

Common symptoms of a perinatal mood disorder may include:
*Changes in sleep (not being able to sleep at all, even when the baby is or
oversleeping)
*Irritability
*Fears of something happening to the baby (being dropped, not
breathing, etc)
*Concerns (despite weight gain) that baby isn’t eating enough
*Uncontrollable crying
*Disinterest or lack of connection to the baby
*A feeling of not being yourself

Nearly 1 in 8 women (and 1 in 10 men) experience a perinatal mood disorder. Treatment is simple and can range from therapy, medication, or both. However, without treatment, there can be long-term consequences that are dangerous for both mother and baby, as studies of depressed mothers have shown difficulties in their children as they age. There is a simple screening that you can opt to take to see if you might be experiencing a perinatal mood disorder and it can be found here. People who are are risk for developing a perinatal mood disorder include those that have experienced depression or anxiety during pregnancy; those that have a family member who had a perinatal mood disorder; those with a history (or family history) of depression or anxiety; those that have suffered a pregnancy loss; those that conceived through infertility; those with a baby that was in the NICU; teenage mothers; those that are having financial/housing/medical concerns; and those that do not have a social support system or a limited one. Certainly, this is not an exhaustive list, but is inclusive of many “red flags”.

 

If you are concerned about you or someone you know that might be having difficultly adjusting to life postpartum, you can contact your OB-GYN/Midwife/Primary Care Physician about a mental health referral. It is important that the clinician you meet with has experience and training in treating perinatal mood disorders as it is not something that most graduate programs cover.

By Julie Bindeman,  Psy-D

http://www.greaterwashingtontherapy.com/

The Importance of Healthy Nutrition Throughout Your Pregnancy

Adequate nutrition during your preconception and prenatal periods is important for a healthy pregnancy and healthy baby. Achieving a normal body mass index (BMI) prior to your pregnancy as well as improving your nutritional status prior to and during your pregnancy can lower your risk of pregnancy complications such as gestational diabetes and pre-eclampsia. Remember, you are not eating for two; you only need to increase your calorie intake by 300-500 calories. You should gain weight gradually during your pregnancy, with most of the weight gained in the last trimester.

Read your food labels! What are you consuming to help with your baby’s growth?  Food labels will tell you what nutrients are in the foods you eat. The letters RDA, which you find on food labeling, stand for recommended daily allowance, or the amount of a nutrient recommended for your daily diet. When you’re pregnant, the RDAs for most nutrients are higher.

Pregnant women need a balanced diet including:

• Whole grains: Breads, cereals, pastas and brown rice.
• Fruits: All types of fruits, fresh, frozen or canned without added sugar.
• Vegetables: Eat a variety of colorful vegetables, fresh, frozen or canned with no added salt. Raw sprouts should be avoided.
• Lean protein: Choose lean protein from meat, poultry, fish, eggs, beans and peas, peanut butter, soy products and nuts. Pregnant women should avoid eating tilefish, shark, swordfish and king mackerel, and limit white (albacore) tuna to 6 ounces per week. Deli, luncheon meats and hot dogs should be reheated if consumed.
• Low-fat or fat-free dairy: This includes milk, cheese and yogurt. Unpasteurized milk and some soft cheeses that are made from unpasteurized milk should also be avoided.
• Healthful fats: Vegetable oils including canola, corn, peanut and olive oil are good choices.

Avoid extra calories from added sugar and fats, which can lead to unhealthy weight gain. Cut down on foods such as regular soda, sweets and fried snacks. These are empty calories and of no nutritional value.

Key Nutrients for Healthy Pregnancy

• Folate/Folic Acid: Folic acid reduces the risk of birth defects that affect the spinal cord. All women of childbearing age and pregnant women should consume 800 micrograms of folic acid each day. Sources include fortified foods such as cereals, pastas and breads, supplements and natural food sources of folate, including legumes, green leafy vegetables and citrus fruits.
• Iron: Maternal iron deficiency is the most common nutritional deficiency during pregnancy.  A pregnant woman needs 27 milligrams a day. Your body uses iron to make hemoglobin, a protein in the red blood cells that carries oxygen to your tissues. During pregnancy your blood volume expands to accommodate changes in your body and help your baby make his or her entire blood supply, doubling your need for iron.

If you don’t get enough iron, you may become fatigued and more susceptible to infections. The risk of preterm delivery and low birth weight also might be higher.

Foods with high and moderate amounts of iron include red meat, chicken and fish, fortified cereals, spinach, some leafy greens and beans. For vegetarians and women who do not eat a lot of meat, increase iron absorption by combining plant-based sources of iron with vitamin C-rich foods. For example, try spinach salad with mandarin oranges or cereal with strawberries.

• Calcium: During pregnancy, calcium is needed for the healthy development of a baby’s teeth, bones, heart, nerves and muscles. When a pregnant woman does not consume enough calcium, it is taken from her bones for the baby. It is important to consume adequate amounts of calcium daily before, during and after pregnancy. The recommended amount of calcium during pregnancy is 1,000 milligrams per day for adolescents 14 to 18 years old and 1,300 milligrams per day for women aged 19 to 50. That means at least three daily servings of calcium-rich foods such as low-fat or fat-free milk, yogurt or cheese or calcium-fortified cereals and juices.

Vitamin D Promotes bone strength and helps build your baby’s bones and teeth.  Fatty fish, such as salmon, is a great source of vitamin D.  Other options include fortified milk and orange juice.

There has been many studies recently revealing how common it is women of childbearing age are either insufficient or deficient in their levels of Vitamin D. This can cause an adverse outcome in pregnancy if not addressed.  Your vitamin D3 level should be > 40 ng/ml for a healthy pregnancy and for breastfeeding. Ask your healthcare provider to include your 25-OH-D concentrations of your Vitamin D level in your initial prenatal lab work.

Prenatal vitamins currently contain only 400 IU of Vitamin D3 which is inadequate.

 Protein is crucial for your baby’s growth, especially during the second and third trimesters. You need 71 grams/day. Good sources of protein include: Lean meat, poultry, fish and eggs are great sources of protein. Other options include dried beans and peas, tofu, dairy products, and peanut butter.

When you look at your food choices on your plate, you should have a variety of color!

Fine-tuning your eating habits to ensure you are receiving adequate nutrition for the health of you and your baby is key. Healthy eating during pregnancy is critical for a healthy pregnancy, healthy mom and baby!

Shelia L. Kirkbride,  MS, NC, VE.

 

References:

Mayo clinic.org-Nutrients in pregnancy

maternal vitamin D supplementation reduces the risk of premature birth

http://tinyurl.com/q83koe6

https://www.vitamindcouncil.org/newsletter/newsletter-pregnancy-and-gestational-vitamin-d-deficiency/

Building a Strong Foundation for Your Pregnancy

Contemplating pregnancy?  Nutritional and optimal health should be priority number one!  Women contemplating pregnancy must keep in mind that healthy eating habits and healthy lifestyle behaviors should be established before pregnancy to make sure proper nutrient levels for early embryo development and growth.

Eating a balanced diet that includes the proper amount servings of protein, grains, fruit, and vegetables is key. Protein is essential to the very foundation of your baby’s growth. Eating enough protein ensures that your little one, from the very beginning, is getting adequate food stores to support cell growth and blood production.  Regular exercise should also be incorporated in your daily routine to prepare your body for the demands of pregnancy. Habits such as drinking or smoking must be avoided to allow for optimal health and development of the child during pregnancy and after birth.  Good habits should  include taking a daily multivitamin or a daily prenatal vitamin.  Even if you are consuming healthy foods daily, you can miss out on key nutrients.  A daily prenatal vitamin — ideally starting three months before conception — can help fill any gaps.  A quality, fast absorbing prenatal vitamin is necessary for all the basic micronutrients needed during pregnancy.

Through the course of pregnancy there is an increased need for nutrients and calories to make sure proper fetal growth. The increased need for vitamins and minerals such as folate, calcium and iron is necessary to prevent birth defects, ensure proper bone formation/retention, and to reduce the risks of preeclampsia or anemia. Folic acid intake increases to a daily amount of 800 mcg, calcium to 1200 mg, and iron to 30 mg. Your Vitamin D levels should be checked with your initial prenatal labs to be sure you levels are not insufficient or deficient.  Fetal needs for vitamin D increase during the latter half of pregnancy, when bone growth and ossification are most prominent. Vitamin D travels to the fetus by passive transfer, and the fetus is entirely dependent on maternal stores. Your body needs vitamin D to maintain proper levels of calcium and phosphorus, which help build your baby’s bones and teeth. A vitamin D deficiency during pregnancy can cause growth retardation and skeletal deformities. It may also have an impact on birth weight.  Therefore, maternal status is a direct reflection of fetal nutritional status.

Researchers believe that a vitamin D deficiency during pregnancy can affect bone development and immune function from birth through adulthood.

Blog by Shelia Kirkbride

Best Exercises for Your Pregnancy

Congratulations on your pregnancy! Now you can sit back, relax and put your feet up for the next nine months, right? Not so fast! Attitudes and beliefs about prenatal exercise have drastically changed over the past twenty years. No longer is pregnancy viewed as a time to sit, watch TV and each chocolate. These days, moms can actually maintain and improve their fitness levels while pregnant. And exercise provides many numerous benefits such as a boost in your mood and energy levels, helps you sleep better, helps prevent excess weight gain and increases your stamina and muscle strength. You cannot lose!

Regular exercise during your pregnancy can improve not only your heart health and boost your energy, but improve your overall health. Maintaining a healthy body and healthy weight gain can help reduce common pregnancy complaints and discomforts like lower back pain, fatigue and constipation and can even help with shortening your time during labor by strengthening your endurance.

First, consult your health care provider if it is okay to exercise. If you have been participating in a regular exercise regimen and are having a healthy pregnancy, there should not be a problem continuing with your regimen in moderation. You may have to modify your exercise according to your trimester of pregnancy.

If you have not participated in an exercise regimen three times a week before getting pregnant, do not jump into a new, strenuous activity. Start out with a low-intensity activity and gradually move to a higher activity level.

The best type of exercise during pregnancy:
• Increases your heart rate steadily and improves your heart circulation
• keeps you flexible and limber
• manages your weight gain by burning calories
• prepares your muscles for labor and birth
• won’t cause you to push your body too hard

Research shows that healthy pregnant women who exercise during their pregnancy may have less risk of preterm labor and birth and a shorter labor process, are less likely to need pain relief, and recover from childbirth faster.

Regular, moderate exercise not only gives you a healthier pregnancy, it may give your baby a healthier start. Research shows that when pregnant women exercise, their developing babies have a much lower heart rate. Babies of active moms may also have a healthier birth weight. Experts recommend that you exercise for 30 minutes a day, on most days. Most exercises are safe to perform during pregnancy, as long as you exercise with caution and do not overdo it.

Your pregnancy exercise regimen should strengthen and condition your muscles. Always begin by warming up for five minutes and stretching for five minutes. Following your choice of exercise, finish your regimen with five to ten minutes of gradually slower exercise that ends with gentle stretching.

The safest and most productive activities to perform during your pregnancy are brisk walking, swimming, indoor stationary cycling, prenatal yoga and low-impact aerobics (taught by a certified aerobics instructor). These activities carry little risk of injury, benefit your entire body, and can be continued until the birth of your baby. Other activities such as jogging can be done in moderation. You might want to choose exercises or activities that do not require great balance or coordination, especially later in your pregnancy.

Use common sense:
• Avoid exercising that involves lying on your stomach or flat on your back after the first trimester of pregnancy.
• Stay well hydrated and drink plenty of fluids before, during and after you exercise.
• Avoid overheating and humidity, especially during the first trimester when the fetus is undergoing its most important growth and development.
• Stop exercising if you feel fatigued, develop persistent pain or experience any vaginal bleeding; check with your healthcare provider if regular contractions occur more than 30 minutes after exercise (possibly a sign of pre-term labor).
• Avoid heavy weightlifting and any activities that require straining.
• Avoid exposure to extremes of air pressure, as in high altitude exercise (unless you’re accustomed to it) or scuba diving.
• Do not increase the intensity of your workout beyond pre-pregnancy intensity level
• Eat small, frequent meals throughout the day. Sedentary pregnant women need about 3,000 calories per day during the second and third trimesters; if you are physically active, your caloric needs will be higher to make up for the calories burned up during your exercise regimen.

Basic exercise guidelines:
• Wear loose-fitting, comfortable clothes, as well as a good support bra
• Choose shoes that are designed for the type of exercise you choose. Proper shoes are your best protection against injury
• Exercise on a flat, level surface to avoid injury
• Finish eating at least one hour before exercising
• Get up slowly and gradually to prevent dizziness
• Never exercise to the point of exhaustion. If you cannot talk normally while exercising, you are probably over exerting yourself, and you should slow down your activity.

Physical changes during your pregnancy will create extra demands on your body. Keeping in mind the changes listed below, remember you need to listen to your body and adjust your activities or exercise regimen as necessary.
• Your developing baby and other internal changes require more oxygen and energy.
• Hormones (relaxin) produced during pregnancy cause the ligaments that support your joints to stretch, increasing the risk of injury.
• The extra weight and the uneven distribution of your weight alters your center of gravity. The extra weight also puts stress on joints and muscles in the lower back and pelvic area, and makes it easier for you to lose your balance

If you have any medical condition, such as asthma, heart disease, hypertension or diabetes, exercise may not be advisable. Again, consult with your health care provider before beginning any exercise regimen.

Exercise may also be harmful if you have a pregnancy-related condition such as:
• vaginal Bleeding or spotting
• Low placenta (low-lying or placenta previa)
• Threatened or history of recurrent miscarriage
• Previous premature births or history of early labor
• Weak cervix

Talk with your health care provider before beginning any exercise program. Your health care provider can also suggest personal exercise guidelines, based on your medical history.

Stop exercising and consult your healthcare provider if you:
• Feel pain
• Have abdominal, chest, or pelvic pain
• Notice an absence of fetal movement
• Feel faint, dizzy, nauseous, or light-headed
• Feel cold or clammy
• Have vaginal bleeding
• Have a sudden gush of fluid from the vagina or a trickle of fluid that leaks steadily (when your bag of “water” breaks, also called rupture of the amniotic membrane)
• Notice an irregular or rapid heartbeat
• Have sudden swelling in your ankles, hands, face, or experience calf pain
• Have increased shortness of breath
• Have persistent contractions that continue after rest
• Have difficulty walking

Regular exercise will keep you and your baby healthy while staying fit, and enjoying your pregnancy!

Written by: Angel J. Miller, MSN, CNM, certified nurse-midwife, Midwifery Service Director, Washington, D.C. Area and co-author: Nine Months In ~ Nine Months Out.
References
Miller, Angel, Kelly, Stacia, Kirkbride, Shelia, Matthews, Corry. Nine Months In ~ Nine Months Out. Sterling, Va. Ironcutter Media, 2011.
http://www.webmd.com/baby/exercise-during-pregnancy
http://kidshealth.org/parent/index.jsp?tracking=P_Home
http://www.mayoclinic.org/healthy-living/pregnancy-week-by-week/in-depth/pregnancy-and-exercise/art-20046896

Limiting Weight Gain during Pregnancy

How much weight should I gain? Gaining the right amount of weight during pregnancy by eating a healthy, balanced diet is a good sign that your baby is getting all the nutrients he or she needs and is growing at a healthy rate. Weight gain should be slow and gradual. In general, you should gain about 2 to 4 pounds during your first three months of pregnancy and 1 pound a week for the remainder of your pregnancy, unless otherwise directed by your healthcare provider. Your healthcare provider will tell you how much weight you should gain during pregnancy. A woman of average weight and height and/or normal BMI before pregnancy can expect to gain 25 to 35 pounds during pregnancy. You may need to gain more or less weight, depending on what your healthcare provider recommends. It is not necessary to “eat for two” during pregnancy. It’s true that you need extra calories from nutrient-rich foods to help your baby grow, but you generally need to consume only 200 to 300 more calories than you did before you became pregnant to meet the needs of your growing baby. Follow the guidelines below if you are gaining weight too quickly during pregnancy. What if I have gained too much weight? If you have gained more weight than recommended during the beginning of your pregnancy, DO NOT try to lose weight. It is never safe to lose weight during pregnancy — both you and your baby need the proper nutrients in order to be healthy. Be sure to eat a variety of foods to get all the nutrients you and your baby need. Follow the guidelines and serving recommendations on The Food Guide Pyramid to avoid further excess weight gain. Think about the foods you eat and avoid those foods that will not give you and your baby the nutrition you both need. Follow the glycemic index,which is simply a measurement of the impact carbohydrates have on your blood sugar levels. Check out http://tinyurl.com/8vqbtv. Make sure you are active and getting adequate time in for exercise. Keep in mind that you will lose some weight during the first week your baby is born. You’ll be surprised at how quickly you lose the remaining weight by following a balanced diet and exercising. If you are gaining weight too fast during pregnancy… When eating out at a fast food restaurant, choose lower fat items such as broiled chicken breast sandwich with tomato and lettuce (no sauce or mayonnaise), side salad with low-fat dressing, plain bagels or a plain baked potato. Avoid fried foods such as french fries, mozzarella sticks or breaded chicken patties.Avoid whole milk products. You need at least 4 servings of milk products every day. However, using skim, 1 or 2 percent milk will greatly reduce the amount of calories and fat you eat. Also choose low-fat or fat-free cheese or yogurt.Limit sweet or sugary drinks. Sweetened drinks such as soda, fruit punch, fruit drinks, iced tea, lemonade or powdered drink mixes provide many calories with little nutrients. Choose water, club soda, or mineral water to avoid extra calories. Do not add salt to foods when cooking. Salt causes your body to retain water. Limit sweets and high calorie snacks. Cookies, candies, donuts, cakes, syrup, honey and potato chips provide many calories with little nutrition. Try not to eat these types of foods every day. Instead, try fresh fruit, low-fat yogurt, angel food cake with strawberries, or pretzels as lower calorie snack and dessert choices.Use fats in moderation. Fats include cooking oils, margarine, butter, gravy, sauces, mayonnaise, regular salad dressings, sauces, lard, sour cream and cream cheese. Try the lower fat substitutes that are available for these foods.Prepare meals using low-fat cooking methods. Frying foods in oil or butter will increase the calories and fat of that meal. Baking, broiling or boiling are healthier, lower fat methods of cooking. Read Labels of food you purchase! Exercise. Moderate exercise, as recommended by your healthcare provider, can help burn excess calories. Walking or swimming is safe, effective exercises for pregnant women. It is perfectly safe for you to walk 30 to 60 minutes every day. Wear comfortable shoes and clothes. Open your front door and walk away from your house for 15 minutes as fast as you can. If you can sing while you walk, you are not walking fast enough. Be sure to talk to your healthcare provider before starting an exercise program.

DO’S AND DON’TS OF PREGNANCY

What to Strive For During Pregnancy
DO:
Develop a positive attitude. Pregnancy is for most women a happy, healthy time in which their bodies function the way they were designed to do. It is a time of looking forward not only to having an adorable baby, but also to starting an exciting, and challenging phase of life. Even though it can be a little scary because it is a new experience, most fears can be overcome, by thinking of it as a great adventure with a great reward at the end. Maintaining a realistic but optimistic attitude goes a long way in helping you through the pregnancy and birth even when everything does not go exactly as you expect. Please trust your body and your intuition. Trust your healthcare providers so that they can work with you to make your pregnancy, birth and early parenting experiences the best that they can be. Learn all you can about pregnancy, birth, and parenting. Read, take classes and watch DVD’s. Your healthcare providers want to help you become a well-informed consumer so let them know what you need to know during your visits. Ask questions!!

• Eat well. Good nutrition is important for a healthy mom and baby. Eat a well-balanced diet with adequate protein, fruits, vegetables, whole grains, and calcium. Most need extra calcium and magnesium supplements for bone health along with Vitamin D3. In addition to a balanced diet women should take a prenatal vitamin throughout the pregnancy. Some women may also need additional iron supplementation or an increase in iron rich foods. Optimal weight gain varies depending on your starting weight. A weight gain of about 15 pounds is recommended for those who are overweight at the beginning of pregnancy. The average weight for height woman should plan to gain 25-35 pounds. Those who are underweight need to gain approximately 28-40 pounds during pregnancy to ensure optimal nutrition for the fetus as well as building their own reserves.
• Exercise. Along with eating well, regular exercise is an important part of being healthy. With a normal pregnancy it is safe and helpful to exercise throughout your pregnancy, though some forms of exercise might not be appropriate during late pregnancy (i.e., kickboxing). Check with your healthcare provider especially if beginning an exercise program. You need to pay special attention to hydration, heart rate and body temperature, but, if done appropriately, exercise can help you have an easier pregnancy and labor! If you are able to talk through your activity, that exercise activity is appropriate.
Women who exercise routinely will have:
• less interventions during birth
• fewer Cesarean births
• shorter labors
• less risk for gestational diabetes
• lower rates of depression
General Exercise Guidelines:
• Thirty minutes of moderate exercise almost every day is appropriate for a normal pregnancy. (If you were inactive pre-pregnancy, you will need to start at a much slower level).
• Make sure you balance exercise with periods of rest and relaxation.
• Listen to your body; it is possible to hurt yourself, even with gentle exercise. As your belly grows, your center of gravity changes, joints soften, and positions or exercises that were easy become challenging. Listen to your body if it says “I need a break.” Avoid long periods in the supine position (lying directly on your back).
• Pay special attention to hydration, heart rate and body temperature. If you start to feel overheated, you should slow down and stop.
• No directed abdominal exercises after 20 weeks of pregnancy. As your baby and belly grow, abdominal muscles separate and focused strong abdominal exercise will exacerbate the separation.
• Enjoy sex during pregnancy. Enjoyment of sex during pregnancy is a healthy, satisfying part of a couple’s total relationship. Female orgasm during late pregnancy will cause uterine contractions, which are harmless to the baby and will not cause premature labor. (If orgasm did cause labor, induction of labor would be a simple, fun procedure!) Different positions for intercourse will need to be used as the woman’s abdomen enlarges. Any position which is comfortable is safe. Increased or decreased desire in women is normal both during pregnancy and the postpartum period.
• Intercourse should be avoided under the following conditions:
• After the membranes (bag of water) have ruptured – there is danger of infection.
• When bleeding or premature labor occurs, or if you have been told that there is a medical reason to avoid sex (such as with Placenta Previa)
• Women who have had repeated miscarriages (more than 2) should avoid intercourse during the time they usually miscarry.
• The only sexual activity reported as dangerous is blowing air into the vagina of a pregnant woman. This can detach the placenta from the uterine wall and/or cause an air embolism. If you have questions about sex, please feel free to discuss them with the nurse-midwives.
• Travel if you wish. All types of travel are permitted during a normal low risk pregnancy. In pregnancies after 36 weeks, you should consider the fact that you may end up giving birth in an unfamiliar place with an unfamiliar provider. Try not to travel more than one hour away from your planned facility for your birth. Air travel is permitted as long as the airplane cabin is pressurized. Most airlines require a letter from your provider after 34 weeks gestation. Travel to high altitude locations is also permitted up to approximately 6000 feet. Be sure to drink plenty of water and walk around intermittently during the trip (every 60-90 minutes)
• Prepare your birth plan. You may develop a birth plan during your childbirth education class with your partner. Please be realistic and limit to two pages. Decide who you want to be with you and what each person will do to help. Be sure to tell your healthcare provider of any special procedures that you would like or want to avoid. Be sure when you complete your birth plan or “wish list” you discuss it in detail with your healthcare provider(s).
• Purchase and properly install an infant car seat. Most if not all states have child seat safety laws. Please obtain an infant car seat by 36 weeks so you may safely transport your newborn to and from home.
• Choose a pediatrician or family practice doctor. The following are some sample questions to ask:
• Where is the office located in relation to your home? The ease of travel to the office at any time and especially in an emergency is very important.
• If the doctor is a family practice physician, ask him/her what arrangements he has made in case of an admission to a hospital. Does he/she routinely see newborns?
• Where does the doctor have hospital privileges? What are the special practices, if any, of that hospital’s pediatric unit, i.e., open visiting or rooming-in?
• Does the doctor have staff privileges at the hospital where you might go for the birth of your baby? If not, who will see your baby?
• What is the size of the practice? How long do you have to wait to obtain an appointment? How much time is designated for each appointment?
• Who are the other persons who may be associated with the physician, another physician you might see, and/or a pediatric nurse associate who can answer many of the daily parental concerns? Is there a telephone hour?
• What are the arrangements for covering emergency calls, including nights and weekends?
• What are the various costs for care: office visit, immunization, telephone consultation, emergency visits?
• What are the doctor’s views on infant feeding? (Bottle and breast feeding as well as how to start the intake of solid food.)
• Is the doctor supportive of breastfeeding?
• What is the doctor’s management for newborn jaundice?
• How many times does the physician expect to see the baby for normal health maintenance?
• What are the doctor’s responses to your questions? If invited into the office, take the opportunity to observe doctor-child interaction. Did you feel comfortable talking with the physician?
• Discuss circumcision vs. no circumcision and his/her views on immunizations.
• Ask your friends who they use and what they think of their relationship with their pediatrician or family practice doctor.

Since these are suggested guidelines, you may have some other criteria upon which you are making your decision. You need to feel comfortable with the physician you choose for your baby.
What to Avoid During Pregnancy
DON’T:
• Take any medications (prescription or over-the-counter) without consulting your healthcare provider.
• Consume excessive amounts of caffeine. Recent studies have shown small amounts of caffeine are not harmful.
• Drink alcohol. The current recommendation is that no amount of alcohol is proven safe during pregnancy.
• Smoke. In addition to the risks of tobacco related disease for the mother:
• Babies born to mothers who smoke average 6 ounces less at birth than babies of nonsmoking women (a lot when only considering 7 or 8 lbs.!)
• Nicotine restricts the blood vessels and oxygen circulation of the mother.
• Increased carbon monoxide in the mother reduces oxygen levels in the fetus’ blood.
• Vitamin metabolism is disturbed in both mother and fetus.
• Incidence of low birth weight babies greatly increases for those who smoke one pack or more per day.
• There is a direct correlation that exists between smoking during pregnancy and the increased incidence of premature rupture of membranes, preterm labor, placenta abruption and stillbirth.
• Behavioral effects on infants of smoking mothers, determined by developmental testing, are noted as long as 8 months after birth.
We urge you and/or your partner, if either or both of you smoke, to register in a Smoking Cessation Program in your area. IT is the best thing to do for you, your partner, and your baby.

What Do I Do When My Bag of Waters Break?

It is common to be in labor without your water breaking.  Actually, only thirty percent of women experience their water breaking before the start of labor.

What Is My Bag of Waters?   The bag of waters—or amniotic sac—is a bag or “membrane filled with fluid that surrounds your baby in your uterus during pregnancy.”  The bag of waters is very important to your baby’s health.  The fluid protects your baby and gives your baby room to move around.  The bag itself protects your baby from infections that may get into your vagina.

  Is it urine or is it amniotic fluid? If you are leaking, it can be difficult to determine if your membranes are leaking or if it is urine.  In most cases, it is probably urine.  There are several ways to tell the difference, but there is no definite answer.  When in doubt, smell it! Urine has a distinct smell and color.  You will leak urine when your bladder is full, when coughing , sneezing or laughing; even when you are exercising.  

Only 3 percent of pregnant women will go into premature labor (before 37 weeks) as a result of ruptured membranes.   In most cases your membranes will rupture as you are nearing the end of your pregnancy, and this is definitely one of the early signs of labor.  If your water does break in public, and you have visions of a huge gush of water running all over the floor, then you have probably been watching too many movies.  It is most likely going to occur as a slow trickle, or at most, a small gush of fluid of colorless and odorless amniotic fluid. 

It is common to be in labor without your water breaking.  Actually, only thirty percent of women experience their water breaking before the start of labor.

What Should You Do When Your Water Breaks ?  First, don’t panic!  Follow the instructions your healthcare provider discussed with you if and when your water breaks.  Immediately after your water breaks, know that nothing should be placed in your vagina at this point.  This will help prevent infection.

•  Wear a maxi pads, not tampons, to keep the amniotic fluid from wetting your clothes
• Keep your vaginal area clean
•  When you go to the bathroom,  be sure to wipe from front to back
•  Sexual intercourse is officially off-limits  

Call your healthcare Provider immediately if:  

• Your due date is more than 3 weeks away from today
•  The water is green, or yellow, or brown, or has a bad smell
•   You have a history of genital herpes, whether or not you have any herpes sores right now
•  You have a history of Group B strep infection (“GBS positive”)
•  You don’t know if you have GBS or not
•  Your baby is not in the head-down position, or you’ve been told it is very high in your pelvis
•  You have had a very quick labor in the past, or feel rectal pressure now
•  You are worried.
•  If you feel something in your vagina, or see any of the umbilical cord at the vaginal opening, get medical help immediately  

Call your health care provider within a few hours if:

 •Your due date is within the next 3 weeks and

 • You are not in labor and the fluid is clear, pink, or has white flecks in it

 • Your baby is in the head-down position

 •Some health care providers will want you to come in to the office to confirm that the bag of waters has broken and listen to the baby’s heartbeat as soon as you notice that the bag of waters has broken.  Others will suggest you stay home for several hours to wait for labor to start.  

What Do I Do Until Labor Starts?   Most women will go into labor within 48 hours.  If you are waiting for labor to start and your bag of waters has broken:  

• Put on a clean pad  

•Do not put anything in your vagina

 •Drink plenty of liquids—a cup of water or juice each hour you are awake

 •Get some rest

 •Take a shower

 •If there is any change in your baby’s movements, call your health care provider right away  

Check your temperature with a thermometer every 4 hours—call right away if your temperature goes above 99.6.   For more information regarding this topic visit:

  www.acnm.org  

www.webmd.com

 

The Benefits of Red Raspberry Leaf Tea in Pregnancy

Red Raspberry leaf tea is one of the safest and commonly used tonic herbs for women wanting to get pregnant or for women who are already pregnant. Red Raspberry Leaf (Rubus idaeus) tones the uterus, improves contractions and decreases constipation. Most tonics need to be used regularly, for a tonic is to the cells much like exercise is to the muscles; not much help when done irregularly . But you will still benefit even from occasional use of tonics during pregnancy, since they contain nourishing factors. The herb comes in forms of leaves to make teas or tonics as well as pill like capsules you can swallow.
Most of the benefits given to regular use of Raspberry lea tea throughout pregnancy can be traced to the strengthening power of fragrine, an alkaloid which gives tone to the muscles of the pelvic region, including the uterus itself; and to the nourishing power of the vitamins and minerals found in this plant. There is rich concentration of Vitamin C, the presence of Vitamin E and the easily assimilated calcium and iron. Raspberry leaves also contain vitamins A and B complex and many minerals, including phosphorus and potassium.
When to use: There are two basic points of view on the subject. There is agreement among many clinicians that in the 3rd trimester frequent (2- 3 cups per day of tea or 1 – 2 cups per day of infusion) is beneficial to the uterine and pelvic muscles.
The more radical point of view is that drinking one cup of tea per day in the 1st trimester and 2 cups in the 2nd trimester and switching to the infusion in the 3rd trimester ensures a strong uterus, is good for you nutritionally and prevents miscarriage. Some say it is advised to not use it in the first trimester, particularly if you have a history of miscarriage. If a mother is prone to miscarriages she may feel safer avoiding raspberry until the third trimester. This is an herb with centuries of safe use behind it, there is usually little cause for concern, but check with your healthcare provider before using.
According to Susun Weed, author of “Wise Woman, Herbal for the Childbearing Year,” the benefits listed below for drinking a Raspberry leaf brew before and throughout pregnancy are as follows:
• Increasing fertility in both men and women. Red Raspberry leaf is an excellent fertility herb when combined with Red Clover.
• Preventing miscarriage and hemorrhage. Raspberry leaf tones the uterus and helps prevent miscarriage and postpartum hemorrhage from a relaxed or atonic uterus.
o Use raspberry leaf infusion to help facilitate placenta delivery. Chips of frozen raspberry leaf infusion sucked throughout labor help keep the uterus working strongly and smoothly.

• Easing of morning sickness. Many women attest to raspberry leaves’ gentle relief of nausea and stomach distress throughout pregnancy. Drink a cup or two of raspberry leaf tea or infusion each day. Sipping the infusion before getting up or sucking on ice cubes made from the infusion increases the strength of this remedy.

• Reducing pain during labor and after birth. By toning the muscles used during labor and birth, Raspberry leaf eliminates many of the reasons for a painful birth and prolonged recovery. It does not counter the pain of dilation of the cervix.

Red Raspberry Leaves do not start or encourage labor. It can help the contractions to be productive once true labor has begun because it strengthens the uterine and pelvic muscles but it is not an oxytonic herb (one that would induce labor). That being said, it’s important to talk with your midwife, obstetrician or herbalist before beginning drinking red raspberry leaf tea or taking a supplement. Some will recommend you wait until you are 36 weeks along before incorporating the tea into your health regime while others may encourage you to begin right away. Each situation and pregnancy is different so it’s best to get other’s opinions before beginning red raspberry leaf tea.

Tea recipe: To make a tea, pour 1 cup boiling water over 2 teaspoons of herb and steep for ten minutes. Strain. During the first two trimesters, drink 1 cup per day. During the final trimester, drink 2-3 cups per day.

Excerpts from Weed, Susun. “Wise Woman Herbal Childbearing Year.”
http://www.motherandchildhealth.com/Prenatal/raspberry.html