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The role of your physician or midwife is primarily that of a careful observer and counselor. This careful observation is tempered with an appreciation for those conditions that may complicate or be complicated by pregnancy.

Office Visits During Pregnancy
Office visits during pregnancy are part of the observation and counseling process. Your first prenatal visit includes a comprehensive review of your medical history, including current symptoms, past illnesses and surgeries, detailed menstrual history, and family history.

A complete physical examination is performed with special attention to assessing the size of your pelvis and estimating the size of your growing uterus.

Laboratory studies include the Pap smear to screen for cervical or vaginal cancer, blood counts to check for anemia or infection, blood typing with a screen for any abnormal antibodies, and tests for syphilis, AIDS, hepatitis, and one to determine if you have been adequately immunized against German measles. Urine is checked for infection, kidney abnormalities, and diabetes.

Subsequent prenatal visits are not as extensive as the initial exam. During each visit, we will measure your weight and blood pressure. You are asked to bring a first morning urine sample to be checked for the presence of sugar and/or protein. Your uterus will be carefully measured to determine if the baby’s growth is appropriate, and we will listen to the baby’s heartbeat.

From the initial exam, these visits are usually scheduled every four weeks until the 28th week of pregnancy, every two weeks between the 28th and 36th week, and weekly after the 36th week.

Please write down any questions that arise so that we can discuss them at the time of your visits. Be sure to report any unusual headaches, altered vision, vaginal bleeding, urinary discomfort, or abdominal pain.

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Rest
Rest is necessary to respond to the pregnancy’s increased demands on your body. Ideally, you should spend 15–30 minutes lying on your side at least two or three times a day. This improves the circulation to the placenta and is very good for your baby. This becomes more and more important as your pregnancy progresses, and it is particularly important if you develop high blood pressure during your pregnancy.

Exercise
Exercise in moderation can be done safely during most pregnancies. (Prenatal conditioning exercises are discussed in detail in the “Prenatal Exercises” chapter.) Many women are involved in some type of recreational sport or physical conditioning program when they conceive. It is safe to continue activities such as skiing, bicycling, jogging, tennis, racquetball, volleyball, basketball, and various forms of aerobic exercise. You should, however, avoid overexertion.

The point of overexertion exists when you feel breathless (unable to comfortably carry on a conversation while exercising) or if your pulse rate is greater than 140. You should also avoid contact sports or activities with a high risk of bodily injury such as skydiving, motorcycle racing, or water-skiing. Moderation is the key for physical activity during pregnancy.

Employment
Employment outside the home is usually permissible and even desirable during your pregnancy. If your work involves severe physical strain, we can work with your employer to develop appropriate modifications of your duties. In most cases, you may continue working until the time of your delivery as long as you remain comfortable and no complications arise. It may be necessary to quit working or to limit the number of hours you work if pregnancy complications occur.

Travel
Travel is safe during pregnancy, but consider a few common-sense guidelines. During the last four to six weeks of your pregnancy, it is advisable to stay within an hour or two of the hospital in case labor begins.
When traveling for long distances, you should avoid sitting in one position for long periods of time. While sitting, you should exercise your calf muscles by curling your toes and moving your legs to lower the risk of blood clots. It is also a good idea to stand up and walk around every one to two hours, which is usually not a problem due to an increased need to urinate during pregnancy.
Travel by commercial airlines offers no unusual risk to your pregnancy. Some airlines occasionally require permission to travel late in pregnancy. We also prefer that you avoid traveling to altitudes above 10,000 feet if possible, although brief periods spent at that altitude are probably not harmful.

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Sexual Intercourse
Sexual intercourse during pregnancy is permissible as long as it remains comfortable. Avoid intercourse if miscarriage or premature labor threatens, or if there has been bleeding or leakage of fluid from the vagina.

Dental Care
Dental care, including brushing and flossing, is something to be particularly dedicated to during your pregnancy. Continue your regular dental checkups. Necessary procedures such as fillings or extractions may be performed. Dental x-rays may be taken if required, but the abdomen should be shielded. If your dentist is considering x-rays, anesthetic, or antibiotic, please consult with us first.

Clothing and Shoes
Clothing and shoes should be practical and relatively non-constrictive. Maternity support hose, although expensive, may help with symptoms related to fluid retention and vein distention. Wear supportive bras that fit well. You may find that a larger bra size is required during your pregnancy.

Bathing
Bathing, in the form of tub baths or showering, is not a problem during pregnancy. As your balance changes later in pregnancy due to the enlarging uterus, you must take care when entering and leaving the bathtub. Be sure to have a good non-slip surface on the bathtub bottom. Since water does not readily enter the vagina, the risk of infection from tub baths is minimal.

Douches
Douches used for routine cleansing are neither necessary nor desirable. During pregnancy, douching may cause bleeding or rupture the membranes.

Hot Tubs and Saunas
Information concerning the safety of hot tub and sauna use during pregnancy is not conclusive. It is known, however, that elevated body temperatures may be associated with birth defects or other pregnancy complications. If you wish to use either hot tubs, saunas, or steam rooms, it should be for brief periods of time, and you should avoid excessively high temperatures.

Smoking
Smoking during pregnancy increases the chances of miscarriage or premature birth. Smoking mothers tend to have low-birth-weight babies who are at greater risk of death or disability than normal weight infants. If you smoke, we strongly recommend that you quit smoking before you become pregnant, or as soon as you know that you are pregnant. We would be happy to discuss a plan with you to accomplish this goal, but only you can make the decision to quit smoking.

Alcohol
Alcohol that the mother drinks quickly reaches the fetus. Alcohol produces both physical and mental defects in the baby, including growth deficiency, malformed facial features, and mental retardation. An occasional glass of wine with dinner is probably not harmful to your child, but no one knows exactly how much or how little it takes to affect the physical or mental development of your baby. Only you can decide if it is worth the risk.

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Hard Drugs
Hard drugs should absolutely be avoided during pregnancy. Avoid the use of narcotics, hallucinogens, and recreational drugs.

Medications
Medications and their potential benefits may or may not outweigh their potential risks. Some medications, such as thyroid medication, should definitely be continued during pregnancy. Other symptoms can often be controlled by changes in either diet or activities. A few over-the-counter products are advised in this book when these methods fail. If you have any questions about taking a medication (prescription or non-prescription), please check with us first.

Painting
Painting is okay during pregnancy as long as the area is well ventilated and you avoid prolonged inhalation of the fumes.

Cats
Cats can present the possibility of toxoplasmosis, a particular and dangerous infection that can affect the fetus if it occurs during pregnancy. Miscarriage or birth defects may result. The infection is thought to be acquired either by eating raw meat or contacting infected cat feces. Pregnant women should avoid any contact with cat litter boxes.

Radiation
Radiation, such as routine x-rays for dental diagnosis, may be performed as long as the abdomen is shielded. You should be especially cautious during your first trimester. If x-rays are necessary, we recommend that you consult with your physician or nurse midwife to determine if the benefits outweigh the potential risks.

Exposure to Childhood Diseases
Exposure to childhood diseases, such as German measles and chicken pox, is not a cause for worry if you have immunity to these illnesses, either by immunization or having had the actual infection. If your immunity status is unknown, avoid situations where you might be exposed to these common childhood illnesses. Blood testing is available if you are not certain of your immunity status.

Caffeine
Caffeine is a drug most commonly found in coffee, tea, chocolate, and many soft drinks. Current information suggests that there may be a risk of miscarriage in women who consume moderate amounts of caffeinated beverages (three or more cups per day). Minimal consumption is safest for you and your baby.

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