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Questions about your pregnancy? One of our experts has the answers.
David Priver, M.D., FACOG
Hope Ricotti, MD
June Tester, MD, MPH
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Newborns - Answered by June Tester, MD, MPH
Q. I have an infection in my breast that my obstetrician said is mastitis. Do I have to stop breastfeeding until it's gone?
A. Absolutely not. You should continue to breastfeed, which will actually help you to get over the infection faster. While it is normal for your breasts to feel uncomfortable at times when they are full, a particularly painful area in one breast (especially if you notice any redness around that area) can be a sign of an infection. Mastitis occurs when milk ducts become engorged and backed up, and milk leaks into surrounding breast tissue, causing inflammation and creating an opportunity for infection. Bacteria can also get into breast tissue and cause infection through cracked nipples. Your physician can prescribe an antibiotic that’s safe to take while breastfeeding, and your baby (and your breast pump) will help by emptying out your milk and relieving that pressure. Applying heat to the area can accelerate the healing process and reduce the pain.
Q. I have heard that newborns need to be fed every two to three hours. Does this mean I need to wake up my baby in the middle of the night??
A. Few newborns will actually sleep more than four hours without a feed until they are several weeks old. In general, until your baby has regained her birth weight, you should wake her for a feed if she has been sleeping for four hours. Babies typically lose weight initially, but by ten days of age most are at or above their birth weight. If your baby was born early (before 37 weeks) or is on the small side, it’s particularly important to make sure that she is getting regular feeds. If your baby is jaundiced, more frequent feedings will help her to stay hydrated and help eliminate the bilirubin that is causing the yellowness in her skin.
Q. My breastfed six-week-old hasn't had any bowel movements for an entire week. Does this mean she is constipated?
A. Stool frequency can vary a lot among babies, and can often be the subject of much stress in new parents as they worry about the color, frequency and consistency of their baby’s bowel movements. In the first days of life, infants pass meconium stool, which is thick, black and sticky. (Meconium is actually normal debris such as skin cells that the baby swallows in the amniotic fluid.) Once all of the meconium passes, stools transition to a soft, seedy appearance for breastfed babies and firmer brown stools for formula-fed babies. Stool frequency can range anywhere from once after every feed to once every other day. As long as the stool is soft and there is no blood, the baby is not constipated. After a few weeks of age, stooling can become less frequent. Breastfed infants typically have more frequent stools than formula-fed infants. However, for some breastfed babies, it is not uncommon to have an entire week go by with no stool – not to worry! This occurs sometimes because breast milk is absorbed so efficiently.
Q. I heard about tummy time, but am afraid to have my child on her stomach. Isn't that supposed to be dangerous?
A. It’s important for your baby to sleep on her back to reduce the risk of Sudden Infant Death Syndrome (SIDS), otherwise known as crib death. However, this doesn’t mean that she should be spending all of her time on her back. Babies need to spend time in the tummy-down position to develop their neck and shoulder muscles, and too much time spent supine (on their backs) can lead to skull flattening. (Many parents don’t realize that time spent reclined in an infant seat is also considered to be time spent on the baby’s back.) Whenever your baby is awake and alert, take the opportunity to place her for a few minutes on her tummy on a surface like a soft mat or across your lap, alternating the side of the head on which she is resting. This can be done safely from birth. Babies are able to lift their heads while prone (on their stomachs) at around two months of age, and they will likely participate in tummy time more eagerly if they are already accustomed to being in this position.
Q. My mother insists that I should be cleaning my baby's umbilical cord with alcohol swabs, but the nurse in the hospital didn't mention anything about rubbing alcohol.
A. Years ago, parents were instructed to clean around the umbilical cord with rubbing alcohol. However, we have found that the umbilical stump heals faster without alcohol. The key is to keep the umbilical stump clean and dry, using just plain water to clean at the base (or soap and water if it gets soiled). Stick with sponge baths until the stump falls off (usually within two weeks). Though many parents worry about the cord getting infected, this is really not all that common. Some crusting or a small amount of blood is a normal finding. If, however, you see redness or swelling, continued bleeding or any discharge that looks like pus, you should have it evaluated by your doctor.
Q. How can I bond with my premature baby while she's still in the hospital?
A. Most parents of preemies find themselves in a strange and frustrating world that they didn't quite plan on visiting, and feel that they have to temporarily suspend all of the parental joys that they had been so eagerly anticipating, including bonding with their new loved one. However, there are more ways to bond with your preemie than you might realize. Intensive care nursery (ICN) nurses are particularly well-trained and quite invested in helping you through the experience. Your nurse can teach you how to touch your baby in a way that soothes rather than agitates her. (While parents often try to reach out with a tentative light stroke of their finger, it is a more firm and cradling touch that a preemie prefers.) When your baby is doing well enough, your nurse can help you place your baby on your chest for some skin-toskin contact. (You can often do this even when your baby is hooked up to quite a bit of equipment!) And when you can't be in the nursery, you can soothe your baby with your scent. Many nurseries will give you a small piece of fabric that you can tuck in your clothing to get your scent, then keep it in your baby's isolette.
Q. Should we circumcise our baby?
A. Many parents feel conflicted about whether to circumcise or not, and the decision can be particularly difficult when parents don't agree about what to do, or if other family members have opinions that differ from the desires of the couple. The official stance of the American Academy of Pediatrics (AAP) is that there is no medical reason to necessitate circumcision. Though there is a higher likelihood that an uncircumcised male will develop a urinary tract infection (when compared to a circumcised male), the overall risk of an uncircumcised male developing a urinary tract infection is too small (less than one percent) to necessitate that all boys be circumcised routinely. Like any procedure, a circumcision carries some risks, most commonly that of bleeding or infection, but these are very uncommon. Injection of a local anesthetic is safe and effective at reducing pain. Overall, the decision is up to parents, and cultural, religious and ethnic reasons are legitimate considerations. For more information, see the AAP Policy Statement on circumcision: http://aappolicy.aappublications.org
Q. Will it matter if I read to my newborn or not?
A. Your baby has been hearing your voice from the womb for many months now, and likes to hear you talk! Reading a story can be one way for your little one to hear your reassuring voice, but other daily activities like feeding and changing diapers can also be opportunities for verbal bonding as well. You should read to your newborn if you enjoy doing so, but you will probably discover that it becomes a lot more fun for both you and your baby in a few months, as your child develops the ability to be more interactive during storytime. In time, your infant will be eagerly watching your lips as you read, taking an interest in the colors and shapes on the pages, and batting at the book as you flip through it.
Beauty Concerns - Answered by Hope Ricciotti, MD
Q. Will having my hair colored or highlighted during pregnancy pose a risk to my baby, and is one trimester safer than another?
A. Hair dyes and their ingredients pose no risk of harmful reproductive effects, according to reproductive toxicity studies and investigations. The scientific evidence indicates that exposure to hair dyes presents no carcinogenic or other health risks to clients and salon workers. Thus, you can color or highlight your hair while pregnant, without trimester being an issue.
Q. My best friend and I have been treating ourselves to weekly manicures and pedicures. Now that I'm pregnant, I'm wondering about the possible effects of the chemicals on the baby. Also, what if I got a nail infection?
A. Clients of nail salons don't need to worry about exposure to harmful chemicals, nor will a nail infection affect your pregnancy. Very few studies have been done on prenatal exposure to nail care products, so the following information is based upon only a small amount of data. Nail salon employees can be exposed to harmful chemicals, depending on the amount of material they use, how often they use it and whether the work site has a good ventilation system, which can minimize risks. No data have been collected on salon workers to date, but it is thought that nail salon clients will not have adequate exposure to cause problems in pregnancy.
Q. I am 12 weeks' along and experiencing the acne I never had as a teen. What can I do?
A. The effects of pregnancy on acne are unpredictable. Some women notice improvement in acne, while others see worsening, and still others may develop acne for the first time. Topical benzoyl peroxide, which works to unclog pores, can treat acne such as blackheads and whiteheads safely. Topical antibiotics, which require a prescription, work on acne that has infection associated with it. You should avoid tetracycline (topical or oral) in pregnancy, due to potential risks to fetal teeth and bone development. Use of topical tretinoin (Retin-A, Atralin, Renova, Avita, Altinac) has not been associated with any birth defects, but because oral exposure has been, and because significant skin absorption is theoretically possible, you should avoid it.
Q. Can I whiten my teeth during pregnancy?
A. There is currently no data about the possible toxicity of teeth whiteners, which use hydrogen peroxide, during pregnancy. Animal studies do not suggest a risk, but there is inadequate evidence in humans to determine the risk of carcinogenicity. Thus, it is best to wait until after pregnancy to whiten your teeth, but likely no risk if you inadvertently use tooth whiteners before learning you are pregnant.
Q. My dentist said I need a crown, but I'm six weeks' along and don't want to take any chances. I was also told I have gingivitis. What should I do?
A. In general, during pregnancy you should undergo dental procedures that prevent infections, since the risk of worsening infections outweighs any theoretical risks from having the procedures. This is because the infections in the teeth and gums that can result from delays in dental care can put the pregnancy at risk. Your dentist can usually tell you if the procedure can safely wait, or if postponing it will risk infection. If waiting is not an option, then it is good practice to restrict X-rays to those absolutely necessary for the procedure, and to double-shield the fetus with lead pads. The numbing medicine Novocaine is fine in pregnancy, but must be without epinephrine (a medication used to minimize bleeding).
Regarding gingivitis: The high estrogen levels of pregnancy, along with the increase in blood volume,result in high blood flow and swelling of the capillaries in the gingiva (gums). It is considered a normal finding in pregnancy. This change in the gums frequently results in mild bleeding during routine oral hygiene, such as brushing and flossing. This is usually worst in the third trimester. Good dental hygiene will minimize symptoms, and the condition will resolve after pregnancy.
Regarding gingivitis: The high estrogen levels of pregnancy, along with the increase in blood volume,result in high blood flow and swelling of the capillaries in the gingiva (gums). It is considered a normal finding in pregnancy. This change in the gums frequently results in mild bleeding during routine oral hygiene, such as brushing and flossing. This is usually worst in the third trimester. Good dental hygiene will minimize symptoms, and the condition will resolve after pregnancy.
Q. My friend said not to have a bikini waxing or use a home depilatory during pregnancy. Is there a danger to the baby?
A. No, there is no danger to the baby from bikini waxing or using a home depilatory. Most women find an increase in hair growth during pregnancy, especially on the lower abdomen, around the nipples and on other unwanted areas. Some women find they have a bit more pain with hair removal during pregnancy than when they are not pregnant, but others don't notice a difference.
Q. Are laser treatments for hair removal or skin refining harmful during pregnancy?
A. Theoretically, no, since the laser beam is targeted very superficially and should not affect the fetus. However, there are no studies about the safety of laser in pregnancy, and thus, most ob/gyns tell their patients to avoid it.
Q. Is having botox injections during pregnancy harmful?
A. You should avoid botox injections during pregnancy and breastfeeding. Although there are no human data on the safety of botox during pregnancy or breastfeeding, animal data show some risks to off spring.
Q. I'm in my tenth week of pregnancy and seem to be developing large brown spots on my face. I'm pale, so it really shows, even under makeup. I read about the "mask of pregnancy." Is the pigmentation permanent? What can I do to reduce it?
A. Melasma, or the "mask of pregnancy," is very common on the face during pregnancy. The condition is stimulated by sunlight acting on cells in the skin — called melanocytes — that make pigment, so any sunexposed area can develop these spots. Melasma is most noticeable and occurs most commonly in the face, as the face is more likely to be in the sun. More research is needed, but melasma is thought to be due in part to the hormone estrogen, since it can also develop in women taking birth-control pills. The best way to avoid getting these spots is to keep your face out of the sun. Most cases of melasma resolve completely after the pregnancy. The condition may take several months postpartum to fully disappear. Dermatologists can treat the cases that don't with bleaching (depigmenting) agents.
Diet and Fitness - Answered by Hope Ricciotti, MD
Q. Can I have Caesar dressing in my salad? I'm concerned about the raw egg ingredient.
A. Traditional Caesar salad is made with romaine lettuce, croutons, Parmesan cheese, lemon juice, olive oil, Worcestershire sauce, raw egg and black pepper. Raw eggs carry the potential risk of salmonella bacterial contamination, which can cause food poisoning.
Today, many Caesar salads and bottled Caesar dressings don't contain raw eggs, and many restaurants don't use raw eggs. This ingredient is generally clearly marked on the menu when it is included in the recipe. In this case, it is worth asking if the salad can be prepared without the raw egg, since some versions are made with cooked eggs or no egg.
Bottled Caesar dressing carries no risk of salmonella, and thus is safe during pregnancy.
Today, many Caesar salads and bottled Caesar dressings don't contain raw eggs, and many restaurants don't use raw eggs. This ingredient is generally clearly marked on the menu when it is included in the recipe. In this case, it is worth asking if the salad can be prepared without the raw egg, since some versions are made with cooked eggs or no egg.
Bottled Caesar dressing carries no risk of salmonella, and thus is safe during pregnancy.
Q. Is drinking herbal tea safe during pregnancy?
A. If you drink herbal tea when you're pregnant, you need to use caution. In general, you can have teas made from foods you can safely eat, such as oranges, apples and ginger. Even then, you shouldn't have multiple cups, since the ingredients are very concentrated. Stay away from some of the more esoteric herbs, since their safety in pregnancy is unknown. Herbs can be drugs, so just because they are natural does not mean they are safe in pregnancy. Some ingredients, such as rasp-berry leaves, are known to be uterine stimulants and should be avoided.
Q. I do daily power walking to stay in shape, and was wondering if I'm overdoing it. I'm in my third month of pregnancy.
A. Recommendations for exercise in pregnancy are individualized and based upon common sense. Be sure to stay hydrated, avoid getting overheated and decrease your activity if you experience any pain while walking. Be aware that sometimes in pregnancy you'll be fine during the actual walk, but later in the day, or the next day, you'll develop back or hip pain. Th us, moderation and staying in close touch with your body's signals are key. Your body will tell you your limits far better than anyone can. Of course, if you have any pregnancy complications like bleeding or premature labor, you should consult your ob/gyn.
Birth - Answered by Hope Ricciotti, MD
Q. Two women I know have had preterm labor, and I'm frightened at the prospect. What exactly is it, and is there any way to prevent it?
A. Preterm labor means that there are contractions that lead to cervical dilation and, eventually, in some cases, to premature delivery (prior to 37 weeks). This is in contrast to premature contractions, in which the uterus contracts, but there's no dilation, and thus no preterm delivery. The best way to lower your chance of preterm labor is through regular prenatal care, so that problems can be identified and treated early.
Q. Can I give birth naturally with twins?
A. When twins are both head down (vertex position), they may be delivered vaginally. However, if either of the babies is in a bottom-down (breech) or transverse position, then your ob/gyn or midwife will need to discuss with you if having a C-section may be the safer option for you and your babies.
Q. We're considering a home birth, but everyone seems to be discouraging us. Why?
A. Most pregnancies are very low risk, and complications are rare. Complications do happen, however, and a previously uncomplicated pregnancy or labor can quickly change to one needing urgent medical attention. Because of this, experts agree that the safest setting for labor, delivery and the immediate postpartum period is the hospital, a birthing center within a hospital complex that meets the standards jointly outlined by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology, or a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, the Joint Commission or the American Association of Birth Centers. These various settings allow for women and their partners to have a birth experience that meets all of their needs and desires, and yet emergencies can be handled quickly.
Dad - Answered by Hope Ricciotti, MD
Q. My husband seems genuinely thrilled about the pregnancy, but says he has no interest in attending childbirth education classes. What can I do to get him to go? I'm worried he won't want to be in the delivery room, either.
A. Speak to your husband to find out what is causing him to be reluctant. It may be that he is afraid, worried about his ability to help you, or concerned about seeing you in pain. Try telling him that you really need and want his support, and that going to classes will help him know how best to help you. Make it clear that no one expects him to be an expert — that is exactly why we have childbirth classes! If he is simply not sure he can go through with it, then perhaps you might be better off with a trusted family member or friend. Your husband can then play a more secondary role, yet still be involved in a way in which he feels more comfortable. Most Labor and Delivery units (check with your hospital or birthing center) will allow two sup- port people in the delivery room — so that both he and your primary support person can be present.
Health Issues - Answered by Hope Ricciotti, MD
Q. My husband's truck has a very loud stereo system with strong vibrations. I'm pregnant and wondering if this can affect my baby in some way.
A. It probably depends upon how much time you spend in the truck with the stereo very loud. Noise is everywhere in our environment. In adults, loud noise has been associated with numerous health eff ects, including noise-induced hearing loss and high blood pressure. Noise also has the potential to damage fetal and newborn hearing. Studies on pregnant women and noise have been in the workplace, where the noise exposure is consistent over time. These studies suggest that fetuses and newborns exposed to excessive noise may suffer noise-induced hearing loss. It is likely that occasional exposure to loud noises will do no harm, but regular high levels of noise for extended periods have the potential to damage your baby's hearing.
Q. I am ten weeks' pregnant and have been bleeding lightly. Should I see my doctor?
A. Yes. Bleeding should be reported immediately, and evaluated by your doctor.
Q. I took five home pregnancy tests, all positive. However, my doctor could not detect a pregnancy with a urine test, and did a blood test. Do I have a reason to be concerned?
A. Possibly. Urine pregnancy tests are typically accurate, even very early in pregnancy. Usually, a urine pregnancy test will show reliably the pregnancy hormone HCG, around the time of your missed period or even a few days before, about 10 to 14 days after conception. One reason that a previously positive urine pregnancy test might turn negative could be related to drinking a lot of fluids.
The best time to do an early urine pregnancy test is your first morning urine, which is usually the most concentrated. If you are very early in pregnancy, and you drink a lot of fluid, the test might turn negative because your urine pregnancy hormone level gets diluted, even though all is still well. In this case, the blood pregnancy test would remain positive.
Another reason a pregnancy test might go from positive to negative, though, is a chemical pregnancy. This is a very early pregnancy that develops far enough to make the pregnancy hormone, and then miscarries. You will ultimately have vaginal bleeding from this, but many women mistake this bleeding for a normal, or slightly late period. In this case, your blood pregnancy test would also be negative.
The best time to do an early urine pregnancy test is your first morning urine, which is usually the most concentrated. If you are very early in pregnancy, and you drink a lot of fluid, the test might turn negative because your urine pregnancy hormone level gets diluted, even though all is still well. In this case, the blood pregnancy test would remain positive.
Another reason a pregnancy test might go from positive to negative, though, is a chemical pregnancy. This is a very early pregnancy that develops far enough to make the pregnancy hormone, and then miscarries. You will ultimately have vaginal bleeding from this, but many women mistake this bleeding for a normal, or slightly late period. In this case, your blood pregnancy test would also be negative.
Q I'm on bed rest, but I can't sleep, and I'm certainly not resting. I need to move before I lose my mind. What can I do?
A. There is nothing easy about bed rest. It is hard work. Th e best way to cope is to make a schedule of activities that you can follow while in bed. For example, you may have a time when you read books, write letters, answer e-mails or spend time with your family. Your doctor may also allow you to do some isometric exercises, in which you can tighten and relax the muscle groups in your body, combining this with breathing techniques. Try not to nap during the day, and stay on a regular sleep schedule — getting up at the same time and going to bed at night at the same time — to help with sleeplessness.
Q. Can my highcholesterol level have a negative effect on my baby?
A. Several studies do suggest that very high cholesterol levels during pregnancy can have adverse effects on both fetus and mother. Studies in both humans and animals reveal a tendency toward atherosclerosis (hardening of the arteries and heart disease) in the children of women with high cholesterol during pregnancy. It is, however, important to understand that these are very high levels of cholesterol, and not the mildly elevated levels that are actually a normal part of pregnancy changes. Currently, lipid-lowering drugs (statins) are not used in pregnancy due to worries about safety, although the evidence with statin use in pregnancy is scant and conflicting. For now, it is best to consume a hearthealthy diet rich in fruits, vegetables, and healthy fats such as olive oil, canola oil and omega-3 fatty acids.
Q. My mother and sister had gestational diabetes — how can I avoid it?
A Gestational diabetes can run in families. Th e best way to avoid it is to maintain a healthy weight during pregnancy. Women who are overweight or obese are at a higher risk for developing gestational diabetes. Foods that can help control blood sugar levels are those that are broken down more slowly by the body — whole grains, brown rice, whole-wheat breads — instead of sugary foods like soda, fruit juices, white bread, white rice and white potatoes. Finally, staying physically active can also keep glucose levels in the blood stream at a normal level.
Q. Can I contract toxoplasmosis from my cat?
A. Toxoplasmosis comes from cat feces. You should avoid handling the litter by having your partner change it. Cats are very clean, though, and touching your cat or close contact with your cat will not spread toxoplasmosis, so it is fine to cuddle with your kitty.
Questions on your pregnancy answered by David Priver, MD, FACOG
Am I Pregnant?
Q. I took a couple of positive pregnancy tests, but am now spotting a week later. What does that mean?
A. In most cases, it doesn't mean anything other than some leakage from a small broken blood vessel. If it does not resolve in the next couple of days, it would be reasonable to consider an ultrasound and/or blood tests to measure HCG (pregnancy hormone).
Q. I've been getting heartburn, which I never get. Also, a burning sensation in my stomach, wetness in my underwear, hair loss, white bumps around my areola, and a couple of white pimples on my nipple area. I've been very emotional, crying at anything, irritable, very moody and hungry a lot. I have cramps. Could I be pregnant? My period isn't due for a few days, yet I've been like this for two to three weeks.
A. None of the symptoms you describe is indicative of pregnancy, although that cannot be ruled out until your period is late. This sounds more like a hormonal imbalance, which will usually resolve once the menses begins, so just give it a few days and the situation should become clear.
Q. I just saw some blood on my underwear today at school and I'm 19 years old and I missed my period 12 days ago and I ovulate in two days so I'm confused about the bleeding and I think it's implantation bleeding.
A. It is a major precept of gynecology that any woman from menarche to menopause who misses a period is pregnant until proven otherwise. However, if you are now 12 days late for menses already, then this is far too late for implantation, an event which occurs before a menses is even due (an average of seven days post conception). In the event that you do prove to be pregnant, a small amount of spotting requires only that it be watched and reported in the event it becomes heavy or painful. Be sure you run a pregnancy test right away.
Q. I had my daughter in Oct 09 and got an IUD put in in Nov 09. About two months ago I started to feel what seems like fetal movement in my lower abdomen. My last normal period was about three to four months ago and since then I've only had a couple days of spotting each month. I've taken two pregnancy tests both a month apart and both negative. I've been lightheaded, have heart burn, a few pains that feel like ligament stretching, shortness of breath, and sharp pain inside my ribs on the right side back and front, sometimes shooting over to the left. Other than that I have no symptoms. I'm not showing like I'm pregnant. Could I be pregnant?
A. Not at all likely. Your absence of menses suggests to me that you have a Mirena device (in which this is a common and harmless side effect). There are some generally minor hormonal effects of the Mirena, and these probably account for what you're experiencing. The failure rate for this device is well under 1%, so you may feel secure it is doing its job.
Q. I'm 24 and I just had my first baby in March via C-section. About two months later I started feeling a slight flutter in my lower abdomen. I have taken two home pregnancy tests, both negative. Now six months later I'm still feeling this flutter stronger than before. I have had normal periods. Is there a chance I could be pregnant again? Or could it be from the surgery?
A. The greatest likelihood is that what you're experiencing is intestinal movement which is of a different nature than it was before because of scar tissue which inevitably forms in any surgical site, including C-sections. There is no cause for concern unless additional painful symptoms develop.
Q. I'm 15 years old and had sex for the first time Friday night. It was unprotected, so I took the morning-after pill 43 hours later, as soon as I could. I have what feels like bruises on each side of my hips and don't know if that is a symptom of pregnancy. Can you help?
A. What you are experiencing is not a symptom of pregnancy. Also it is much too early for the typical symptoms of breast soreness, fatigue, and frequent urination to develop. If you are late for your next period, be sure to have a pregnancy test done as early as possible.
Q. I am 36 years old and have always had a normal menstrual cycle. Now I have noticed my periods are lighter and shorter than in previous years. This month I am one week late and have taken four pregnancy tests, starting on the first missed day of my cycle. All tests read negative. I did have a small amount of red blood last night mixed with a mucus-like discharge. This morning the blood and discharge were random and by this afternoon gone. Is there a chance I could be pregnant? Or is something else going on? Was that my period?
A. Pregnancy is highly unlikely, but hormonal imbalances do start to occur fairly often once women reach about age 35. This is the most likely explanation, and is a temporary, non-worrisome situation.
Q. I took two pregnancy tests about a week ago and both were positive. Now I am experiencing some bleeding, not as heavy as my period, but not too light either. I have no cramping or clots. I did bleed around this time with my first child. Do you think everything is fine? What could this be?
A. What you're experiencing is considered a "threatened abortion." It is not unusual. In most cases, pregnancies proceed normally from this point. Your doctor can measure your hormone production over a couple of days so as to determine if this is likely to be a normal pregnancy or a miscarriage.
Q. I am 31 and have had four children. I had pomeroy tubal ligation six years ago. A couple weeks ago I started feeling fluttering in my lower abdomen, which has gotten stronger in the last two weeks and feels only like a baby moving. I know the feeling. I haven't missed a period, and am not sure if this period is a little late. My periods have gotten shorter and lighter. I have had sweats and nausea, and my lower abdomen looks slightly bigger. I took two pregnancy tests, which were negative, but the kicking continues, just like a baby, and it is the only thing I can describe it as, I can also sit and watch the movement. Please tell me what you think!
A. The first thing you can be assured of is that this is not a pregnancy. Negative tests and continuing menses are very adequate evidence for that conclusion. There are a couple of other things which can be causing a sensation of abdominal movement. These include increased intestinal activity which can be associated with your diet or changes in your hormonal levels, as well as spasms of the muscles of the abdominal wall. It is most unlikely that any of these are likely to be related to any serious health conditions, but should be brought to your doctor's attention if they don't disappear within the next couple of weeks.
Q. I have been pregnant two times, once at 18, and then at 19. I'm 31 and one month late. HPT is negative. Is it possible to be pregnant with negative HPT?
A. It's possible, but very unlikely. Today's pregnancy tests are extremely sensitive. Far more likely is that you've failed to ovulate this month, which is not unusual in stressful circumstances. This situation should resolve itself within a couple of weeks. If not, see your ob/gyn.
Q. I had some brown discharge four days before my cycle was supposed to begin. I had very light cramping on the left side of my lower stomach area, which moved to the direct center at random times. The discharge lasted for three days: first day, dark brown with a thick, pasty-like texture; second day, lighter in color mixed with a pale pinkish tone; third day, pink spots when I wiped on three occasions throughout the day. The total discharge phase was never a flow. My cycle was set to begin the next day and nothing has happened so far. Could I be pregnant?
A. That's an excellent possibility as what you saw could have been what we call "implantation," a process by which a fertilized egg works its way into the wall of the uterus, often releasing a small amount of blood. A pregnancy test should be positive by now if that's the case.
Q. At 11 dpo I had a doctor's visit. A pregnancy test was done and it was negative. The doctor did a pelvic/vaginal exam and said she could not feel anything. Is it too early to feel anything at 11 dpo? I still/have been feeling symptoms of pregnancy: fatigue, heavy/tender breasts, nausea, mild cramping, rise in bbt,lower backaches, headache, dizzyness/lightheadedness, constipation, hungry and cravings. I'm not late yet. My period comes this week. I tested at 7 dpo, 9 dpo and 11 dpo all negative. Please help.
A. Assuming that "dpo" means days post-ovulation, then it is much too early to be testing for pregnancy as you are not even late for menses. You may expect a positive test by another 7 or 8 days. At 11 dpo, it is not possible to detect any changes on exam.
Q. My period lasted five days, then I missed my period. I have no cramping. Could I be pregnant?
A. Absence of a menstrual period is always pregnancy until proven otherwise. By now, a pregnancy test should show positive.
Q. I miscarried a year ago, and have been on birth control to regulate my periods. It worked. I had normal periods for four months, then three two-day light periods. Seven pregnancy tests were negative. Could I still be pregnant?
A. That's not at all likely. It often takes several months to resume ovulating on a regular basis after a miscarriage, especially if you took the pill for a while thereafter.
Q. I'm in my first trimester and am eating less because I have no appetite. Will this affect my baby?
A. This is a very common first-trimester symptom. Unless it is quite severe, there is no danger to the baby as its nutritional needs are quite minimal at this point.
Q. My period is due and I have had swollen breasts for over a week, with mild cramping. I took a home pregnancy test today and it was negative. I normally do not get sore breasts prior to my period. I have also had clear discharge last week for a couple of days and now today. Would a blood test be more accurate?
A. Yes, a blood test is more accurate, buy why not just wait until you miss a period? If you go a few days past, a urine pregnancy test will be accurate.
Q. For the past week I have had pressure, not painful, in my uterus area. I also noticed weight gain. Every now and then there is a gassy kind of pain. I also have been experiencing more headaches than usual. I feel sick in the mornings, throughout the day, and sometimes feel like vomiting. My mood swings are worse. I cry over the littlest things. And for the past few days I have been feeling very tired. Could I be pregnant? My period isn't due for about a little over a week. I have a three-year-old and a LONG history of miscarriages, and don't want these symptoms to be from a miscarriage.
A. The obvious advice under this condition is to run a pregnancy test. If it's negative, then just wait and see if your period comes. If it does not, re-run the test. If it's still negative, your doctor can run some tests to see if the matter is the result of hormonal imbalance, which can often cause these symptoms.
Q. I was on Implanon but took it out because of movement in my belly. I had a baby six months ago and know what it feels like to be pregnant. But recently I've been dropping eggs and feeling like I'm pregnant. The pregnancy test came back negative on the Implanon but positive after I took it out. Am I pregnant?
A. If I'm understanding your question, you have had your Implanon removed even though your pregnancy test was negative, which is a decision which I do not understand. Now your test is positive. That indeed does indicate that you are pregnant.
Q. I was supposed to get my period last Thursday but did not. Friday I had brown spotting just once. I took a pregnancy test that was positive, then went to the clinic Monday. They said it was negative, but that I should come back Friday if I still don't get my period. I have also been having cramping off and on, but no period. What could be going on?
A. If pregnancy turns out not to be the case, then the most likely scenario is failure of ovulation, which is not at all uncommon. In most cases, it resolves itself. Most important at this point is to be sure about the pregnancy possibility, as spotting and cramping can reflect miscarriage or ectopic pregnancy.
Q. Will I get a positive pregnancy test if I am injecting HCG for weight loss?
A. Yes, you will, as pregnancy tests measure HCG levels.
Q. I had an irregular period last month, and about three or four days ago I took two pregnancy tests and they both had faint lines. For the last month I've had off and on nausea, irritability, weight gain and extreme fatigue. I know it could be something else, but it all seems right. Yesterday I started bleeding. At first it looked like old blood but then the color became brighter. I only had very mild cramps last night. I passed a blood clot about the size of a quarter and they're getting smaller. I had no PMS signs. I'm not sure if it is my period or what.
A. It sounds to me like the only thing you can say for sure at this point is that if this is a period, it certainly isn't a normal one. It's a fundamental tenet of gynecology that when a woman has periods which she doesn't consider normal, she is pregnant until proven otherwise. Your doctor can resolve this situation by runningblood tests for the pregnancy hormone, HCG, possible is a serial fashion so as to evaluate the changes going on.
Q. I got my period twice this month, and feel dizzy and lightheaded. Could I be pregnant?
A. Irregular flow is more often due to hormonal imbalance than pregnancy. That imbalance can readily cause lightheadedness and dizziness, but these are not dangerous and normally correct themselves.
Q. My stomach is extremely sore. I am 7 DPO and was wondering if this could be a sign of pregnancy. I also have been lightheaded, nauseated and I have been urinating frequently.
A. While you may have conceived 7 days ago, there are no symptoms which would occur this early. Be aware, however, that ovulation is often hard to pinpoint, so you might be further along. Pregnancy tests these days are accurate and show pregnancy before a period is missed, so you should know in the next few days.
Q. If you have sex every night that you are ovulating, is it possible to conceive more than one child?
A. Theoretically, it is possible to conceive more than one embryo if more than one ovum has been released from the ovary. If this were to happen, however, it would not be from having frequent intercourse.
Q. I'm 18 years old and not allowed to get pregnant. My parents will abandon me, and I never want that to happen. I've had unprotected sex for one month, two days after my period. Now, I feel constantly bloated, I urinate more frequently, I have light bleeding (the blood is red), continuous abdominal cramping, diarrhea, and sometimes I feel so sleepy, dizzy, or my head aches. I have also noticed increased vaginal discharge for a week. I took three pregnancy tests, which were all negative. I am totally lost and very confused and seriously depressed. Please help me. Am I pregnant?
A. It is very unlikely that you are pregnant, but you definitely do need a gynecologic evaluation. Most likely, your high level of anxiety is causing some hormonal disturbances, which are causing the symptoms you describe. From this point onward, be sure to use reliable protection against pregnancy.
Q. I went to the hospital for stomach pain, they took blood and urine and told me that I was pregnant. I went to the clinic the next day and took a urine test, which was negative. I'm confused.
A. Clearly, there needs to be more follow-up here, as you are showing mutually exclusive results. This may represent a very early miscarriage in which the hormone level has remained too low to turn the less sensitive urine test reliably positive. A repeat of the blood test should clarify things.
Q. I have been feeling movement in my belly for a few weeks. I can physically see my belly move. I took a pregnancy test a couple of days ago, which was negative. Would a pregnancy test be accurate if I were far enough along to feel and see movement? If I am not pregnant, what could it be?
A. Pregnancy tests are extremely reliable nowadays, so you may be assured that you are not pregnant. Abdominal muscle spasms as well as intestinal movements are likely causes of what you are noticing.
Q. I took a pregnancy test, which was positive, but also had an ultrasound that showed a cyst on my left ovary. Can I still be pregnant?
A. Yes, you can. A relatively small ovarian cyst accompanies all pregnancies during the first trimester. This is what keeps the pregnancy going until the placenta takes over later on.
Q. I missed my period and took a pregnancy test, which was negative, but I have a light brown line under my belly button. What is this?
A. When women miss periods but are not pregnant, it usually means that they have failed to ovulate, which is not unusual or worrisome. What happens then is that the ovary releases estrogen, but not progesterone. That imbalance may stimulate skin cells to produce melanin, which is a brown pigment. That is likely the explanation.
Fertility
Q. I will be having intrauterine insemination (IUI) done soon. I am also scheduled to fly out of town, possibly the same day. Is it safe?
A. I don't believe there is evidence that a person's activity level has any more bearing on the likelihood of success after IUI than after more traditional insemination, so, unless you are counseled otherwise, I don't feel that you need to change your travel plans.
Q. I have been trying to get pregnant, and have been having unprotected sex for almost two years. I have been spotting and I thought I was pregnant due to the spotting. I then started bleeding light orange. I am wondering what that means. I took a pregnancy test and it was negative.
A. You've already exceeded by a full year the amount of time that a woman should try unsuccessfully to conceive before seeking help. With the sort of irregular,abnormal bleeding you describe, a good possibility is that your ovulation mechanisms are not operating properly. A fertility specialist can explain to you how that sort of thing is addressed.
Q. I had the IUD Mirena 4 years ago after my daughter was born. I had it removed at the end of May and had a regular period June 26th. I had intercourse with my husband on the two "most fertile days" in July. I have been feeling heaviness and tightness in my lower abdomen and have been slightly nauseous the last few days. Instincts are telling me that I am pregnant, but it might also me just being hopeful. How soon can I start testing for pregnancy?
A. Assuming you have the customary 28 day cycle and that if you conceived, it occurred on your "fertile days", which would likely be around July 9-10, then you should start testing around July 19-20, which would be 5 days prior to your next anticipated menses and 2-3 days following likely implantation. As there are a lot of assumptions implicit in this sort of analysis, do not be discouraged by initially negative results. Certainly by the time you are 3-4 days late for menses, test results should be positive.
Q. I came off the pill a few months ago and after that my first period was on time and everything was fine. Then the next period was about two weeks late and right now I'm a month late or more. I've taken pregnancy tests and all have been negative. Around two weeks ago I was taking Nitrofurantoin for a bladder infection. Could this be a reason? I'm worried I might not be able to have children!
A. There's very little reason to worry about your long-term fertility, even though your cycle has been temporarily disrupted as a result of using the BCP. This is a problem which will resolve itself, although it may take a few months. It has nothing to do with your recent UTI.
Q. I am having the usual period symptoms since in-vitro three days ago. Now it has been 12 days. Does it mean there's no pregnancy?
A. Not necessarily. Premenstrual-type symptoms often occur during the early days of a pregnancy as a result of hormonal patterns which are quite similar for a brief while. Wait a few more days, then begin testing for pregnancy.
Q. I have been taking prenatal vitamins while trying to get pregnant. Will it affect the reading of my test?
A. No, it will not. Vitamins will not affect the results of a pregnancy test.
Q. We are having sex every day but I cannot get pregnant. Is there a solution?
A. It depends upon how long you've been trying to conceive. The traditional criterion is that infertility is not considered until a couple has been trying for a full year. Many fertility centers, however, will initiate testing sooner as more and more couples are delaying the starting of their families. You might wish to have an initial consultation before deciding to proceed with a detailed investigation.
Q. I have had unprotected sex several times and have not become pregnant. We have sex almost every day with no protection. Does this mean I can't get pregnant?
A. Not necessarily. We don't consider there to be a fertility problem until one full year of trying has occurred. Once that point has been reached, however, then a series of tests will be performed that may well confirm that the problem lies in your partner..
First Trimester
Q. I'm seven weeks pregnant. I had my first scan yesterday due to light spotting. They could not find a gestational sac. Blood was taken and my hcg levels are 8,000. I was called back for another scan so they could check my ovaries and Fallopian tubes again. Nothing was found. I have to go back tomorrow for more tests, I'm not in any pain. What are the chances that this could be a normal pregnancy?
A. Not very good unless there's an incorrect date involved (which does often happen). By seven weeks from the last menses, a fetus with an active heart beat should be seen easily. At this point, the main issue is going to be whether or not you have an ectopic pregnancy or simply an intrauterine pregnancy which has failed (miscarriage).
Q. I am 27 years old, and pregnant 1 month, 4 days. My skin is dry. I am facing the problem of itching at the abdomen, hands, legs. Will itching during pregnancy produce permanent marks on my stomach? Can you suggest lotions and oils for massaging?
A. Any moisturizing cream or lotion will help prevent dryness. This doesn't have anything to do with whether or not you will develop stretch marks. There's been a lot of interest in Vitamin E oil and its reported ability of improve skin flexibility, but there is no definitive proof of this.
Q. I'm ten weeks pregnant and experiencing tightness and swelling in my hands and feet, mostly on my right side. It goes down, but the tightness is still there. What's wrong?
A. Nothing's wrong. You are simply retaining water, which a very normal result of the massive increase in the amount of estrogen you are producing from your pregnancy. Resting on your left side will somewhat help enable the kidneys to excrete the extra water.
Q. I found out I'm pregnant. Funny thing is I had no symptoms but my mate did. Will I experience them anyway?
A. You may not. Not everyone has the same experience. That said, it's unusual not to experience some degree of breast soreness, fatigue, nausea or urinary frequency.
Q. I used a rented fetal doppler with my prior two pregnancies and did not think anything of it. At eight weeks and three days into this pregnancy, I rented a doppler and used it for about 30 minutes trying to find the heartbeat, which I eventually found. Then I read that I could have heated the tissues and caused brain damage by using it too long. Do you think I could have caused a problem?
A. There is not the faintest evidence that any harm can be caused to a fetus by the use of ultrasound, although this fear continues to be stoked by folks with an alarmist bent.
Q. In January I was five months' pregnant, and my son was stillborn. I was told it was going to happen anyways because my sac was weak. Why didn't my doctor tell me before? What does it mean, and how can it be prevented? I'm five weeks' pregnant.
A. Not sure I know what is meant by your sac being weak, but I assume you mean that your membranes ruptured prematurely. This is not something your doctor could have predicted, as it's generally believed to be due to infection. You should not be at any increased risk for this happening in the future.
Q. I am supposed to be 11 weeks' pregnant. I went for my first ultrasound and it was only six weeks developed. My irregular cycle is 52 days long. Could I still be pregnant? Could the fetus have stopped growing?
A. It is most unlikely that there is anything wrong with your pregnancy. It is to be expected that your long cycle will throw off predictions as to the length of your pregnancy. What that means is that you likely conceived on around day 38 of your cycle rather than day 14. You will likely have another sonogram soon which should reassure you and also help pin down a reliable due date.
Q. The last time I had a period was April 3. I took a pregnancy test in May, which was positive. I had a scan last week, which showed that the pregnancy was six weeks and five days, but from my calculation it ought to be ten to 11 weeks. What do you think?
A. This is a very common event in pregnancy. Fully one-third of the time, the correct gestational age as determined by ultrasound does not square with menstrual dates. From what you tell me, it is most likely that you got pregnant a few weeks later than you thought you did as a result of delayed ovulation. If, for example, your pregnancy test first showed positive in late May, you could have conceived around the middle of that month and still be only six to seven weeks by mid-June. This is why many of us are encouraging that ultrasound be done quite early in the pregnancy, so that a reliable due date can be established.
Q. I am almost 11 weeks and having cramping. Is it normal? Also, should I not be lifting anything heavy or bending this early in the pregnancy? Will I miscarry if I do?
A. Cramping in the first trimester which is not accompanied by bleeding is a normal stretching phenomenon. It does not imply any higher than normal risk of miscarriage and does not require you to be at restricted activities.
Q. My daughter is six weeks pregnant. She was bleeding pretty badly, went to the hospital and was told the placenta was bleeding at the top. They said the baby was still fine but she had a 50-50 chance of losing it. She was put on bedrest (it has been a week) and the bleeding stopped for three days, but now she is bleeding a little again. What can she do to help stop the bleeding?
A. By "bleeding at the top" I suspect you mean that there was blood between the implanted egg and the wall of the uterus, what we call subchorionic hemorrhage. In most cases it subsides with no adverse potential for the fetus. It can be expected to stop on its own. However, if this does not occur by 7 to 10 days later, another sonogram is warranted to determine if the pregnancy is continuing.
Q. What does an HCG of 600 mean?
A. It means nothing by itself other than that there is, or recently was, a pregnancy. What matters is how the number is changing. In a normal first trimester, the value should double every 72 hours from about 6 to 10 weeks. So, in order to take any valuable information from this test, it needs to be repeated in a few days in order to see if it's increasing as it should.
Q. I am 6 weeks pregnant. I had light spotting with small bits of tissue. I went to the ob/gyn and the ultrasound showed 1 sac with a strong heartbeat. I then had a gush of blood with a clot the day after. I had ivf and had 3 embryos transferred. My hcg level was also very high. Is it possible the blood is from miscarriage of one of the other embryos?
A. Yes, that is quite possible. This situation requires close follow-up with sonograms and possibly serial HCG levels. However, the visualization of a heart beat is a very favorable sign that at least one of the embryos will survive.
Q. I have decreasing HCG levels (153, then 109 a week later), but my cervix is closed and my uterus is enlarged. Could I be having a miscarriage?
A. A miscarriage is very likely under the conditions you describe. HCG levels should consistently rise throughout the first 10 to 12 weeks.
Q. Using BBT I determined ovulation was on day 19 of my cycle. On day 29 I began spotting and had a what I thought was a light period for two days. Ten days later (39) I was having light spotting that was dark brown. I took a HPT and it was positive. A blood test the next day confirmed positive. A week (47) later my HPT is negative but I haven't have any cramping or bleeding. Has the embryo stopped developing and am I going to miscarry? If yes how long until I actually miscarry?
A. It appears likely that you have already miscarried. Very early, there may not be more than a light bloody, brown discharge. An easy way to confirm this is to measure blood levels of the hormone HCG. If it is going down the pregnancy has been lost.
Q. Two weeks ago I had a big cramp that lasted maybe two seconds, and in the morning I had a piece of what looked like pink tissue. However, there's no blood and I'm almost three months pregnant. Should I be concerned?
A. Not if the event occurred two weeks ago and has not recurred. If anything important, such as a miscarriage were occurring, the bleeding would not be brief and limited, but would persist. Your doctor should be able to reassure you at your next visit.
Q. Does a weak positive mean that the baby was conceived within the last couple of weeks? If not, what does it mean?
A. All it means is that the HCG hormone level is low, which can mean a very early pregnancy or a later one that is in the process of being lost. If the pregnancy is healthy, the test should turn strongly positive in five to seven days.
Q. I purchased a fetal Doppler for home use and tried it at 10w3d and again at 10w6d. On the lower left side just above my pubic bone I pick up a fairly fast, faint swish-swish sound and also a much louder whistling-type sound, like wind down a tunnel. Problem is, I pick up the exact sounds in the same position on the right. A 6w3d the ultrasound showed only one sac and one h/b. Am I hearing my own femoral arteries? What is the wind sound?
A. At less than 12 weeks, a fetal Doppler is not going to be able to reliably detect fetal heart tones, so most likely you are hearing the pulsation of your own arteries. Blood circulating through an artery can cause a sound a bit like the rushing of wind.
Q. I just found out I am pregnant with my first. I usually babysit two toddlers twice a week. My mother told me that being around them increases my risk of getting diseases that could affect my pregnancy. Is this true? I know many women have several toddlers when they get pregnant and it's usually not a problem, but my mother insists it is an unnecessary risk. What is your opinion?
A. The risk would be extremely low, as the conditions which can adversely affect an early fetus are things that you almost certainly have had as a child yourself and, therefore, are immune from. That said, if you know for a fact that you've never had common childhood illnesses such as measles, mumps, chicken pox or German measles, then there is some risk involved and it would be best not to risk exposure until you're past the first trimester.
Q. This is my second pregnancy. I went to the ER at four weeks, three days due to brown spotting that turned red. Transvaginal US results show an elongated GS "moving slowly in utero" and comments in the report state "0 IUP seen." I have been told that they suspect an ectopic pregnancy and I should expect the worse. Could they be a little ahead of themselves given that the pregnancy is so young? My cervix remains closed and is normal and I have a small amount of spotting with occasional mild cramps.
A. If they actually saw a "GS" (gestational sac) in the uterus, then ectopic pregnancy is most unlikely, almost a zero possibility. At four weeks, three days, no definitive signs of pregnancy are going to be seen on ultrasound. Serial quantitative HCG levels are helpful in a situation like this.
Q. This is my third pregnancy. I miscarried the first two times. I had IUI for all. I got a call today from my nurse who said that my results for my pregnancy test was 1 week positive but it may be weak. The number I was told was 14 at the moment and that the right number should be 50. Can you tell me what the numbers mean? I have to go back in two days to have another blood test to see what the number is. I took a home pregnancy test the same day and it says positive. In my past pregnancies I was never told about numbers to have a positive result. I am seeing a new doctor for this IUI. In my last pregnancy I was pregnant with five, then reduced to three. I lost that pregnancy. I had a cerclage done but not at 12 weeks. It was at 17 weeks. I was already dilating when they did the stitch. For this pregnancy if it is in fact full positive I will need the stitch. Will I have to be on bed rest the whole time?
A. There are several questions here. As to the hormone numbers, there are no hard and fast rules, but 14 is considered extremely low and raises the possibility of early miscarriage. The next test will be important in answering that question. If you had a cerclage before, you'll need it again. There's no scientific evidence that bed rest adds anything to the success rate of pregnancy. You should discuss this with your doctor.
Q. I will be two months pregnant next week. I went for sonography two days ago, and my doctor said that no heartbeat can be detected. Is something wrong?
A. Not necessarily. You might not be as far along as you think; one third of menstrual pregnancy dates turn out to be incorrect. On the other hand, if you are essentially certain when you got pregnant, then by two months, or eight to nine weeks, a heartbeat should be easily seen on vaginal ultrasound. The matter can be settled by a combination of blood pregnancy hormone levels and repeat ultrasound tests.
Q. I'm eight weeks pregnant. The doctor said the baby is hiding, and he couldn't find the heartbeat. Should I be worried?
A. This depends upon what method the doctor used to try to detect the heartbeat. If it was a Doppler device in which only a sound is produced, then it would be quite a bit too early to hear the heartbeat. However, if this was a sonogram, in which a picture is produced, then the beating heart should definitely be detectable by eight weeks. Your doctor can follow this latter situation by repeating the sonogram in a week or two.
Q. I'm pregnant and wake up four or five times in the middle of the night because my left arm is numb and my fingers (mainly my middle finger) are as well. It is very painful. Is there anything I can do to relieve the pain? I have tried elevating my arm on a pillow, sleeping with a pillow between my legs, in front of my belly, etc.
A. This is called "carpal tunnel syndrome" and is very common during pregnancy due to water retention. There is a brace device that can be applied and that is usually quite helpful. Talk to your ob/gyn about this.
Q. Is it possible to have your period throughout your whole pregnancy?
A. It is possible to have intermittent bleeding episodes during pregnancy, usually for reasons that are not harmful. These episodes, however, are not "periods" in the traditional sense as menstrual activity ceases during pregnancy.
Sex During Pregnancy
Q. I'm roughly six weeks' pregnant and have been ok up until two days ago. After having gentle intercourse and now every other few times I go to the toilet, I'm wiping away thick mucus which looks to have faint bits of blood in it. I'm also having very gentle cramping. Is this normal?
A. Yes, it is. Blood vessels in the genital area tend to become a bit fragile during pregnancy, so very light flow is not considered abnormal, although levels approaching menses certainly would be. Also, the stretching of the uterus will cause mild cramping.
Q. I'm 15 weeks pregnant. For the past few days I have been feeling pressure in my vaginal area. Could something be wrong? I always bleed a bit after sex. Is something wrong? They told me my blood type is B negative and my boyfriend is O positive.
A. Pressure in the pelvic area is a standard and normal sensation in pregnancy and can be expected to continue for the duration. It is not abnormal, nor is a small amount of bleeding following intercourse. This is due to the increased fragility of small blood vessels in the cervix.
Q. I am eight months' pregnant, and started bleeding a little bit after sex, but I felt the baby move and kick! Is everything ok?
A. Small blood vessels in the cervical area commonly break as a result of intercourse late in pregnancy, but there is nothing dangerous about it. In fact there is an (unproven) theory that the prostaglandin in semen helps to soften the cervix, making labor faster and easier. As you can imagine, this is not a simple matter for reliable investigation, but certainly does stand to reason.
Q. My girlfriend was bleeding for longer than normal. It stopped, and then she started bleeding during sex. We went to the hospital and they took a urine sample that came back positive. They drew blood and said the hormonal level was 106. Then they did a ultrasound that showed nothing. Please tell me what this means.
A. That level is consistent with a very early pregnancy. With bleeding, however, it could also signify such problems as miscarriage or ectopic pregnancy. This needs to be followed closely via a combination of further blood tests and ultrasound..
Q. I am wet all the time, and after we have sex it hurts. I have been swollen about a week and a half, extra moody for almost two weeks, tired and I have to pee all the time. What's wrong with me?
A. It's not possible to make a reliable diagnosis of what might be causing this array of symptoms, but it is safe to say that none of them sound normal. One would want to start by ruling out such conditions as urinary infection, vaginitis, ovarian cysts and hormonal imbalance. So, a visit for a gynecologic evaluation is clearly in order.
Ultrasounds / Fetal Health
Q. I just had an ultrasound, which showed an extra bubble in my baby's tummy. They will not tell me anything. What could the possibilities be? Do I need to prepare myself for bad news?
A. What you are referring to is the "double bubble sign." This means that fluid is not moving properly through the digestive system. This suggests a condition called "duodenal atresia," which is not normal, but can be corrected surgically. Also, there is a correlation between this finding and chromosome disorders. There is reason to be concerned, and your pregnancy will need additional evaluation right away.
Q. The doctor said that my child has a enlarged kidney and fluid on the base of the spine. What could this mean? Could it mean birth defects, nothing or surgeries?
A. These are both clearly abnormal findings which must be taken seriously. The kidney may be obstructed and there may be a spinal abnormality. Your OB physician will be able to refer you for a detailed evaluation and should be done as soon as possible.
Q. I'm in my first trimester and am eating less because I have no appetite. Will this affect my baby?
A. This is a very common first-trimester symptom. Unless it is quite severe, there is no danger to the baby as its nutritional needs are quite minimal at this point.
Q. I am 34 weeks pregnant and my ultrasound showed a lack of growth of my baby's head and abdomen. What could be the reasons? I have had all normal reports before this. The doctor says I might have to go for early delivery. Will an early delivery keep my baby from having normal mental and physical growth?
A. A single reading of this sort is not going to provide definitive information. However, if another reading still shows no growth, this could be due to inadequate delivery of oxygen and/or nutrients to the baby. There is a form of late pregnancy testing which can shed more light on this.
Q. I went for my 20-week sonogram yesterday and my doctor told me that they were unable to confirm that the baby had four chambers in the heart. She said it was due to the position of the baby and I was fine with that until she asked if we would terminate the pregnancy if there was something wrong. This is my fourth baby and I have NEVER had them say they couldn't confirm proper heart development at 20 weeks. Baby is growing right on schedule and her heart rate was 154. Should I be concerned, or is this common?
A. Fetal position does have a big impact on the ability to see small items like heart chambers. Another sonogram in a week or two should be able to resolve this fairly common issue.
Q. I'm 16 weeks' pregnant and my three-year-old kicked me hard with the back of her heel below the belly button and I would just like to know if the baby is ok. Is there anything I could do, and what are the chances that the baby was kicked in the face?
A. It is almost unheard of for this sort of event to cause any problems with the baby as it is extremely well protected by amniotic fluid. In the unlikely event that something dangerous has happened, it is essentially certain that your water would have broken or bleeding would have happened. If you're still worried about this (and it is, after all, a mother's job to worry about her children), you can have your doctor's office listen for the heartbeat.
Q. I am 18 weeks' pregnant. I went for an ultrasound this week, and my doctor told me that my baby had dilated kidneys. The next appointment I have been given is 32 weeks. I am assuming that after this find the doctor would want to see me a little more often. I am worried about the baby's condition and I don't want to have amniocentesis due to chances of miscarriage. I would like to know if I need to worry both about my baby and the doctor not wanting to see me frequently. Thank you.
A. I'm concerned as well. Prenatal appointments are never supposed to be less than every four weeks. In this situation, I'd want to get another ultrasound by 24 weeks at the latest. By the way, I don't know if anyone has advised you to have an amniocentesis, but if they do, you really needn't worry much about miscarriage. It's extremely rare following that procedure and a lot of important information can be gained by it.
Q. My son had a CAT scan today. I stood beside him to hold his head while wearing the apron. I think I may be pregnant as my period is late. Should I be concerned for the fetus?
A. No, you needn't be alarmed. The apron will protect you quite well.
Second Trimester
Q. I'm 22 weeks pregnant. At my first ultrasound they found my cervix 1 cm dilated, and my water bag visible. The ob suggested a cerclage. I declined because of the risk of rupturing the water bag. I went to another hospital for an alternative and they told me about a pessary, which was not painful at all, so I went for it. I feel like it's taking the pressure off my pelvic area but the cerclage was still recommended. When I stand up I feel some mucus come out, but there's no leaking fluid down my legs and no blood. Will everything be ok?
A. At 22 weeks a visible bag of waters is a clear indication of what we call an incompetent cervix, the only treatment for which is cerclage. A pessary will perhaps make you feel more comfortable, but will not reduce the risk of an extremely premature birth. So, my advice is to have the cerclage. In qualified hands the risk of rupture of membranes should not be more than around 5%.
Q. I'm 24 weeks' pregnant, my ob/gyn said that my amniotic fluid is too high. What does it means? Should I be worried?
A. Excessive amniotic fluid is a potential danger sign of fetal maldevelopment and needs to be carefully followed. That said, amniotic fluid volumes are subject to frequent and harmless shifts. I would suggest that a high resolution ultrasound be considered so as to evaluate both the intestinal and urinary systems, which would be the main areas of concern.
Q. I am 23 weeks and having a boy. I went to the doctor yesterday and they are concerned because my baby's abdomen was two weeks behind in growth. What does this mean? Is there something wrong?
A. As an isolated finding, it doesn't mean a thing. At 23 weeks, a two-week discrepancy is fairly minor. Undoubtedly, the matter will be explored further in weeks to come, but the risk of a fetal abnormality in this circumstance would be small.
Q. I'm 22/23 weeks' pregnant, with moderate hip, lower-back, stomach and pelvic pain and liquid leaking every time I get up. Should I be worried?
A. Yes, you should. Fluid leaking from the vagina means that the membranes have ruptured until proven otherwise. This raises a number of serious dangers, including infection and premature birth. Be sure your doctor is notified immediately about these symptoms.
Q. I am 23 weeks' pregnant, and my baby's head is at 60 percent. Is that normal?
A. Yes, it is. This just means that your baby's head measurements are in the 60th percentile; in other words, very slightly larger than average, but certainly not reflecting anything abnormal.
Q. I am 22 weeks, 5 days' pregnant. The doctor's office told me my belly measured too big, and they are going to send me for an ultrasound. What could this mean?
A. In most cases, it doesn't mean anything as there is quite a lot of individual variation among pregnant women. If you've not yet had an earlier ultrasound, then the possibility exists that your dates are inaccurate or that you might have twins. Very rarely, there exists an excessive amount of amniotic fluid, which can be a sign of a fetal abnormality.
Q. At my 21-week scan, my baby's head was tilting back. The midwife said the scan showed nothing abnormal, but why is my baby tilting his head back in my womb?
A. There is nothing any more abnormal about a baby tilting its head back than for you to do so. Remember that a sonogram is just a momentary view during which a fetus can assume any position.
Q. I'm 18 weeks' pregnant with my second child. Three days ago I noticed a gaslike pain under my left rib cage. I thought it would subside, but it hasn't and is quite painful and annoying. I've had two bowel movements since then and the pressure or pain has not gone away. I've tried carbonated beverages to assist the gas in making its way out, but that hasn't helped. I've had blood in my stool maybe once a week since I've been pregnant, and am wondering if the two could be related or if I might have an ulcer or if this is just a painful gas bubble.
A. This sounds quite suspicious for a digestive condition called acid reflux, which is fairly common in pregnancy. It is usually quite easy to treat nowadays. It is a nuisance, but not dangerous. Bring it to your doctor's attention at your next OB visit.
Q. I'm 21 weeks' pregnant, and my doctor said that my cervix is opened just a tiny bit and that it's normal for it to be not completeley closed if you have had kids before. Is this true?
A. This is completely true, and, for that reason, there is no purpose served by examining your cervix in the absence of abnormal symptoms.
Q. I'm 15 weeks' pregnant and I did not miss a period. I went to the doctor today and was told that my cervix has dilated 2 cm and I probably am having a miscarriage. What can I expect?
A. This could be an urgent situation. When the cervix dilates painlessly in the second trimester, that is a condition called an "incompetent cervix." If it is detected in time, a suture can be placed around the cervix so as to hold the pregnancy until term, at which time it is removed to permit labor and birth. If the information you are providing is correct, this matter needs to be discussed ASAP with your OB.
Q. I went for my 20-week sonogram yesterday and my doctor told me that they were unable to confirm that the baby had four chambers in the heart. She said it was due to the position of the baby and I was fine with that until she asked if we would terminate the pregnancy if there was something wrong. This is my fourth baby and I have NEVER had them say they couldn't confirm proper heart development at 20 weeks. Baby is growing right on schedule and her heart rate was 154. Should I be concerned, or is this common?
A. Fetal position does have a big impact on the ability to see small items like heart chambers. Another sonogram in a week or two should be able to resolve this fairly common issue.
Q. I am 19 weeks' pregnant with my first baby and during a Pap smear my doctor said my cervix was irritated. It was also very painful during the exam. He also said I have a tipped uterus. Is this why it was so painful and what causes your cervix to be irritated?
A. What your doctor likely meant was that your cervix is reddened. What this means is simply that the hormonal changes of pregnancy have caused the part of the cervix that is normally confined within the cervical canal, to grow out onto the visible part of the cervix, a process we call eversion. It is normal and harmless and would not cause pain. A tipped uterus is not unusual, but, in most cases, it should be starting to straighten out by now. Your doctor will want to be sure that happens in the next three to four weeks, as there are some rare but serious implications of an advancing pregnancy with the uterus "trapped" in that position.
Q. I'm 16 weeks' pregnant and my three-year-old kicked me hard with the back of her heel below the belly button and I would just like to know if the baby is ok. Is there anything I could do, and what are the chances that the baby was kicked in the face?
A. It is almost unheard of for this sort of event to cause any problems with the baby as it is extremely well protected by amniotic fluid. In the unlikely event that something dangerous has happened, it is essentially certain that your water would have broken or bleeding would have happened. If you're still worried about this (and it is, after all, a mother's job to worry about her children), you can have your doctor's office listen for the heartbeat.
Q. I'm 19 weeks' pregnant, my doctor said it looks like my placenta is breaking off. Today I woke up and had bad pain on the lower right side and there was spotting on my underwear but no blood. What should I do?
A. If you remain at rest, there's a good chance that this will resolve on its own. However, placental abruption, as this is called, is potentially dangerous, so you need to watch closely for increasing bleeding or abdominal pain.
Q. I am 17 weeks' pregnant. Since I was about 14 weeks' along I have felt a knot when I press on the lower right side of my stomach. It seems to move slightly at times and does not hurt. Sometimes it seems as though it is different sizes. They say it could be the baby, a hernia or a mass, which really scares me. What do you think it could be? Is this normal?
A. Most likely, you are feeling the top of your uterus. It is not uncommon for the uterus to lean to one side or the other. While it's most unlikely that this is a cause for concern, you should mention it at your next prenatal visit.
Q. I am 26 weeks' pregnant. Every morning when I wake up, my belly seems to have decreased in size. What could this mean?
A. Certainly, it's not a sign that anything's wrong with the pregnancy or with you. The most likely explanation is that what you're seeing is a reduction in the size of your stomach as a result of digestion which has occurred in the 10 or 12 hours since you last had anything to eat. During the day, your uterus presses your full stomach upwards, but by the next morning, most of that fullness is gone.
Q. I am 25 weeks' pregnant, and my cervix is 1.3 cm. I'm also having a slight lack of blood flow through the cord. What are the chances I will make it to term, and what can be done besides bed rest, prometrium and betmethasone?
A. Probably not that good, given the parameters you describe. That said, however, if you can get past 28 weeks the chances for an acceptable outcome are reasonably good, given the fantastic strides that have been made in neonatal care in the past couple of decades. It sounds like you are getting excellent care at this point. Just continue to have a low threshold for going into the hospital if you begin to detect contractions and/or a decrease in your baby's kicking activity. This will give your doctors a better chance of preventing premature birth.
Third Trimester
Q. I am 33 weeks' pregnant and when walking I am getting a severe pelvic pain that will stop me in my tracks. Is this normal?
A. Most likely, this pain is being caused by the normal separation of the area of the pubic bone we call the symphysis. There is actually a joint in this midline area which opens up a bit, and this provides more room for descent of the baby during labor. This separation, however, causes the two ends of the bone to rub together, which can be quite painful. Think of it as your body's way of telling you that it's time to rest more and walk less.
Q. I'm 29 weeks' pregnant, and about a week ago I lost what looked like an eighth of a cup of fluid while sitting down, and I urinated blood twice since. Yesterday I had a little fluid running down my leg. This is my seventh child and never has this happened before. I've had premature babies before. What could this be, and is it normal?
A. The major issue of importance here is the question of whether your membranes have ruptured prematurely. Your OB caregiver needs to be notified right away, as the only way to tell is by a speculum exam.
Q. I'm 31 weeks' along and my doctor told me that my cervix is only at 1 cm when normal is about 3 cm. Could this mean that my little boy is coming early?
A. I don't think you heard your doctor correctly. 1 cm. is entirely normal and indicates nothing. 3 cm. is not normal and could well indicate a prematurity risk. Be sure to clarify this with him/her as there are steps which can be taken to reduce prematurity risks to the baby.
Q. I'm 35 weeks' pregnant and keep getting a burning feeling in my belly. It's been going on for 2 or 3 days, and some days it will burn in my throat as well. If it's heartburn, will I have it all the time? Could the baby have heartburn?
A. Very likely it's heartburn, as your large uterus forces acid into the esophagus. It will continue to happen, but should respond well to antacids. The baby does not experience the same thing.
Q. I'm 32 weeks' pregnant. For about an hour my vagina has been burning inside and out. Also my belly button. And since then my stomach has been rolling from the bottom to the top of my chest. It hurts. Please help.
A. Most likely these symptoms are a variety of ways in which you are responding to changes in your baby's position within your uterus. When the baby is low, it causes congestion in the vaginal area and when it's high, it will tend to cause pressure upwards toward the chest. None of these are at all dangerous and should resolve themselves fairly quickly, although you will likely experience them and other pressure symptoms more frequently over the next few weeks. The good news: At around 37-38 weeks, the baby should settle into a more or less final position so the changes won't be as noticeable.
Q. I'm 38 weeks' pregnant and just found out I have two sacs of water. What does that mean?
A. That's pretty hard to respond to since there is only one sac of waters for each fetus (other than some very rare instances), so the implication here is that there may have been an unrecognized second twin fetus here at some earlier point. The reason this is strange is that this situation, which, by the way, is not terribly unusual, would usually be detected much earlier on ultrasound. In any event, this is not likely at all to produce any problems for you.
Q. My waterbag was leaking some fluid out, but the ultrasound shows some fluid is there. What does it mean? I am 29 1/2 weeks' pregnant.
A. What this means is that it is quite likely that you will deliver prematurely, most likely in the next few days, so some special precautionary measures will need to be taken to improve your baby's chances for survival. Nowadays, most babies do survive at this gestation, although several weeks of hospitalization will be required.
Q. My baby is 36 weeks and the ultrasound reads that the baby's only 34 weeks. I am supposed to see a specialist this week. What could be wrong?
A. Ultrasound at this point of pregnancy has no accuracy whatever in determining gestational age, so it is most unlikely that anything is wrong at all. However, it is valuable to make sure that a baby is growing adequately and that there is a normal volume of amniotic fluid surrounding the baby.
Q. I'm 39 weeks' pregnant. I just took a hot bath, and felt a lot of movement in my tummy for the first time. Is something wrong? Should I not take baths? I also found out I was 1 cm dilated but I am not thinned and my cervix is high.
A. I doubt if there is anything as comfortable for a term pregnant woman than to be immersed in a nice hot bath. This, among other things, brings an increased blood supply to your uterus, which is why your baby began to move more vigorously. Do continue to enjoy this as long as you can.
Q. I am 31 weeks, and very high risk. About a month ago, I started noticing that I had mucus in my stool. Lately, I have been seeing more mucus. Tonight, though, there were "clumps" of mucus on the stool. Is this normal?
A. Yes, it is. Mucus is a normal product of the glands within the colon and is not a sign of any disorder. As with similar glands within the cervix, the amount produced can increase during pregnancy and become more noticeable.
Q. I'm 32 weeks' pregnant as of this coming Saturday--how often should I feel fetal movements, how many times a day, for how long etc.?
A. You are at a point in your pregnancy where you should be doing what we call "daily kick counting". This is an excellent mechanism for reassuring yourself of fetal well-being. Briefly, you should set aside some quiet time, preferably after dinner, when you can avoid preoccupation and can focus upon fetal movement. Your goal is to determine how many minutes it takes for your baby to move 10 separate times. In most cases, this will be accomplished in just a very short time, say 15 or 20 minutes. If, however, the 10th movement has not occurred by 60 minutes, then you need to start over. If this failure to move 10 times in 60 minutes happens again, you should proceed directly to the hospital for more intensive testing. Kick counting from 28 weeks onward has been shown to cut the stillbirth rate in half and should be done by all pregnant women. Your provider likely can give you a form on which to maintain these records.
Q. I'm 37 weeks' pregnant. Should I start trying to induce my own labor like natural ways?
A. I am so glad you asked this question, as there is so much misinformation out there about what women at term should be doing to help bring on labor. To begin with, there has long been the false belief that labor is brought on by walking around a lot. While women have tended to buy this because of all the pelvic discomfort that this activity produces, it is completely false. What women should actually do is spend as much time as possible at rest and taking in good amounts of liquids, as this is what will result in increased blood flow to the uterus which brings with it oxygen and nutrients needed to make the uterus contract. If you doubt this, pay attention to what happens when you first get off your feet; you will most likely feel an increase in the contractions we call Braxton-Hicks. That said, there is great benefit to ambulating once labor is established as gravity will help bring the baby down against the cervix and open it up rapidly. However, ambulating does not help to initiate labor and most likely actually tends to inhibit it. There is another approach, albeit a bit controversial and certainly not scientifically tested, which I mention only because I have seen it work many times in my practice. Sexual intercourse results, as we all know, in the deposition of semen onto the cervix. This material is absolutely loaded with a hormone called Prostaglandin, which is know to both soften the cervix and stimulate uterine contractions. Naturally, this particular approach will need to be employed only if comfort permits, which is not always the case. It must also be avoided if there are certain risk factors such as ruptured membranes or placental bleeding problems.
Q. I am 30 weeks' pregnant, overweight and having back problems. I'm dizzy, nauseous, and am having a headache and cramps. What should I do?
A. This sounds like a situation requiring a dramatic reduction in activity levels. Your body is simply not able to keep up with all the demands being placed upon it right now. You should do what you can to go off of work right away and spend the majority of the day off your feet between now and the delivery. Also, pay attention to your diet, so that you eliminate empty calories and focus upon healthy food and a good level of fluid intake.
Q. I am 39 weeks' pregnant and just noticed a small spot of blood when I went to the loo, but nothing when I wipe and no mucus plug, etc. Is this a sign that labor is not far off?
A. Not really, unless it is accompanied by mucus and some level of contractions. Blood vessels in the cervix are easily broken, but do not have any predictive significance.
Q. I am eight months' pregnant, and started bleeding a little bit after sex, but I felt the baby move and kick! Is everything ok?
A. Small blood vessels in the cervical area commonly break as a result of intercourse late in pregnancy, but there is nothing dangerous about it. In fact there is an (unproven) theory that the prostaglandin in semen helps to soften the cervix, making labor faster and easier. As you can imagine, this is not a simple matter for reliable investigation, but certainly does stand to reason.
Q. I am almost 33 weeks' pregnant, and my baby has dropped. I am starting to leak a little milk from my nipple, and have a few Braxton-Hicks contractions. Is labor around the corner?
A. Not necessarily. Fetal position changes, lactation and Braxton-Hicks contractions are all common in the third trimester and do not usually result in pre-term labor.
Q. I'm 37 weeks' pregnant and have sharp pains across the middle of my stomach every 20 minutes. I also feel like I need to vomit. What's wrong?
A. You are experiencing what are called Braxton-Hicks contractions, which are entirely normal at this stage. They can be quite uncomfortable and also tend to divert blood flow away from the intestines so that digestion can be impaired. The good news is that this will all be over soon.
Q. I am 33 weeks' pregnant and my hips are starting to hurt worse than normal. My mother-in-law told me my pelvis is stretching. Is my baby getting ready to come, because the contractions are getting worse?
A. Your mother-in-law is correct. Your joints are starting to open so as to ease the labor process. This is not related to premature labor. If your contractions continue to become more frequent and stronger, your doctor can examine your cervix, which is the only way to detect premature labor.
Q. I am starting my 36th week. The hospital gave me IV fluids and two different medications to try to stop my contractions, which didn't work. They sent me home to wait because I have only dilated two centimeters. Now I have a constant pain in my lower left abdomen. I'm not bleeding, but hurting nonetheless. What could this be?
A. This is a fairly common and harmless condition called dysfunctional labor. It means that your uterine muscles are contracting in an uncoordinated fashion. At 36 weeks, there is no reason to try to inhibit contractions, as labor at this point does not pose a hazard to either you or your baby. The matter will resolve itself soon.
Q. My 31-week scan showed everything was normal and my EDD was July 8, but now I'm 34 weeks and showing 38 weeks. The EDD also shifted to June. My doctor said the baby might be big. Is it possible there will be complications? I am very scared about my delivery since my first delivery was premature because of less fluid at 32 weeks and the baby's brain was not developed and expired in 15 days. Please suggest any test or scan required to check the baby's condition. My GTT is also normal.
A. It is not possible to accurately date a pregnancy during the third trimester, so your EDD does not change as a result of this measurement. Also, fetal weight estimates by ultrasound tend not to be reliable. As far as testing the baby's well-being is concerned, daily kick counting is as good a paramater as there is.
Q. Why am I so weak during my seventh month of pregnancy? I don't have energy to walk or to do anything! Is there something wrong with me?
A. Most likely nothing is wrong with you other than you carrying around a lot of extra baggage - the baby and about 25 pounds of extra water. Women in the third trimester should look for every possible opportunity to be off their feet. That said, it would be advisable to evaluate a few things, such as your blood count and blood sugar to be sure you're not becoming anemic or diabetic. If you are reassured about these things, just look at it as an opportunity to rest.
Q. I'm 39 weeks' pregnant. I just took a hot bath, and felt a lot of movement in my tummy for the first time. Is something wrong? Should I not take baths? I also found out I was 1 cm dilated but I am not thinned and my cervix is high.
A. I doubt if there is anything as comfortable for a term pregnant woman than to be immersed in a nice hot bath. This, among other things, brings an increased blood supply to your uterus, which is why your baby began to move more vigorously. Do continue to enjoy this as long as you can.
Q. I am 34 weeks' pregnant, and have been unable to hold down food except yogurt. Should I be concerned?
A. Yes, you should. Your baby is now requiring substantial levels of nutrition, and yogurt will not provide it. This may be a simple matter of gastric reflux, which is not difficult to control. Start with trying some ordinary antacids, but do bring this to your doctor's attention if this does not help.
Q. My wife is 35 weeks' pregnant. Right before bed she started feeling sick to her stomach, felt like she was going to vomit and was developing a headache. Is there anything we can do to comfort her and ease her suffering?
A. At this point in pregnancy, nearly all women are developing acid reflux in which stomach acids back up into the esophagus due to pressure from below. You can generally keep this sort of symptom to a minimum by the use of antacids and this is perfectly safe for both mother and baby.
Q. I am currently 28 weeks' pregnant. I am only 33 years old, and have had to have a hip replacement this year due to a tumor. Am I going to have to have a C-section, what type of recovery can I expect, and how long will the recovery take?
A. Hip replacement surgery does not necessarily require you to have a C-section, so long as you are able to flex your thighs adequately to open the pelvis. In fact, it should be avoided if possible as it will certainly slow down your ability to get around following the birth, which is not something favorable in someone who has had this type of surgery. Ordinarily, C-section recovery takes about eight weeks. I would not expect it to be longer because of your hip status.
Q. I'm 38 weeks, 6 days' pregnant. I lost my mucus plug 5 days ago, and have been having lower dull back pain and pelvic pressure. I'm having hot flashes at night and a lot of loose bowel movements. The doctor says I haven't started dilating. Could these be signs of labor?
A. These are not signs of labor, but, rather, your body preparing for labor. This consists mostly of your cervix softening and opening a tiny bit as well as the digestive system emptying and blood flow shifting to the region of the uterus. The more you see of this sort of thing before actual labor, the better off you are as some amount of the work of labor will be accomplished beforehand.
Q. I am 35 weeks' pregnant, and at times I start cramping when I'm urinating, which stops when I finish. Is this normal? Is it Braxton-Hicks contractions?
A. This is normal. In late pregnancy, the uterus will contract whenever there is some sort of postural change. This includes even the slight positional change which occurs when the bladder empties. It does fall within the definition of Braxton-Hicks contractions, so it has nothing to do with actual labor.
Q. When I sit down, no matter when or where, I feel pressure right above my pelvic bone. I am only 25 weeks, so I'm very concerned.
A. This is not a matter for concern. By sitting down, you bring the uterus into contact with the back side of the pubic bone. This area has the potential to stretch beginning in the second trimester, which ultimately provides for more room for a baby to descend during labor. It is this stretching that you are feeling, and this improves your chances for a normal birth.
Q. I am 38 to 39 weeks' pregnant and scheduled to have a C-section in ten days. I'm having a LOT of milky-white discharge. Is this normal? This is my second pregnancy,but I have not experienced this before.
A. In the absence of itching, burning or a bad odor, it's probably nothing more than a combination of cervical mucus and epithelial cells, which is very normal.
Q. I'm 31 weeks' pregnant and my baby has dropped and the cervix has opened. Does this mean the baby is coming?
A. No, it doesn't. The way you will know that your baby is coming is that your labor will start. No other methods can predict when delivery will occur.
Q. I am 80-percent firm and 1 centimeter dilated. My doctor says I am going to have my baby this month, when my due date is May 22. What do you think?
A. There is no possible way for an exam of the cervix be used to predict when someone will deliver, so unless there is some additional information regarding your situation, you may disregard that prediction.
Q. I'm almost 33 weeks' pregnant, and I have noticed more frequent contractions over the last three days. They are not regular but I have a dull cramp that doesn't really go away. I have had small chunks of blood and it feels as though I am starting my period. I'm not quite sure if I should call my doctor or wait until my appointment next week.
A. This is not likely to be of any great importance, but should still be communicated to your doctor if it has not resolved in the next two or three days. Bleeding in pregnancy is never considered normal, but, at a very low level as you describe, usually resolves itself.
Q. My mom wants to be in the room when I deliver, but my baby's daddy doesn't want her there and I don't know how to tell my mom in a right way that I want my baby's daddy there only.
A. Although this is not really a medical issue, I have run across it a number of times during my practice. To me, it is a no-brainer. The father's preferences must be observed. If your mother is any sort of reasonable person she will understand. The issue of who should be present during a birth is very sensitive and should be discussed between the parents well in advance. Just tell her that the two of you have given the matter a lot of thought and have made a decision you are both comfortable with.
Q. I had a pelvic exam today. The doctor said my cervix is open to fit the size of the tip of his finger and the baby's head has dropped. He said I had thinned about 70 percent, dilated one percent. After the exam I noticed a water discharge on the paper on the table, a normal size spot which means I had some kind of water discharge. What does all this mean?
A. Most likely, it doesn't mean very much. These descriptions of the status of your cervix are quite routine for someone near or at term. They predict nothing. As to the "water discharge" this could be anything from the lubricant gel from your doctor's glove to cervical mucus, to amniotic fluid. The latter is quite important. If water continues to trickle out of you, it is imperative to determine whether or not your water has broken, as this has serious implications.
Q. I am 32 weeks' pregnant and I have been feeling numb and hot all over my body. Just wondering what that could be and what I should do.
A. This is a sign of hormonal change which is a common event in the third trimester. These changes cause fluctuations in blood flow to the skin, which causes these symptoms. It is not dangerous and does not need attention.
Q. I am 39 weeks' pregnant and I have been losing big globs of my mucus plug over the past three days. Now I am having a bit of light pink spotting but it is not coming with the mucus. What could it be?
A. This is what is called the "bloody show." It indicates that the cervix is starting to shorten, or efface. It usually means that labor will be starting in the next few days.
Q. I am 25 weeks' pregnant and have been feeling strong fetal movement from what feels like near my cervix. I have been feeling FM for over ten weeks but never this low. Should I be worried?
A. There is no reason to be worried. As your pregnancy progresses and the baby grows, you'll feel the kicking in different locations as the baby changes position.
Q. I am 35 weeks' pregnant with my first child, and I am a half centimeter dilated. Does this mean my baby will come early? I know another expectant mother who is three weeks ahead of me and not dilated, but 50 percent effaced. What's the difference?
A. Neither of these findings have any bearing whatever on when labor will start. There is no benefit to knowing the status of your cervix unless this information is needed in order to plan some intervention, such as trying to head off a premature birth or inducing labor for some good reason.
Q. Is being diabetic and having a kidney infection a reason to delay a C-section at 39 weeks? Is it serious enough for immediate admission to the hospital?
A. Kidney infections at any stage of pregnancy are dangerous and usually do require hospitalization. It would not be advisable to undergo a C-section until the infection is cleared, unless there is no other alternative.
Q. I am 36 weeks' pregnant and had a nasty fall last night. I have been having bad cramping. Could being this far into my pregnancy put me into labor?
A. Yes, it could, but this would not be a dangerous thing at this point in the pregnancy. If the fall created bruising of the uterine muscle, this could result in enough irritability to trigger labor. Most likely, what will happen is that the injury would not be enough to cause labor and the cramping will gradually diminish over the next few days.
Q. Is it safe if the umbilical cord is around my fetus's neck during the 34th week of pregnancy?
A. This is a very common position for the cord and does not subject the fetus to any increased hazards prior to delivery, although it can become a problem in labor if it interferes with adequate blood flow to the baby. Monitoring will nearly always detect if that is becoming a problem.
Q. I'm 34-and-a-half weeks' pregnant. Last night I woke up and vomited about seven times. The midwife said it was just "bugs" in my stomach. Now I'm not urinating much. Am I going to have any problems with the baby? When I was sick the first time, a bit of urine leaked. Did my water break or was it urine?
A. It doesn't sound like your water broke as that is usually pretty dramatic, continuous, and hard to miss. On the other hand, you need to be sure that the repetitive vomiting hasn't caused you to become dehydrated, which happens easily during pregnancy. Be sure to report if this level of vomiting happens again.
Q. I'm 32 weeks' pregnant. I had a very sharp pain in my back that lasted for about one hour. I took a hot bath and it stopped for 30 minutes; then it started back up ten times worse than before. What's happening?
A. Most of the time, sharp back pains in late pregnancy are caused by pressure upon and stretching of nerves coming from the lumbar area as a result of the dramatic changes in posture that are occurring. Generally, reduced activity will cause this to resolve, but if that doesn't happen, bring it to your doctor's attention.
Q. I'm 36 weeks', four days' pregnant. Today my ob checked my cervix and it was closed. Since then I have been spotting. I am experiencing pain in my left side with a lot of pressure. What does this mean?
A. What is happening is that the vaginal exam has caused a few small blood vessels in your cervix to break and also that there has been some release of hormones causing your uterus is to contract. At this early point, most likely both of these symptoms will stop within a day or two.
Q. I'm 37 weeks' pregnant with my third baby. My left breast, including my nipple, is extremely sore. It feels as if I have a plugged duct and that the nipples are sore from poor latch, although I am not currently nursing. I am planning on nursing this baby but am concerned about what could be going on.
A. It's not likely to be a plugged duct as that is caused by milk which solidifies in the duct, and significant milk flow does not usually start until after the birth occurs. More likely, there is the beginning of milk production without flow which is causing pain. Ice packs to the area for a few minutes at a time should keep this under control for now.
Q. I wake up throughout the night with swollen finger pain and numbness. I am drinking lots of water and am on a low-sodium diet. I also exercise, but the swelling seems to continue to grow. Any advice?
A. This is carpal tunnel syndrome. It is caused by water retention, usually late in pregnancy, which causes the nerves in the wrist to be compressed. If you are past 28 weeks, there may be benefit in spending time lying on your left side, as this will permit more blood flow to the kidneys, which helps get rid of the extra water. In severe cases, an orthopedist can fit you for an arm brace, which will help. The problem resolves after the birth.
Q. I am having a burning sensation in my upper stomach below my breast. What does it mean? I'm 35-and-a-half weeks' pregnant.
A. At this gestation, stomach acids have a tendency to back up into the esophagus, causing acid indigestion. Antacids will help a bit, but don't expect this to clear completely until after the birth.
Q. I am 32 weeks' pregnant with our second daughter. I am dilated 3 cm, and 75 percent effaced. I'm on bedrest. I have mild sporadic contractions, but the large ones are kept under control by medication every 4 hours. How likely is it that I will deliver her soon? If I do deliver her in the next week or so, will she be okay?
A. Premature birth (prior to 37 weeks) is quite likely here, especially as you are already under treatment to prevent labor. The good news is that with premature newborn care as effective as it is nowadays, healthy survival is the rule and not the exception at your current gestation.
Q. H1N1 flu has been in our town. I have been working so hard trying to get ready for my maternity leave and have put in lots of hours this past week. I got sick a couple of days ago and have asthma and am having a hard time breathing and the baby has slowed in his movements. What should I do?
A. First of all, stop working as soon as possible, and be sure your asthma continues to respond to the bronchodilators as it usually does. If it doesn't, see your doctor right away, as you are in the high-risk group for H1N1. As to the baby's movements, be sure you're doing kick counts daily and report immediately if the baby's movements are not adequate.
Q. My mucus plug broke and ever since I have been having some minor contractions and a lot of pain. What should I do?
A. There's nothing you need to do other than remain well rested and hydrated. This is a sign that your cervix is beginning to soften, efface, and open, so labor should not be far off.
Q. I'm 33 weeks' pregnant, and my cervix is slightly open. What are possible consequences? Is it safe to deliver at 34 weeks?
A. Your cervix being slightly open does not mean that you are at any increased risk of delivering prematurely, unless, of course, you are having strong and regular contractions as well. In any event, 34-week births do not usually create any serious problems for the newborn.
Epidurals
Q. I'm 20, with a two-year-old girl. When I had her, I had no pain medication whatsoever. Talk about serious pain. I am having a girl on June 1. Everyone is advising me to get an epidural this time, but I'm scared of the needle. Also, some people talk about back problems after that. Not sure if I should suffer this one or get the shot. Please advise.
A. I am so glad for this question to come up as I have seen far too many patients suffer unnecessarily during labor out of entirely unfounded fears about epidural anesthesia. There's a reason why everyone you know is advising you to have an epidural, and that's because it's a spectacularly safe and effective anesthetic. The only caveat: It's best to have it done in a hospital where there is 24- hours-on-the-premises anesthesia coverage as the process does have to be monitored closely.
Inducing Labor
Q. I'm 37 weeks' pregnant. Should I start trying to induce my own labor like natural ways?
A. I am so glad you asked this question, as there is so much misinformation out there about what women at term should be doing to help bring on labor. To begin with, there has long been the false belief that labor is brought on by walking around a lot. While women have tended to buy this because of all the pelvic discomfort that this activity produces, it is completely false. What women should actually do is spend as much time as possible at rest and taking in good amounts of liquids, as this is what will result in increased blood flow to the uterus which brings with it oxygen and nutrients needed to make the uterus contract. If you doubt this, pay attention to what happens when you first get off your feet; you will most likely feel an increase in the contractions we call Braxton-Hicks. That said, there is great benefit to ambulating once labor is established as gravity will help bring the baby down against the cervix and open it up rapidly. However, ambulating does not help to initiate labor and most likely actually tends to inhibit it. There is another approach, albeit a bit controversial and certainly not scientifically tested, which I mention only because I have seen it work many times in my practice. Sexual intercourse results, as we all know, in the deposition of semen onto the cervix. This material is absolutely loaded with a hormone called Prostaglandin, which is know to both soften the cervix and stimulate uterine contractions. Naturally, this particular approach will need to be employed only if comfort permits, which is not always the case. It must also be avoided if there are certain risk factors such as ruptured membranes or placental bleeding problems.
Postpartum
Q. I had my baby three weeks ago and was having some light red/yellow bleeding. Yesterday, I started bleeding dark red blood like a light to medium flow period. Is this normal? Should I call the doctor?
A. Some amount of vaginal bleeding is considered normal throughout the first six weeks after birth. What you describe does not read abnormal. If it seems to be getting heavier, try to rest more and increase your fluid intake. Then notify the doctor if you see no improvement.
Breastfeeding
Q. I made a pitiful attempt at breastfeeding three years ago. How do I do well the second time around?
A. Groups like La Leche League and various guidebooks will provide you with a lot of suggestions, but one I've found helps a lot is to realize that a baby's appetite can vary greatly from day to day, so that some days your breasts have more milk than they need and other days, not enough. When they seem to be too full, applying ice packs will reduce the volume, while when they're not full enough, you can increase production and flow by the opposite: applying warm compresses. The other thing to consider is to work at thickening the nipple skin by massaging them with a coarse towel. This will reduce nipple tenderness. You may hear it said that this could threaten early onset of labor, but no data to confirm that concern has ever been produced.
Birth Control
Q. I have had a Mirena IUD in for almost three years. For the last four days I have been feeling nauseous all day, bloated, and feeling pressure and sometimes cramps in my private area. Could I be pregnant?
A. Very unlikely. The Mirena has a failure rate of well under 1 percent. Also, the progestin hormone in the Mirena is not likely to be producing these symptoms. Most likely this is unrelated to your device, but should be reported if it does not resolve in a few days.
Q. I have had Implanon for two years. I had a blood test for pregnancy that came back negative. I have been feeling flutters in my belly, my belly seems to be getting bigger, my appetite has changed and I'm feeling nauseous. I was wondering if Implanon is giving me a false result. I have two other children, and feel like I'm pregnant again.
A. Pregnancy tests are extremely reliable nowadays, so pregnancy is quite unlikely. The symptoms you are having could have a variety of explanations, including digestive or hormonal problems. Further evaluation in a couple of weeks is advisable if the symptoms don't resolve.
Q. I have been taking birth-control pills correctly. My period starts a week early then stops on the first day of the non-hormone pills and then starts again the day after. What does this mean?
A. Nothing important, just that days of flow have become less predictable now that extremely low doses of hormones are being used by most people. There's no loss of protection involved. You could likely correct this by increasing the hormone dose, but then you'd risk creating more bothersome side effects.
Q. I was given two samples of Yaz by my doctor. I wasn't happy with them and have decided on the copper IUD. I am taking a month off since Yaz is done and my IUD appointment isn't for another month. I never got my period after that second pack of pills. Just a bit of blood mixed with mucus. I have felt dizzy and crampish and have had headaches since the day of the spotting. Could this be withdrawal from the pill? I have been on and off the pill for ten years and have two children. I have never had this reaction from discontinuing the pill. My husband says I'm pregnant, but I disagree. The only thing I did differently was taking high doses of vitamin D-3 for a few weeks to keep from getting the swine flu. And I wasn't able to find any info on it interacting with the pill's effectiveness. What's going on?
A. This is most likely withdrawal from the pill, which is quite common. There's nothing wrong with Yaz; it's as good as any other pill. Be sure that pregnancy is carefully ruled out before you have the IUD placed.
Having Twins
Q. I'm 33 weeks' pregnant with fraternal twins. It's my third pregnancy and everything has gone well so far, as far as my health and the babies. I feel awful and have been in pain for weeks, but that's to be expected. Yesterday the doctor said I was a 1-2 and 50 percent effaced. Could this mean I'll have these babies anytime soon? I want to make it to 34 weeks but at the same time I think I'll die if i had to go until I'm due!
A. 1-2 cm. and 50 percent effaced really don't mean anything as far as predicting the onset of labor. This being other than your first pregnancy, you actually stand a good chance of going to term, which is best for the babies, even if it's uncomfortable for you. 36 weeks would be a good goal to shoot for.
Q. I am 11 weeks' pregnant, and it's my third pregnancy. Is it normal to start feeling your uterus above your pelvis at nine weeks? I can feel about two inches. Could it mean twins?
A. The height of the uterus within the pelvis is very variable, so I wouldn't put much emphasis upon it. Twins are always a possibility, but that will very soon be determined via ultrasound.
Acupuncture
Q. Is it safe to get acupuncture/massage during pregnancy? I have back pain and cannot sleep because of it.
A. There is no evidence to suggest that there is any danger to pregnancies from acupuncture/massage as long as it is carried out competently by a practitioner who knows that you are pregnant and has experience treating pregnant women.
Stretch Marks
Q. Is there anything I can use or do to prevent the appearance of stretch marks?
A. Lot's of things have been tried, but none have been shown to work reliably. My suggestion is that you work during the first 20-22 weeks at keeping your abdominal muscles toned and fit. The extra blood flow to the area which will result may be of benefit. Some people have claimed benefits from topical Vitamin E, but there is no scientific evidence to support that.
Ectopic Pregnancy
Q. I was just told that I may have an ectopic pregnancy. I'm definitely pregnant, but my uterus is empty and there is some formation on my right Fallopian tube. Right now, I'm experiencing dizziness, cold hands and feet, and my belly button is pulsating. I don't have a babysitter for my one year old, and I would feel stupid going in to the ER, because the staff there think I'm paranoid. They have sent me home countless times when my baby was sick. I guess I just would like to know this: at what point do I need to go in anyway?
A. At this moment, you do not need to go to a hospital unless you have serious abdominal pain. However, the matter needs close and careful follow up, which your doctor can provide via the use of sequential hormone testing and ultrasound.
Medication Safety
Q. I fractured my pelvis about three years ago and am now pregnant. If I have pain, can I take painkillers? OTC pain relievers have not helped.
A. Yes you may. There is no evidence linking narcotic pain relievers with any form of birth defect.
Q. Is it safe to take asthma medication during pregnancy?
A. Yes, it is and one must remember that it is important to permit as much oxygen as possible to get to your baby. Be sure to be vigilant in treating episodes of wheezing or shortness of breath.
Q. I usually get frequent severe headaches, and have been using ibuprofen for the pain. Is this safe? If not, what should I use?
A. Ibuprofen is considered safe in pregnancy, but a good many pregnant women get headaches because they don't hydrate well enough. Your fluid demands are very great, so try increasing significantly the amount of water you drink each day.
Q. My girlfriend had spontaneous bleeding a little over a month ago. On the same day she have undergone a D&C. After two weeks she suffered from measles and started to feel an abdominal pain, which she still has. The doctor said it was normal, but I can't accept what he says. What shall I do? Today I am giving her a pain reliever.
A. First of all, you should not be deciding what is or is not correct about what the doctor told your girlfriend. That is her business and should be taken up by her. Moreover, let her decide if she needs a pain reliever. If there are unresolved issues regarding her health, she should discuss this with her doctor. I can't reach any conclusions about her status based upon this information.
Q. I had my period after missing it for ten months, and took medroxyprogesterone and Clomiphene. Ten days after my period stopped I had light pink spotting for two days on and off, with cramping and nausea. Now I am tired all the time and nauseous, with pain in the abdomen. I am urinating all the time, especially at night. I have difficulty sleeping, and have hot/cold flashes. I cry at the drop of a hat, have a runny nose, breast tenderness, am always hungry and have had a headache every day for a week. What could this mean?
A. These are pretty typical symptoms of someone whose hormones are out of balance. If you've been given Clomiphene, then your doctor has presumably concluded that your ovulation process is not working properly. Clomiphene is designed to induce ovulation, but it may have to be raised to a higher dose in order to effect the desired result.
Gestational Diabetes
Q. When I was about six months' pregnant I had surgery to remove a hemorrhoid. At seven months, my sugar was 140 and I was told I could have gestational diabetes. I did a diet for a week and when I had the test again it came out negative. I'm 6', and my husband is 6'2". I'm 34 weeks and the doctor said my baby is probably about 8 lbs and already on the fetal position. Is the baby big because of the gestational diabetes or because we're tall? I'm afraid this baby will be too big to deliver vaginally. What would be best?
A. What would be best is not worry about this situation. It is clear that you do not have diabetes, if that's what your test showed. There is nothing surprising about big parents having big babies. Be aware that estimates of fetal weight are notoriously undependable. I have not seen many 6' tall women who have had trouble delivering their babies.
Caffeine Safety
Q. I love drinking at least 1 cup of coffee daily. Is my unborn child at risk of birth defects? Do you recommend no coffee at all?
A. Your baby is not at a significantly increased risk of birth defects, although caffeine is a drug which constricts blood vessels, thus reducing blood flow to your baby. One cup per day should not be a concern, but I wouldn't encourage any more than that.
Medical Coverage
Q. What type of medical coverage does one need to make an appointment with a ob/gyn?
A. There is no insurance coverage that is required for someone to make an appointment with any doctor, with the exception that some insurance plans, such as HMOs, may limit the choices of doctors available to you. If, however, you are inquiring as to whether or not your appointment will be a covered benefit, the best approach is to inquire from wherever you got the plan, i.e., your employer's benefit office or a private insurance broker.
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