Maternal & Fetal Medicine

To boost your chances of having a problem-free pregnancy and delivery, get to your ideal weight before pregnancy, eat a healthy diet, exercise, reduce stress—and seek good medical care throughout your pregnancy.

[worth the wait]
Experts say waiting until 39 weeks to perform elective inductions can improve the outcomes for mothers and babies.

Dr. Craig Boyd, Allied Associates Obstetrics & Gynecology:
The American Congress of Obstetricians and Gynecologists recently changed the medical definition of a full-term pregnancy from 37 weeks to 39 weeks. To try to improve outcomes for babies. We have found that early term deliveries are associated with more problems than previously recognized. Local rules prohibiting elective inductions prior to 39 weeks do not apply to inductions done for medical reasons, when the benefit to the mother and/or baby outweighs the risks.

The new guidelines are in the mother’s best interest, too. Inducing labor before the due date or before the cervix has dilated clearly increases the risk of cesarean section. There are times when inductions are done for the convenience of the mother or doctor, but it’s important that you, the patient, have open communication with your doctor. Be an advocate for yourself and question, not challenge, the doctor about the reasons for inducing.

Dr. Teresa Knight, Women’s Health Specialists:
A planned delivery in an uncomplicated pregnancy should not be performed prior to 39 weeks because of the possibility of the baby’s lungs not being fully mature. Different organs mature at different rates and the last organs to mature enough for birth are the brain and lungs.

When women at the end of their pregnancies are eager to induce, I focus on things that can help them feel better, like rest, massage and warm baths and I talk frankly about the risks and benefits of options. Babies who are born early may have difficulty clearing the fluid out of their lungs. Some will require oxygen as the lungs are not fully mature. Some will need more frequent feeding to maintain their blood sugars and may have difficulty maintaining their body temperature.

If labor has not started naturally by 42 weeks, induction will be necessary because the placenta is no longer able to meet the demands of the baby and there is a greater risk of still birth.

[exercise and diet]
Pregnancy is an especially good time to start new healthy habits, like eating a balanced diet, exercising, practicing stress reduction and getting adequate sleep.

Dr. Diane Sanford, Midwest Mind, Body, Health Center:
Exercise provides a healthy stress outlet when hormones are in flux and also can help offset the discomfort some pregnant women experience with their changing bodies.

The key is to listen to your body. This is not a time to push yourself too far. You should not feel sore after exercising. If you already have an exercise routine in place, it’s probably safe to continue. If not, start slowly with walking, gentle stretching and toning. Yoga is great for pregnant women. Of course, it’s important to consult with your physician prior to starting an exercise routine.

Though it may be challenging to find time to exercise after the baby arrives, exercise will continue to provide you with a valuable stress outlet and help you shed your remaining pregnancy weight.

Dr. Ashley Ryan, Genesis OB/GYN:
A healthy diet is important during pregnancy. A pregnant woman needs additional folic acid and iron, which can be supplemented with prenatal vitamins. A well-rounded diet should supply the other nutrients needed, such as calcium and vitamins A, B, C and D. I recommend to help plan a diet specific to your needs.

During the first trimester you don’t need any additional calories. During the second and third trimesters you need only an extra 300 calories per day. If you experience extreme nausea, try to eat nutritious foods when you can tolerate them. Ginger or ginger ale, vitamin B6 and anti-emetics also may help. If nausea still prevents you from eating enough, supplement shakes like Boost or Ensure are an option.

Other things to keep in mind: Try to limit caffeine to less than one 12 oz. cup of coffee per day; eat two servings of fish per week to get beneficial Omega-3 fatty acids (but not fish high in mercury like swordfish and tuna); and avoid foods made with unpasteurized milk, hot dogs, lunch meats, and raw or undercooked food.

[placenta previa]
“Placenta previa is a fairly common condition in pregnancy in which the placenta covers part or all of the cervix,” says Dr. George Macones, chair of the department of obstetrics and gynecology at Washington University School of Medicine. “Because the placenta is over the cervix, any dilation of the cervix could result in severe bleeding.” As many as 5 percent of women have previa early in their pregnancy, he notes. “Fortunately, as the uterus grows, the placenta often migrates and the previa will disappear.”

The main issue with placenta previa is bleeding, which can be unexpected and life-threatening, Macones explains. “But bleeding with placenta previa usually happens in the third trimester of pregnancy.” While there is no treatment for the problem, per se, it’s important to know if a previa is present and take appropriate precautions to limit the risk of a serious bleed, he adds. “This includes close medical supervision by an obstetrician and abstaining from intercourse.”

If previa persists, it will be necessary to deliver the baby via cesarean section.

[obesity and pregnancy]
Women who are obese before pregnancy or who gain an excessive amount of weight during pregnancy are at greater risk for developing gestational diabetes and other dangerous complications.

Dr. Jodie Rai, Women’s Healthcare Consultants, Inc.:
More than one-third of pregnant women are obese, which increases the risk of dangerous complications, for mothers and their babies. For mom, these complications include miscarriage, diabetes, high blood pressure, preeclampsia, cesarean delivery, postpartum weight retention and life-threatening blood clots. For baby, these complications include an increased risk of congenital abnormalities like neural tube defects (i.e. spina bifida), macrosomia (large babies), stillbirth and childhood and adolescent obesity.

If you are obese or overweight, talk to your provider about specific weight-gain guidelines. In 2009, the Institute of Medicine recommended a weight gain of 25 to 35 pounds for pregnant women of normal weight, 15 to 25 pounds for overweight women, and 11 to 20 pounds for obese women. Many providers, including myself, encourage pregnant patients to stay at the lower limits of these recommendations.

Obese women do not need to see a high-risk doctor if there are no other complications to the pregnancy. However, it’s important to find a provider who shows sensitivity and compassion for the challenges the overweight and obese pregnant patient faces in pregnancy.

Dr. Kent Snowden, St. Louis Associates in OB/GYN:
Gestational diabetes is diabetes that develops during pregnancy when the pancreas is not able to make enough insulin to control blood glucose levels. Currently, about 10 percent of pregnant women develop gestational diabetes. However, it will become more prevalent with the increase of obesity in America and the rising age of pregnant women. Gestational diabetes is associated with dangerous conditions, including preeclampsia, macrosomia (large baby), neonatal respiratory and metabolic problems, and fetal death.

All pregnant women should be screened for gestational diabetes. The universal screen is performed at 24 to 28 weeks. Women at higher risk should be screened earlier and, if negative, screened again at 24 to 28 weeks. Risk factors include having a family history of diabetes, maternal obesity, gaining excessive weight during pregnancy, previous delivery of a large baby, advanced maternal age and polycystic ovarian disease. The best way to decrease your chance of gestational diabetes is to maintain a regular exercise program and reach your ideal weight prior to getting pregnant.

Gestational diabetes is treated initially with a diabetic diet and exercise. Insulin or oral agents are used if the patient cannot control her glucose through diet and exercise alone.

[postpartum recovery – what to expect]
While you’re relishing those first snuggles following the birth of your new baby, your body is beginning to heal. According to Dr. Salina Green of Women’s Health Partners, the standard hospital stay is two nights for an uncomplicated vaginal delivery or four nights for a cesarean section. “I think for most families this is an adequate time in the hospital,” Green says. “If there are any complications surrounding the pregnancy or birth, the normal stay can be extended.” Also, arrangements can sometimes be made for women who have babies in the NICU to have a hospitality room close to the nursery or stay in the Ronald McDonald house after being discharged, she adds.

During the hospital stay, patients are monitored for excessive bleeding, increased blood pressure and fevers. “We also want to make sure that moms are comfortable caring for their newborns and, if they are breastfeeding, to make sure it’s going well,” she says.

Following discharge, let your physician know if you experience excessive bleeding, develop a fever greater than 100.4 F or if your pain gets worse rather than better, Green advises. “And I always address postpartum depression warning signs with new moms and their partners before they go home,” she says.

By Sara Savat

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