Fetal Movement

If this is your first baby, you will normally feel the baby move for the first time when you are 18-20 weeks pregnant. If this is not your first baby, you may feel the baby move as early as 16 weeks. If you are overweight, you may not feel the baby move until after 20 weeks.

Movements can be described as rolling, punching, kicking, or stretching in your womb. Once you become 28 weeks pregnant, you can monitor your baby’s movement DAILY by following the directions below:

Count the number of times the baby moves in ONE HOUR each day. (During your baby’s usual “active times.”)

• If the baby moves at least four times in ONE HOUR, your baby is behaving normally
• If the baby does not move at least four times in the hour, do the following:
• Eat some food and drink 32 ounces of fluid.
• Lie down on your side.
• Count the number of times the baby moves the next hour.
• If the number is four or more, you are done.
• If the baby does not move at least four times, call us.

Common Problems and Discomforts

Vaginal spotting

Vaginal spotting occurs in almost half of all pregnancies, especially in the first 12 weeks. Most of the time, the spotting will stop on its own. If the spotting is light, avoid intercourse and call us to discuss the problem. If the bleeding is as heavy as a period or if it is associated with any pain, you should call us immediately.

Vaginal Discharge

Vaginal discharge normally increases in pregnancy. It should be thin and white. If the discharge is irritating, causes itching, has an odor, is yellow/brown, or is watery, call us.

Cramping

Cramps and contractions are normal in pregnancy. When they occur, empty your bladder, lie down on either side, and drink two large glasses of water. If they continue, occur more than 4 times in an hour, or are painful, call us. If you are less than 36 weeks pregnant, please try the above pain relief measures and call us if you are still experiencing pain in an hour.

Round Ligament Pain

The round ligaments are fibers that support the uterus. When stretched they can cause groin pain. Usually this pain is worse with position changes, and better when you are sitting still. If you are unsure about the pain you are feeling, you should call us. If you have been told that your pain is round ligament pain, you can wear support garments (belts, girdles, bike shorts) and make your position changes slowly. Please call us if the pain worsens, changes in character, or does not improve with the above suggestions.

Morning Sickness

Morning sickness is common and causes no significant problems. It usually starts at around 5 to 6 weeks gestation and usually ends by 16 to 18 weeks gestation. However, for some women, it may continue throughout the pregnancy.

The most important thing with morning sickness is to make sure you do not become dehydrated from prolonged vomiting. Try drinking water, diluted sports drinks, or diluted fruit juice. Drinking 1 ounce every 15 minutes will provide adequate fluids. Try to eat multiple small meals each day. Unlike when you have a viral illness, you should eat even if you were recently vomiting. The key is to try to keep something on your stomach. If your regular diet is not working for you, try a bland diet of bananas, rice, applesauce, and toast. Also, it often helps to just go with your cravings.

In terms of medications, the best treatment to start with is 10-25 mg vitamin B6 three times a day alone or in combination with 12.5 mg of doxylamine (1/2 tablet of Unisom) three times a day. Tums, ginger tablets or powder, or Emetrol may also help.

If you are unable to keep any food or liquids down for 24 hours, you become dizzy with standing, or if your urine becomes dark and scant, call us.

If you have nausea and vomiting that starts after 12 weeks gestation, then you probably do not have morning sickness. In this case you should give us a call as well. In this case you should give us a call if the above symptoms last more than 24 hours or are accompanied by fever or pain.

Diarrhea

Diarrhea can cause intense cramping and discomfort and can lead to dehydration. Begin treatment by consuming only liquids for 24 hours. If the diarrhea improves then you can advance to a bland diet of bananas, rice, apples, and toast. It is fine to take Immodium. Avoid Pepto Bismol. If diarrhea is not improved after 24 hours call us. Also, if you have severe cramping or tightening of your uterus with the diarrhea, give us a call as well.

Constipation

Constipation is very common in pregnancy. You should try to avoid constipation by eating a diet high in fiber (such as fresh fruits, vegetables, whole grains, bran cereals, and dried fruits) and drinking 8 to 10 glasses of water every day. A good idea would be to have a bowl of raisin bran or other high fiber cereal every morning. You may also use a fiber supplement such as Metamucil, Citrucel, or Senna. Some women find that using a stool softener like Colace twice a day also helps. If you still have problems with constipation, it is fine to use Milk of Magnesia as necessary.

Colds, Flu, allergies

During pregnancy, women are more susceptible to respiratory ailments like and colds and the flu. It is also common for it to take longer to recover as well. Most over-the-counter medications are safe to use. See our list on the previous page. If you develop a fever of 100.4°F or greater, you have green or bloody nasal discharge, you are feeling short of breath, having chest pain, or you are coughing up green or bloody sputum, call us. Flu shots are recommended for pregnant women who will be in their 2nd or 3rd trimester during flu season.

Vaccinations

It is recommended that women in their second and third trimesters of pregnancy between the months of October and March be vaccinated against seasonal flu and H1N1. You may check with your local health department, pharmacy, or primary care office for vaccine availability. In addition, the Tdap (Tetanus, diptheria, and pertussis) vaccine is recommended in the post partum period for all women who have not had a tetanus shot in the last 10 years. You may ask your nurse in the hospital for this vaccine. Women’s Medical Center participates in the GRITS (Georgia Registry of Immunization Transactions and Services) and all vaccinations you receive in our office are recorded in this system should you need proof of immunization.

Cord Blood Information

Currently both private and public cord blood donation is available. Accorging to the American College of Obstetrics and Gynecology, “It cannot be estimated what the chances are that a child will use his or her own saved cord blood later in life”. You can get more information about public and private cord blood collection at www.ParentsGuideCordBlood.org. The decision on whether to bank your child’s cord blood is a personal decision. We encourage you to read the information on the web site listed above and ask your provider if you have further questions.