Dr. Rupe shared a wonderful, comprehensive list on what to know while waiting for your first OB appointment last week. It was chock full of helpful medical facts and guidelines for you to follow even before you ever set foot in a room with the person who will deliver your baby. For all you information junkies, this list will hopefully fill your craving for knowledge as you wait for your 6-10 week check up.

As I was considering what to write about this week, I felt an overwhelming pull to follow up Dr. Rupe’s post with encouragement on what to set your mind on while waiting for that first appointment. If, like me, you have suffered pregnancy loss you may be very guarded during these first few weeks.  Perhaps you’ve never experienced loss but this is your first pregnancy and you’ve heard so many stories about loss that thoughts of the possibility are consuming your mind. Your reservations and your fears are understandable but they do not have to rule your heart.

5 Things Your Heart Needs to Know While Waiting for Your 1st OB Appointment

1. He is holding your baby’s life together in his capable hands {Colossians 1:16-17}.
2. He knows every concern in your mind but bring them to him so he can help you deal with it.
3. Worrying about it will not change anything. It will only make you miss out on the miracle happening inside you.
4. Now is the time to begin praying fervently for every little piece and part of your growing baby. These early stages of growth are so intricate. Cover    them with prayer instead of fear.
5. Faith and fear cannot dwell in the same place. Let faith in to push fear out.

{from, The Pregnancy Companion Introduction}

Now, before we jump into all of the stats, rules, and regulations, here’s what I want you to do. I want you to take a deep breath. In and out. Slowly. (This is good practice for your impending labor.) Breathe in slowly. And with that breath, I want you to take in a fresh infilling of the Spirit of God. Allow him to permeate your entire being and fill you with fresh faith, peace, and perspective. Now breathe out. Slowly. And with that release, I want you to let go of every concern or fear you’ve carried up until this point and every concern or fear you might be tempted to carry over the next nine months. Let go of every question, every symptom, and every insensitive, stupid thing your friend or family member will say to you. Let it go. Let it all go.

You see, when you allow God to come and fill you with his peace, there is no longer room for your fears. Faith and fear cannot dwell in the same place. So let him in and push fear out. Remember this exercise every time you encounter fear on this journey. You will likely encounter fear or worry or anxiety at some point. The important thing is not to give it place in your mind or your heart.

We are always praying for the mommies-to-be in our community so know that you are covered during this time of waiting. I know it can be hard, believe me! But a peaceful body is the best place for your baby to flourish so commit yourself to promoting peace within your heart and mind.

Rejoicing in the miracle with you,

Jessica

From the first moment you see the test turn positive until you sit down with your doctor for the initial appointment, the waiting can sometimes feel like an eternity. Some of you will spend those weeks worrying if you really are pregnant since you feel so normal.  For others, the pregnancy symptoms will be so severe that you will be desperate for some relief. The following is a list of common concerns that I get asked about at the first pregnancy appointment as well as some helpful hints for common symptoms.

Vitamins
If you are not already on a prenatal vitamin, then please start one as soon as you find out you are pregnant. Folic acid is the most important ingredient in a prenatal vitamin. We recommend 1 milligram of folic acid per day during pregnancy. Taking folic acid can significantly reduce the risk of birth defects like spina bifida. If someone in your family has had a baby with spina bifida you may need to take higher doses of folic acid, so talk to your doctor.

One common question of expectant mothers is “Do I need a prescription prenatal vitamin?” The main difference in over the counter and prescription prenatal vitamins is a higher dose of the all-important folic acid that is included in a prescription vitamin. They have 1 mg, whereas most over the counter prenatals have 600 micrograms. Other “extras” that come with a prescription strength prenatal vitamin are stool softeners, special coatings to help you swallow, DHA (for brain development) and a special form of iron that causes less stomach upset. It’s usually easier to take the prescription prenatal because it has everything you need and it’s easier on your stomach. If it’s too expensive you can take the over the counter prenatal and simply add a folic acid and DHA supplement. It is important to note that folic acid is best absorbed as a supplement rather than its natural source.

You can take too many of some vitamins (like vitamin A) so you should not add additional supplements in pregnancy without talking to your doctor first. I’ve heard lots of women say that their prenatal vitamins upset their stomach so they took ‘a few’ Flintstone’s chewable vitamins instead. This is probably not a great idea because as I said, you can have too many of some vitamins. A better option would be to take one Flintstone chewable and then an additional folic acid supplement if you really can’t tolerate prescription prenatals. Here is link to a company that sells prenatals by mailorder for less than you can usually get them at the pharmacy: http://www.vitamedmd.com

Nutrition
Pregnancy should be a time of very purposeful, deliberate eating. Look at how many calories your body needs, and fill those calories with the most high yield nutritious foods. There are several websites that will tell you the amount of calories you need for your height and activity level. www.choosemyplate.gov is a good site that will give you a sample food pyramid based on your caloric needs. The best strategy is to plan ahead. Focus on getting 5 servings of fruits and vegetables a day with at least one of those vegetables being a dark green or leafy vegetable (sorry pickles don’t count). Drink lots of water. Around 8 glasses a day is ideal. Also make sure at least half of your grains are whole grains. You only need an additional 100 calories a day in the first trimester, so you not need to increase the amount of food eaten at this point.

Food Precautions:

Meat. All  meat should be well cooked. Raw sushi should be avoided as well as rare and medium-rare steak.

Alcohol. There is no known safe amount of alcohol during pregnancy so please discontinue all drinking.

Fish. Shark, swordfish, king mackerel, and tilefish contain high levels of mercury. It is recommended that they be avoided while pregnant. Salmon and tuna should be eaten in moderation. Please note that fish sticks and fast food fish sandwiches are in general made from low mercury fish. See the following link for a complete breakdown of fish safety. http://womenshealth.gov/publications/our-publications/fish-facts.pdf

Caffeine. Caffeine intake should be limited to 200 mg a day during pregnancy.

Unpasteurized food. Cheeses, milk and juices should all be fully pasteurized.  Soft cheeses such as feta and bleu cheese are some times sold in the unpasteurized form, so read labels.

Listeria associated foods. Several different foods have been associated with outbreaks of Listeria bacteria, which can be associated with miscarriage and bad pregnancy outcomes.  While the overall incidence of this bacteria is extremely low, precautions should be taken to make sure that all vegetables are thoroughly washed.  If a food cannot be well cleaned (such as fresh sprouts) it should probably not be eaten. Deli meats should be eaten only if fresh and for added precaution can heated in the microwave until sizzling to kill any possible contaminating bacteria.

Other precautions:

Smoking. Please stop smoking immediately when you find out you are pregnant. Smoking is associated with an increased risk of miscarriage, stillbirth, preterm delivery and fetal growth restriction. If you smoke more than a pack a day and are having difficulty quitting, talk to your doctor about whether the nicotine patch would be appropriate for you.

Cats. Toxoplasmosis is a parasite that can live in cat feces. If it is contracted during pregnancy it can cause severe pregnancy complications. You should avoid handling cat litter or being in the room when the cat litter is being changed. You can still pet your cat and be in the same room as the cat litter if needed.

Exercise. We recommend you stay active during pregnancy. This helps you maintain your overall stamina, avoid excess weight gain and decreases your risk for gestational diabetes. If you are not already active, then I recommend you start walking or swimming 30 minutes daily, or at least 5 times a week. As you exercise, you want to maintain your heart rate at under 150 beats per minute. This is an exertion level of about 6-7 (on a scale of 1-10). At this level you should still be able to talk.

If you are already active in an exercise routine such as running or aerobics, you can usually continue with the above modifications. Make sure to keep your heart rate under 150. It is also a good idea to maintain your flexibility and strength. A prenatal yoga or pilates class (or DVD) can help you maintain your core muscles to help reduce the back pain associated with mid-pregnancy. After 15 weeks, exercises that involve laying flat on your back should be avoided. Additionally weight lifting should be limited to under 40 pounds.

Heat. There are a few things that are known to cause malformations at this stage of development. One of them is extreme heat. This is a time when it is especially essential to avoid hot tubs or very hot baths (higher than body temperature). Having a high core temperature in early pregnancy has been shown to cause malformation of the spinal cord. If you have a fever at this time it is best to take acetaminophen (Tylenol) to help keep your temperature down. If that does not lower your temp, call your doctor.

Medications. Be cautious of taking any medications that might interfere with the development of the baby. Check with your doctor before taking any additional medication: prescription, over the counter, herbal supplements and/or additional vitamins. Thyroid medication and asthma medications are probably the most common medications that women can take in pregnancy. They are safe for the baby and can be harmful if discontinued suddenly.  If you care taking any other mediation, then notify your doctor’s office to determine if it is safe to continue.

Medications that are generally accepted as safe in pregnancy:

Tylenol

Benedryl

Guafenesin

Throat lozenges

Tums

Volace

Milk of magnesia

Immodium

Other things that are considered safe:

Hair dye has not been proven to cause malformations because it is minimally absorbed by the skin. Coloring your hair is considered safe, but if you want to be overly cautious you can wait until you are 12 weeks along.

Self-tanning lotions are also minimally absorbed and are considered safe to use. We always recommend you stay away from tanning beds and this applies during pregnancy as well.

Regular cleaning supplies are fine (sorry, I can’t give you an excuse to get out of your housekeeping). Just make sure you keep all areas well ventilated while cleaning. Avoid solvents such as paint thinner. Use common sense, if a chemical requires specialized disposal, you probably shouldn’t handle it while you are pregnant.

Most cosmetics and lotions are safe. If you use Retin-A, you should probably discontinue use during pregnancy. If you have questions about any prescription lotions, ask your doctor.

Sex is safe as long as you are not having any bleeding or complications.

Symptoms

Cravings. If you are craving a specific fruit, then go with it. If you need a Hershey’s bar every afternoon then you may need to slow down. I tell patients to give into their ‘bad’ cravings once or twice a week, just not once or twice a day!

There are weird cravings that could be a signal that something abnormal may be going on. For instance if you crave plain ice all the time, you could be anemic. Also some women will crave dirt or laundry soap, as well as other non-foods. This could be a signal of specific vitamin deficiencies. If this is the case inform your doctor. Needless to say, don’t give in to these ‘bad’ cravings!

Fatigue. I think fatigue is the least discussed early pregnancy symptom. Everybody knows about the “morning sickness,” but sometimes fatigue can be the most debilitating symptom in early pregnancy. The source is thought to be a combination of the high levels of HCG and Progesterone. But whatever causes it, from about 6 weeks to 12 weeks most pregnant women just want to sleep. Like 12 hours a night…and then take a nap later. If you can get away with it, go for it. The good news is that fatigue and nausea seem to get better after 12 weeks.

Links to discussions on other symptoms:

Nausea

Constipation

Vaginal Discharge

In our book I go into greater detail on all these issues and symptoms, with Jessica adding a faith based perspective on how to journey through pregnancy without fear. If you are looking for additional resources,  I also recommend the ACOG Pregnancy Guide.

Hopefully this post will help fill the information gap that may crop up during those weeks between peeing on the stick and your initial pregnancy appointment. As an obstetrician, I love seeing patients for their first pregnancy visit. The joy and excitement on their faces when they see that first tiny flicker of the heart beat on the sonogram, still melts my heart.  Thank you for letting us be a part of your journey and congratulations during this exciting time in your pregnancy.

The majority of women will experience at least occasional nausea during the first trimester, with about 2% experiencing severe daily vomiting. Symptoms usually peak at around 10 weeks as pregnancy hormone levels peak and then slowly improve over the next few weeks.

Because morning sickness is usually at the top of a mommy-to-be’s list of concerns, I wanted to offer my best advice for dealing with this unwelcome side effect of pregnancy.

As a starting strategy, eat small meals throughout the day. Stop before you are full, and try to eat again before you are hungry. High carbohydrate meals seem to be the most helpful. Sucking peppermint candy has been shown to reduce nausea after meals. Keep crackers beside your bed so you can eat them before you get up in the morning. Getting up very slowly can also be helpful.

Some women will have specific foods or smells that trigger the nausea. If you know what the troublesome foods are then you can plan ahead and avoid them. In general steer clear of spicy, rich or fried foods. Other women will experience nausea with brushing their teeth (but please don’t avoid this one!) or other activities like pumping gas.

Try to to take your prenatal vitamin at night with a small snack.  If the vitamin still causes nausea, then switch to one without iron.  It is very important to get adequate folic acid during the first trimester. So if you can’t hold down an entire vitamin, try a folic acid supplement.

If the nausea is not improving, the next option would be a combination of Vitamin B6 (10 mg) + doxylamine (10 mg…like Unisom) taken every 6 hours as needed. It is safe and is available over the counter. Obviously a sleeping pill may make you tired, but it does help the nausea. Natural ginger supplements have been shown in some studies to reduce nausea. A product that some of my patients have found helpful is  Tranquil Tummy Crackers. These are saltines with added ginger.

Another great option is the Prima Bella.  It is a medical device that is worn on your wrist that feeds an electrical impulse through the nerves in your arm that modulate the nausea centers of your brain and stomach. It is FDA approved and drug free. You do need a prescription from your provider.  Several of my patients have gotten significant improvement from this device.

If you’ve tried these tips and you’re still vomiting regularly or find your nausea incapacitating, then please call your doctor’s office. There are several prescription medications that can help reduce the nausea.

Reasons that you may need to be seen urgently are: vomiting blood, dehydration that results in decreased urination, or not being able to hold down anything for 24 hours.  Please let your provider know if you have these symptoms.

I found nausea to be the most challenging symptom in my own pregnancy. I found that keeping snacks close by during the day was helpful. At times, I took the anti-nausea medication in order to function and found it helpful. I would love to hear from our readers about any other helpful hints or products they found beneficial.

As always, we encourage you to discuss these remedies with your doctor so together you can determine what is best for you.

Dr. Rupe

I recently read an advice column in the news paper concerning how to tell people you are pregnant. The writer was concerned with how to give the good news to a friend who had been struggling with infertility. I was struck by the thoughtfulness of the writer to be so considerate as to realize the mixed emotions that are processed by those wanting children when they hear that someone near them is expecting. The advisor (I think it was Dear Abby, but I can’t specifically remember) recommended to tell the person in private or consider writing a note to inform them, giving them permission to process the news however they needed to emotionally, before they have to see you. I thought this was really good advice.

I remember during my adoption journey, that it didn’t bother me when close friends got pregnant or adopted, but sometimes when I would hear the ‘good news’ from acquaintances it would sometimes upset me, I’m embarrassed to say. I’m not exactly sure why. I guess if it was someone I knew, then I could identify with their journey, but it was harder to process when I didn’t know the entire story. For some strange reason it would also bother me when TV characters had babies. I remember one specific Blue’s Clues I was watching with Ryan. Mr. Salt and Mrs. Pepper were having another baby. Umm, really! Couldn’t they just be happy with a baby Paprika! But NO, here comes cute little baby Cinnamon. It’s funny now, but it really ruined my day.

On a related note I will often get asked by patients when is it safe to tell people that they are pregnant. Especially those that have previously struggled with infertility, I get the sense sometimes, that they feel that if the doctor tells them it’s OK to spread the word then nothing can happen. Each person’s situation is different. I can give them the statistics for their pregnancy, but deciding how and when to tell the good news is a personal decision. Some patient post their pregnancy test on twitter as soon as it comes back with a double line, others anxiously await the second trimester to feel safe to speak a word.

Some reassuring numbers for those waiting to tell:

In a healthy women less than 32 years old with no history of previous miscarriage the chances of having a miscarriage drop to 3% after a heart beat is seen at 7 weeks. This number drops to less than .5% after entering the second trimester. The risk of miscarriage does increase with age >35, smoking, medical condition and history of previous miscarriages. Even with these risk factors, though, the chance of loss decreases with each advancing week. So if you are looking for a ‘safe point’ to tell, after seeing a heart beat is a reassuring time. If you want an even ‘safer’ point, then second trimester is better. Really, the best time to tell, is when you feel it’s the right time to tell.

I get to hear from my patients some cute stories of ‘how’ they spread the news to their family; like framing their ultrasound picture to be opened at holidays, making a video featuring the news or having the good news written on cake. However you tell have fun with it, but be sensitive to those who may have a difficult time with hearing it.

I’d love to hear some feedback on ways you have told people about your pregnancy and also from our readers who have struggled with infertility on how they think is the best way to ‘break the good news’.

I am 10 weeks along in my pregnancy and all of a sudden I am hungry ALL THE TIME! Dr. Rupe talks about this symptom in the book. Hunger, with cravings and aversions.

I’m hungry all the time but not much sounds good to me. I am blessed in that I don’t suffer from extreme nausea or vomiting during my first trimester. Just a touch of queasiness from time to time. But I have lots of food aversions and honestly, they seem to come and go. One minute chicken sounds good, the next anything related to my feathered friends makes me want to puke. It makes it very challenging to eat healthy during these early stages of pregnancy.

My hope is that after I share my pregnant point of view on this symptom, Dr. Rupe will chime in with another entry that gives the facts and some good, doctorly advice on how to handle this early pregnancy dilemma.

Preparation is perhaps the most important action you can take when trying to eat healthy in your first trimester (and throughout your entire pregnancy for that matter). Since I know that chicken is hit or miss for me right now, I have to be ready with other options. What does sound good? Make a list of foods you have not been averse to and make sure you keep them around. Any kind of meat is tough for most women I talk to in their first trimester. What other forms of protein can you stomach at this stage?

I don’t hear much that fruits and vegetables bother women in pregnancy so focusing on those things is a good idea. I’ve eaten a lot of salads (the tangy vinegar helps the queasiness) along with citrus fruits (sour is great for nausea). When all else fails look to whole grains. Toast and whole wheat pasta are mild and will give you the carbs you need for energy. Try to find some form of protein to add to it though. Cheese is a good idea. Lastly, make sure you drink lots of water to keep you from dehydrating. Water is also just a great cleansing agent. It almost resets my system to drink a tall glass of cold water. Chicken might sound yucky but after downing 8 oz of agua, it might not be so bad.

We’d love to hear your pregnancy menu secrets. What worked for you?