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Induced Labor: When, Why, How

For many women, the labor process begins naturally on its own. For some, a little intervention may be needed to help things along. Sometimes mom’s prefer this too, and that is okay!

Labor induction means using interventions to help labor start. This could be before the due date (for medical or personal reasons), or after the due date if labor has not started naturally. Inductions may be a part of a woman’s desired birth plan, or quite a surprise recommendation if a medical issue develops.

Despite some common concerns about inducing labor, it’s no more dangerous or necessarily painful than labor and delivery that begins on its own. Here’s what you need to know about induced labor, when induction is recommended, what to expect, and how to plan.

Why Your OBGYN May Recommend Inducing Labor

Your OBGYN may recommend inducing labor for medical reasons to keep you and/or your baby safe and healthy. The recommendation to induce labor isn’t made lightly, especially if it is before 39 weeks gestation. When weighing the risks and benefits of delivery, your OBGYN weighs the risk of continuing the pregnancy with the risk of an earlier delivery. It is always a balance we pay close attention to for the safest outcome for mom and baby.

Medical reasons to induce labor before 39 weeks of pregnancy include, but are not limited to:

Gestational hypertension or chronic hypertension: high blood pressure during pregnancy that can progress to preeclampsia
Preeclampsia: high blood pressure in pregnancy that is associated with spilling protein in your urine, possible liver and kidney effects, risk of seizure and stroke
Gestational diabetes: especially if medications are needed to control blood sugar levels
Fetal Growth restriction: baby is not growing as expected, concerning that the placenta is not functioning optimally
Oligohydramnios: low amount of amniotic fluid around the baby (seen on ultrasound), another sign the placenta may not be functioning well
Cholestasis: a build up of bile acids that causes intense itching and can be associated with stillbirth

Reasons to induce labor after 39 weeks of pregnancy:

Late term pregnancy (if a woman is more than two weeks past her due date)
New development of high blood pressure (as above)
Age (many women can have healthy pregnancy’s after age 40, however, we know that delivering at 39 weeks improves outcomes for these moms and babys)
Abnormal fetal heart rate on monitoring
Maternal weight (moms with higher BMI’s likely benefit from inducing prior to 40 weeks).
Maternal desire (delivery at 39 weeks is safe, healthy, and can be a great experience!)

Until recently, inductions were only done for medical reasons, as advised by a doctor. Elective inductions—when a mom requests to be induced at 39 weeks or later—weren’t offered. It was thought to increase the risk of C-sections. A well-done study in 2018 (called the ARRIVE trial) showed that if induction is done in a safe way, the risk of C-section may actually be reduced.

Reasons women choose induced labor (when no medical reason is present):

Personal reasons (scheduling work, family help with other children, do not like the unpredictability of labor, etc.) .
Aches and pains of the third trimester
Just ready to meet their baby!

How Inducing Labor Works

Cervical Exam

A lot of the process depends on how “ready” your cervix is for labor (or in medical lingo, how “ripe” it is). A pelvic exam or cervical check will let us know how dilated, soft, and thin your cervix is and it’s location in the pelvis. We use these factors to determine what we call a Bishop score. A Bishop score of 8 or more (which means more dilated, soft, or thin) does not require any additional cervical ripening. If your Bishop score is <8, we recommend a few more things to get your cervix ready for labor. If we skip this part, that may increase the risk of needing a C-section. Performing appropriate cervical ripening reduces your C-section risk to baseline, as if you came in labor on your own.

Cervical Ripening

If the Bishop score is less than 8, then your OBGYN will recommend cervical ripening. This can be done with a balloon that helps the cervix soften, thin, and dilate and/or a medication called misoprostol (we give this by mouth, you may read about it given vaginally also). A balloon placement can be uncomfortable, but is generally very well tolerated. We offer this in the clinic (the balloon can stay in up to 12 hours) to shorten the amount of time you need to be in the hospital. The most common thing, however, is to have it placed in the hospital to be given with misoprostol at the same time.

Pitocin (oxytocin)

When your cervix is ready for labor, the next recommended step is oxytocin administration through an IV. Pitocin is not scary! It is the same molecule your body makes to cause contractions, we can just give it in controlled doses through an IV. The dose ranges from 0.5 mu/min to 30 mu/min. Every body reacts differently to the dose and we cannot predict who will need more or less.

Throughout ripening and induction, the baby’s heart rate will be monitored to ensure they are not stressed in labor.

Artificial rupture of membranes (AROM)

If your cervix is ready for labor and your baby is in a good position, we can induce labor by breaking your water. This can also be done as a step after cervical ripening during an induction. This allows your own body to take over the labor process in some instances.

Common Concerns & Questions About Induced Labor

Is it safe to induce labor?

We continuously monitor the baby through a fetal heart rate monitor to ensure labor isn’t stressing the baby. This is commonly done in spontaneous labor also.

We used to think that being induced increased your risk of needing a C-section. Prior to 2018, this elective induction wasn’t an option because of this concern. After the ARRIVE Trial in 2018, we understand that inductions do not increase your risk of needing a C-section and it actually likely lowers your risk (28 inductions to prevent one C-section). After 39 weeks, a baby is fully developed but only continues to grow, the placenta can start to get tired, and there is a higher likelihood of developing preeclampsia and these are some reasons elective induction can be a good idea.

How long does it take to deliver after induced labor?

Like every aspect of pregnancy and labor, the answer is: it depends. Some women will deliver in hours while other times it takes 24 hours or greater. This is true of spontaneous labor also, but the difference is with induction the majority of time you are in the hospital for the process.

Is induced labor more painful than labor that begins on its own?

The answer to this question is also a little tricky. Many studies have shown that pain with induced labor is not greater than spontaneous labor. Pitocin is the same hormone your body uses to cause labor and contractions hurt! Women perceive more pain as labor starts if they start from a place of no labor! Women who undergo induction are more likely to receive an epidural for labor pain control.

How should I prepare for an induction?

A benefit of labor induction is that you can plan ahead a little bit more.

Eat a healthy, light, bland breakfast before coming to the hospital. Toast and scrambled eggs are popular!
Bring your hospital bag with you. (This blog post will give you all the insider information about what to pack.)
If you choose to let many people know when you’re getting induced, remind them that it could still take more than 12 hours. That way, you may receive fewer messages asking “Is your baby here yet?”

Can I induce labor without medication?

If your pregnancy is passing weeks 40 or 41, you may wonder if there’s any way you can speed things along naturally.

Some women swear that sipping herbal teas, snacking on dates and pineapples, or going for extra long walks helped induce labor. However, there is no research data to support these methods.

One activity, however, has been shown to help move things along: sexual intercourse. Sperm contains prostaglandins, which help soften the cervix. Orgasm releases oxytocin, which causes uterine contractions.

Nipple stimulation can also cause contractions but is not recommended without monitoring because it is so unpredictable.

Finally, a membrane strip can be performed in the doctor’s office after 39 weeks. This is done after your cervix has begun to dilate. A membrane strip (or membrane sweep) is when your OBGYN inserts their fingers into your cervix, makes a sweeping motion, and loosens the amniotic sac from the uterus. It can help your body release prostaglandins which will soften your cervix and help your body prepare for labor. (This method is not offered if you test positive for Group B Strep.)

Induced Labor: Like regular labor, only more planned.

You may have fears or concerns about induced labor, especially if your OBGYN is recommending it for medical reasons. While going into labor naturally is typically preferred by patients with the perception that your body and baby are ready, induced labor can be just as safe—or safer. Many women that consider induction worry about missing the experience of going into labor at home. This is valid! But we like to keep in mind, especially when medical reasons come up, that mom and baby’s safety is our priority. We want your experience to be all that you hope for, and that is possible with induction.

Your OBGYN carefully balances the pros and cons of inducing labor versus continuing expectant management. If you have any questions or concerns, always talk to your midwife or OBGYN. At Madison Women’s Health, we value clear, transparent, and caring communication with every one of our patients.

Dr. Ashley Durward has been providing healthcare to women in Madison since 2015 and joined Madison Women’s Health in 2019, specializing in high and low risk obstetrics, contraception and preconception counseling, management of abnormal uterine bleeding, pelvic floor disorders, and minimally invasive gynecologic surgery.

June 25, 2022/by Dr. Ashley Durward

What OBGYNs Say About Depression During Pregnancy

Blog, Pregnancy

Many of the changes associated with pregnancy are things we can see, touch, and hear: a growing baby bump, that first flutter of kicks, your little one on the ultrasound screen sucking their thumb, or the rapid lub-dub of their heart through a fetal heart rate monitor.

Other changes that come with pregnancy, such as labile feelings, emotions and mental health concerns, are harder to observe or measure. As a result, they can often go unseen and untreated. Caring for your mental health — and looking out for signs of depression during pregnancy — is important for both you and your baby.

Already had your baby? Read Postpartum Depression: Everything You Need to Know

Mood Swings or Depression During Pregnancy?

Anyone’s emotions can be up one day and down the next, pregnant or not. It’s part of being human! But pregnancy can take those mood swings to a different level. And every woman, in every pregnancy, will experience those ups and downs in different ways and at different levels of intensity.

It’s normal to feel emotional ups and downs while pregnant. You may feel delighted and anxious, excited and exhausted, serene and stressed all in the same hour. You might feel like your body doesn’t seem like your own anymore while it’s changing size and shape. And you may have all kinds of unanswerable questions about your future and your baby’s future. On top of all that, your hormones fluctuate in different ways than when you’re not pregnant, leading to changes in appetite, energy and sleep.

It’s no wonder that mood swings are more common and pronounced during pregnancy!

However, for nearly 10% of pregnant women* in the U.S., that anxiety, exhaustion, and stress are more than just mood swings. When these symptoms interfere with daily life, they are reasons to seek help for depression.

(We believe the number of women experiencing depression during pregnancy is likely higher than 10%. It is not uncommon to have negative thoughts, emotions, and fears. It’s completely OK to bring these up with your doctor. In fact, we encourage you to share your concerns so that you can get the help you need.)

How to Tell the Difference Between Mood Swings and Depression

Symptoms of depression can include changes in sleep, energy, and appetite. But these symptoms could also be normal, pregnancy-related changes. That’s why it’s important to discuss any symptoms with your doctor. They’ll look for additional clues to see if what you are experiencing is “normal” or something more.

The following may suggest depression during pregnancy:

History of depression — either before pregnancy or during a previous pregnancy
Excessive anxiety — such as being so concerned about the wellbeing of your baby that it negatively affects your daily activities
Poor self-esteem — such as excessive concern about the ability to be a good mother
Despondency or hopelessness
Lack of interest in things or people you used to enjoy
Lack of response to support
Interpersonal problems or domestic violence
Non-adherence to antenatal care
Using alcohol, illicit drugs, tobacco
Poor weight gain due to decreased appetite and inadequate diet
Suicidal ideation (thinking about suicide)

Your doctor will look for these five specific symptoms of major depression:

Dysphoria — which means you feel sad, depressed, or anxious
Anhedonia — which means lack of interest
Excessive guilt or feelings of worthlessness
Impaired concentration and decision making
Suicidal ideation or behavior

Factors that Contribute to Depression in Pregnancy

While we can’t say definitively that one thing causes depression during pregnancy, OBGYNs know there are many contributing factors. The risk factors for depression during pregnancy include:

Prior history of depression (whether while pregnant or not) seems to be the most important risk factor
Current anxiety
Unintended or unwanted pregnancy
Life stress, including adverse life events (job loss, moving to a new place, death of a loved one) and socioeconomic status
Intimate partner violence and lifetime history of physical and/or sexual abuse
Poor social support
Conflict, ineffective communication, and dissatisfaction with partner
Chronic general medical conditions such as diabetes, migraines, obesity
Single marital status
Smoking
Exposure to secondhand smoke
Having had at least one prior birth
Prior history of pregnancy / delivery complications (for example, miscarriage)
Body image dissatisfaction
Certain personality traits (anger, low self-esteem, neuroticism)
Family history of depression

The Impact of Depression on Your Pregnancy

We know that depression can have an impact on your daily life and health — even when you’re not pregnant. Depression can lead to a compromised immune system, poor nutrition, and substance abuse.

When you’re pregnant, studies suggest that depression can affect not only you and your body but also your offspring. Some reasons depression could affect your child longer term include:

Shared genetic factors — furthering the family history of depression to the next generation
Epigenetic changes in the placenta and umbilical cord blood
Changes in maternal and fetal central nervous system functioning
Dysregulation of maternal hormones and increased fetal exposure to cortisol (cortisol is called the “stress hormone”)
Not following prenatal care
Poor nutrition
Lack of exercise
Substance use disorders
Depression lasting even after pregnancy

Depression during pregnancy is also associated with a small increased risk of preterm birth or pregnancy loss. But it does not appear to be associated with the development of preeclampsia or gestational diabetes, or with NICU admission for the baby.

Depression, when left untreated, can continue to affect your baby and child as they grow and develop. Some studies suggest that risk of anxiety, ADHD, conduct disorder, antisocial behavior, and depression in children are greater in children of depressed pregnant women.*

Treating Depression During Pregnancy

Untreated depression causes suffering that you can avoid. It can lead to poor nutrition, substance abuse, increased risk of suicide, and broken relationships between you, your baby, and your other family members.

There are many safe ways to treat depression during pregnancy. When you work with an OBGYN here at Madison Women’s Health, we take an individualized approach to treating your depression.

Activities for Treating Depression

Talk therapy is a common first step in treatment of depression. However, even if you are not diagnosed with depression, it can be very helpful to talk to a professional about the things that worry you. Your doctor or therapist can help identify sources of stress and anxiety and give you ways to cope.

Trying to be active and doing things you enjoyed before becoming pregnant can improve mood. Consider activities to reduce your stress, such as exercise, yoga, meditation, or listening to music. Some studies suggest that listening to music and music therapy can play a role in helping pregnant women with depression.

Other lifestyle factors, such as eating fresh and nutrient-dense foods during pregnancy, as well as getting adequate sleep can help to improve your mood.

Pregnancy-Safe Medication for Treating Depression

Another possible step for treatment is a conversation about medication for depression during pregnancy. Your course of treatment depends on the severity of your depression, your health history, and your support system. For example, do you have people helping with your other children? Are you able to take time off work?

If you may benefit from a medication, your OBGYN will discuss with you which medications are considered safe to take while pregnant or breastfeeding.

You Don’t Have to Be Alone — We Want to Help

We care deeply for every one of our patients and women in our community. We want you to experience the joys of pregnancy, motherhood, and life itself. Depression makes that difficult. Depression during pregnancy isn’t anything to be ashamed of. It’s not something you need to hide from your OBGYN. Feeling stressed, anxious, or disinterested does not mean you are a bad mom. It simply means you need some extra support.

We recognize that many people don’t have the support system they need. Please talk to your OBGYN about your feelings — whether those feelings are happy, sad, confused, or angry. We are here to help you — every part of you, even what can’t be measured by an ultrasound or a stethoscope.

*References

Grigoriadias S. Mild to moderate episodes of antenatal unipolar depression: Choosing

treatment. Accessed April 20, 2022.

Grigoriadias, S. Unipolar major depression during pregnancy: Epidemiology, clinical

features, assessment, and diagnosis. Accessed April 20, 2022.

Grigoriadias, S. Antenatal depression: Risks of abnormal infant and child development.

Accessed April 20, 2022.

Grigoriadias, S. Antenatal depression: Risks of cognitive impairment and

psychopathology in the offspring. Accessed

April 20, 2022.

Sanfilippo, K., Stewart, L., & Glover, V. (2021). How music may support perinatal mental

health: an overview. Archives of Women’s Mental Health, 24(5), 831-839. https://

www.ncbi.nlm.nih.gov/pmc/articles/PMC8492590/pdf/737_2021_Article_1178.pdf

Stephanie Brasser, APNP, A.P.N.P., joined Madison Women’s Health in 2013, specializing in the provision of care for our patients’ non-OBGYN healthcare needs. Stephanie received both her Master’s Degree and Doctorate of Nursing from the University of Wisconsin-Milwaukee and is certified as an Adult Medicine Nurse Practitioner.

May 25, 2022/by Stephanie Brasser

Vaccines During Pregnancy

Blog, Pregnancy

Moms and moms-to-be want to do everything they can to keep their children safe and healthy. While every illness can’t be prevented, modern medicine has given us a great weapon to fight some of the worst diseases. That weapon is vaccination and immunization.

Vaccines “teach” your body how to fight germs that cause infections. They can prevent you from getting seriously ill from diseases such as tetanus, diphtheria, pertussis (whooping cough), and even the flu or COVID-19.

When you are pregnant, these diseases can be even more dangerous for both you and your developing baby. If you contract certain diseases while you’re pregnant you could pass the disease to your baby, increase the risk of miscarriage or birth defects, or increase the severity of the disease in your own body.

When your baby is born, they will receive some vaccinations, but your baby will not be able to receive all of the same ones as older children or adults. That means they could be at risk of contracting these illnesses as a newborn. The flu and whooping cough can be particularly dangerous for infants. The good news is that when you get vaccinated during pregnancy, you share your immunity to these diseases with your baby, protecting your newborn after birth until they’re old enough to be vaccinated themselves.

Recommended Vaccines During Pregnancy

Some vaccines are safe during pregnancy and some are not. Certain vaccines should be given during specific stages of the pregnancy to increase the amount of antibodies you pass along to your baby at birth.

Other vaccines that contain live forms of the virus they are designed to prevent should not be given to a woman who is pregnant because of the risk of infection.

At Madison Women’s Health, we recommend all our pregnant patients receive the following vaccinations during pregnancy:

Influenza (flu) Vaccine

The flu shot can be given during any trimester of pregnancy. It’s made from an inactivated virus, so it is safe for you and your baby. We begin to give this when the vaccine is available for each influenza season, typically around September or October. Getting the flu while pregnant can cause more complications and severe illness than getting it while you are not pregnant.

Important note: Avoid the influenza spray vaccine during pregnancy, which is made from a live virus.

Tdap Vaccine

Tdap stands for tetanus toxoid, reduced diphtheria toxoid and acellular pertussis. The Tdap vaccine is given between 27-36 weeks of gestation during pregnancy to boost your immunity, and to pass along the most antibodies to your newborn.

COVID-19 Vaccine

If you have not already received a COVID-19 vaccine, we recommend an mRNA vaccine (either Pfizer or Moderna) and a booster at the appropriate time. Learn more about the COVID-19 vaccine.

Other Safe Vaccines During Pregnancy

Your doctor may recommend the following vaccines during pregnancy in certain populations while pregnant:

Pneumococcal Vaccine
Meningococcal Vaccines
Hepatitis A and Hepatitis B Vaccines

Vaccines to Avoid During Pregnancy

We recommend avoiding MMR vaccination (measles/mumps/rubella) and Varicella (chicken pox) vaccination in pregnancy because they contain a live form of the virus. If you are planning to become pregnant, be sure to talk with your doctor about how long to wait after these vaccines. If you’re not sure if you’ve had these vaccines, your doctor can check your immunization records or can test your blood for antibodies.

Most people born in America received the Measles-Mumps-Rubella shot as children. Many also received the Varicella (chickenpox) vaccine or acquired immunity by getting chickenpox as a child.

If you got either of these shots while you were pregnant, be sure to let your doctor know as additional monitoring during your pregnancy may be necessary.

Commonly Asked Questions About Vaccinations During Pregnancy

When should I get vaccinations during pregnancy?

Flu shot: As soon as it’s available, typically in September or October. It can be given during any trimester. Avoid the influenza nasal spray vaccine.
Tdap: As early in the 27-36 weeks-of-gestation window as possible.
If you are planning to become pregnant, be sure you are up-to-date on all other recommended vaccines, including COVID-19. You should not get the MMR and Varicella vaccines while pregnant.

Are vaccines safe if I am breastfeeding?

Yes.

Does a vaccination pass along immunity to my baby?

Yes.

Are vaccines during pregnancy linked to premature birth?

No.

Do vaccines harm my baby?

Generally, vaccines that contain killed (inactivated) viruses can safely be given during pregnancy. The vaccinations that are recommended have been studied and do not harm your developing baby.

Vaccines that contain live viruses are not recommended during pregnancy, including MMR and Varicella vaccines. While highly unlikely, there is a small chance that you or your baby could get sick from the live virus in the vaccine.

Do vaccines cause autism?

No. This claim has been proven to be untrue in a number of scientific studies.

What should I do about the side effects from a vaccine while I’m pregnant?

The most common side effects are injection site reactions, fever, muscle pain, joint pain, headaches, and fatigue. These are a normal part of your body’s reaction to a vaccine and developing antibodies. We recommend acetaminophen for pregnant women who experience fever or want relief from joint pain or headaches.

If you have any more questions about getting vaccines during pregnancy or before becoming pregnant, we’re happy to answer them at your next appointment!

Dr. Sarah Yanke has been providing healthcare to women in Madison since 2010, specializing in high and low-risk obstetrics, contraception, management of abnormal uterine bleeding, and minimally invasive surgical techniques. She is a Board Certified Fellow of the American College of Obstetrics and Gynecology.

April 20, 2022/by Dr. Sarah Yanke

Sex During Pregnancy

Blog, Pregnancy

When you’re pregnant, your interest in sex can change a lot! Some women are more interested, some women less, and some are just worried that having sex may not be ok. Let’s talk about sex during pregnancy, what might be affecting your interest, what is safe, and other common questions our patients ask.

Is it ok to have sex during pregnancy?

For women with an uncomplicated pregnancy, the answer is yes! As long as you feel comfortable and are interested in sex (and your doctor has not recommended against it), go for it! It will not hurt your baby. This includes stimulation, penetration and orgasms.

When is sex not ok during pregnancy?

A complication during pregnancy that would affect whether you should have sex is if you have placenta previa spectrum disorder. If your placenta lies low in your uterus and/or blocks the opening to your cervix, then penetrative sex is not recommended (it is contraindicated).

At your 20-week ultrasound, your provider will look at your cervix. If your cervix appears to be thinner than it should be, your OBGYN may also recommend abstaining from all sexual intercourse.

Another time when your OBGYN may recommend abstaining from sex while pregnant is to help ease your anxiety if you have vaginal bleeding in your first trimester. Intercourse won’t cause a miscarriage, but it could cause more bleeding, which in turn can create unnecessary anxiety. (20% to 35% of women experience light bleeding and spotting in their first twelve weeks.)

If you experience spotting or light bleeding after penetrative sex, but no cramping or pressure, there is little cause for concern. Sometimes, surface vessels in your cervix can rupture during intercourse, which causes bleeding. This is not harmful. If you have not had penetrative intercourse AND you are bleeding, if you experience severe cramps, or if the bleeding is heavy (like your period) then you should contact your OBGYN.

What about orgasms?

Orgasms are ideal at any time of your life! Unless your OBGYN has recommended against it, you are cleared to enjoy orgasms. Every woman is unique in the way she experiences orgasm during pregnancy. For some, it is more intense and for others less so.

Orgasms may also feel different as your pregnancy progresses and your baby grows. Your uterus may lightly contract after you orgasm, much like Braxton Hicks contractions.

If you have a placenta previa and experience bleeding after orgasm, contact your provider.

Benefits of sex during pregnancy

Pregnancy is often a stressful time. It can put a strain on any relationship. Having sex with your partner is one way that you can maintain intimacy during this time.

Oxytocin, which is a hormone that is released when you orgasm, is sometimes called the “love hormone.” It can help you feel closer to your partner. Oxytocin gives you feelings of emotional warmth and love. Some women report it can help ease some pain, such as backaches.

You may have heard that having sex (in this case penetrative heterosexual sex) when you’re close to your due date (or overdue!) could help you go into labor. While this hasn’t been studied closely, anecdotally this could be due to the presence of prostaglandins in semen and in the membranes (bag of water) that sit atop the cervix. Prostaglandins can make the uterus more contractile, but it is not known how many are required or how many are released during penetrative intercourse.

Changes to sex drive during pregnancy

Like so many other experiences during pregnancy, changes to your sex drive are highly individualized. Some women may report a higher sex drive during the second trimester. (Often, by the second trimester women feel more energy and are no longer experiencing the morning sickness associated with the first trimester.)

During the third trimester, especially as the due date approaches, women tend to report decreased sex drive. For some, they simply don’t feel comfortable, they’re more tired, or they may have some vaginal dryness due to changing hormones.

Having a lower sex drive during pregnancy is normal. Remember, intercourse isn’t the only way to maintain intimacy. Being open and understanding in your communication with each other is important. You want to do what you can to solidify your relationship especially as you are heading into the newborn phase.

You can also:

trade massages
cuddle or hug (this also releases oxytocin)
find activities to do together that will be difficult when the baby arrives
laugh together

Pain during sex while pregnant

If you experience pain during penetrative sex, it could be related to vaginal dryness caused by changes to your hormones. A good lubricant is typically all you need to offset this and make intercourse more comfortable. Visit a local store that specializes in women’s health, or ask your provider for a recommendation. Here in Madison, we often send our patients to A Woman’s Touch.

If the position is uncomfortable, or you don’t feel supported under your belly, experiment with different positions or pillow placements. Clear communication with your partner will help as well.

How soon after giving birth can you have sex?

Physically, your body could accommodate sex as soon as two to four weeks after giving birth. However, that doesn’t mean the rest of you is ready. Your life has just changed drastically with a newborn! In fact, most women do not resume having sex until after their post-partum follow-up appointment around 6 weeks.

If you had a vaginal delivery with no tears, then you could have sex anywhere from two to four weeks after giving birth. If you had any tears (lacerations) that required stitches (sutures), then four weeks would be the earliest you should have penetrative intercourse. This is because the sutures don’t absorb for at least four weeks.

If you had a C-section, then you may be cleared to have sex after two to four weeks.

Read more about C-sections vs. vaginal births.

It’s OK to wait and take it slowly

Most of all, it’s important to wait until you feel ready. Many women wait six weeks or more to have sex after giving birth. Go slowly and make sure it’s the right moment. It’s important that you are aroused. In other words, don’t have sex simply because you feel badly that it has “been a while.”

Arousal causes relaxation of the vagina. But if you’re nervous about having sex, your brain may unintentionally send a message to your muscles — including your vagina — to contract. This could make penetrative intercourse uncomfortable or even painful.

The key to comfortable post-partum penetrative sex is lubrication, especially if you are breastfeeding. This is because when your body is not ovulating, your estrogen levels are low, which leads to vaginal dryness.

In summary, if your OBGYN provider has not recommended otherwise, enjoy sexual intercourse with your partner. If it causes you stress or anxiety, find another way to maintain intimacy with each other. Choose a good lubricant and be creative with positions if you experience discomfort. Finally, make sure you are emotionally and physically ready for sex after giving birth. There’s no rush!

Dr. Beth Wiedel has been providing healthcare to women in Madison since 2002 and is a founding partner of Madison Women’s Health. She shares the vision of all the partners of being a strong healthcare advocate for her patients, emphasizing compassion and communication throughout her practice.

March 25, 2022/by Dr. Beth Wiedel

Ultrasounds During Pregnancy: What You Need to Know

Pregnancy

Moms-to-be typically look forward to ultrasounds during pregnancy more than any other prenatal appointment. It’s easy to see why! It’s fun to get a sneak peek of your bundle of joy while your OBGYN looks for specific growth and development markers. Many women look forward to learning their baby’s sex as soon as possible and wait impatiently for their 20-week ultrasound. Others want to be surprised. Whether or not you intend to learn about your baby’s sex ASAP, it’s important to keep all your ultrasound appointments.

An ultrasound, also known as a sonogram, is typically performed by an ultrasound technician or sometimes by an OBGYN. It uses sound waves to create an image of the organs inside your body. (These sound waves are not harmful to you or your baby.) Ultrasounds during pregnancy help doctors diagnose many diseases and conditions, even those not related to pregnancy.

This article will cover why and how ultrasounds are used during your pregnancy, how many ultrasounds to expect while you’re pregnant, and what your OBGYN may be looking for at each ultrasound.

Most pregnant women typically only get two ultrasounds, one at the beginning of pregnancy and one about halfway through. Other women may have three or more ultrasounds done depending on a number of factors.

Your First Ultrasound

Your first ultrasound is called the “dating” or “viability” ultrasound. It’s typically done between 7 and 8 weeks to verify your due date, to look for a fetal heartbeat, and to measure the length of the baby from “crown to rump.” At this ultrasound, you’ll also learn whether you’re having one baby, pregnant with twins, or more! You may even get to see or hear your baby’s heartbeat during this appointment.

If you have irregular periods, or didn’t have a period after coming off birth control, this ultrasound will be especially helpful in determining a more accurate due date. Your due date is important because it helps your doctor know whether your baby’s development is on track each month.

We’ll perform this ultrasound at our Madison Women’s Health clinic.

What to Expect at Your First Ultrasound

When you’re just 7 or 8 weeks pregnant, your fetus is only about two centimeters long. In order to get a close enough view of your uterus and fetus, the dating ultrasound is done transvaginally. This means the ultrasound is done internally, literally “through the vagina.” A transvaginal ultrasound can be a little uncomfortable, but it is not painful. Most would say it feels less invasive than a gynecological exam that uses a speculum.

To perform this ultrasound, your OBGYN or ultrasound tech will gently insert a narrow ultrasound wand just inside your vagina. The transvaginal ultrasound wand is also called a transducer. It’s about three centimeters around, a little larger than a tampon. It will be covered by a condom and lubricant. The wand will not reach your cervix and is safe for your baby.

You may be asked to arrive at your first ultrasound with a full bladder. Having a fuller bladder helps to put your uterus in a better position for the ultrasound.

What Your Doctor is Looking for at Your First Ultrasound

Viability of pregnancy
Fetal heartbeat
Fetal size
Single or multiple pregnancy

Genetic Screening Ultrasound

If you choose to have prenatal genetic testing done, you’ll have your next ultrasound at 12 to 13 weeks gestation. This ultrasound is also called nuchal translucency screening. It’s offered to everyone and is covered by most insurance plans. This genetic screening ultrasound is optional.

During this ultrasound, your doctor will look for indicators of chromosomal disorders. Chromosomal disorders mean that the baby received an extra chromosome at conception and could have moderate to extreme physical or mental challenges. These disorders include:

Trisomy 21, known as Down Syndrome
Trisomy 13
Trisomy 18

Read more about carrier screening and prenatal genetic testing. Also check out the article about at-home genetic testing kits.

What Your Doctor is Looking for at the Genetic Screening Ultrasound

This ultrasound will be an anatomical scan. Your doctor will look to see if all four limbs are present. They will also look for basic structures in the brain, the stomach, the bladder, the nasal bone, and last but not least, something called nuchal translucency. Nuchal translucency is a fluid sack at the back of the baby’s neck that is filled with lymphatic fluid. There are correlations between the size of that sack of fluid and the likelihood that the fetus could be affected by a major chromosomal disorder.

After the ultrasound has been performed, your OBGYN will interpret the results and share the information with you. You may also meet with a genetic counselor who could recommend having additional tests done to verify the ultrasound results.

Keep in mind that ultrasound screenings for other genetic disorders or anatomic abnormalities become more accurate further into the pregnancy.

We’ll perform this ultrasound at the Madison Women’s Health clinic.

Should you Get a Genetic Screening Ultrasound?

There’s no right or wrong answer to this question. Ultimately, the decision is up to you. Here are some good questions to ask yourself as you decide whether to have the genetic screening:

Is there a family history of these genetic birth disorders?
Would I terminate my pregnancy if there was a risk of Downs Syndrome, Trisomy 13, Trisomy 18, or other genetic disorder?
Would knowing about my pregnancy’s risk of genetic defect make it easier to emotionally or physically prepare for a baby with a birth defect?
Would it be easier for me to cope with and enjoy pregnancy if I focus on the more likely positive outcome rather than the chance of birth defects?

Whether you choose to have genetic screening done at this time is entirely your decision. Some women prefer to have as much information as possible as early as possible, while other women do not. If you’re still uncertain, you can discuss the pros and cons with your OBGYN.

Basic Anatomy Scan Ultrasound

This is the ultrasound that people look forward to the most! The full anatomy ultrasound is typically performed at about 20 weeks, or 5 months. As the name implies, this ultrasound will look at all the baby’s organ systems to make sure they’re present, are a normal size and shape, and are in the right location.

What to Expect at a Full Anatomy Scan Ultrasound

The full anatomy scan is a transabdominal ultrasound. It uses a transducer that looks a lot like a store checkout scanner. The ultrasound technician will put warm ultrasound gel on your stomach and then slide the transducer in the gel around your stomach. The gel helps the sound waves travel through your skin.

Tip: Come to your appointment with a relatively full bladder. This will make it easier for your ultrasound technician to get better images of your baby.

Because there are so many things to look for, this ultrasound will take at least 45 minutes—if your little one cooperates! If you’ve got an extra squirmy baby who is “camera shy,” it could take a few hours to get all the images that we need. Don’t worry, we have a lot of tricks to encourage your baby to change positions—everything from asking you to lay on one side and then the other, emptying your bladder or filling it, maybe even walking around. We’ll do whatever it takes to get the images we need to track your baby’s growth and development.

What Your OBGYN is Looking for at a Full Anatomy Scan

During the full anatomy, 20-week ultrasound, you can find out if your baby is male or female. If you want the sex to be a surprise, be sure to tell your technician know ahead of time so they don’t accidentally let it slip. When the scan is complete, Meriter will even send you a link to view some fun photos of your baby!

Your ultrasound technician will capture a large number images and measurements:

limbs: arms, legs, feet, hands
torso: chest, heart, kidneys, stomach, bladder, diaphragm, genitals
head and face
spine
umbilical cord
amount of amniotic fluid
location, size, and shape of your placenta
length of your cervix

After your ultrasound technician has captured all these images and measurements, your OBGYN will review the pictures and look for abnormalities such as congenital heart defects or cleft lip or palate. They’ll discuss their findings with you and help you understand what you’re looking at in the different images.

If everything looks normal and there are no other issues during your pregnancy, the next time you’ll see your baby is when he or she is in your arms! In the meantime, you can enjoy those 2D or 3D photos of your baby!

This ultrasound will be performed at UnityPoint Health – Meriter Hospital Center for Perinatal Care.

“Extra” Ultrasounds

Sometimes, women need additional ultrasounds during pregnancy. Your OBGYN may ask you to come in for additional ultrasounds to check your:

Cervical length: if your cervix is shorter than expected, you may need to have your cervix checked regularly to be sure it stays closed so that you can maintain your pregnancy. If the cervix continues to shorten or thin, you may need a cerclage to help strengthen it until it’s time to deliver your baby. Cervical length ultrasounds occur at 16, 18, 20 and 22 weeks and are done transvaginally.
Placental location and size: if your placenta is too small, if it is in an abnormal location or if it is an abnormal shape, then we will need to monitor it and the growth of your baby with regular ultrasounds. Your placenta is responsible for passing blood and nutrients to your baby, so it’s important thrat it is growing correctly.

You may need growth ultrasounds if you have:

hypertension
diabetes
high BMI (body mass index) going into pregnancy
preeclampsia
indicators that your placenta or uterus is not growing appropriately

Sometimes, growth ultrasounds are needed to check that your baby’s growth is continuing along the growth curve. They’re done at 28, 32, and 36 weeks. One way doctors estimate whether your baby is growing as expected is by measuring your fundal height. Fundal height is the number of centimeters from your pubic bone to the top of your uterus. This measurement typically increases about 1 cm each week. If your uterus has not grown appropriately in the last month, your OBGYN will surmise that your baby is also not growing and will want to perform monthly growth ultrasounds.

What to Expect at a Growth Ultrasound

These ultrasounds take less time than the full basic anatomy ultrasound because there are fewer measurements required. The ultrasound technician will measure the baby’s head circumference, bi-parietal diameter, abdominal circumference, and femur length.

What Your OBGYN is Looking for at Growth Ultrasounds

Your OBGYN is looking to see if your baby is staying on its growth curve. We will also use the measurements to estimate your baby’s weight. A large or extra large baby isn’t typically concerning. An extra-small baby or a baby who does not grow according to their growth curve could mean that the baby is not getting enough nourishment through the placenta and may need to be delivered early.

2D, 3D, and 4D Ultrasounds

2D ultrasounds are the black and white images that you’re probably used to seeing. To an untrained eye, they can look pretty fuzzy or obscure. However, they give the best definition of the structures of your growing peanut and are considered the “gold standard” of diagnostic imaging.

3D images are especially popular among parents-to-be who want to enjoy those cute baby pictures even before the baby is born! These pictures show facial features and look much more baby-like than the kind of obscure 2D images. 3D ultrasounds have usefulness beyond the cuteness factor, however! In the case of abnormalities of the spine or palate, 3D ultrasounds can help your OBGYN get a better idea of the severity.

4D images are like a 3D image, but show the baby moving around. They’re like getting to see a live action video of your little one. These are less commonly done because they don’t actually help with diagnoses. Depending on which perinatal center you go to, you might receive a link to view your ultrasound images or videos online.

While there are some stand-alone ultrasound centers offering to tell you your baby’s sex early on or to give you keepsake 3D or 4D images, these aren’t necessary and are rarely covered by insurance. You’ll find out everything you need to know during your appointments at the perinatal center — and those appointments will be covered by your insurance.

The best place to have an ultrasound performed is always at a clinic, where you will have access to a physician who has been trained in interpreting the images. At Madison Women’s Health, we’re happy to print off pictures for you to put in your baby’s scrapbook — or anywhere else you’d like to display those “coming soon” photos.

Final Thoughts

Ultrasounds during pregnancy are a fascinating way to get a glimpse of your developing baby. Don’t be afraid to ask your OBGYN for more details about genetic screening as you determine whether that is something you want done. And make sure you’ve set aside a good amount of time for your ultrasounds — especially the all-important full anatomy scan!

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March 24, 2021/by Dr. Beth Wiedel

Hypertension & Preeclampsia: How to Prevent and Treat These Conditions

Pregnancy, Women's Health

Because gestational hypertension occurs in women who previously had normal blood pressures — and often is without noticeable symptoms — a diagnosis of hypertension often comes as a surprise.

We understand a diagnosis of gestational hypertension can be worrisome, especially if it develops into preeclampsia. But you’re not alone. Many women have received these diagnoses. In fact, gestational hypertension and preeclampsia are some of the most common issues we take care of with our pregnant patients, complicating 5-10% of pregnancies. Both conditions have become more prevalent over the last 30 years.

Let’s take a closer look at blood pressure during pregnancy and the risk factors, symptoms, and treatment options for both gestational hypertension and preeclampsia.

What Your Blood Pressure Means

Your blood pressure tells the story of how hard your heart works to send blood throughout your body. Your arteries are under constant pressure as your blood circulates. That pressure is necessary to get the blood flowing to your internal organs, to the tips of your fingers and toes, and back to your heart again.

The ideal blood pressure is between 90/60 mm Hg and 120/80 mm Hg. The first number is called systolic pressure — that’s how much pressure your heart puts on your arteries with each pump of blood. The second number is called diastolic pressure. That’s the level of pressure that is constantly on your arteries. Blood pressure over 140/90 mm Hg is considered high.

If your systolic pressure is over 140 mm Hg, or your diastolic pressure is over 90 mm Hg, or both numbers are high at your prenatal appointment, then your doctor will want to measure it again within a short timeframe (within a few hours or sometimes the next day). Sometimes, it is just the stress or worry of a doctor’s appointment or other outside factors that temporarily raises your blood pressure. Temporarily elevated blood pressure is not considered hypertension.

Gestational hypertension is defined as either number in your blood pressure being over 140 / 90 mm Hg when measured two times at least 4 hours apart. It is diagnosed after you are 20 weeks pregnant and in women who previously had a normal blood pressure.

Why Your Blood Pressure Matters More When You’re Pregnant

Blood pressure can increase at the end of pregnancy. For that reason (and several others!), you’ll have many more prenatal appointments in the final weeks of your third trimester.

When your blood pressure is high, your heart has to work harder to pump blood through your body. Chronic high blood pressure, or hypertension, puts extra stress on your heart and arteries, and even on your eyes. When you’re pregnant, high blood pressure makes it harder for your placenta to get enough blood, which limits the nutrients and oxygen your baby receives. When there’s decreased blood flow to the placenta, your baby’s growth can slow, which can lead to low birth weight or premature birth. Hypertension can also lead to low levels of amniotic fluid and placental abruption (when the placenta pulls away from the uterus).

Gestational hypertension can progress to preeclampsia and can affect your other organs, leading to seizure, stroke, and problems with your kidney or liver. It puts you at increased risk for heart disease, stroke, and high blood pressure later in life.

The Difference Between Preeclampsia and Gestational Hypertension

The difference between gestational hypertension and preeclampsia is how they affect your other organs.

Sometimes, gestational hypertension develops into preeclampsia, which can be a dangerous condition because of how severely it affects your organs. It can happen after you’re 20 weeks pregnant but is more frequent when you’re closer to full term. It is usually, but not always, accompanied by protein in your urine (new-onset proteinuria).

Sometimes, there is no protein in the urine, but there are other lab abnormalities and symptoms such as:

low platelets
impaired liver function
pain in the upper right part of your abdomen
renal insufficiency (problem with kidney function)
pulmonary edema (fluid in the lungs)
severe headache
or visual changes

These lab abnormalities are known as HELLP syndrome. HELLP syndrome stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count. HELLP syndrome is one of the more severe forms of preeclampsia.

Symptoms of Gestational Hypertension and Preeclampsia

Some patients have no symptoms of high blood pressure. The only reason they know their blood pressure is high is because it’s being monitored at each prenatal exam. (This is why it’s so important to attend all your prenatal appointments!)

Some patients have these symptoms:

increased edema (swelling)
headaches
changes in their vision
pain in the upper right side of their abdomen (the location of the liver)
nausea
or vomiting

It’s important to call your doctor if you experience those symptoms.

Risk Factors of Preeclampsia and Gestational Hypertension

Right now, it’s not known why some women develop gestational hypertension or preeclampsia. However, some factors put women more at risk of developing these hypertensive disorders.

Risk factors in your personal and family history include:

if your mother or sister had preeclampsia
if you had preeclampsia before
if you’re a first time mom
if it has been more than 10 years since your previous pregnancy
or if a previous pregnancy had complications

Risk factors in your health before pregnancy include:

if you have chronic hypertension
if you have Type 1 or Type 2 diabetes
if you have renal (kidney) disease
if you have an autoimmune disease
or if you have obesity

Other risk factors include:

if you’re having twins, triplets, or more
if you are Black
or if you are older than 35

Prevention and Treatments for Preeclampsia and Gestational Hypertension

Because the causes of gestational hypertension and preeclampsia are not entirely understood, the best way to try to prevent this from happening is to maintain a healthy lifestyle before pregnancy. For those who are at higher risk of preeclampsia, it’s also recommended to take 81 mg of aspirin (baby aspirin) daily starting at 12-16 weeks gestation. This may help prevent or delay the development of preeclampsia.

Gestational hypertension and preeclampsia are ultimately treated with the delivery of the baby. If someone is diagnosed with this condition after 37 weeks, your OBGYN will recommend delivery at that time. If these conditions develop earlier in your pregnancy, then there is more clinical decision making and monitoring involved. Sometimes, this may lead to delivery earlier than 37 weeks or close monitoring (either outpatient or inpatient) until 37 weeks.

Your OBGYN may use an antihypertensive medication to treat blood pressure during and after delivery. In the case of severe gestational hypertension or severe preeclampsia, she may also use a medication called magnesium sulfate to prevent seizures.

There is no natural remedy to treat preeclampsia. There is insufficient evidence to prove vitamin C, vitamin E, vitamin D, fish oil, garlic supplementation, folic acid or sodium restriction reduces the risk of preeclampsia.

What to Do if You’re Diagnosed with Gestational Hypertension or Preeclampsia

Most often, our patients want to know what happens next, especially when their diagnoses appears suddenly at the end of pregnancy. If you have elevated blood pressure at a prenatal appointment, it’s common for more labs to be drawn. A plan will be made for management of the condition at that time — most often, that plan includes delivery (induced labor) if you are after 37 weeks pregnant, or additional fetal monitoring if you are less than 37 weeks.

Gestational hypertension and preeclampsia are the most common reasons a woman would be induced. These are some of the most common complications we see in the day-to-day practice at our OBGYN clinic.

Any diagnosis or complication during pregnancy can be worrisome. Hearing that you need to be induced can be scary — it probably wasn’t part of your original birth plan. Please know we are here to help you understand the diagnosis and what it means for you and your baby. At the same time, be reassured that this is a relatively common diagnosis that we see almost every day.

We always want you to feel heard and that you know what your options are. We will address any fears or concerns you have and answer your questions to the best of our ability. Our goal is that you have a healthy pregnancy and the best possible outcome for you and your baby!

December 29, 2020/by Dr. Sarah Yanke

Food During Pregnancy: Cravings, Aversions, Foods to Eat and What to Avoid

Pregnancy

When you’re pregnant, you are technically “eating for two.” But, that doesn’t mean you should double up on your calories! What it does mean is that what you eat and drink affects both you and your baby. While there isn’t a magical “pregnancy diet,” there are foods you should avoid and foods you should eat more of while you’re pregnant. That’s because the healthier you are, the healthier of a start you can provide for your baby.

As an added bonus, research suggests your food choices could even help your child not to be a picky eater. Prenatal and postnatal exposures to flavors through amniotic fluid and breast milk could have a possible influence on food acceptance.

When it comes to food during pregnancy, many women have questions about what to eat and what to avoid. And many experience cravings or aversions while pregnant.

The food guidelines below are general recommendations from a doctor and OBGYN, but some women will need to further modify their diets if they are at risk of developing gestational diabetes or if they become anemic during pregnancy.

The Best Pregnancy Diet is a Balanced Diet

There isn’t truly a one-size-fits-all “best pregnancy diet.” Instead, we recommend that our patients follow a balanced diet of protein, fruits, vegetables, healthy fats, and whole grains. An easy balanced diet to follow is the Mediterranean Diet. It includes many colorful vegetables and nutrient-dense grains, focuses on lean meats, and avoids processed foods and refined sugars.

The Mediterranean Diet has been shown to support healthy weight gain during pregnancy while helping ensure women get the necessary vitamins and macronutrients (protein, carbohydrates, and fats) they need to support their pregnancy.

Does that mean you don’t get to enjoy ice cream, chips, or cookies while you’re expecting? Not at all! Just limit the amount of sugary, processed foods you’re eating. Fill up on the good, healthy stuff first.

The Best Foods to Eat While Pregnant

Just like there isn’t a “best pregnancy diet,” there isn’t a list of the “best foods to eat while you’re pregnant.” The same colorful, nutritious foods you would eat before you become pregnant are the same kinds of foods you should eat when you are expecting.

For example:

Vegetables: carrots, sweet potatoes, pumpkin, spinach, greens, tomatoes, peppers, broccoli, squash
Fruits: melon, mangoes, plums, bananas, apricots, oranges, grapefruit, berries, nectarines, peaches, grapes
Dairy: yogurt, pasteurized milk, pasteurized cheese
Grains: cereal, bread, oatmeal, brown rice, pasta, quinoa
Proteins: beans and peas, nuts and seeds, lean meats, most cooked seafood/fish
Healthy fats: Avocado, olive oil, nuts

This is not a complete list of all the healthy foods you can eat — but these ones are pretty easy to find in any grocery store. As much as possible, choose fresh or frozen produce instead of canned.

In addition, every woman should also take a daily prenatal vitamin containing folic acid.

How to Manage Food Aversions and Cravings

During the first trimester is when women typically develop a food aversion. Their heightened sense of smell or taste and increased nausea could make certain foods, spices, soaps and perfumes off-putting and overpowering. Do the best you can with your nutrition during this time while eating foods that are tolerable to you. Your baby will get what he or she needs from your body, even if you aren’t keeping all your food down.

Once your first trimester nausea has passed, your food aversions tend to go away and can be replaced by food cravings. Typically, women crave something sweet or salty. Try to satisfy your craving with a healthy option, like actual fruit instead of a handful of Skittles. But if you need that occasional scoop of cookie dough ice cream or pickles with potato chips — go for it once in a while! (Just make sure that cookie dough is pasteurized!)

The cravings my patients most commonly report to me are sweets, pizza, carbohydrates, pickles, tacos, cereal, and mac and cheese. In other words, comfort foods!

It isn’t uncommon for people to offer anecdotes about what your food cravings or aversions might mean for your child or your child’s sex. But what you crave and what makes you sick to even think about during your first trimester is unique to you! There are no studies that prove that food cravings or aversions play a role in what your baby’s personality might be like or what sex your baby will be.

Is Spicy Food OK During Pregnancy?

You determine your level of spice during pregnancy. If you like spicy food, go for it! Pay attention to how you feel afterward, though. Sometimes, spicy foods can make pregnancy heartburn worse.

Foods and Drinks to Avoid During Pregnancy

We like to focus on the positive — what you can have rather than what you can’t. And there are so many wonderful foods you can eat! However, there are some foods that need to be avoided during pregnancy because they could put your baby at risk.

The foods you should avoid while you’re pregnant are those that could contain harmful bacteria, such as listeria, E. coli, salmonella, and toxoplasma, or parasites. Listeria could lead to a serious infection (listeriosis) which could result in the loss of your baby. This is why we urge you to avoid unpasteurized foods, milks and juices, and raw or undercooked fish, eggs, and meat.

Reduce your risk of listeria, salmonella, and E. coli poisoning by avoiding these foods:

Unpasteurized milk and foods made with unpasteurized milk. For example, avoid soft cheeses, including feta, queso blanco and fresco, Camembert, brie or blue-veined cheeses unless they’re labeled “made with pasteurized milk.”

Fresh-squeezed, unpasteurized juice from restaurants and farm stands. If juices haven’t been pasteurized, they aren’t protected against e coli or salmonella, which could grow in the beverages as they sit out.
Hot dogs and lunch meats/cold cuts. Even though these meats have been cooked and are kept refrigerated, it’s possible that they could harbor listeria, which is capable of growing at temperatures in your fridge. Heat these until they’re steaming hot before serving, or order the toasted version of your favorite sandwich at the deli.
Raw eggs. Cookie dough, some made-from-scratch salad dressings and mayonnaise, homemade desserts like mousse, meringue, and egg nog all use raw eggs. Choose pasteurized versions of these treats instead. Skip poached and soft-boiled eggs during pregnancy as well.
Raw and undercooked seafood. Do not eat sushi made with raw fish. Cooked sushi is fine.
Raw and undercooked meat. Cut down on your chances of ingesting harmful bacteria and parasites by ordering your burgers with “no pink” and your steaks medium-well done.

Food poisoning is never fun. But when you’re pregnant, it can be especially dangerous because the harmful bacteria can be passed to your baby. You can prevent food poisoning by following food safety guidelines when you’re handling and cooking food:

Wash.

Rinse all raw produce thoroughly under running tap water before eating, cutting or cooking.

Clean.

Wash your hands, knives, countertops and cutting boards after handling and preparing uncooked foods.

Cook.

Cook beef, pork or poultry to a safe internal temperature verified by a food thermometer.

Chill.

Promptly refrigerate all perishable food.

Food Poisoning vs Pregnancy Nausea

If you think you have food poisoning, you should contact your doctor right away.

Food poisoning feels like sharp, sudden abdominal pain. You’ll likely suffer from diarrhea and a sudden onset of significant vomiting. You’ll also develop fevers and chills.

Pregnancy nausea is different than food poisoning. You may feel sick several times a day. The feeling lingers and is more nausea, less vomiting. Typically, the feeling gets better if you eat a little bit, like a simple cracker or bread.

It’s important to call your doctor with any concerns, especially if you’ve been having a hard time keeping any foods down.

Avoid drinking alcohol during pregnancy

Because there is no known amount of alcohol that is proven to be safe during pregnancy, it is best to avoid alcohol entirely. Prenatal exposure to alcohol can interfere with the healthy development of your baby. Depending on the amount, timing, and pattern of use, alcohol consumption during pregnancy can lead to fetal alcohol syndrome or other developmental disorders.

Cut back on the caffeine

Many women ask me if they have to give up their morning cup of coffee or tea when they’re pregnant. The good news is, you don’t need to give it up completely! Stick to just one or two cups a day (about 200-300 mg). Consuming greater amounts of caffeine when you’re pregnant could cause growth restriction or miscarriage.

Safe & Unsafe Fish During Pregnancy

The FDA recommends that pregnant women eat 2-3 servings (8-12 ounces) of fish each week. Fish provides protein, iron, zinc, and omega-3 fatty acids like DHA. All of these are necessary for your baby’s development.

We’ve already talked about making sure to only eat cooked fish. (Save those sushi dates for after your little one is born.) But it’s important to consider the types of fish you eat and where it comes from because of the amount of mercury, PFOS, or other pollutants that the fish could contain. Some types of fish have higher levels of mercury than others. Mercury is a metal that has been linked to birth defects.

Fish that will provide you with lots of omega-3 fatty acids:

Salmon
Anchovies
Herring
Sardines
Freshwater trout
Pacific mackerel

Other safe fish that don’t have much mercury:

Shrimp
Pollock
Tilapia
Cod
Catfish
Canned light tuna — Limit white (albacore) tuna to only 6 oz a week.

Do not eat these fish that are high in mercury:

Bigeye tuna
King mackerel
Marlin
Orange roughy
Shark
Swordfish
Tilefish

You also should check advisories about fish caught in local waters. If you’re in Wisconsin, you can learn about which pollutants might be in your locally caught fish on the DNR website here: https://dnr.wi.gov/FCSExternalAdvQry/FishAdvisorySrch.aspx

We’re Here to Help You!

Pregnancy is a wonderful time to begin or continue healthy eating habits. Not only will you feel better, but you’ll be healthier, your baby will be healthier, and you’ll find it easier to manage your pregnancy weight gain.

If you need help creating a healthy menu that you and your family enjoy following, let us know! We can refer you to a nutritionist. And if you have other complications, like gestational diabetes or anemia, we will connect you with someone who specializes in managing these issues during pregnancy.

Dr. Sarah Yanke, OBGYN, has been providing healthcare to women in Madison since 2010, specializing in high and low-risk obstetrics, contraception, management of abnormal uterine bleeding, and minimally invasive surgical techniques. She is a Board Certified Fellow of the American College of Obstetrics and Gynecology.

August 27, 2020/by Dr. Sarah Yanke

Pregnancy Weight Gain: What is Average and What is Recommended by OBGYNs?

Family Planning, Pregnancy

Your weight gain during pregnancy is important not only for your baby’s growth and development, but also for your health during and after your pregnancy.

It’s important to have a healthy perspective on pregnancy weight gain even though it can be a very sensitive, personal topic. While some women enjoy the “freedom of eating for two” as soon as the first trimester’s morning sickness goes away, others get upset when they see the scale creep past numbers they’ve never seen before. Most women are concerned about getting back to their pre-baby weight.

But a healthier perspective falls somewhere in the middle.

The weight you gain while pregnant supports your baby’s growth and development while you are pregnant and supports breastfeeding your newborn. However, too much weight gain can lead to problems like diabetes, heart disease, pre-term delivery, or even miscarriage and still birth. And even your pre-pregnancy weight affects your child’s weight and health as they grow older.

Paying attention to your pregnancy weight gain and returning to your pre-baby weight is not about meeting body image or societal standards—rather, it’s about achieving optimal health for you and your baby. At Madison Women’s Health, we care about your health and your baby’s health. That’s why we want to help you understand the recommended weight gain for pregnancy and the risk factors for carrying an unhealthy amount of weight while you’re pregnant.

So what is the “right” amount of weight you should gain while pregnant?

The National Academy of Medicine created these guidelines to help women estimate how much weight they should gain while pregnant, based on her BMI (body mass index) before pregnancy.

Average Weight Gain During Pregnancy:

Underweight: Gain 28-40 pounds
Healthy weight: Gain 25-35 pounds
Overweight: Gain 15-25 pounds
Obesity: Gain 10-20 pounds

If you have twins, you’ll gain a little more weight:

Healthy weight: Gain 37-54 pounds
Overweight: Gain 31-50 pounds
Obesity: Gain 25-42 pounds

Gaining Weight at the Right Rate

Your pregnancy weight gain will be gradual, with some jumps and plateaus. What matters the most is your overall weight gain. Most women don’t gain very much weight during their first trimester. But in the second and third trimesters, you can expect to gain 1/2 to 1 pound per week.

Your OBGYN will track your weight gain with you at your monthly check-ups and may recommend changes to your nutrition or activity levels. Experiencing major weight gains, like 15 pounds in 4 weeks, would not be considered healthy. Your doctor will make recommendations to help you slow your weight gain.

Source: https://nam.edu//www/wp-content/uploads/2019/12/Table-1.png

What Makes Up Your Pregnancy Weight

Based on a healthy pregnancy weight gain of about 25 pounds, this is where your pregnancy weight goes:

baby: 7-8 lbs
amniotic fluid: 2 lbs
placenta: 1.5 lbs
increased blood volume: 3-4 lbs
increased fluid volume: 2-3 lbs
larger breasts and uterus: 3-5 lbs
increased fat stores to support nutrition during pregnancy and for breastfeeding afterward: 6-8 lbs

(Source: https://nam.edu/the-current-understanding-of-gestational-weight-gain-among-women-with-obesity-and-the-need-for-future-research/)

Risks of Gaining Too Much Weight While Pregnant

Your weight before and during pregnancy plays a large role in your health and your baby’s health. If you are overweight at the time of conception, or if you gain more than the recommended amount during pregnancy, you and your baby can be at risk of the following:

fetal anomalies,
preeclampsia,
heart disease,
gestational diabetes,
depression,
stopping breastfeeding early,
developing sleep apnea,
preterm delivery,
delivery requiring induction,
C-section,
miscarriage,
and still birth.

In addition to those risk factors, babies who are born to women who are obese are also at risk of:

higher percentage of body fat,
childhood obesity,
lifelong metabolic syndrome,
and asthma.

But there is good news! If women who are overweight or who have obesity lose even a small percentage of weight prior to conception, they can impact the health of their pregnancy. For example, if a woman weighing 300 pounds loses just 15 pounds, she would improve both her health and her baby’s health. A 5% weight loss is the perfect starting goal prior to pregnancy – and can reduce the risk of complications. Once that goal is reached, it’s good to reassess and set a new goal.

Risks of Gaining Too Little Weight While Pregnant

Some women struggle to gain weight during pregnancy. This is typically caused by hyperemesis, which is excessive nausea and vomiting in pregnancy. Eating disorders that lead to continued restrictive eating are also causes.

If a woman doesn’t gain enough weight, her baby is at risk because it isn’t getting the proper nutrients. Babies born to underweight women are at risk of:

being small for gestational age,
growth problems,
and failure to thrive.

How to Achieve Healthy Weight Gain While Pregnant

Instead of becoming anxious about weight gain or permissive about unhealthy eating habits, focus on staying active and eating a balanced diet.

Make an eating plan

Choose a healthy eating plan that you can continue. There isn’t one specific pregnancy diet to follow. Instead, your healthy pregnancy diet should consist of lean proteins, healthy fats, fruits and vegetables. (Whether my patients are pregnant or not, I usually recommend the Mediterranean diet—it meets all the nutrition requirements, isn’t very restrictive, and will give you many satisfying meal plan options.)

Eat nutritious food

Focus 95% of your diet on healthy, nutritious food. Then, the remaining 5% should be other choices you really enjoy. If ice cream is your thing, take time to savor it—it’s ok! For more information about food during pregnancy, read our article about food cravings, aversions, what to eat and what to avoid.

Add a Few Calories

Add about 300 calories per day to maintain a healthy weight while you’re pregnant. That’s like adding another slice of bread, a cup of cottage cheese, or a couple more ounces of meat at your meals. If you are overweight, you will not need to add as many calories. There is no need to “eat for two!”

Listen to your body

Pay attention to your hunger cues. Stop eating before you feel too full.

Stay Active

Stay moderately active every day. If you struggle with your weight or body image, your pregnancy is a great time to reset your focus on overall health and establish healthy eating and exercise habits. You’ll be making a positive step for your child and yourself.

Any patient at Madison Women’s Health who starts a pregnancy when overweight or obese is given the option of a nutrition consultation. When you work with a nutritionist, you will learn how to choose healthier options, how to create healthier habits, and even how you could change your dietary preferences.

Getting Back to Your Pre-Baby Weight

The majority of women gain a healthy amount of weight during pregnancy, and much of that weight is lost soon after delivery. But about 60% of the time, women still retain about 10 pounds of their pregnancy weight gain 12 months later. And 40% of women maintain 20 pounds of their weight gain even after their baby is one year old.

When should you lose that baby weight so it doesn’t become a permanent weight gain?

Weeks 1-6: Don’t worry about your pregnancy weight for your first six weeks with your new baby. Instead, focus on recovery, connecting with your baby, getting enough sleep, and establishing breastfeeding. Check with your OBGYN about resuming more activities at your postpartum visit!
Months 3-6: It’s okay to begin working toward a healthy weight at this point. This should be gradual and your diet should continue to support breastfeeding.
Months 7-12: Add more activity to your daily routine. Just as you gained your pregnancy weight gradually, you will lose it gradually. Give yourself time to lose the weight in a healthy way.

If you haven’t returned to your pre-baby weight by the time your baby is one year old, then consider making more changes to your nutrition and exercise. You can also request a nutrition consult to learn how to get all the nutrients your body needs without overdoing it on calories.

At Madison Women’s Health, we want to support your health before, during, and after your pregnancy. We’re here to help you learn how to make the best decisions so you can be well.

Dr. Kate Sample has been providing healthcare to women in Madison since 2002 and is a founding member of Madison Women’s Health, specializing in high and low risk obstetrics; minimally invasive surgical techniques; pelvic floor disorders; and exercise, weight loss and obesity. She is a Diplomate of the American Board of Obesity Medicine and is trained in Cognitive Behavioral Therapy for weight loss through The Beck Institute.

May 26, 2020/by Kate Sample