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During Pregnancy - Taking care of you and your baby

Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

Is prenatal care important?

Yes! You can help make sure that you and your baby will be healthy by following some simple guidelines and checking in throughout your pregnancy with your doctor.

What will happen during prenatal visits?

Your doctor will start by talking to you about your medical history and how you've been feeling. You'll be weighed and have your blood pressure taken on every visit.

On your first visit, you'll also probably have a pelvic exam to check the size and shape of your uterus (womb), and if needed a Pap smear to check for signs of cancer of the cervix (the opening of the uterus) and cultures to check for infections. Urine and blood tests may be done on the first visit and again later. Urine tests are done to check for bacteria in your urine, high sugar levels and high protein levels (which can be a sign of can put you at risk for preeclampsia, a type of high blood pressure in pregnancy). Blood tests are done to check for low iron levels (anemia), certain infections including HIV and your blood type. You may be offered screening tests called IPS (Integrated Prenatal Screening) or MSS (Maternal Serum Screen). This is to assess the risk that your baby may have for neural tube defect, Trisomy 18 or Down Syndrome. If you will be over the age of 35 at the time of delivery of your baby, have some specific risk factors, or have a positive MSS screen, you may also be offered an amniocentesis or CVS.

Often an ultrasound may be done around 18 weeks to help figure out when your baby is due or to check on your baby's health and the position of the placenta in your uterus. Sometimes ultrasounds are used to follow the baby's growth. Other tests may be needed if you or your baby are at risk for any problems.

Warnings
"Don't do this, don't do that." You've probably heard every old wives' tales but here are some warnings worth heeding:

Don't smoke. Smoking raises your risk for miscarriage, premature birth, low birth weight and many other problems.
Don't use drugs. Cocaine, heroine, and marijuana increase your risk of miscarriage, premature birth and birth defects and your baby could be born addicted to the drug you've been taking.
Don't drink alcohol. Drinking alcohol during pregnancy is the major cause of birth defects that could be prevented, including mental slowness.
Don't clean your cat's litter box, or eat raw or undercooked red meat. You could get toxoplasmosis, a disease that can cause birth defects.
Don't sit in the sauna or hot tub. This raises your risk of miscarriage and birth defects by raising your body temperature.
Don't douche which can cause risks while you're pregnant.
Avoid overuse of Vitamin A and D:
Vitamin A � daily limit of 3000 IU or less
Vitamin D � daily limit of 400 IU or less

How much weight should I gain during pregnancy?

About 11 to 14 kilograms (25 to 30 pounds). If you don't weigh enough when you get pregnant, you may need to gain more. If you're very heavy when you get pregnant, you may need to gain only 7 to 11 kilograms (15 to 25 pounds).

Pregnancy isn't the time to diet! It's best to gain about two to three pounds during the first 12 weeks and about a pound a week after that. Talk to your doctor about how much weight to gain.

What should I eat?

Pregnancy isn't the time to diet. What you eat feeds your baby, so choose healthy foods and skip the junk. You need about 300 extra calories each day. Be sure to include the following in your daily diet:

Three to four servings of milk or dairy products
Five to ten servings of vegetables and fruit
Five to twelve servings of breads, cereals, rice or pasta
Two to three servings of meat, fish, poultry, dried beans, eggs or nuts
At least six to eight glasses of liquids.
Limit your daily caffeine intake to 2 cups of coffee or 6 glasses of soda

You can get all the nutrients you need through what you eat but your doctor may suggest taking prenatal mineral and vitamin pills that include iron to help protect you against anemia, calcium to help keep your bones strong and folic acid, especially early in pregnancy (even before you get pregnant), to help prevent your baby from having neural tube defects (serious problems with the brain and spinal cord).

There are programs to help women access financial help during pregnancy to ensure a good diet. Talk to your family doctor about what's available in your area.

Is it okay to take medicine?

Check with your doctor before taking any medicine, including ASA (an example is aspirin). Even medicine you can buy without a prescription can cause birth defects, especially during the first three months of pregnancy. Many drugs can be taken safely when you are pregnant but it is always wise to check with your doctor or pharmacist first. For specific concerns you may want to contact MotherRisk at www.motherisk.org .

Acetaminophen and many other medicines are safe. If you take prescription medications talk to your doctor before stopping them. It's just to keep medical problems well controlled and you and your doctor can figure out what to keep taking and what can be stopped.

How long can I keep working?

This depends on if you have any problems with your pregnancy, what kind of work you do and if you're exposed to anything at work that could harm your baby. For instance, lifting heavy objects or standing for long periods can be hard on you. Radiation, lead and other heavy metals, such as copper and mercury, could be damaging. Working in front of a computer screen is thought to be safe for your baby.

What about exercise?

Unless you have problems in your pregnancy, you can mostly do the exercise you did before you got pregnant. You may feel better if you're active. Some women say staying fit during pregnancy makes labor and delivery easier. Walking and swimming are great choices. If you didn't exercise before pregnancy, start slowly. Avoid anything that could injure you or your baby. Avoid getting too hot and drink fluids to replace your body's losses from sweating.

Is it okay to have sex?

Yes, unless your doctor believes you're at risk for problems. Don't be surprised if you're less - or more - interested in sex. As you get larger, you may find you need to try different positions, such as lying on your side or being on top. If you have oral sex, tell your partner not to blow air into your vagina. This could force air inside you.

What can I do to feel better?

Here are the most common discomforts of pregnancy and some tips for handling them:

Morning sickness. Nausea or vomiting may strike anytime during the day (or night). Try eating small, frequent meals, and avoid greasy foods. Keep crackers by your bed to eat before getting up. Other tips include eating cold foods or to avoid smelling foods as they are cooked. Talk to your doctor if morning sickness lasts past the first three months of pregnancy or causes you to lose weight. On the positive side, women with lots of morning sickness rarely miscarry.

Tiredness. Sometimes being tired in pregnancy is due to anemia, so tell your doctor. Get enough rest. Take a daytime nap if possible.

Leg cramps. Gently stretch the calf of your leg by pointing your toes upward, toward your knee.

Constipation. Drink plenty of fluids. Eat foods with lots of fibre, such as prunes and bran cereal. Don't take laxatives without talking to your doctor first. Stool softeners are safe. Use only fibre laxatives such as Metamucil and Prodiem.

Hemorrhoids. Don't strain during bowel movements. Try to avoid becoming constipated. Take several warm soaks (sitz baths) a day and use hemorrhoid ointment if needed.

Urinating more. You may need to void ("pee") more often as your baby grows because he or she will put pressure on your bladder. This can't be helped and is normal. If it burns when you void, see your doctor.

Varicose veins. Avoid clothing that fits tightly around your legs or waist. Rest and put your feet up as much as you can. Move around if you must stand for long periods. Ask your doctor about support hose.

Moodiness. Your hormones are on a roller coaster ride for nine months. Plus, your life is going through a big change. Don't be too hard on yourself. If you feel very sad or think about suicide, talk to your doctor.

Skin changes. Stretch marks appear as red lines on your skin. Lotion can help keep your skin moist and may help reduce the itchiness of dry skin. Stretch marks really can't be prevented but they often fade after giving birth. Other skin changes may include darkening of the skin on your face and around your nipples, and a dark line below your belly button. Staying out of the sun or using a sunscreen may help lessen these marks. They'll probably fade after you have your baby.

Heartburn. Eat small meals often. Avoid spicy or greasy foods. Don't lie down right after eating. Ask your doctor about taking other treatments.

Yeast infections. The amount of discharge from the vagina increases during pregnancy. But yeast infections, which can also cause discharge and itching, are more common during pregnancy so it's a good idea to talk with your doctor about any discharge that doesn't get better after treatment.

Other infections: Your doctor may offer to test you for germs called group B streptococcus (GBS) when you are about 36 weeks. A sample is taken from your vagina and rectal area for the test. Babies can catch GBS from the birth canal and get very sick although it is quite rare. If you test positive, you will be given antibiotics during labor.

If you or your partner has genital herpes, talk to your doctor. The risk of passing herpes to your baby is small. If you do not have herpes but your partner does, do not have sex when your partner has a herpes sore. Use a condom during sex while you are pregnant. Talk to your partner about taking medicine for herpes. Abstain from oral sex if your partner has cold sores.

Bleeding gums. Brush and floss regularly, and see your dentist for cleanings. Don't put off dental visits because you're pregnant and be sure to tell your dentist you're pregnant.

Stuffy nose. This is related to changes in the levels of the female hormone estrogen. You may also have nosebleeds. Avoid decongestants.

Edema (retaining fluid).Rest with your legs up. Lie on your left side while sleeping so blood flows from your legs back to your heart better. Don't use diuretics (water pills).

See your doctor if you have

Blood or fluid coming from your vagina
Sudden or extreme swelling of your face or fingers
Headaches that are severe or won't go away
Nausea and vomiting that won't go away
Dizziness
Dim or blurry vision
Pain or cramps in your abdomen
Chills or fever
A decrease in frequency of your baby�s movements
Less urine or burning when you void
Any illness or infection that doesn't go away
If you are experiencing abuse
Anything that bothers you

Tracking my baby�s development
You may follow your baby�s development by using the Maternity Care Calendar approved by the CFPC. It is available for purchase at http://www.maternitycarecalendar.com/about_maternity.cfm

Revised 2007
The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor.

This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada:

The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages.

This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.