• Medications During Pregnancy
• Nausea and Vomiting
• The First Trimester (1-13 Weeks)
• The Second Trimester (13-28 Weeks)
• The Third Trimester (28 Weeks to Delivery)

It is advised that you do not take medicines until you are 13 weeks pregnant, except prescribed Vitamins, Tums, Calcium, Iron or Surfac. If you are on any daily prescription medicines please discuss them with Dr. Rosenfeld.

During your pregnancy you should not take aspirin or aspirin products, unless prescribed by Dr. Rosenfeld. You may take Tylenol or Extra Strength Tylenol.

Avoid during entire pregnancy:

• Aspirin
• Aleve
• Nuprin
• Advil
• Motrin

If you take routine medicine routinely, please notify the office Dr. Rosenfeld will review it on an individual basis.

Vitamins are prescribed to supplement a balanced diet. Iron supplements are prescribed to be taken twice a day. You may use any over the counter Iron that is 50-65 meq. of Iron. Slow Fe has a stool softener in it. Surfac, Colace, or Metamucil will help mild constipation. Notify us if constipation persists for more than 2 days. Additional fluids and exercise will also help. If your prenatal vitamin makes you nauseated, stop taking them until you are finished with your first trimester.The nausea typically goes away at that time.

• small frequent meals
• complex carbohydrates before rising such as crackers, toast, or cereal
• have high protein snacks such as yogurt or nuts
• take fluids between meals rather than with meals
• sip carbonated beverages such as ginger ale or sprite in small amounts
• sip clear liquids such as: clear soups or broth, diluted Gatorade, jello water, ginger or any
• herbal tea with sugar, and popsicles

Helpful medications:

• Vitamin B6 50mg - one by mouth three or four times a day
• Emetrol 15 ml - on arising, can repeat every three hours

Avoid:

• Coffee
• Alcohol
• Iron and vitamins
• Fried foods
• High fat foods
• Spicy foods
• Dairy products

Additional rest periods during the day are encouraged.

*Call Dr. Rosenfeld's office if you are unable to retain small amounts of liquids for 12 hours.

Eat moderately! An additional apple a day - only. For a healthy pregnancy it is recommended that you gain no more than 35 pounds total. 3-4 pounds the first 12 weeks and 3-4 pounds the second 12 weeks, and 1/2 pound per week the last 12 weeks. pregnancy. You are encouraged to take the Calcium every day. Tums or Calcium supplements have been shown to lower and prevent BP problems in 5 to 10 regular Tums or 4 Tums 500.

Please tell the nurse if you have a house cat with a litter box. If you do it is recommended that you not change the litter box while you are pregnant. Do not dig in the garden during your pregnancy.

When pregnant :

• Do not douche
• Do not drink alcohol
• Do not smoke
• Do not use drugs

What are the normal body changes that I feel while pregnant?
Your breasts will get larger and firmer. The areolae or dark areas around your nipples will get darker and may develop bumps in them. Veins in the breast may become more noticeable. At the 4th or 5th month your nipples may start giving off a clear or cloudy liquid.

You may have to urinate (empty your bladder or pass water) more often. However, this may lessen during the middle months of pregnancy and then become more frequent toward the end of pregnancy.

You may feel sick to your stomach during the first half of your pregnancy. Sometimes this is worse in the morning. Also, you may feel heartburn (a burning sensation in your chest). These discomforts can be helped by eating smaller meals and eating more often. For example, rather than eating three regular meals a day, try six small meals each day. Also try to snack on plain crackers (without butter) especially early in the morning before getting out of bed. Try getting more rest and drinking very hot or very cold liquids. For heartburn, try not to lie down for at least one hour after eating. Your moods may change. It is not unusual for a pregnant woman to feel happy one minute then sad soon after without an apparent reason.

You may get tired more easily.

You may notice pulling pains in your lower belly and hip areas. These are usually caused by the growth of your uterus.

Your belly will get larger as your baby grows inside.

You may notice skin changes such as stretch marks or striae (pinkish lines on your breasts or belly) later in the pregnancy and some brown blotches on your face. Creams, lotions or oils do not prevent these changes. However, after pregnancy the marks tend to fade and are less noticeable. You may get constipated and have to strain to have a bowel movement. Hemorrhoids (large blood vessels near the opening in your rectum) may develop. Constipation is best prevented or relieved by including more fiber in your diet. Foods such as fresh fruits, fresh vegetables and bran cereal are often helpful. Do not take laxatives unless this is first discussed with your physician. Surface is stool softener that is fine to take during pregnancy.

You may experience changes in your legs such as cramps and possibly develop enlarged blood vessels (varicose veins).

You may get acne and body hair increase. These are usually normal results of changes in the body's hormones during pregnancy.

What should I do if any of these changes happen?
If they are bothering or worrying you, don't hesitate to let us know at your next visit. If you need it taken care of sooner, call the office.

Recently, there has been an increased interest on the part of fathers in the birth experience. There has also been a change in our society's attitude and now men are encouraged in their efforts to experience the pregnancy and childbirth.

The pregnant woman experiences the physical changes taking place and is constantly reminded of impending parenthood. Often the man feels like an outsider and has difficulty relating to his changing role.

The father needs to understand what is happening to the mother of his child, what effect this pregnancy will have on his relationship with her, and what the new baby will mean to both of them. Many men begin to worry about finances. There are the costs for the prenatal care and delivery at the hospital. He wonders if his salary is sufficient or will they also need hers.

Sexual concerns often surface. The father may fear that sexual intercourse will somehow harm the developing child. Conflicting feelings regarding the pregnancy, physical difficulties, and a constant concern over how all this will effect their relationship contributes to much frustration. With others, there is a "fear of abandonment", that the child's birth will change his relationship with the mother and that perhaps she will no longer love him.

It is very important that both parents openly discuss their feelings. They must come face to face with what is happening and how it is affecting them so they may make changes accordingly. Men who are well informed and attend childbirth classes to help with the birth of their child, often express their pride in their being there to "give birth". They often have tremendous feelings of importance. These men seem to be able to more readily accept the role of fathering and quickly become actively involved in all aspects of their child's care.

When the father views pregnancy as a "growing" experience, he has the opportunity to gain a deep understanding of himself and the mother of his child. This can help make this period in their lives quite satisfying which may help smoothly pave the road into parenthood.

The arrival of a new baby is often the first real "crisis" in the life of a young child. There is no "right" time to tell the other children about another child coming. It all depends upon their ages, how long they may need to adjust to the news, and how comfortable you are discussing it with them at that time. It is important to tell them before you go to the hospital and before the baby is born.

Each child will react in his own way depending upon how he views this "new addition" to the family. Children may feel threatened and react with behavior unlearned. They return to soiling their clothes, acting helpless, speaking baby talk, or acting hostile.

It is best to help them view the situation positively. Encourage them to talk about some of the changes that may occur in the household with the arrival of the new baby. Encourage conversation from your children about their feelings. Allowing your children to help prepare for the new baby is often helpful. Perhaps taking them along on a shopping trip for baby items will help with their understanding and good feelings about the situation. Allow them to help around the house in new and different ways. They will usually appreciate the independence and enjoy their new feeling of importance.

After the baby comes, be sure to set aside time especially for your older children, so they won't feel neglected. Young children need constant reassurance that they are loved.

Several hospitals now allow young children to visit the new baby soon after birth. The existence of "sibling visitation" programs may be a consideration in deciding which medical facility you might like to utilize when your baby is born. Many parents feel that involving the other children early with a new baby promotes family closeness and helps to avoid other possible problems with insecurity, jealousy and rivalry.

You may want to think about "what is right" for your family and what is available in your community for providing you with the type of birth experience you desire. Please feel free to discuss with your doctor any questions or concerns you may have regarding the adjustments of your other children to your new baby.

• Bleeding from the vagina
• Bad pains that do not quickly go away
• Chills and fever
• Vomiting that doesn't get better and if you are unable to hold down fluids
• Burning or any trouble passing urine

What are the dangers of cigarettes, alcohol, caffeine and drugs?
These things can damage your unborn baby. If you already smoke cigarettes or drink any alcohol, you will be given more information. It is best not to smoke or drink alcoholic beverages while you are pregnant.

Some new information suggests caffeine in coffee, tea, many cola's and other soft drinks may be a cause of miscarriage (loss of babies early in pregnancy) or harm the growth of the baby. It is best to try to avoid or limit caffeine-containing drinks while you are pregnant. Discuss the amount with your doctor.

It is wise to check with your doctor about the safety of any medication before taking it. But, if you are taking a medication necessary to your health, do not stop the medication without discussing it with your doctor. As for drug store medicines you can buy without a prescription, please discuss these with us before taking them.

Is it true that cats may carry a disease that could affect my baby while I am pregnant?
Cats may carry a disease that is called Toxoplasmosis. This problem is rare but important, as it is rather easy to prevent. Even though it is rare, it has been known to cause very serious problems in newborn babies including mental retardation, growth failure, blindness and deafness.

To prevent it, avoid changing or cleaning the cats litter box as the disease is usually spread to humans by cat droppings. Ask someone else to do this for you.

Raw or poorly cooked meat (especially beef) is another cause of this disease. Cook all meat until it is well done and avoid eating raw beef in any form, including raw hamburger meat while you are pregnant. It is also important to wash your hands after handling raw meat.

Other ways of preventing this problem are to wash fruits and vegetables before eating them and wearing gloves while gardening. Let your doctor know if you have eaten raw meat or handled cat droppings (litter box). Your doctor will decide whether or not this is important.

Should I use seat belts during pregnancy?
Yes! Your doctor strongly recommends you use them for your baby's safety, as well as your own.

Why are seat belts so strongly recommended during pregnancy? I have heard that they can be dangerous?
Studies of pregnant women in car accidents have shown that you and your baby are much less likely to have injuries if you are wearing a seat belt.

What kind of seat belts are recommended?
The best is the combination of a lap plus a shoulder belt. If no shoulder belt is available, a lap belt, worn correctly, is better than no belt at all.

What is the correct way to wear a seat belt while I am pregnant?
The lap belt should be worn low around the hip bones and be kept as tight as is comfortable. The shoulder belt should be kept above the high point of the abdomen (belly), but low enough to avoid having it cross over your neck. Be sure to use the head rest to support your neck. It is important to keep good posture while traveling.

If I am in an accident, what should I do?
In anything more than a simple fender-bender, you should get checked by your doctor as soon as possible. This is true even if you are not hurting as your baby could be affected. Your doctor may decide to do some simple tests to be sure your baby is doing well. If any vaginal bleeding or contractions occur, call your doctor immediately.

Are you saying I should buckle up whenever I get into a car?
Yes. Most accidents happen close to home so please don't save your best safety measures for long trips. Buckle yourself and your baby up every time you travel, even on the way home from the hospital. By not using your seat belt, you are taking the risk of hurting yourself or your baby. By buckling up you are doing the very best you can to avoid injury.

Why is my doctor concerned about the kind of exercise I do during my pregnancy?
Exercise makes you feel good and look good. Your physician wants to be sure you set up a safe exercise program. It is important that you know of any risks that could affect both you and your growing baby. If you provide your doctor with accurate information about the kind of exercise, frequency, and intensity you are used to or would like, a satisfactory exercise program can be set up to carry you through pregnancy.

What actually happens to my body during pregnancy that changes the way exercise affects both the baby and me?
Your ligaments become easier to stretch. That is why you may feel a little wobbly just walking. It is easier to sprain something, like an ankle, or to pull a muscle. As your baby grows, your weight distribution is different, your center of gravity changes which may make it easier for you to lose your balance. Your ability to catch your breath (get enough oxygen), is decreased during exercise. Because of these changes in your breathing and circulation systems you may occasionally experience dizziness or weakness. Now, when you exercise, you will notice you don't have the aerobic capacity you did before. With some adjustments you can continue to enjoy exercising and return slowly, to your desired program after your baby is born and your body is ready.

Are there times when I should not exercise all?
Yes! Your doctor may tell you to avoid exercise if you :

1. Have problems with early labor
2. Are excessively overweight or underweight.
3. Have blood pressure, heart, lung, or thyroid problems.
4. Have experienced vaginal bleeding during the pregnancy.
5. Are having problems with your baby's growth.
6. Are severely anemic.
7. Have leaking from your bag of water.
8. Have experienced #1, 3, 5, or 7 on the above list during a different pregnancy.

How about some guidelines for safe exercising that I can use during my pregnancy?

1. Drink enough before exercising, even in the winter.
2. Warm up slowly, at least 5 minutes before starting.
3. Stretch, but not to your limit so as not to injure your ligaments. Remember, they are looser now.
4. Avoid exercises with jerky or bouncing motions.
5. Use a stable floor. Avoid loose rugs that may slide.
6. Exercise regularly (every other day), not just once in a while.
7. No competitive exercises.
8. Do not exercise during hot humid weather or if you have a fever.
9. Your body temperature should not go above 38 degree C. (101 degrees F.). Avoid the use of hot tubs and saunas.
10. After the 4th month, do not exercise lying down on your back.
11. No weight lifting or anything where you hold your breath and strain.
12. During pregnancy caloric intake is to be over and above your usual need. Adjust it to your level of activity.
13. Avoid strenuous exercise at altitude.

How about things other pregnant women have found helpful?
Choose exercise shoes that feel secure and help your balance. Support hose can help your legs feel better during and after exercise. Watch how you put your feet down, especially if you are planning to walk and there is ice outside. If you need to increase your bra size you might go right into a nursing bra if you plan to nurse, or you may need an athletic bra for more support during your workouts. Put your feet up with pride, this allows any swelling of your ankles to go down. Your body is working hard helping your baby grow, 24 hours a day!

I've always wanted to take up a new sport, like tennis, I don't even look pregnant yet, is this a good idea?
It is NOT a good idea to take up a new sport while pregnant. But you can begin something that is on the "good for pregnancy" list, that will give you a head start in beginning tennis after your baby is born. Some good sports are, Yoga (without breath holding), swimming, pregnancy classes, stationary bicycling (gently), easy stretching (but not to your limit), and don't forget about daily walking in fresh air!

Truthfully, I am worried about gaining weight during this pregnancy, I like to exercise,can overdoing it cause any problems?
There are several things to remember. Being pregnant is not being fat. Exercise does release a chemical into the body called "endorphins" which gives you that feeling of well being. Even with adjustments, your body will have that feeling of "well being". Lastly, gaining 20 to 30 lbs. is healthy. Your baby's size and health depends on this increased nutrition (but we don't mean candy, cola, and chips). You must normally INCREASE calories during exercise for your pregnancy and INCREASE calories and fluid over and above that for exercise. If you do not have enough calories, your body can go into a chemical state called ketosis which can cause developmental problems for your baby. If you don't get enough calories regularly during pregnancy your baby may not grow as well.

If I stopped exercising regularly a few months ago, and want to start back up, what should I do?
Begin very slowly with low intensity. Remember, even if you are in great shape, you will not be able to do what you did. Pregnancy is a special time and requires not lower goals, but special ones to help you and your growing child feel happy and stay well.

What are the rewards of a sensible program?
Your baby will be growing safely. You will feel and look good. After the birth of the baby it will make it easier to return to the exercise program of your choice.

When should I stop exercising immediately and call my doctor?
If any of the following happen to you, stop what you are doing and call your doctor immediately:

1. Regular contractions.
2. Vaginal bleeding or leaking of fluid.
3. Blacking out of fainting.
4. Shortness of breath.
5. Pain.
6. Unusually fast heart beating that doesn't seem to pass.
7. Anything else that concerns you.

Is it safe for me to use a sauna, spa, or hot tub?
During the first 12 weeks of pregnancy, the high heat to the body from these activities may have as harmful effect on your baby. There is a very small possibility that the brain and spine areas of your baby may not form the right way.

Avoid these activities until after the first 12 weeks of pregnancy. If you have already been in a hot area such as a sauna or hot tub during these first 12 weeks of pregnancy, let your doctor and staff know now. You will be offered a blood test for alpha-fetoprotein around the fourth month of pregnancy that can help find out if your baby might have the type of problem mentioned above. More information on this test will be given to you.

How much weight should I gain during pregnancy?
The best amount to gain depends on how much you weighed right before you became pregnant. The doctor or staff will let you know if this weight is considered overweight, normal or underweight. If you are overweight the best amount to gain is 15 or so pounds. If you are normal the best amount to gain is between 25 and 40 pounds. If you were underweight the best amount to gain is between 28 and 40 pounds.

Important: do not try to lose weight while you're pregnant.

What problems can be caused by not gaining enough weight?
There is a slightly higher chance of your baby being smaller than normal. This might lead to being delivered early. Small babies, whether born premature or at the due date, can still have serious problems after birth. To help lower the chances of having a small baby, try to gain the amount of weight recommended by your doctor or nurse.

What problems can be caused by gaining too much weight?
The extra pounds will put more strain on your back and legs. Also being overweight can lead to serious medical problems for you such as high blood pressure and diabetes. The extra weight may stay with you after you deliver your baby. Breast feeding may help you lose the extra pounds, but this is not true for everyone. Even if you are overweight, do not try to lose weight while you are pregnant.

What is a good diet to follow during my pregnancy?
Your body needs a good balance of foods to keep you healthy and build a healthy baby. Try to eat regularly and not skip meals.

Important parts of your daily diet should include :

• Protein at each meal from meat, chicken, fish, eggs, beans, milk, or cheese.
• Calcium, Vitamins A and D from a few glasses of milk each day (low fat is best).
• B Vitamins from whole wheat cereals, breads or noodles.
• Vitamin C from the fruit or juice of oranges or grapefruits.

Other healthy additions to your diet are fresh fruits and vegetables. Butter, margarine or vegetable oils should only be used in moderation (these are empty calories). It is best to avoid "junk food" (candy, sodas, desserts) as they are very high in calories and filling but have few nutrients or vitamins.

To keep from becoming constipated, it might be helpful to have high fiber foods like bran, bran cereals, breads, as well as fresh fruits and vegetables including salads.


What about taking vitamins and iron pills?
If you eat a balanced diet, the only extra things you may need are some iron and multi-vitamins with folic acid. Later in your pregnancy we may suggest you take an iron pill up to 3 times each day. Taking additional vitamins and supplements available over the counter may be harmful to your developing baby. Please check with us before taking other vitamins or medications.