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Questions about your pregnancy? David Priver, M.D., FACOG, has all the answers.

Read what your fellow expectant and new parents are asking about below.

*At You & Your Family, we respect your right to privacy. Please feel free to submit only the information which you are comfortable sharing.

Common Pregnancy Questions & Answers

Q.

I had an irregular period last month, and about three or four days ago I took two pregnancy tests and they both had faint lines. For the last month I've had off and on nausea, irritability, weight gain and extreme fatigue. I know it could be something else, but it all seems right. Yesterday I started bleeding. At first it looked like old blood but then the color became brighter. I only had very mild cramps last night. I passed a blood clot about the size of a quarter and they're getting smaller. I had no PMS signs. I'm not sure if it is my period or what.

A.

It sounds to me like the only thing you can say for sure at this point is that if this is a period, it certainly isn't a normal one. It's a fundamental tenet of gynecology that when a woman has periods which she doesn't consider normal, she is pregnant until proven otherwise. Your doctor can resolve this situation by runningblood tests for the pregnancy hormone, HCG, possible is a serial fashion so as to evaluate the changes going on.

Q.

My mom wants to be in the room when I deliver, but my baby's daddy doesn't want her there and I don't know how to tell my mom in a right way that I want my baby's daddy there only.

A.

Although this is not really a medical issue, I have run across it a number of times during my practice. To me, it is a no-brainer. The father's preferences must be observed. If your mother is any sort of reasonable person she will understand. The issue of who should be present during a birth is very sensitive and should be discussed between the parents well in advance. Just tell her that the two of you have given the matter a lot of thought and have made a decision you are both comfortable with.

Q.

I had a pelvic exam today. The doctor said my cervix is open to fit the size of the tip of his finger and the baby's head has dropped. He said I had thinned about 70 percent, dilated one percent. After the exam I noticed a water discharge on the paper on the table, a normal size spot which means I had some kind of water discharge. What does all this mean?

A.

Most likely, it doesn't mean very much. These descriptions of the status of your cervix are quite routine for someone near or at term. They predict nothing. As to the "water discharge" this could be anything from the lubricant gel from your doctor's glove to cervical mucus, to amniotic fluid. The latter is quite important. If water continues to trickle out of you, it is imperative to determine whether or not your water has broken, as this has serious implications.

Q.

I went for my 20-week sonogram yesterday and my doctor told me that they were unable to confirm that the baby had four chambers in the heart. She said it was due to the position of the baby and I was fine with that until she asked if we would terminate the pregnancy if there was something wrong. This is my fourth baby and I have NEVER had them say they couldn't confirm proper heart development at 20 weeks. Baby is growing right on schedule and her heart rate was 154. Should I be concerned, or is this common?

A.

Fetal position does have a big impact on the ability to see small items like heart chambers. Another sonogram in a week or two should be able to resolve this fairly common issue.

Q.

I am 19 weeks' pregnant with my first baby and during a Pap smear my doctor said my cervix was irritated. It was also very painful during the exam. He also said I have a tipped uterus. Is this why it was so painful and what causes your cervix to be irritated?

A.

What your doctor likely meant was that your cervix is reddened. What this means is simply that the hormonal changes of pregnancy have caused the part of the cervix that is normally confined within the cervical canal, to grow out onto the visible part of the cervix, a process we call eversion. It is normal and harmless and would not cause pain. A tipped uterus is not unusual, but, in most cases, it should be starting to straighten out by now. Your doctor will want to be sure that happens in the next three to four weeks, as there are some rare but serious implications of an advancing pregnancy with the uterus "trapped" in that position.

Q.

I just found out I am pregnant with my first. I usually babysit two toddlers twice a week. My mother told me that being around them increases my risk of getting diseases that could affect my pregnancy. Is this true? I know many women have several toddlers when they get pregnant and it's usually not a problem, but my mother insists it is an unnecessary risk. What is your opinion?

A.

The risk would be extremely low, as the conditions which can adversely affect an early fetus are things that you almost certainly have had as a child yourself and, therefore, are immune from. That said, if you know for a fact that you've never had common childhood illnesses such as measles, mumps, chicken pox or German measles, then there is some risk involved and it would be best not to risk exposure until you're past the first trimester.

Q.

I am 32 weeks' pregnant and I have been feeling numb and hot all over my body. Just wondering what that could be and what I should do.

A.

This is a sign of hormonal change which is a common event in the third trimester. These changes cause fluctuations in blood flow to the skin, which causes these symptoms. It is not dangerous and does not need attention.

Q.

I am 39 weeks' pregnant and I have been losing big globs of my mucus plug over the past three days. Now I am having a bit of light pink spotting but it is not coming with the mucus. What could it be?

A.

This is what is called the "bloody show." It indicates that the cervix is starting to shorten, or efface. It usually means that labor will be starting in the next few days.

Q.

I am 25 weeks' pregnant and have been feeling strong fetal movement from what feels like near my cervix. I have been feeling FM for over ten weeks but never this low. Should I be worried?

A.

There is no reason to be worried. As your pregnancy progresses and the baby grows, you'll feel the kicking in different locations as the baby changes position.

Q.

I'm 16 weeks' pregnant and my three-year-old kicked me hard with the back of her heel below the belly button and I would just like to know if the baby is ok. Is there anything I could do, and what are the chances that the baby was kicked in the face?

A.

It is almost unheard of for this sort of event to cause any problems with the baby as it is extremely well protected by amniotic fluid. In the unlikely event that something dangerous has happened, it is essentially certain that your water would have broken or bleeding would have happened. If you're still worried about this (and it is, after all, a mother's job to worry about her children), you can have your doctor's office listen for the heartbeat.

Q.

I am 35 weeks' pregnant with my first child, and I am a half centimeter dilated. Does this mean my baby will come early? I know another expectant mother who is three weeks ahead of me and not dilated, but 50 percent effaced. What's the difference?

A.

Neither of these findings have any bearing whatever on when labor will start. There is no benefit to knowing the status of your cervix unless this information is needed in order to plan some intervention, such as trying to head off a premature birth or inducing labor for some good reason.

Q.

I got my period twice this month, and feel dizzy and lightheaded. Could I be pregnant?

A.

Irregular flow is more often due to hormonal imbalance than pregnancy. That imbalance can readily cause lightheadedness and dizziness, but these are not dangerous and normally correct themselves.

Q.

Is being diabetic and having a kidney infection a reason to delay a C-section at 39 weeks? Is it serious enough for immediate admission to the hospital?

A.

Kidney infections at any stage of pregnancy are dangerous and usually do require hospitalization. It would not be advisable to undergo a C-section until the infection is cleared, unless there is no other alternative.

Q.

I am 36 weeks' pregnant and had a nasty fall last night. I have been having bad cramping. Could being this far into my pregnancy put me into labor?

A.

Yes, it could, but this would not be a dangerous thing at this point in the pregnancy. If the fall created bruising of the uterine muscle, this could result in enough irritability to trigger labor. Most likely, what will happen is that the injury would not be enough to cause labor and the cramping will gradually diminish over the next few days.

Q.

I am 18 weeks' pregnant. I went for an ultrasound this week, and my doctor told me that my baby had dilated kidneys. The next appointment I have been given is 32 weeks. I am assuming that after this find the doctor would want to see me a little more often. I am worried about the baby's condition and I don't want to have amniocentesis due to chances of miscarriage. I would like to know if I need to worry both about my baby and the doctor not wanting to see me frequently. Thank you.

A.

I'm concerned as well. Prenatal appointments are never supposed to be less than every four weeks. In this situation, I'd want to get another ultrasound by 24 weeks at the latest. By the way, I don't know if anyone has advised you to have an amniocentesis, but if they do, you really needn't worry much about miscarriage. It's extremely rare following that procedure and a lot of important information can be gained by it.

Q.

This is my second pregnancy. I went to the ER at four weeks, three days due to brown spotting that turned red. Transvaginal US results show an elongated GS "moving slowly in utero" and comments in the report state "0 IUP seen." I have been told that they suspect an ectopic pregnancy and I should expect the worse. Could they be a little ahead of themselves given that the pregnancy is so young? My cervix remains closed and is normal and I have a small amount of spotting with occasional mild cramps.

A.

If they actually saw a "GS" (gestational sac) in the uterus, then ectopic pregnancy is most unlikely, almost a zero possibility. At four weeks, three days, no definitive signs of pregnancy are going to be seen on ultrasound. Serial quantitative HCG levels are helpful in a situation like this.

Q.

Is it safe if the umbilical cord is around my fetus's neck during the 34th week of pregnancy?

A.

This is a very common position for the cord and does not subject the fetus to any increased hazards prior to delivery, although it can become a problem in labor if it interferes with adequate blood flow to the baby. Monitoring will nearly always detect if that is becoming a problem.

Q.

I'm 34-and-a-half weeks' pregnant. Last night I woke up and vomited about seven times. The midwife said it was just "bugs" in my stomach. Now I'm not urinating much. Am I going to have any problems with the baby? When I was sick the first time, a bit of urine leaked. Did my water break or was it urine?

A.

It doesn't sound like your water broke as that is usually pretty dramatic, continuous, and hard to miss. On the other hand, you need to be sure that the repetitive vomiting hasn't caused you to become dehydrated, which happens easily during pregnancy. Be sure to report if this level of vomiting happens again.

Q.

I have had Implanon for two years. I had a blood test for pregnancy that came back negative. I have been feeling flutters in my belly, my belly seems to be getting bigger, my appetite has changed and I'm feeling nauseous. I was wondering if Implanon is giving me a false result. I have two other children, and feel like I'm pregnant again.

A.

Pregnancy tests are extremely reliable nowadays, so pregnancy is quite unlikely. The symptoms you are having could have a variety of explanations, including digestive or hormonal problems. Further evaluation in a couple of weeks is advisable if the symptoms don't resolve.

Q.

Will I get a positive pregnancy test if I am injecting HCG for weight loss?

A.

Yes, you will, as pregnancy tests measure HCG levels.

Q.

Does a weak positive mean that the baby was conceived within the last couple of weeks? If not, what does it mean?

A.

All it means is that the HCG hormone level is low, which can mean a very early pregnancy or a later one that is in the process of being lost. If the pregnancy is healthy, the test should turn strongly positive in five to seven days.

Q.

I'm 32 weeks' pregnant. I had a very sharp pain in my back that lasted for about one hour. I took a hot bath and it stopped for 30 minutes; then it started back up ten times worse than before. What's happening?

A.

Most of the time, sharp back pains in late pregnancy are caused by pressure upon and stretching of nerves coming from the lumbar area as a result of the dramatic changes in posture that are occurring. Generally, reduced activity will cause this to resolve, but if that doesn't happen, bring it to your doctor's attention.

Q.

I'm 36 weeks', four days' pregnant. Today my ob checked my cervix and it was closed. Since then I have been spotting. I am experiencing pain in my left side with a lot of pressure. What does this mean?

A.

What is happening is that the vaginal exam has caused a few small blood vessels in your cervix to break and also that there has been some release of hormones causing your uterus is to contract. At this early point, most likely both of these symptoms will stop within a day or two.

Q.

We are having sex every day but I cannot get pregnant. Is there a solution?

A.

It depends upon how long you've been trying to conceive. The traditional criterion is that infertility is not considered until a couple has been trying for a full year. Many fertility centers, however, will initiate testing sooner as more and more couples are delaying the starting of their families. You might wish to have an initial consultation before deciding to proceed with a detailed investigation.

Q.

This is my third pregnancy. I miscarried the first two times. I had IUI for all. I got a call today from my nurse who said that my results for my pregnancy test was 1 week positive but it may be weak. The number I was told was 14 at the moment and that the right number should be 50. Can you tell me what the numbers mean? I have to go back in two days to have another blood test to see what the number is. I took a home pregnancy test the same day and it says positive. In my past pregnancies I was never told about numbers to have a positive result. I am seeing a new doctor for this IUI. In my last pregnancy I was pregnant with five, then reduced to three. I lost that pregnancy. I had a cerclage done but not at 12 weeks. It was at 17 weeks. I was already dilating when they did the stitch. For this pregnancy if it is in fact full positive I will need the stitch. Will I have to be on bed rest the whole time?

A.

There are several questions here. As to the hormone numbers, there are no hard and fast rules, but 14 is considered extremely low and raises the possibility of early miscarriage. The next test will be important in answering that question. If you had a cerclage before, you'll need it again. There's no scientific evidence that bed rest adds anything to the success rate of pregnancy. You should discuss this with your doctor.

Q.

I have been taking birth-control pills correctly. My period starts a week early then stops on the first day of the non-hormone pills and then starts again the day after. What does this mean?

A.

Nothing important, just that days of flow have become less predictable now that extremely low doses of hormones are being used by most people. There's no loss of protection involved. You could likely correct this by increasing the hormone dose, but then you'd risk creating more bothersome side effects.

Q.

I'm 37 weeks' pregnant with my third baby. My left breast, including my nipple, is extremely sore. It feels as if I have a plugged duct and that the nipples are sore from poor latch, although I am not currently nursing. I am planning on nursing this baby but am concerned about what could be going on.

A.

It's not likely to be a plugged duct as that is caused by milk which solidifies in the duct, and significant milk flow does not usually start until after the birth occurs. More likely, there is the beginning of milk production without flow which is causing pain. Ice packs to the area for a few minutes at a time should keep this under control for now.

Q.

I will be two months' pregnant next week. I went for sonography two days ago, and my doctor said that no heartbeat can be detected. Is something wrong?

A.

Not necessarily. You might not be as far along as you think; one third of menstrual pregnancy dates turn out to be incorrect. On the other hand, if you are essentially certain when you got pregnant, then by two months, or eight to nine weeks, a heartbeat should be easily seen on vaginal ultrasound. The matter can be settled by a combination of blood pregnancy hormone levels and repeat ultrasound tests.

Q.

I was given two samples of Yaz by my doctor. I wasn't happy with them and have decided on the copper IUD. I am taking a month off since Yaz is done and my IUD appointment isn't for another month. I never got my period after that second pack of pills. Just a bit of blood mixed with mucus. I have felt dizzy and crampish and have had headaches since the day of the spotting. Could this be withdrawal from the pill? I have been on and off the pill for ten years and have two children. I have never had this reaction from discontinuing the pill. My husband says I'm pregnant, but I disagree. The only thing I did differently was taking high doses of vitamin D-3 for a few weeks to keep from getting the swine flu. And I wasn't able to find any info on it interacting with the pill's effectiveness. What's going on?

A.

This is most likely withdrawal from the pill, which is quite common. There's nothing wrong with Yaz; it's as good as any other pill. Be sure that pregnancy is carefully ruled out before you have the IUD placed.

Q.

I wake up throughout the night with swollen finger pain and numbness. I am drinking lots of water and am on a low-sodium diet. I also exercise, but the swelling seems to continue to grow. Any advice?

A.

This is carpal tunnel syndrome. It is caused by water retention, usually late in pregnancy, which causes the nerves in the wrist to be compressed. If you are past 28 weeks, there may be benefit in spending time lying on your left side, as this will permit more blood flow to the kidneys, which helps get rid of the extra water. In severe cases, an orthopedist can fit you for an arm brace, which will help. The problem resolves after the birth.

Q.

I am having a burning sensation in my upper stomach below my breast. What does it mean? I'm 35-and-a-half weeks' pregnant.

A.

At this gestation, stomach acids have a tendency to back up into the esophagus, causing acid indigestion. Antacids will help a bit, but don't expect this to clear completely until after the birth.

Q.

My girlfriend was bleeding for longer than normal. It stopped, and then she started bleeding during sex. We went to the hospital and they took a urine sample that came back positive. They drew blood and said the hormonal level was 106. Then they did a ultrasound that showed nothing. Please tell me what this means.

A.

That level is consistent with a very early pregnancy. With bleeding, however, it could also signify such problems as miscarriage or ectopic pregnancy. This needs to be followed closely via a combination of further blood tests and ultrasound.

Q.

I am 17 weeks' pregnant. Since I was about 14 weeks' along I have felt a knot when I press on the lower right side of my stomach. It seems to move slightly at times and does not hurt. Sometimes it seems as though it is different sizes. They say it could be the baby, a hernia or a mass, which really scares me. What do you think it could be? Is this normal?

A.

Most likely, you are feeling the top of your uterus. It is not uncommon for the uterus to lean to one side or the other. While it's most unlikely that this is a cause for concern, you should mention it at your next prenatal visit.

Q.

I have had unprotected sex several times and have not become pregnant. We have sex almost every day with no protection. Does this mean I can't get pregnant?

A.

Not necessarily. We don't consider there to be a fertility problem until one full year of trying has occurred. Once that point has been reached, however, then a series of tests will be performed that may well confirm that the problem lies in your partner.

Q.

I was supposed to get my period last Thursday but did not. Friday I had brown spotting just once. I took a pregnancy test that was positive, then went to the clinic Monday. They said it was negative, but that I should come back Friday if I still don't get my period. I have also been having cramping off and on, but no period. What could be going on?

A.

If pregnancy turns out not to be the case, then the most likely scenario is failure of ovulation, which is not at all uncommon. In most cases, it resolves itself. Most important at this point is to be sure about the pregnancy possibility, as spotting and cramping can reflect miscarriage or ectopic pregnancy.

Q.

I am 32 weeks' pregnant with our second daughter. I am dilated 3 cm, and 75 percent effaced. I'm on bedrest. I have mild sporadic contractions, but the large ones are kept under control by medication every 4 hours. How likely is it that I will deliver her soon? If I do deliver her in the next week or so, will she be okay?

A.

Premature birth (prior to 37 weeks) is quite likely here, especially as you are already under treatment to prevent labor. The good news is that with premature newborn care as effective as it is nowadays, healthy survival is the rule and not the exception at your current gestation.

Q.

My stomach is extremely sore. I am 7 DPO and was wondering if this could be a sign of pregnancy. I also have been lightheaded, nauseated and I have been urinating frequently.

A.

While you may have conceived 7 days ago, there are no symptoms which would occur this early. Be aware, however, that ovulation is often hard to pinpoint, so you might be further along. Pregnancy tests these days are accurate and show pregnancy before a period is missed, so you should know in the next few days.

Q.

If you have sex every night that you are ovulating, is it possible to conceive more than one child?

A.

Theoretically, it is possible to conceive more than one embryo if more than one ovum has been released from the ovary. If this were to happen, however, it would not be from having frequent intercourse.

Q.

H1N1 flu has been in our town. I have been working so hard trying to get ready for my maternity leave and have put in lots of hours this past week. I got sick a couple of days ago and have asthma and am having a hard time breathing and the baby has slowed in his movements. What should I do?

A.

First of all, stop working as soon as possible, and be sure your asthma continues to respond to the bronchodilators as it usually does. If it doesn't, see your doctor right away, as you are in the high-risk group for H1N1. As to the baby's movements, be sure you're doing kick counts daily and report immediately if the baby's movements are not adequate.

Q.

I'm 19 weeks' pregnant, my doctor said it looks like my placenta is breaking off. Today I woke up and had bad pain on the lower right side and there was spotting on my underwear but no blood. What should I do?

A.

If you remain at rest, there's a good chance that this will resolve on its own. However, placental abruption, as this is called, is potentially dangerous, so you need to watch closely for increasing bleeding or abdominal pain.

Q.

I went to the hospital for stomach pain, they took blood and urine and told me that I was pregnant. I went to the clinic the next day and took a urine test, which was negative. I'm confused.

A.

Clearly, there needs to be more follow-up here, as you are showing mutually exclusive results. This may represent a very early miscarriage in which the hormone level has remained too low to turn the less sensitive urine test reliably positive. A repeat of the blood test should clarify things.

Q.

I have been feeling movement in my belly for a few weeks. I can physically see my belly move. I took a pregnancy test a couple of days ago, which was negative. Would a pregnancy test be accurate if I were far enough along to feel and see movement? If I am not pregnant, what could it be?

A.

Pregnancy tests are extremely reliable nowadays, so you may be assured that you are not pregnant. Abdominal muscle spasms as well as intestinal movements are likely causes of what you are noticing.

Q.

My mucus plug broke and ever since I have been having some minor contractions and a lot of pain. What should I do?

A.

There's nothing you need to do other than remain well rested and hydrated. This is a sign that your cervix is beginning to soften, efface, and open, so labor should not be far off.

Q.

I'm 18 years old and deadly not allowed to get pregnant. My parents will abandon me, and I never want that to happen. I've had unprotected sex for one month, two days after my period. Now, I feel constantly bloated, I urinate more frequently, I have light bleeding (the blood is red), continuous abdominal cramping, diarrhea, and sometimes I feel so sleepy, dizzy, or my head aches. I have also noticed increased vaginal discharge for a week. I took three pregnancy tests, which were all negative. I am totally lost and very confused and seriously depressed. Please help me. Am I pregnant?

A.

It is very unlikely that you are pregnant, but you definitely do need a gynecologic evaluation. Most likely, your high level of anxiety is causing some hormonal disturbances, which are causing the symptoms you describe. From this point onward, be sure to use reliable protection against pregnancy.

Q.

I'm 33 weeks' pregnant, and my cervix is slightly open. What are possible consequences? Is it safe to deliver at 34 weeks?

A.

Your cervix being slightly open does not mean that you are at any increased risk of delivering prematurely, unless, of course, you are having strong and regular contractions as well. In any event, 34-week births do not usually create any serious problems for the newborn.

Q.

My son had a CAT scan today. I stood beside him to hold his head while wearing the apron. I think I may be pregnant as my period is late. Should I be concerned for the fetus?

A.

No, you needn't be alarmed. The apron will protect you quite well.

Q.

I'm eight weeks' pregnant. The doctor said the baby is hiding, and he couldn't find the heartbeat. Should I be worried?

A.

This depends upon what method the doctor used to try to detect the heartbeat. If it was a Doppler device in which only a sound is produced, then it would be quite a bit too early to hear the heartbeat. However, if this was a sonogram, in which a picture is produced, then the beating heart should definitely be detectable by eight weeks. Your doctor can follow this latter situation by repeating the sonogram in a week or two.

Q.

I took a pregnancy test, which was positive, but also had an ultrasound that showed a cyst on my left ovary. Can I still be pregnant?

A.

Yes, you can. A relatively small ovarian cyst accompanies all pregnancies during the first trimester. This is what keeps the pregnancy going until the placenta takes over later on.

Q.

I'm pregnant and wake up four or five times in the middle of the night because my left arm is numb and my fingers (mainly my middle finger) are as well. It is very painful. Is there anything I can do to relieve the pain? I have tried elevating my arm on a pillow, sleeping with a pillow between my legs, in front of my belly, etc.

A.

This is called "carpal tunnel syndrome" and is very common during pregnancy due to water retention. There is a brace device that can be applied and that is usually quite helpful. Talk to your ob/gyn about this.

Q.

I missed my period and took a pregnancy test, which was negative, but I have a light brown line under my belly button. What is this?

A.

When women miss periods but are not pregnant, it usually means that they have failed to ovulate, which is not unusual or worrisome. What happens then is that the ovary releases estrogen, but not progesterone. That imbalance may stimulate skin cells to produce melanin, which is a brown pigment. That is likely the explanation.

Q.

Is it possible to have your period throughout your whole pregnancy?

A.

It is possible to have intermittent bleeding episodes during pregnancy, usually for reasons that are not harmful. These episodes, however, are not "periods" in the traditional sense as menstrual activity ceases during pregnancy.

Q.

Are there some foods that can be eaten to correct a dilated kidney in a male fetus six months in gestation?

A.

No, I'm afraid there are not. However, a fetal kidney can be dilated to a minor extent for reasons that are not necessarily harmful. I'm sure there are plans to follow this closely. It may well resolve on its own.

Q.

I am having a baby in mid-November. Is it worth getting the H1N1 vaccine?

A.

Definitely YES. H1N1 is very serious business, especially for pregnant women.

Q.

Is there a downside to having the medical team flip my baby in a hospital setting? Should I have a Cesarean instead? The baby is feet first.

A.

There are potential downsides to any medical procedure, but the risks are really quite small for this one. First, it might fail to work or it may work and then the baby turns back again. On very rare occasions, the turning process might compress the umbilical cord, which would necessitate an immediate C-section. My advice would be to go ahead with the procedure (known as version) especially if you are planning to have more children. Multiple C-sections are to be avoided if possible.

Q.

I'm 33 weeks' pregnant and I have a fear of hurting the baby's head or squishing her whenever I sit down or bend over. Is this even possible? I feel as though sitting down or wearing any type of formfitting clothing on the lower waist will harm her.

A.

No, it is not remotely possible for you to harm your baby by sitting or bending. The baby is incredibly well protected in the uterus. No clothing you might wear could do her the slightest bit of harm.

Q.

I had a negative blood test but my uterus is measuring six weeks. What's going on?

A.

Probably nothing. The difference between a normal sized uterus and one at six weeks is very minimal. This is a highly subjective judgment and has no bearing on your health.

Q.

Two days ago I started having light brown spotting that turned reddish pink. I'm five to six weeks' pregnant. The fifth-week HCG showed 2079 and this week showed 1920. Today's ultrasound shows a healthy heartbeat. What does this mean? Am I miscarrying or having implantation bleeding?

A.

The healthy heartbeat is a very reassuring sign, more important than the HCG level. Obviously, the situation is not yet clear and will need to be followed. This, however, is not implantation bleeding; that happens much earlier in pregnancy, even before the missed period.

Q.

I will be 23 weeks' pregnant. I noticed just in the last couple of days that my belly has been really sensitive to touch. It hurts when there is pressure put on my tummy. Why is this?

A.

What's happening here most likely is that the abdominal muscles are beginning to stretch. Often that can lead to the breaking of small blood vessels within the muscle fibers which can cause tenderness. It's not a serious matter. A warm compress should help soothe the area.

Q.

I will be 23 weeks' pregnant. I noticed just in the last couple of days that my belly has been really sensitive to touch. It hurts when there is pressure put on my tummy. Why is this?

A.

What's happening here most likely is that the abdominal muscles are beginning to stretch. Often that can lead to the breaking of small blood vessels within the muscle fibers which can cause tenderness. It's not a serious matter. A warm compress should help soothe the area.

Q.

Months ago I was having pain, moodiness and extreme fatigue. My doctor confirmed that I had a lot of ovarian cysts and said my next period would have a lot of bleeding and be very painful. I have been having unprotected sex daily for the last three months. I never got my period regularly before but now have gotten it twice exactly 28 days apart. I went to the ob/gyn last month because I was experiencing similar pains as in the month before and he said everything looked normal, but if I did not get my period in 2.5 weeks I would most likely be pregnant. Five days later I had bleeding that lasted for five days. A few days after it ended I started feeling dizzy and could only eat at night and after eating wanted to throw up. It has been harder to sleep and I feel slight cramps in my lower abdomen. My lower back also aches a lot. Could I be pregnant? What is going on?

A.

Assuming that your pregnancy tests are negative, then that would be very unlikely. Your history of ovarian cysts and irregular cycles strongly suggests that your ovulation mechanism is impaired. The approach taken here depends upon whether or not you desire pregnancy. If so, ovulation can be induced. If not, hormones can administered to regulate the cycles.

Q.

I'm 25 weeks' pregnant with my third child and have been placed on complete bed rest due to the length of my cervix (2cm). I also have placenta previa (anterior position). I have been feeling a pinching feeling by what I believe is my cervix (same feeling as when I had a biopsy of my cervix years ago). I have also been experiencing mild cramping across my lower abdomen and lower backache. My doctors seem to shrug off or not answer my questions fully. Are placenta previa and a short cervix related? Should I be concerned that these are signs of preterm labor and not minor aches and pains associated with pregnancy?

A.

There is no question about the fact that you are at high risk for pre-term labor so you will need to be vigilant about your contraction pattern. What you describe does not sound like labor, which is strong, regular contractions lasting at least 30 seconds each. There is no direct relationship between placenta previa and a shortened cervix other than the fact that both predispose patients to pre-term labor.

Q.

Can a healthy implantation still occur a couple of days after a missed period? When is the best time to test for pregnancy?

A.

Implantation occurs prior to a missed period, at around day 21 or so. It would be most unlikely for this process to occur by the time of a missed period. Pregnancy tests these days are extremely sensitive, usually turning positive by day 25 or 26, even before a period is missed.

Q.

I found out I have a low-lying placenta (2.33 cm from os) in my 15th week, after I had light spotting. I was on bed rest for one week and took Duvadilan. We had sex on the 20th week and I had heavy bleeding after (like menstruation). The doctor prescribed�isoxilan and duphaston for three days. Today is the 2nd day, the bleeding is light, and there's no pain. Is my baby safe? Does this mean no sex for the rest of the pregnancy?

A.

Not unless the placenta has descended to cover the internal os of the cervix, which is quite unlikely. Most bleeding after intercourse during pregnancy is just the result of disruption of small capillaries in the cervix. This is not dangerous, but certainly can be disconcerting. Your next sonogram should clarify the issue for you.

Q.

I'm 18 weeks' pregnant and after I urinate I have vaginal itching. Could I have a UTI or a vaginal yeast infection?

A.

You could, of course, but the itching would not likely be limited to after urination. More likely this is simply the effect of the urine irritating these somewhat swollen tissues.

Q.

I am 19 weeks' pregnant and I woke up the other morning in extreme pain on my upper right side. My doctor was concerned about my gallbladder and sent me for an ultrasound. My gallbladder turned out to be fine, but they found my right kidney dilated. She said this is very common in pregnancy and since I do not have infections or kidney stones they would just keep an eye on it for now. The pain has subsided to just a constant dull ache. She said to use Tylenol and heat for pain relief. Everything I have read, however, says this is very serious and that I might have permanent damage and a stint put in. I have half of my pregnancy left. Should I be concerned?

A.

Most likely not. I agree that this is a very common event during the second and third trimesters. It results from the tendency of the uterus to rotate to the right as it enlarges, thus intermittently blocking the ureter. There really is no danger involved here, although it can be quite painful. When it happens, lie for a while on your left side, which should shift the uterus off your ureter.

Q.

In my wife's 28th week she had her first sonogram,and the doctor said we are expecting a girl. We have two girls and this time the pregnancy symptoms have been totally different from the beginning. The baby's heart beat is 140 and my wife's stomach is like a basketball. Please let us know if sonography is 100 percent accurate.

A.

At 28 weeks, I would estimate the accuracy of sex determination by ultrasound to be 99 percent, so you can be reasonably assured that you're having a third girl. You'll be an amazingly well cared-for man when you get old!

Q.

I'm 32 weeks' pregnant and I was just wondering at how many weeks is the baby supposed to turn, and will I feel it?

A.

The baby will usually "turn," meaning bring its head to the lower segment of the uterus at that point when it becomes the heaviest part of the baby, which is around 35 weeks. About three to four percent of the time, this turn does not occur, which results in a breech baby and usually requires a C-section.

Q.

I have not been on birth control for several months. The past couple of months I have been experiencing hot flashes, swollen fingers (especially later in the evening), movement in my upper and lower abdomen, all over abdominal cramps as well as only lower abdominal cramps, leg cramps in the evening, and NOW very swollen and sore breasts that are producing breast milk. I have continued to have a typical period every month although the past month I started about four days early which is very unusual for me. I have taken several HPT and even a urine test at my ob/gyn. They have all been negative. Could I be pregnant and it not have been detected?

A.

Not at all likely. Pregnancy tests are rarely in error these days. More likely this is due to changes in your female hormone levels due to the BCP you're taking. The symptoms you describe are commonly associated with variations in your estrogen and/or progesterone levels. You could discontinue the method temporarily, as long as you have another method available, or you could be tried on a different dosage.

Q.

I'm not sure if my wife is pregnant. She has been experiencing kicks in her tummy but she says they hurt to the point where she feels like crying. She feels them near her ribs, belly button and lower back. She has been staying up late like until 3 or 4 a.m but she sleeps until 4:30 pm. She is also having soreness around and on her breasts. Please help.

A.

I'm assuming her pregnancy tests have been negative, in which case there is almost no chance that she is pregnant; these tests are very reliable. This sounds much more like a digestive system issue, such as gall stones or gastritis. Her doctor can help make this determination.

Q.

I found out I was pregnant on July 17. My doctor said my progesterone was low and put me on pills. Three weeks later, I had a miscarriage. At first I was really upset, but now I feel it was for the better, and I am ok with this. I know it's common for women to still have pregnancy symptoms after a miscarriage due to the levels of hormones in their body and they will slowly disappear. However, instead of my pregnancy symptoms lessening, they are getting stronger than they were before I miscarried. I'm guessing this isn't normal, I'm not able to locate anything on the Web about it. Is this something I should worry about?

A.

Not likely. It usually takes between four and six weeks for the symptoms of pregnancy to fully disappear following miscarriage. In rare circumstances, the pregnancy tissue fails to dissolve and continues to produce hormones, which cause the symptoms you describe. Seek your doctor's assistance if things are not back to normal by six weeks after the event.

Q.

I am 28 weeks' pregnant and have been feeling like someone has kicked me in the vagina. It hurts to stand and it hurts to walk long distances. Is this serious?

A.

No, it isn't. What's happening is that the bones of the pelvis are starting to separate, which is actually a good thing, as it will make for an easier labor. Just reduce activities, and it should be manageable.

Q.

I am nine weeks' pregnant. I have a bladder infection, very bad cramps and a bad lower backache. My doctor put me on antibiotics and muscle relaxers. Should I be concerned? I have been on meds for almost two weeks and just started a new antibotic because I still have the infection. I am drinking water. Will it all hurt the baby?

A.

No, it won't, but it is important to determine what organism is causing this infection so that it can be effectively treated. Urinary infections later in pregnancy can lead to premature birth.

Q.

I am nine weeks' pregnant. I have a bladder infection, very bad cramps and a bad lower backache. My doctor put me on antibiotics and muscle relaxers. Should I be concerned? I have been on meds for almost two weeks and just started a new antibotic because I still have the infection. I am drinking water. Will it all hurt the baby?

A.

No, it won't, but it is important to determine what organism is causing this infection so that it can be effectively treated. Urinary infections later in pregnancy can lead to premature birth.

Q.

I am 34 weeks' pregnant. I woke up this morning with terrible lower left back/buttocks pain and couldn't get up. Now it's even worse and I also have some abdominal pain and feel like throwing up. Is this a sign of labor?

A.

No, it's not. This sounds a lot more like a pinched nerve, which is fairly common in late pregnancy because of the dramatic postural changes which occur then. Heat to the low back may help, and it's almost certain that it will disappear once the baby is born.

Q.

I am 38 years old and, despite being overweight, am reasonably healthy. I have been pregnant twice. The first ended in miscarriage. I have an 18-year-old daughter whom I love, but neither my boyfriend (who has two adult children from a prior marriage) nor I desire any more children; especially at our ages (he's 47). We had unprotected sex in late February, and I had a three-day period in March and none since. I have had several negative urine tests, two negative quantitative blood serum tests and a cat scan. Everything is normal. There is no detectable presence of HCG in my blood or urine, no sign of a tubular pregnancy, no sign of a molar pregnancy, no sign of a viable baby, no cysts, and no visible sign of disease or abnormality anywhere in my body; including my uterus. And I pride myself on being a logical person. But my body is looking, behaving and feeling just as it did during both of my prior pregnancies. Why on earth is this happening to me?

A.

Most likely, this is all due to hormonal imbalance, which would be common at this point in life. Your ovaries are still functioning, but not releasing eggs. This leads to a relative overabundance of estrogen, which, among other things, works as a muscle stimulant. It is likely that this is causing a lot of intestinal movement, which you are perceiving. Your doctor can provide you with the hormone you are missing, Progesterone. This will result in a balancing of the hormones, which, in turn, will resolve these symptoms and most likely produce a menstrual period. Most likely, this is all due to hormonal imbalance, which would be common at this point in life. Your ovaries are still functioning, but not releasing eggs. This leads to a relative overabundance of estrogen, which, among other things,works as a muscle stimulant. It is likely that this is causing a lot of intestinal movement, which you are perceiving. Your doctor can provide you with the hormone you are missing, Progesterone. This will result in a balancing of the hormones, which, in turn, will resolve these symptoms and most likely produce a menstrual period.

Q.

Could nursing or taking an antibiotic cause a false negative on a pregnancy test?

A.

No, they cannot.

Q.

I had to go to a fetal specialist because my blood screening came back positive for DS. However, today the doctor said my cervix is opening from the inside and that it is short. The doctor does not want to test my child for DS because it could cause early labor. Please explain what this means. I have three boys and this is my first girl so I am really scared.

A.

It sounds like your doctor is reluctant to perform amniocentesis (in which a needle is inserted through the abdomen so as to withdraw a sample of amniotic fluid) for fear of causing the uterine muscle to become irritated and contract more. While I certainly understand that concern, you have a major need to know your baby's status, so my own preference would be to go ahead with the amniocentesis and try to prevent contractions with one of the readily available drugs designed for that purpose.

Q.

I'm 39 weeks' pregnant with my second child. The first was born at 37 1/2 weeks by C-section after my water broke. She was breech. This baby is in the right position and I want a VBAC. I have been having Braxton-Hicks for several months and the contractions I've felt over the last four days are nothing like those. These are in my lower back and lower abdomen. They have ranged from seven minutes apart for a full hour to every half hour. They never lessen in intensity and everything I've tried to speed them up has made them stronger but not closer. They continue whether walking, sleeping, even unrinating. Is this normal?

A.

Yes, it is. We call this situation dysfunctional labor, i.e., painful contractions that do not lead into labor and that do not cause the cervix to dilate. In most cases, it resolves itself, but, if it does not, it can be treated in the hospital by use of a strong painkiller, such as Morphine. This tends to help get the contractions coordinated and more effective.

Q.

I'm 39 weeks'pregnant and my doctor said my baby's head is not engaged correctly. He said it was not the right presenting part and was more of the side of the face/head rather than the top of the head. I am not dilated or effaced because of this, he said. My first child was headdown at 36 weeks and I was dilated to one. He said walking and crawling will help. Any other suggestions? And is my baby okay in this position?

A.

This situation, in which the baby presents with its head slightly tilted to one side, is called asynclitism. It is common and not dangerous, although it does tend to delay the descent of the head into the pelvis. I'm not aware of any specific remedies, but it's reasonable to assume that it will correct itself when labor begins. The best way to have that happen is to rest most of the day and keep well hydrated.

Q.

I am 21 weeks' pregnant and have constant cramping and some spotting. My doctor said my cervix was long and closed. Should I be concerned?

A.

To a limited extent, yes. It is never considered normal to bleed at this point in a pregnancy. That said, there's not much to be done other than frequent observation to be sure nothing dangerous develops such as an infection or premature labor. My advice, until the picture becomes clearer, is to avoid strenuous or sexual activity.

Q.

I'm 33 weeks' pregnant and I have a fear of hurting the baby's head or squishing her whenever I sit down or bend over. Is this even possible? I feel as though sitting down or wearing any type of formfitting clothing on the lower waist will harm her.

A.

No, it is not remotely possible for you to harm your baby by sitting or bending. The baby is incredibly well protected in the uterus. No clothing you might wear could do her the slightest bit of harm.

Q.

I had a negative blood test, but my uterus is measuring six weeks. What's going on?

A.

Probably nothing. The difference between a normal-size uterus and one at six weeks is very minimal. This is a highly subjective judgment and has no bearing on your health.

Q.

Two days ago I started having light brown spotting that turned reddish-pink. I'm five to six weeks' pregnant. The fifth-week HCG showed 2079 and this week showed 1920. Today's ultrasound shows a healthy heartbeat. What does this mean? Am I miscarrying or having implantation bleeding?

A.

The healthy heartbeat is a very reassuring sign, more important than the HCG level. Obviously, the situation is not yet clear and will need to be followed. This, however, is not implantation bleeding; that happens much earlier in pregnancy, even before the missed period.

Q.

Months ago I was having pain, moodiness and extreme fatigue. My doctor confirmed that I had a lot of ovarian cysts and said my next period would have a lot of bleeding and be very painful. I have been having unprotected sex daily for the last three months. I never got my period regularly before but now have gotten it twice exactly 28 days apart. I went to the ob/gyn last month because I was experiencing similar pains as in the month before and he said everything looked normal, but if I did not get my period in 2.5 weeks I would most likely be pregnant. Five days later I had bleeding that lasted for five days. A few days after it ended I started feeling dizzy and could only eat at night and after eating wanted to throw up. It has been harder to sleep and I feel slight cramps in my lower abdomen. My lower back also aches a lot. Could I be pregnant? What is going on?

A.

Assuming that your pregnancy tests are negative, then that would be very unlikely. Your history of ovarian cysts and irregular cycles strongly suggests that your ovulation mechanism is impaired. The approach taken here depends upon whether or not you desire pregnancy. If so, ovulation can be induced. If not, hormones can administered to regulate the cycles.

Q.

I'm 25 weeks' pregnant with my third child and have been placed on complete bed rest due to the length of my cervix (2 cm). I also have placenta previa (anterior position). I have been feeling a pinching feeling in what I believe is my cervix (same feeling as when I had a biopsy of my cervix years ago). I have also been experiencing mild cramping across my lower abdomen and have a lower backache. My doctors seem to shrug off or not answer my questions fully. Are placenta previa and a short cervix related? Should I be concerned that these are signs of pre-term labor and not minor aches and pains associated with pregnancy?

A.

There is no question about the fact that you are at high risk for pre-term labor, so you will need to be vigilant about your contraction pattern. What you describe does not sound like labor, which is strong, regular contractions lasting at least 30 seconds each. There is no direct relationship between placenta previa and a shortened cervix other than the fact that both predispose patients to pre-term labor.

Q.

Can a healthy implantation still occur a couple of days after a missed period? When is the best time to test for pregnancy?

A.

Implantation occurs prior to a missed period, i.e., around day 21 or so. It would be most unlikely for this process to occur by the time of a missed period. Pregnancy tests these days are extremely sensitive, usually turning positive by day 25 or 26, i.e., even before a period is missed.

Q.

I found out I have a low-lying placenta (2.33 cm from os) in my 15th week, after I had light spotting. I was on bed rest for one week and took Duvadilan. We had sex in the 20th week and I had heavy bleeding after (like menstruation). The doctor prescribed isoxilan and duphaston for three days. Today is the 2nd day, the bleeding is light, and there's no pain. Is my baby safe? Does this mean no sex for the rest of the pregnancy?

A.

Not unless the placenta has descended to cover the internal os of the cervix, which is quite unlikely. Most bleeding after intercourse during pregnancy is just the result of disruption of small capillaries in the cervix. This is not dangerous, but certainly can be disconcerting. Your next sonogram should clarify the issue for you.

Q.

I'm 18 weeks' pregnant and after I urinate I have vaginal itching. Could I have a UTI or a vaginal yeast infection?

A.

You could, of course, but the itching would not likely be limited to after urination. More likely this is simply the effect of the urine irritating these somewhat swollen tissues.

Q.

I am 19 weeks' pregnant and I woke up the other morning in extreme pain on my upper right side. My doctor was concerned about my gallbladder and sent me for an ultrasound. My gallbladder turned out to be fine but they found my right kidney dilated. The doctor said this is very common in pregnancy and since I do not have infections or kidney stones they would just keep an eye on it for now. The pain has subsided to just a constant dull ache. She said to use Tylenol and heat for pain relief. Everything I have read, however, says this is very serious and that I might have permanent damage and a stint put in. Should I be concerned?

A.

Most likely not. I agree that this is a very common event during the second and third trimesters. It results from the tendency of the uterus to rotate to the right as it enlarges, thus intermittently blocking the ureter. There really is no danger involved here, although it can be quite painful. When it happens, lie for a while on your left side, which should shift the uterus off your ureter.

Q.

I had my second ultrasound yesterday, at six weeks, one day. We clearly saw a baby with a heartbeat but saw two other areas that were flickering like the heartbeat. I was told it could be a vein. I have never heard of this. They also went back and started measuring again, especially right at the front of my uterus, near my cervix. I have two children and with both pregnancies ultrasounds were done by the same person the same way. First measure and then record the baby for a few minutes, and then you're done. Why did they go back to measure again? At 19 dpo my levels were 2163, which I have read is high, and during my first ultrasound at four weeks, three days, nothing could be seen, not even the sac. Is it possible that the flickering was the heartbeats of other babies but for some reason we could not see them? Or just a vein?

A.

Probably not either of those things. A separate second pregnancy would show other additional findings beyond just a "flickering" and veins do not pulsate. On the other hand, arteries do pulsate, so most likely an artery of yours in the vicinity of the uterus was what was seen. Hard to know why your sonographer decided to take a second measurement, but, as you know, it's always a good idea to confirm any observation if at first it's not clear.

Q.

I am 30 weeks' pregnant and I have a sharp pain in my pelvis that comes and goes. What does that mean?

A.

In general, sharp sensations in the third trimester are a sign of some form of stretching, either of ligaments or joints, not usually contractions, which tend to be of a dull and achy nature. These stretches enable your body to labor more efficiently.

Q.

I am 21 weeks' pregnant and just look chubby (I do not have the hard belly most pregnant women have). I am 5'6" with a pre-pregnancy weight of 150 and now weight 163. Will I get the large hard pregnant belly that every mother-to-be wants?

A.

You certainly will, but it might not be for three or four more weeks, especially if this is a first pregnancy, when relatively tight abdominal muscles tend to hold the uterus back. Growth of the fetus from here on will be rapid, so it won't be long before you'll have trouble looking down and seeing your feet.

Q.

I had an Implanon fitted ten months' ago and have had no problems until recently, when my breasts became sore and started leaking clear fluid. Is this normal?

A.

It is certainly not a common symptom, but it's doubtful that it's of any importance. The most likely explanation is that the soreness and fluid leakage is the result of hormonal stimulation of the breast glands by the progestin contained within the Implanon. I would expect this to disappear on its own within a couple of weeks.

Q.

I am 31 weeks' pregnant and have just started getting bad nausea again. Is this common in late pregnancy?

A.

It is, but for a different reason than in the first trimester. At this point, the pregnant uterus is beginning to push up against the stomach, forcing acids into the esophagus. By elevating your head at night and taking antacids, you should be able to keep it under control.

Q.

I am 32 weeks' pregnant and my cervix is soft. There's no dilatation. What does it mean?

A.

Probably nothing of importance. The cervix begins to soften in preparation for labor, and the process goes on throughout the third trimester. In the absence of effacement and dilatation, there is not an increased risk of premature labor.

Q.

I am 18 weeks' pregnant and an ultrasound shows that my baby has a swollen kidney. What could this be and what can I expect?

A.

This implies that fluid (urine) has collected in the kidney because of an obstruction to flow. This could be temporary because of brief kinking or it could reflect a serious problem. Follow-up studies are planned, I'm sure, which should resolve this question. It's hard to be very definitive at this early stage as the kidneys are still quite small.

Q.

I went to the ER with light bleeding and cramping. They took an ultrasound and determined I was six weeks', one day pregnant which was five weeks different from my estimate. They also found an ovarian cyst and subchorionic hemhorrage (they stated it was small). During the ultrasound they found the baby's heartbeat, which was 106. However, since then the bleeding has gotten heavier and now I'm clotting, no intense cramps though. What are the chances that this will be a healthy pregnancy?

A.

Not good, I'm afraid. The heart rate is abnormally slow and, combined with the increasing flow, it sounds like this pregnancy is likely to be lost. In most cases, this is a one-time event with no increased risk for future pregnancies.

Q.

I am 34 weeks' pregnant. Until today all sonograms and my sugar have been normal. My doctor said that the tubes to the kidneys are dilated a little but it's not too serious. I am really concerned. Does it mean my baby has suddenly developed a symptom of Down syndrome? How common is this? I am in tears at the slightest thought there might be something wrong with my baby.

A.

To worry about your baby this much, I can tell you're going to be a great mother and will some day receive well-deserved Mother's Day cards! Your question provides an important message to all caregivers about how careful we need to be in talking to patients, as it is so easy to inadvertently frighten them. There's absolutely nothing abnormal about a small amount of ureteral dilatation late in pregnancy. Were there a problem here, it would have been detected much earlier. Relax and enjoy the magnificent event which is about to happen!

Q.

I am 35 weeks', 3 days' pregnant. I have been having cramping pains every now and then and a little bit of tightness around the stomach, and sometimes in the abdominal area. And since yesterday I have been noticing that when I wake up and go to the bathroom my urine is a dull yellow, but throughout the day the urine becomes clear. Should I call my doctor? When I had my first child I didn't feel her moving much and it turned out that I had 60-percent less fluid, so the doctor induced me on the due date itself. My doctor has planned to induce me at 39 weeks and 2 days. Please let me know what I should do.

A.

First thing you should do is to think over whether you really want to be induced before your due date without there being a sound reason, such as a health problem affecting you or your baby. Elective induction carries significant risks, including a much increased risk of C-section. That said, your urine is dull yellow in the morning because it is more concentrated then. This is not a problem.

Q.

About four months ago I stopped taking the pill and started trying for a baby. My second period came after 28 days, the third after 25 and now it's the 29th day and I still have not had my period. I have had a sore tummy (different from period cramps) for about a week, but tested negative for pregnancy. Could it be that I tested too early?

A.

Not likely. If you became pregnant around mid-cycle this past month, then by day 29, the test should be positive. Delayed or otherwise abnormal menses is a very common event during the first few months after going off the pill.

Q.

I'm 23 weeks' pregnant. At my 20-week sonogram the baby looked great, developing normally. I thought that I felt some fluttering around 17 weeks up until my 20-week appointment, but since then have felt nothing. My placenta is in the front and my doctor said that this could be a reason I am not feeling her, but I am nervous that something might be wrong. Is is normal not to have felt the baby move at 23 weeks?

A.

Not necessarily. If your doctor found normal results on your last sonogram, then I would agree that the location of the placenta could be the reason. I would report it if you are not feeling some level of movement by 26 weeks.

Q.

I am 28 weeks' pregnant and for the last week I have been feeling severe pressure in my lower belly to the point where it is hard to get up and walk. I have also been very sore. Is this normal, or might I be overdoing it with my other two children?

A.

You are a bit early to be unable to walk just from the postural changes of a normal pregnancy. I would not expect you to unable to care for your two children any time in the next four to six weeks. While it may not be of any importance and might well resolve with more time off your feet, I'd be interested to see if your cervix might be effacing and/or dilating, so be sure to mention this at your next ob/gyn visit.

Q.

I took a home test about an hour ago when I woke up and there was a faint positive line, only the bottom half but it's there. I took one earlier at about 1 am but that one showed only one line. Can you help me interpret the results?

A.

Obviously, these results are not compatible with one another. At this point, then, it's best to consider yourself pregnant until proven otherwise. Your doctor's office should be able to tell you with no difficulty.

Q.

I am 15 weeks' pregnant and the doctor says I measure at 17 weeks. The doctor had a really hard time finding the baby's heartbeat on the Doppler also. They found a heartbeat on one side of my abdomen (where it's painful), but in my mid-abdomen they felt movement. I'm confused.

A.

There is no practical difference in uterine size between 15 and 17 weeks. So long as the heartbeat is detectable anywhere on your abdomen, things are fine.

Q.

I had my period twice in June, and now I am having pain and clear fluid leaking from my vagina. I woke up this morning, my undies were soaked and it reminded me of the smell of amniotic fluid. I am still leaking but not gushing. What could this be?

A.

The most likely explanation, so long as pregnancy has been eliminated as a possibility, is that your female hormones have gotten out of balance, which often results in the production of a lot of cervical mucus. Amniotic fluid does not actually smell; what you are referring to is the odor of vaginal acids.

Q.

I'm 37 weeks' pregnant, I lost my mucus plug with blood, now I feel this sharp pain down in my vagina and lower back. Are these signs that I'm going into labor?

A.

Most women do not describe labor as being "sharp," usually more dull and crampy. Most likely, what you're experiencing is the result of the baby descending and the cervix effacing, all of which is good.

Q.

I am 34 weeks' pregnant, but I have been feeling as though I am going into labor. I have had really bad pain in the pelvic area, like period pain, sometimes like a stitch pain and other times a sharp pain. The pains have stopped today. I have also had a lot more discharge, which last night started to turn brownish/redish. Last night I also had diarrhea after being constipated the night before. I have an appointment with my midwife but was just wondering if you think this sounds as though labor won't be long.

A.

While labor at 34 weeks is not at all rare, this doesn't sound like it, especially if the pains have now disappeared. More likely, your pelvic bones are separating and your cervix is effacing, all of which are favorable signs.

Q.

My water broke at 18 weeks. I went to the hospital and was told it was only urine and sent home. Is there anything that could have been done from the time I went home till the next day when I saw my doctor?

A.

Sadly, there is not a thing that would change the outcome once the water breaks that early. Outcomes are nearly always bad in this circumstance, as I presume they were in your case. It is not something that was caused by anything you or anyone else did.

Q.

I am 17 weeks' pregnant, and there is a hard bump on the lower left side of my stomach. What does this mean?

A.

Unfortunately, this doesn't really provide enough information to narrow down the possibilities. In general, if there is no serious discomfort, it will not likely be anything dangerous. Be sure to mention it on your next prenatal visit.

Q.

I was 23 weeks', 4 days' pregnant. Suddenly my baby's heartbeat stopped. I am trying to find the cause, and want to know how long to wait before trying for another pregnancy. It's so emotionally painful.

A.

Sadly, the cause for this event may never be known, as in the majority of such cases, the fetus will show no abnormalities. It's possible that your baby's umbilical cord became pinched off, which, although rare, can't be predicted or prevented. As to how long to wait, most experts feel that it's best to let the grieving process run its course, usually four to six months, before trying again.

Q.

I am 39 weeks' pregnant and for a few days I have had Braxton-Hicks on and off, plus diarrhea, headaches, lower-back pain, pelvic pressure and vaginal pains. What does this mean, and is it normal?

A.

These are all symptoms of someone getting ready to go into labor. While they can be a bit of a nuisance, especially at night, think of it as something that will help shorten the time you have to spend in actual labor.

Q.

My first son was born spontaneously at 29 weeks. I am now 28 weeks with my second son. I've been on bed rest since 19 weeks with a cervical cerclage and was 50 percent effaced since then. Just wondering how much longer I have.

A.

That's not something anyone could predict, but if your doctor says the cerclage is holding well and the effacement is not progressing, you should be able to carry until term or quite nearly.

Q.

I'm about seven weeks' pregnant and for about four weeks my esophagus has been hurting and I feel like I can't breathe, especially at night when I lie down. What is that feeling and what can I do for it?

A.

What's happening is that stomach acids are backing up into your esophagus, a common occurrence in pregnancy. Try elevating your head in bed as well as using antacids, which are quite harmless.

Q.

My 19-year-old daughter has not had a normal period since January. She had a short period with mucky blood and a brown discharge in February. She has taken several urine test and a blood test, with all being negative. She is now starting to feel movement in her abdomen. Can she be pregnant and, if so, could she be carrying more than one? I am scared that it could be a tubal pregnancy.

A.

Pregnancy testing is so reliable these days, that there is essentially no chance of these symptoms being due to pregnancy. On the other hand, it's quite common for women, particularly when under stress, to have hormonal imbalances which disturb the cycles. In most cases, they resolve themselves.

Q.

I'm 39 weeks' pregnant and had spasms in my lower right abdomen that were about two seconds' apart for close to an hour. Could this be the baby's hiccups? My abdominal area right above my vagina feels a lot softer than the rest of my stomach. I have also had flulike symptoms and some nausea. Please advise.

A.

Are you sure you mean seconds and not minutes? There really are no physical phenomena related to pregnancy that occur that often. If you meant minutes, then most likely this is what we call Braxton-Hicks contractions, a sort of uncoordinated contraction which causes little or no cervical change and has no importance.

Q.

I'm 39 weeks' pregnant and had an internal and sweep yesterday. Today I'm suffering really bad cramps and having shooting pain. What does it mean?

A.

It means that your cervix is starting to dilate and efface. "Sweeping" or "stripping" the membranes is a technique by which the examiner inserts a finger through the cervix and sweeps it around so as to separate the cervical tissue from the amniotic membrane. This is believed to result in the release of a hormone called prostaglandin, which causes contractions and softening of the cervix. This tends to result in hastening the onset of labor.

Q.

I am ten weeks' pregnant and have been spotting brown, dark brown, dark red and red for about seven days. I also noticed this tissue-like material the size of a dime that my doctor was not worried about. He was not sure he found the heartbeat and said it was too early. I was treated for a cyst last year and just had an IUD removed before I got pregnant. My blood type is O-. Could any of this cause this spotting/bleeding, or did I have a miscarriage? I just had another positive pregnancy test, but I've had a backache on and off and just noticed that I no longer have pregnancy symptoms. I have lost five pounds and don't feel pregnant anymore. What should I be looking for if it's a miscarriage?

A.

This does sound quite suspicious for a miscarriage. At ten weeks, this should not be at all difficult to determine. A sonogram should easily tell you if there is a living fetus present. If there is not, then miscarriage is likely, and you may need a D+C to remove the tissue.

Q.

I am two weeks' late, which normally is not a big deal because I have been irregular. I am not on birth control, have sex regularly, and have had unprotected with my boyfriend. I am constantly hungry, but when I eat I feel like throwing up. I cannot sleep very well, seem moody, and am having a lot of diarrhea. I have also noticed slightly more than usual sensitive nipples. I was wondering if and when I should take a pregnancy test, or if it could be something totally different.

A.

As someone whose cycle is irregular, your female hormone production will tend to be unbalanced, with more estrogen than progesterone. This imbalance can be the cause of all of these symptoms. If the problem becomes persistent, a few days each month on progestins will usually keep it under control.

Q.

I have been nervous for the past two weeks. I started feeling bloated, and have had cramps on my left side. Two days prior I had unprotected sex. I went to my doctor and had a negative pregnancy test. My doctor said if I felt the pain in a week or two I should have an ultrasound, so I did today. I am on Loestrin, so I don't really get a period anymore, but do spot throughout the month. I am worried I might be pregnant or have a cyst. What could this be?

A.

A small cyst on your left ovary is quite likely. This is not harmful. Loestrin is a very low-dose pill, so often there is a bit of activity of one or both ovaries. If this is what turns out to be the case, a change in your pill dosage should correct it.

Q.

I have had Implanon for eight months, and my last period, which was very light, was two months ago. My breasts have started to get milk again, and my son is nine months old and he has not been breastfed in seven months. Could I be pregnant?

A.

Not likely. Implanon can cause these symptoms due to the small amount of progestin that is being released. At nine months, your milk glands can still be producing milk, which is harmless. If it is uncomfortable, ice packs will usually shut down this function.

Q.

I am six-and-a-half weeks' pregnant and started to experience a weird discharge about five days ago that went from creamy light pink, to brown, to chunky light pink, to brown. My doctor's office said it was not normal but happens to a lot of women. I am also experiencing some pain in different parts of my stomach and was told it is just ligaments stretching. I am still very worried about having a miscarriage.

A.

I agree with your doctor that none of this sounds unusual for early pregnancy. You are not at any higher miscarriage risk than normal based upon this. If the discharge turns frankly bloody, you should report this to your doctor.

Q.

I am 35 weeks' pregnant, have been having diarrhea for two days, and now I have bad stomach pain. Every time I stand my stomach feels heavy. I have back pain, and my baby is not as active as she was a few days ago. My doctor said to drink plenty of water, which is not helping. What else can I do?

A.

This sounds like gastroenteritis, but there is also some concern about your baby's activity level, which really should not be decreasing. There is no harm in over-the-counter or prescription medications, such as Lomotil, but you should also be doing daily kick counting to be sure your baby is doing well.

Q.

I have been feeling nauseous for about seven weeks and lately have been tired. I took a pregnancy test, which came back negative. Certain smells, like scented soaps and cleansing agents, make me even more nauseated. What could be wrong?

A.

Persistent nausea in the absence of pregnancy is most likely related to your digestive system. Such conditions as ulcers, hepatitis and gall stones are possibilities. As this has been going on a long time, you should consult your physician.

Q.

I had unprotected sex a week ago. Since then the lower part of my stomach has been hurting so badly. My period should be coming in three days. Could I be pregnant?

A.

While you certainly could be pregnant, it is most unlikely that the pain you are experiencing is related to pregnancy, unless, of course, you conceived earlier than you suspect, say two or three weeks ago. Most pregnancy tests available now will show positive three or four days before a period is due, so you should be able to find out in the next couple of days.

Q.

I am 40 weeks', 4 days' pregnant, and for the last 3 days have been having constant extreme lower-back pains, mainly on my left side. It is extremely painful to even walk, especially when putting pressure on my left leg. Sleeping is almost impossible. My baby's head is still not engaged and I have had no signs that labor is near. This is my first baby. If I can barely walk now, will I be able to handle childbirth? I am 28 years old and have had a reasonably smooth pregnancy up until now. The baby apparently has his back against my back, so I have been doing everything I can to encourage him to move off, but the pain is still there. I am almost at the point of needing a wheelchair, and in so much pain. What can I do for the pain, and to naturally induce? I am booked for an induction of labor in six days, which I would prefer not to have.

A.

What you are experiencing is a common event in a first pregnancy with a baby that is face-up. Some women have managed to get the baby to turn face-down by spending time on their hands and knees, which can employ gravity to cause the needed rotation of the head. It will also take the pressure off your back. Also, you should be doing as little moving about as possible. Bedrest will not only reduce your pain, but will increase blood flow to your uterus, thus helping get the labor started.

Q.

After being on birth control for five years, I stopped four to five weeks ago as my husband and I are trying to have a baby. About two weeks ago I started feeling tired, my nipples were really tender, and I have been having hot flashes. I never get headaches, and I have had about two or three really bad ones lately. My period is always between 25 and 30 days, lasting five days. This month my period came five days early and lasted only two days. I have also had weird cramping, nothing like I get when I have my period. My nipples are hurting. I have taken five pregnancy tests, which were negative. Could I still be pregnant, or is this from coming off birth control? I don't want to see the doctor until I have a positive HPT.

A.

This is almost certainly not pregnancy, but rather the commonly seen effects of going off the pill after using it for a long time. Your ovaries, which have been inactive for the past five years, are taking a while to resume their function. This can take as long as six months, but normal function eventually returns in almost every case. In the meantime, expect to experience the kind of symptoms you are describing as well as cycles that are quite unpredictable.

Q.

I am 25 years old, and 39 weeks', 6 days' pregnant with my first child. Last night I was having period-like pain and sometimes feeling pinching in my uterus. Could I be going into labor?

A.

You certainly could, although you need a bit more information before you can conclude that. Most women do not describe labor as a "pinching" sensation. Generally, the sensation is more dull and crampy, and, most important, is a sensation which can be timed and is regular. A good rule of thumb is to await that point where you experience these cramps every 5 minutes for an hour and that they last at least 45 seconds. Then head off to the hospital. Best wishes for a good birth experience!

Q.

I am seven weeks' pregnant. I fell last night. I noticed spotting when I went to the bathroom, then I started feeling sharp cramps. Can I still be pregnant? I took two pregnancy tests since, which were both positive. Is it too early for me to take them?

A.

The embryo is very well protected from injury, so a fall will almost never cause a miscarriage. However, if a miscarriage had occurred several days earlier, the fall can trigger the bleeding that you are seeing. Pregnancy testing will not be of value. Your doctor can quickly provide the answer with ultrasound testing.

Q.

I am four months' pregnant, and my breast is already producing milk. Is this normal?

A.

Yes, it is. What your breasts are producing is most likely a relatively clear and somewhat sticky substance called colostrum. It is frequently seen when pregnancy hormone levels are high, which is good. This is a very favorable sign that your milk production will be good when the time comes.

Q.

I have swollen breasts and have missed three periods. My tummy hurts when I move around too much, my nipples are darker, my stomach is hard above the belly button, and I have a white pinstripe from chest to navel and beyond. I had a UTI for about a week. I have never had one, got it randomly and couldn't get checked. It's getting better without treatment. I'm really hoping so. Please help me.

A.

You did not indicate that you have had a pregnancy confirmed, so I will assume you have. As to your "UTI," it is absolutely mandatory to have it evaluated by your physician, particularly if you have never had one before. Other, more significant, conditions can produce very similar symptoms. The fact that it appears to be getting better does not mean anything. Pregnant women often have urinary infections without symptoms. These can be quite dangerous and result in premature births. It sounds like you need a medical appointment ASAP.

Q.

I am one-and-a-half weeks' late. I had my normal mood swings two weeks ago and thought it was just PMS. I felt my cervix when my period was due and e/o day after and it was hard, low and open. So I figured it was coming and just had to wait. My moods have evened out and I just felt my cervix this morning, which is now moving up and has softened and closed. I took a test a week ago and it was negative. Should I retest? Could I be pregnant?

A.

You certainly could be, so a retest would be advisable. If the test remains negative and the period continues not to occur, then most likely you're dealing with failure to ovulate, in which case your doctor can provide you with a hormonal treatment which should bring back the normal cycle.

Q.

I have been feeling movements in my lower stomach for about two months. I have had two periods since it started and I have taken two pregnancy tests that were both negative. I already have three children so I know how it feels when a baby kicks. I also had my tubes tied two years ago. What could this be?

A.

The two most likely explanations are spasms of your lower abdominal muscles and intestinal movements, neither of which is abnormal or dangerous. As long as there is no serious discomfort, you may safely observe the symptom which should ultimately resolve on its own. If it continues a lot longer, bring it to your doctor's attention.

Q.

I am 37 weeks,' 5 days' pregnant. The other night I had what felt like contractions all night. I finally got to sleep and when I woke up they were gone. Is this slow labor? Also, my stomach is constantly tight. What is this?

A.

These are certainly contractions, but definitely not labor. There is, however, some value to this as the cervix will soften and open a bit from this, thus making the labor shorter when it occurs.

Q.

I had tubal ligation five years ago. I don't think I am pregnant. I have a blood-tinged discharge still one week after my last cycle. My stomach is tender and have a constant headache (in my neck area). Help!

A.

Much more likely than pregnancy is failure of ovulation, which is not at all uncommon. However, running a pregnancy test is cheap and easy to do. If it's negative, give yourself three or four weeks for your cycle to resume and then see your doctor if it has not.

Q.

I went to my doctor because I was experiencing abdominal pain, dizziness, difficulty having a bowel movement and nausea. During the ultrasound to check for cysts he said I had a gestational sac (approximately three weeks), but a blood pregnancy test came back negative. Two days later with terrible cramps I started bleeding one week before I was due to start. The doctor is not sure what is going on and ordered another transvaginal ultrasound. What could it be?

A.

At three weeks, a gestational sac is so tiny as to be barely visible and can easily be confused with a small volume of fluid within the uterus. I agree with the plan to repeat the ultrasound, which will likely show that this fluid has now passed and is no longer there.

Q.

I am a 44-year-old sexually active woman who always has protected sex. However, I did not get my usual period this month. Instead I got a dark brown discharge for about six days. Is this a sign of menopause, or should I take a pregnancy test? I do not have any other sign of being pregnant.

A.

Any time a woman who is pre-menopausal fails to get a normal period, she is pregnant until proven otherwise, so you should definitely run a pregnancy test. You are a little early for menopause, but at a very typical age for ovulation disorders, which this probably is.

Q.

I am 38 weeks' pregnant and am having sharp pains in my lower pelvic area that are very uncomfortable. I am having contractions that go from 5 minutes apart to 10 to 15 minutes apart, and the baby is still very active. What does this mean? Am I getting close to going into labor?

A.

None of these symptoms suggest that labor is close, although obviously it could occur at any time. The key will be when the contractions become long and, most important, regular. Until then, rest as much as possible (walking does not put people into labor) and drink lots of water.

Q.

I had two consecutive miscarriages with one D and C and the second was spontaneous. The doctor prescribed baby aspirin without any tests. She said to take it at least one month before trying again and after that throughout pregnancy. I did and now am in my second trimester and all is normal. Should I continue with baby aspirin? I thought it might be a problem during pregnancy.

A.

Aspirin at that low dosage will not be hazardous to either you or the baby, so you may safely continue to take it. It sounds like it has been helpful.

Q.

My teenage daughter has been complaining for about four weeks that it feels like "a fish is swimming in her stomach." She has irregular periods, so it is normal for her to go for two months without her menstrual. Numerous pregnancy tests have come back negative. However, I can feel kicking and jumping in her abdomen. She cannot hold down any meals for more than five minutes! She already weighed 210 pounds, but is steadily gaining and outgrowing more than normal. What else could this be if not pregnancy? She has admitted being sexually active with no protection.

A.

The likelihood of pregnancy is quite low; pregnancy tests are rarely inaccurate. Teenagers are very prone to moodiness and appetite changes, with all the stresses of their lives. Hormone imbalance with water retention is the most likely scenario.

Q.

I am 37 weeks' pregnant and having fever and chills along with loss of appetite for five days now. Should I be alarmed?

A.

To some extent, this depends on the level of your fever. If it is above 101, report it to your doctor. Otherwise, it's OK to take some Tylenol and simply monitor your symptoms.

Q.

I have a one-year-old. In my first pregnancy I had morning sickness and heartburn which began at around five weeks. I am now seven-and-a-half weeks' pregnant and apart from my breasts a little bigger and feeling heavier am not feeling any other symptoms. Should I be concerned? Should I be getting morning sickness if I had it last time?

A.

No two pregnancies are the same, so I wouldn't focus on your symptoms, unless they include vaginal bleeding or serious pain.

Q.

My 17-year-old daughter is due to have her baby in three weeks. We went to the doctor on Friday and she said my daughter hasn't gained a pound in a month and the baby also measured the same as a month ago. They are doing an ultrasound this coming Friday. What do you think is happening?

A.

Most likely nothing abnormal. The fetus is growing at about the same rate that amniotic fluid is decreasing, so uterine growth may not change. Weight change at this point is mostly water-related.

Q.

I am five weeks' and three days' pregnant and I have been having cramping in my ovaries similar to the cramping of my period each month. I am also having sharp pains and cramping in my right side. I had a miscarriage about four years ago. Are these pains normal?

A.

At this early stage, there's not much that can be said about what is to come, but it is quite common to experience stretching pains, which are not at all harmful. Just be alert to the onset of bleeding.

Q.

I lost my mucus plug, then had the bloody show, then a few hours later had contractions that went to three to five minutes apart, lasting more than 60 seconds. Went to the hospital. They did a swab test saying positive that I was going to go into premature labor, then checked to see that I was two centimeters dilated and the cervix was still about two centimeters long but very favorable. They gave me shots to mature the babies lungs and put me on bedrest for three days. They also did a bpp ultrasound with results saying my baby is measuring at only 3l bs and I am 35 weeks. I am home now but if I do too much activity I feel cramping in my lower back, and thigh pain. Are there any precautions I should be taking? This is my third child. What could the pain be from? Is there anything I should be doing to prevent my water from breaking?

A.

It is very fortunate that you have managed to reach 35 weeks. At this point, prematurity poses very little risk to your baby; however, poor fetal growth is more of a concern. From here on it is crucial to monitor fetal status, and, if there is concern for well-being, delivery would be indicated. Your best strategy is to focus a lot of attention on fetal movement and spend as much time off your feet as possible. If your water breaks, just head to the hospital.

Q.

I am 15 weeks' pregnant, and the doctor told me that my cervix is a little soft. Does this means I am going to have a miscarriage and, if so, what can I do to prevent it?

A.

Fifteen weeks is not a common time for miscarriages. In addition, the changes in the cervix which can be worrisome are not softening, but dilation and shortening. If your doctor determines that there is no progressive change in your cervix by the next visit, there should be no further concern.

Q.

I am 39 weeks' pregnant. I do not think I am in labor but I am having severe pains in my vagina that are making it hard for me to walk. It hurts when I sit down and stand up, and it is most painful when I walk. My cervix is still closed, but my 40 weeks are up in 6 days. What's wrong and should I call the doctor? This pain is bringing tears to my eyes.

A.

This sounds very much like a condition we call "dysfunctional labor." It is actually quite common. It is a situation in which the uterus is contracting, but in a very uncoordinated way. This results in a great deal of pain, but no actual cervical dilatation, as well as much fatigue due to the enormous energy consumption involved. The best treatment is rest; if it cannot be accomplished at home, it can be provided with strong pain relievers in the hospital.

Q.

I am 48 and have had no menstrual cycle for almost a year. I am having pregnancy symptoms: enlarged abdomen, increased sense of smell, nausea, veins on enlarged breasts, veins on abdomen, tired, emotional. Two false pregnancies and one false blood test. Waiting for a doctor appointment.

A.

What you are having is a sudden, but likely brief, release of estrogen from your ovaries. This is common during the first year or so of menopause. You can expect these symptoms to resolve on their own, but should consult your doctor if this does not happen in the next three or four weeks.

Q.

I am on day 48 of my first cycle after a miscarriage that began on April 19th. I have been waking up very hot early every morning, getting up to pee at least twice every night for the last few nights and I feel like I can smell everything. HPTs all come up negative. Is it possible I can still be pregnant?

A.

Most unlikely. Pregnancy tests are extremely reliable. More likely, your ovaries have not resumed balanced function following the miscarriage. That can cause all of your symptoms. If your normal cycle has not returned within the coming month, arrange for a visit to your gynecologist.

Q.

I have PCOS and normally only get my period every 30 to 34 days. This month I got what looks like my period two weeks early. I had a pink discharge on the first day, and then a bright red on the second day, both only when I wiped. Nothing yet on day three. I have a bit of cramping and burning in my tummy together with a sore throat. I was last active eight days ago. Please help.

A.

PCOS (polycystic ovarian syndrome) interferes with ovulation, as I am sure you know. The symptoms you are having are most likely the result of hormonal imbalance and are not dangerous.

Q.

I found out I am pregnant about a week ago, but for the last three to four weeks I have been having a massive headache and stomach pain. This is my second child and I never had these symptoms with my first. Also, I drink at least three to four ibuprofens a day. Is this bad? Every time I sneeze I get a sharp pain in my lower stomach. I have not seen a doctor yet.

A.

The ibuprofen is not harmful, but you will do a lot better by simply increasing your water intake. It is very common to become dehydrated in early pregnancy, which is the most likely cause of your headaches. The lower stomach pain is probably the result of pelvic ligament stretching; this is not harmful.

Q.

My period is two weeks' late. My lower abdomen is tight, my breasts tender, I have headaches and I feel nauseous every now and then. My lower back hurts when I get up in the morning. The pregnancy test was negative. Could I be pregnant?

A.

Not likely. These symptoms, while they are quite similar to those of pregnancy, are most likely caused by hormonal imbalance. Once the period arrives, the symptoms should resolve.

Q.

I am about seven weeks' pregnant. I had a sonogram last week because I had a UTI and vaginal infection, as well as dehydration and some vitamin deficiencies (due to all the vomiting). A few days later I had some small bits of red, brown and white tissue discharge, then the day after a large pink clump of mucus. I had some more pink tissue the next day but since then no blood. I stopped vomiting for two days, but since then have had some serious cramps, a slight fever, increased vomiting and chills. Should I worried?

A.

None of this sounds worrisome. Vomiting can cause small blood vessels to rupture, which is probably what you are noticing. It should stop for good when your vomiting finally ends (which it should do by 10 to 12 weeks).

Q.

I am currently eight weeks pregnant and I get frequent back pain. Is it safe to use a heating pad on my back?

A.

Sure it is. Heat will loosen your back muscles, which frequently go into spasm during pregnancy.

Q.

I was supposed to have my period a week-and-a-half ago. I got it today and it's light. I was extremely moody and had sharp pains in my lower abdomen. I took a pregnancy test, which was negative. Could I still be pregnant?

A.

No, it's quite unlikely that you are pregnant. You're describing symptoms of hormonal imbalance resulting from failure of ovulation. You can expect to get your period in the next two weeks, but if that does not happen, you should run another pregnancy test. If it's still negative, your doctor has the option of "re-balancing" your hormones with a progestin tablet for a few days, which should get the cycle back on track.

Q.

I'm 33 weeks' pregnant, and have a lot of clear discharge and sharp vaginal pain as if the baby were kicking me there. Could I expect to have my baby anytime soon? I have been scheduled for another ultrasound next week because the doctors are not sure of my due date.

A.

None of this suggests that your baby will come early. As to your dates, ultrasound will serve no purpose at this late stage. It is only reliable for that purpose prior to about 20 weeks.

Q.

I have been on Implanon for almost three years, and am due to take it out in five months. My periods were irregular but I could not go on for two months without getting it. My last period was five months ago. My stomach has gone bigger and feels full. I get nauseous at times, my breasts seem big and I'm tired. I had negative pregnancy tests. Could I be pregnant?

A.

Almost certainly not. Your Implanon is the reason for your periods being infrequent as well as the other symptoms. All this will resolve when the Implanon is removed.

Q.

I'm 36 weeks' pregnant and getting horrible-smelling breath, plus really itchy skin. Is it something I should worry about?

A.

Your breath is simply showing stomach acids which tend to back up into the esophagus at this stage. As to the itching, it's usually a combination of dryness and the generalized tissue swelling of late pregnancy. These are not worrisome symptoms.

Q.

I am 21 weeks' pregnant and feel the baby move below my belly button, sometimes near my genitals. I also get this quick pain in my vagina sometimes, which then goes away. Is this normal?

A.

These are all entirely normal symptoms at this stage. The baby's position is quite variable and the ligaments supporting the uterus are often being stretched.

Q.

I have been having abdominal pain like small contractions. My doctor says it's either the cyst on my ovaries, my uterine walls expanding, or a sign of miscarriage. This is my second child. Can sex cause a miscarriage? I'm told bed rest one minute, then not. I'm six weeks' along and confused.

A.

The vast majority of the time, this is merely a symptom of growth of your uterus. Bed rest offers no advantages. And, no, sex does not cause miscarriages

Q.

I am 35 weeks' pregnant. I feel the baby move all week, but by the weekend I sometimes feel no movement for almost two days. Is this normal?

A.

No, it certainly is not normal. At this point, you should feel movement several times a day. The best way to evaluate movement of your baby is by the so-called "kick count" test, which your provider can explain to you.

Q.

Can nitrofurantoin cause miscarriages? My baby was fine until I took this drug. I am being told I miscarried at ten weeks, and it happened last week when I started to take this drug.

A.

This drug has been thoroughly studied and does not cause miscarriages. There are, in fact, very few drugs which do. It is important to remember that miscarriages are extremely common events, at least 15 percent of all pregnancies. Almost anyone who miscarries can identify something they did which preceded the event. This does not imply cause and effect.

Q.

I had an ultrasound at 13 weeks, and my doctor told me that I have placenta previa. I just went in for a checkup at 17 weeks. Could I still have a normal pregnancy now that I am further along?

A.

A placenta previa at 13 weeks is a meaningless finding, as it almost always resolves on its own. The matter is easily followed by periodic ultrasound. If the placenta previa is still present by 31 to 32 weeks, then it will likely not resolve and normal delivery will become unlikely.

Q.

I had a miscarriage 13 weeks ago, in my sixth week of pregnancy. Two months ago I had my last period, which was light pinkish and visible only when I would wipe. It lasted two days. A week later, I was having the same cravings I had when I was pregnant, so I went to the doctor. An ultrasound showed a sac, but the blood test was negative. I had the same results last week. What could be the cause?

A.

First of all, it sounds like your periods have really never returned to normal. This raises the question of whether you ever fully passed the tissue at the time of the miscarriage. If there is still a sac present, it needs to be removed, which is a simple office procedure. Only then will your uterus be able to support a pregnancy.

Q.

I am 25 and have had irregular periods since becoming sexually active at age 15. I had PID, then had an ectopic pregnancy that left me with one tube when I was 22. I have been trying to get pregnant for four years and nothing is happening. Lately I have been having trouble keeping food down. Everything comes back up, but I have not lost any weight from the vomiting (I am a bit overweight). I thought I might be pregnant but have had two negative pregnancy tests. Will I ever get pregnant?

A.

This does not sound good. Your history is textbook for infertility. Your best bet at this point would be to find out if your remaining tube is open. This can be done by a simple X-ray procedure called a hysterosalpingogram. If it is closed, you will need to resort to in-vitro fertilization as pretty much your only hope.

Q.

My period was four days' late and lasted for five days instead of the usual three to four days. It started as brownish, then turned crimson. I've taken three negative pregnancy tests, including one at the doctor's office. I've been having headaches and feeling dizzy. I thought it was because I wasn't eating enough, but when I eat a lot I still have those symptoms. I get hungrier faster, my lower back and neck hurt, and I go to the bathroom more. I don't know if it's just my body or if I'm pregnant.

A.

This sounds a lot more like delayed or failed ovulation than pregnancy. You will know soon enough when your delayed period begins. If your tests remain negative for another two weeks and the menses don't begin, your doctor can provide a "hormone withdrawal" test, which should clarify the matter.

Q.

I am eight weeks' pregnant and have been bleeding for over two weeks, heavy, dark red, with occasional clots. I have been to the ER and my doctor. I have also had two sonograms. The baby's heart rate is strong at 150 bpm, but the bleeding wont let up. Can the prenatal DHA I am taking have anything to do with it?

A.

This is not an unusual situation, and nearly always stops with pregnancy progressing normally from that point onwards. Blood vessels are fragile during pregnancy. When a fetal heart beat is seen, there is a 90-percent chance of a subsequent normal outcome.

Q.

I am 35 weeks', 4 days' pregnant with twin girls. I am noticing some vaginal itching, which feels like the beginning of a yeast infection. Last week I was dilated one-half cm and am now having a brown vaginal discharge. Is it still safe to use OTC medicines for yeast infections, since I am dilating and my cervix is starting to efface? I also think that I have lost some of my mucus plug.

A.

OTC medications for yeast infections are harmless at any time, including term pregnancy. The only reason not to use them would be if you suspect your membranes have ruptured.

Q.

Is it safe to have sexual intercourse in the third trimester of pregnancy when scheduled to have a C-section? What will happen if I go into labor?

A.

There is no evidence that a normal pregnancy is put at any risk by having sexual intercourse. In the unlikely event that you go into labor, you would just go to the hospital. I have had it happen that women arrive at the hospital in advanced labor and turn out not to need a C-section at all.

Q.

I was a week late for my period, then started some spotty, thick brown bleeding that lasted only two days. I have numerous pregnancy symptoms, including feeling my uterus contract and having sharp vaginal pains. I had one faint positive home pregnancy test and two negative tests, plus two negative blood tests the past two weeks. I had unprotected sex one month ago. My cervix is high, closed and soft, and has been for over two weeks, with more cervical mucus that is white and lotion-like. Is there any way I can be pregnant without it being confirmed by a blood test?

A.

There is almost no chance of that. Far more likely is that you have a hormonal imbalance which has caused the symptoms you describe as well as the late period. Pregnancy blood tests are very close to 100-percent accurate.

Q.

On Monday my doctor told me that I was one-and-a-half cm and almost 70-percent effaced. This is my second child, and I did not really get a chance to go through labor with my first, because I was induced. By the time I was induced they started me on Demerol. For the last six hours I have had a consistent throbbing in my lower back and sharp pains anywhere from 7 to 12 minutes apart. Could this be labor?

A.

What you are describing is not labor, although it could well be what we call the prodrome, a condition leading to labor. When your contractions reach every five minutes, lasting 45 to 60 seconds, you should head to the hospital and be evaluated.

Q.

I experience irregular menses and a sharp pain on my ovaries. I took a negative pregnacy test. Am I infertile?

A.

Most likely not. The only way to find that out is to try to become pregnant for about six months. If that does not occur, then both you and your partner should be tested. Remember that 85 pecent of women are fertile. Your symptoms are not very specific, so not much can be said about them.

Q.

I am measuring 34 cm at 30 weeks. My fluid and sugar are good. My due date is right. What does this mean?

A.

Most likely it means nothing. Measurements of the fundus (top) of the uterus are not a reliable predictor of fetal status once you get beyond about 20 weeks. All that's important is that the size is neither decreasing nor increasing at a truly rapid rate, which this is not.

Q.

I am spotting two days before my normal period. It's a very light flow, and is usually heavy. How long should I wait to take a pregnancy test? Could this be implantation bleeding?

A.

It's a bit late for implantation bleeding. I would advise you to take a pregnancy test when you are five to seven days late for the menses.

Q.

I don't feel heavy, even at 37 weeks of pregnancy. Does that mean my baby is underweight?

A.

No, it doesn't. Babies are remarkably capable of deriving the nutrition they need during pregnancy. Other than cases of true maternal malnutrition, your weight will not have a major influence upon the weight of your baby.

Q.

At 19 weeks, my doctor said that my uterus is not enlarged and my cervix doesn't look like I'm pregnant but I'm big and I feel my baby. Also I hear the heartbeat. How is this possible?

A.

There are a great many reasons why a person may feel "big" and feel things that closely resemble fetal activity. Intestinal problems are certainly a likely explanation. You may depend upon your physician to be able to confirm pregnancy when the signs are present.

Q.

I am 20 weeks' pregnant and my HCG test still comes up negative. What is wrong? Doctors can't explain it. At first my doctor did not believe I was pregnant until I had an ultrasound. What is the reason for this?

A.

It is simply impossible to be 20 weeks' pregnant with a negative HCG test, as that hormone is produced in massive quantities by the placenta. Best guess is that there's a problem with the lab, and this result should be investigated by them.

Q.

The first day of my last cycle was five weeks ago. I normally have a 28-day cycle. My husband and I had sex before and after my ovulation days. I had my implantation bleeding, which lasted not even a full day. I have frequent urination, fatigue, sore nipples and a bloated stomach. Yesterday I had a milk-like substance coming out of the side of my nipple. I have taken too many HTP tests,which were negative. I am currently five days' late for my cycle. When should I be able to get a positive result?

A.

The test should already be positive unless there was an interference with the process of ovulation, meaning that it was delayed or didn't happen at all. Failed ovulation could produce all the symptoms you describe. If no menses occurs in the coming seven days, run another pregnancy test.

Q.

I am seven months' pregnant. Today I noticed that one side of my skin outside my vagina feels swollen, but I don't have any pain. Is this normal?

A.

This is what we call "dependent edema," a situation in which fluid moves to the dependent, or lower, side of the body. Late in pregnancy, this is very common and completely safe. If it's uncomfortable, lying down with the hips elevated will reduce it.

Q.

I had a miscarriage two weeks ago and began having sex right after I stopped bleeding, which was seven days after my miscarriage. How long does the pregnancy hormone stay in your body? As it goes down could your nipples still be sore, or could this be a sign that I'm pregnant again?

A.

The hormone is detectable for five to six weeks after a miscarriage, so you certainly could still be having some symptoms from that. A new pregnancy this soon is very unlikely.

Q.

I am 38 weeks' pregnant. Thirty minutes after having sex I started having mild period-like cramps. Is this normal?

A.

What you experienced was the uterus contracting, which is a known phenomenon following orgasm. It is not generally believed that this will start labor, but since you're already 38 weeks, that could occur at any time regardless.

Q.

I am 28 weeks' pregnant with my third child. For the past week or so I've been having vaginal pain, almost like I've been kicked in the groin. I've noticed throughout my pregnancy that this feeling has come and gone, but lately it has been constant and hurts when I walk, although I notice no pain while sitting or lying down. I don't think it is anything to worry about, but I had Hellp syndrome with my first child and delivered her at 31.5 weeks, so I can't help but wonder.

A.

What you're describing appears to be the very common, but harmless, condition known as the round ligament syndrome. It creates a sharp pain, usually in one groin or the other and is the result of stretching of the round ligament, which holds the uterus in place. Most often, it occurs after changing position, such as getting out of bed in the morning. Heat to the area and rest will usually shorten the duration of the event.

Q.

I am 39 weeks' pregnant, and at my last appointment one week ago my doctor said the baby's head was very very low and it would be anytime. As of last night, I have had diarrhea, nausea and stronger contractions. I'm not sure if these are the Braxton-Hicks I have been having for the past few weeks. It has been hard to time them since I have a constant low backache/pains, but I can feel when my stomach hardens. I went for a walk and now I have sharper menstrual- like cramps and feel the urge to use the bathroom. I have already been losing my mucus plug as of last week. Should I call my doctor or is this just false labor?

A.

While this doesn't sound like true labor, it does sound like it's very close. Best strategy is to get as much rest as possible so that you have a good level of energy to carry you through the birth process. When you are in true labor, you'll know it.

Q.

My right breast is leaking clear fluid. My lower back has been hurting. The lower left side of my stomach has a knot that hurts and gets hard and then soft at times. When I take my bra off my breasts hurt for a while. I am tired all the time and sometimes have constipation. I had tubal ligation 13 years ago. I took a negative pregnancy test. What can it be?

A.

It is certainly not normal for there to be leakage from the breast. This should be investigated soon. Your wide variety of symptoms is difficult to evaluate without a lot more details. By all means, do make an appointment with your doctor in the near future.

Q.

Since I was about 15 weeks' pregnant, I have been feeling some sudden hardening on a part of my abdomen. At times on the lower abdomen, sometimes on the right side. I am not sure if they are contractions. Some I don't feel it at all unless I touch my abdomen and it's quite hard and feels like there is a lump there. Some give me mild-to-moderate discomfort. It only lasts about a 30 to 60 seconds. I have not had any bleeding or spotting. I am now 16 weeks', 3 days' pregnant and continue to have them once in a while. Are these normal? Do they suggest anything?

A.

It's hard to tell as there are so many minor aches and pains of pregnancy, but it certainly does not sound serious. You might have a small benign uterine tumor, known as a fibroid, which often tend to grow during pregnancy. Although I wouldn't actually be worried, I'd certainly report it if you find the symptom to be worsening.

Q.

I am ten weeks' postpartum. At about five weeks' postpartum I had unprotected sex twice in one night. About a month ago I started progestin-only birth control, seeing how I am nursing. Since I started birth control I have had unprotected sex about five times. About two weeks ago I started having headaches, lower abdominal cramping and upset stomach. And the past couple of days I have had a discharge with blood streaked in it, though it's not bad. I mostly notice it when I wipe. I'm wondering if this is linked to the birth-control pills or if I could possibly be pregnant again.

A.

While a new pregnancy is not impossible, it is the least likely explanation. The vast likelihood is that this is a response to changes in hormone levels as a result of the combination of resumption of ovarian activity and the birth- control pills. The symptoms should resolve when the hormone levels stabilize in a few weeks.

Q.

This is my third pregnancy, and I am 29 years old.�I am 19 weeks' along and can barely walk. There is intense pain in my lower right side and it hurts to sit on the toilet, hurts to cough. Should I see someone or wait a few days to see if the pain goes away?

A.

You are right at the point in pregnancy when the condition known as round ligament pain begins to occur. Although it's quite painful, it's not harmful, and can be observed. Decreased activity and heat to the area will usually help resolve it. There are other possible causes of this sort of symptom, such as fibroids or hernias, but these are rare. Be sure to mention it to your doctor on your next visit.

Q.

Is it bad to have a lot of amniotic fluid?

A.

It can be, depending upon the magnitude. Your doctor can tell you whether the volume is truly excessive, which is pretty rare. In true cases of excessive fluid, a condition called polyhydramnios, there is a serious risk of fetal abnormalities, and a detailed ultrasound exam would be warranted.

Q.

What should you do when you have had a C-section and it's hard to breastfeed? Should I still breastfeed or not?

A.

There is no particular reason why it should be hard to breastfeed because of a C-section, although you may have to experiment a bit with how you hold the baby so as to avoid pressure against the incision. You should make every effort to continue, as breastfeeding speeds up the recovery of the uterus, something especially important when you've had a C-section.

Q.

I am six months' pregnant and have white bumps or what looks like pimples near my vagina. Is it a pregnancy symptom? If not, what could it be?

A.

There is a whole myriad of skin changes which occur during pregnancy. Most are due to hormonal influences and are harmless. So long as there is no serious discomfort or itching, this may be safely observed, but should be investigated if it persists beyond a couple of months after the pregnancy.

Q.

I am 37 weeks and the doctor says I measure like I'm 40 weeks. She scheduled an ultrasound for tomorrow. Could something be wrong? Would they change my due date?

A.

It is most unlikely that there is anything wrong. Uterine size measurements near term are essentially meaningless, so long as they are not going down. By absolutely no means would this change your due date.

Q.

I'm 31 weeks' pregnant with my fourth child. The last couple of weeks I cramp and contract with everything I do. I stand for ten minutes, then start to cramp and contract. Does that mean I might end up on bed rest?

A.

The issue here is whether or not your cervix is undergoing labor-type changes. If not, the issue does not relate to premature births, and you are not required to take any special precautions. Most of the time, this symptom is caused by inadequate hydration, so try to increase your fluid intake.

Q.

I am in my 22nd week and am told that I have a low-lying placenta. I am scared. Is it advisable to fly or travel by train in my 30th week?

A.

Close to 50 percent of patients at that gestation have a low-lying placenta. All but about 1 percent resolve well before term. It is not an issue you need be concerned about, and travel at 30 weeks is OK if there are no other problems.

Q.

I'm 21 weeks' pregnant, and want to know if there is anything I could do to decrease depression. I have had it since I was around 14 years old. It left, then I got pregnant and was scared it would leave me hurt and in the hospital. My depression has gotten so bad that my fiance and I have split up because I am so depressed and so angry at him. Please help. �

A.

Depression related to pregnancy is, unfortunately, quite common and can be very serious. It requires immediate attention. The good news is that there are now extremely effective treatments which you can access through a psychiatrist. They work well and pose very little hazard to you or the baby.

Q.

I had my period on March 13 and sex on March 21, six days before my ovulation date. I have been feeling a twinge in my abdomen, along with nausea. My period is three days' late, but I had a negative pregnancy test result. Could I have taken the test too early?

A.

Not likely. These days pregnancy tests are usually positive even before the period is missed. If you had intercourse on day nine that resulted in conception, which is not at all unlikely given the fact that sperm cells survive for 72 hours, your pregnancy test would certainly be positive by now. That said, ovulation is a very elusive phenomenon (which is what keeps us OB doctors busy), and so you should repeat the test in another few days if your period still does not come.

Q.

I am about 21 weeks' pregnant. I was having sex and a white chunky substance came out during intercourse. What is this?

A.

White "chunky" vaginal discharges are often the sign of a yeast infection, which, by the way, does not always cause other symptoms. It should be easy for your caregiver to diagnose this. While these can be a nuisance, they are not dangerous.

Q.

I am five weeks' pregnant and very scared. I should be so happy, but I have been crying a lot. I keep thinking about labor and how scared I am. What can I do to stop thinking about all the scary things?

A.

You are a victim of wildly fluctuating hormone levels, which is not at all uncommon in early pregnancy. It will resolve. Beyond that, you are quite rightly anxious about what lies ahead in terms of the major responsibility of becoming a parent. By the second trimester, you will nearly always put these issues behind you and focus on the great adventure which awaits you.

Q.

I had a mcdonald cerclage put in at two months for bleeding and dialation. The day before I had this done my doctor said I had a blood clot that showed up on my sonogram. On another visit he told me I would probably have a C-section if my placenta didn't move. On the next visit he said my fetus was very underweight but would catch up, my blood pressure was very high the entire pregnancy. Before I made it to the next appointment I was feeling so bad and my stomach shape had changed and the baby was not moving. I went in that day. The baby had lost all fluid and was born that day and only weighed one pound. My placenta was in quarter-size fractures. My doctor was in shock. What could have caused this? He is a wonderful doctor and I trust him so much. I know it was not his fault.

A.

As you know, none of this is anyone's fault. The major issue here was the loss of the amniotic fluid. Most likely, this was caused by an abnormality of the baby's urinary system, which would have prevented its survival even if you had gone on to term. Most likely, you will not be at increased risk of having this sort of thing happen again.

Q.

I am 26 weeks' pregnant and having a complication-free pregnancy. In March 2008 I had a miscarriage at eight weeks' along. I seemed to have passed all the tissue normally. My ob did an ultrasound when I went in for a follow-up and said that everything looked to have passed. She did say that she saw a small piece of what she thought was tissue, but reassured me I would pass with my next period. I was told from the beginning with that pregnancy that I would more than likely miscarry. It just wasn't developing. After that miscarriage I had seven normal periods and we found out we were pregnant again in October. This piece of tissue would of came out during a normal period, correct? I just keep having this fear that it stayed in my uterus and would cause harm to the new baby.

A.

There is no cause for alarm. It is not uncommon for a small amount of debris (clot, membrane, etc.)to remain in the uterus for a few weeks after a miscarriage. If it doesn't pass on its own, your body will reabsorb it. It is now long-gone and is not an issue.

Q.

I'm 32 weeks' pregnant and a few days ago had a slight fall on my left side. Since then I've had lower-back and lower-belly pains. My baby seems to be moving fine but not kicking as much as usual. Should I worry?

A.

Very rarely will gentle trauma cause any problems with the baby; they are amazingly well-protected in there. On the other hand, you should be focusing upon the baby's movement pattern by doing what are called kick-counts. Your doctor can advise you how to do that.

Q.

I'm 36 weeks' pregnant and woke up this morning with a lot of pain behind my eyes. It has never happened before. Should I be concerned?

A.

Yes, you should. This can be a serious matter reflecting a buildup of pressure in the brain, possibly an indicator of the dangerous condition called PIH (pregnancy-induced hypertension). Be sure to report this event promptly to your caregiver.

Q.

I'm 16 weeks' pregnant. I was bleeding for one week my HCG level was 33 percent. It was suppose to double up and it dropped to 7 percent. I was supposed to go back in a week but I didn't. I'm scared to test negative for pregnancy. Can my baby be saved?

A.

HCG levels are not reported by percent, but rather by absolute levels. While it's not a good sign for the HCG level to be dropping, this lab test is not customarily used to evaluate a pregnancy after the first trimester. An ultrasound test will provide the information you need.

Q.

I'm seven weeks' pregnant and had an ultrasound at about six-and-a-half weeks. The doctor said I have a small blood clot in my uterus, but I'm not bleeding. I don't want to lose the baby. I'm taking it easy like the doctor told me to. So should I worry?

A.

Probably not. Your doctor likely saw a small clot outside the sac in which the pregnancy is contained. We call that a sub-chorionic bleed. As long as it's not increasing in size, which can easily be determined by another ultrasound in a couple of weeks, there should be no danger.

Q.

For the last three years my husband and I have been trying to have a baby. Last month we had sex during ovulation and I got a severe vaginal infection. I'm taking antibiotics and having injections for the infection. I missed my period this month, and had a negative pregnancy test. I feel tired and sleepy all day, sometimes nauseous. I'm worried about having taken the medication if I am pregnant (pacid,tab-manicef 250mg, tab-blydase dp,tab-fucen 150mg and tab-atarex 25mg). What should I do?

A.

Three years is a long time. I hope you've sought fertility evaluation by now. Also, there's no logical reason why having sex at ovulation should cause you to develop a vaginal infection. While none of the drugs you mention have been shown to be hazardous, it's time to start getting these largely unnecessary substances out of your body.

Q.

I'm 39 weeks' pregnant, three-cm dilated and 50-percent effaced. I have had some contractions but now I keep feeling like I have to have a bowel movement and nothing happens when I try to. I also feel period-like cramps. Is this a sign of early labor?

A.

'o, this isn't really a sign of labor, but it is a favorable development in that it reflects the fact that your baby is descending into the pelvis where it creates a sense of rectal pressure that you describe.

Q.

I'm about 5 weeks' pregnant, and am having light pink spotting. My back is a little achy. Is this normal?

A.

Can't really say. There's very little that can be clearly defined about a pregnancy that early. We consider any bleeding in the first trimester to be a potential miscarriage, so a good strategy is to have your doctor measure your HCG (pregnancy hormone) level and repeat it a couple of days later, just to be sure it's going up. If it's going down, miscarriage is likely.

Q.

I'm 36 weeks' pregnant, and for the last couple of days the lower left side of my back has been so sore I find it hard to even walk. What can I do to reduce the pain?

A.

These sorts of pains, which involve the mid-lower torso, fall into the broad category called "musculo-skeletal" issues. They are caused by the dramatic postural changes which accompany late pregnancy. Think of this as a message to you from your body that the time has come to reduce activity so as to provide needed oxygen and nutrients to your uterus to prepare it for labor.

Q.

I'm eight weeks' pregnant and cannot eat without vomiting. I feel very weak and lonely, and want to cry. I'm in the U.S. with my husband, and in school. I feel at a loss.

A.

You have the very common condition known as hyperemesis. Although it's a very disturbing problem, it is not usually dangerous so long as you don't become dehydrated. There are occasions where IV fluids need to be administered, so don't let this matter worsen indefinitely. The good news: Women with hyperemesis almost never miscarry, presumably due to the very high hormone levels which are believed to contribute to the condition. Also, it nearly always comes to an end by 12 to 13 weeks.

Q.

I'm 18 weeks' pregnant and have been having spotting for one week since a visit to the ER where the ER doctor did a pelvic. It has gotten a bit heavier and I'm worried.

A.

Pelvic exams during pregnancy, while not specifically harmful, do have a tendency to rupture small blood vessels in the cervix. Bleeding should remain light, however, and resolve after a few days. If it ever approaches a menstrual level, then this is clearly not normal and should be investigated.

Q.

I was told not to eat pineapples during pregnancy. I first thought it was a joke, but is there a danger?

A.

There is no evidence of anything harmful to you or your baby from eating pineapples (or any other fruit for that matter.

Q.

I'm 20 weeks' pregnant and for the last week have been experiencing mild cramps and diarrhea in the morning that disappear once I have been to the bathroom. Is this normal?

A.

Yes, it is. The digestive system changes dramatically during pregnancy, but these changes should be considered as mostly favorable since the slowed-down digestive process results in more nutrients being absorbed and getting to the baby. In addition, by about 20 weeks, the uterus becomes large enough to compress the large intestine when you are reclining. This tends to prevent bowel contents from passing smoothly until you begin to stand upright.

Q.

I'm 39 weeks' pregnant and have a brown vaginal discharge. What is it, and is it normal?

A.

It is blood that has turned brown as a result of being acted upon by the acids in the vagina. All it means is that your cervix is starting to open and efface (thin out), which it is supposed to be doing. This causes small blood vessels to tear and bleed lightly. It is a normal phenomenon and not dangerous.

Q.

Is it normal at 35 weeks' to have blood and a mucus of clotting while making a bowel movement?

A.

Rectal bleeding is never considered normal, although at 35 weeks, it is quite common to have large hemorrhoids which can cause this symptom and is not dangerous. At this late point, it is best to assume that is the cause, but it should disappear within a week or two following the birth.

Q.

Is having lots of white, clear discharge a sign of pregnancy?

A.

No, it's not. It is true that the volume of clear cervical mucus increases a bit in pregnancy, but this is not a specific sign and can related to lots of other issues. It's not generally considered abnormal.

Q.

I was told I was five weeks', six days' pregnant when I had an ultrasound, but all we saw was my uterus. I was told my uterus was not open yet and it was thick. I am worried because we saw nothing and I need to go back in three weeks to see if we see the baby then. On my papers it said no iup or ivp. I don't know what it means. The doctor never said anything was wrong, but my mother has had five kids and said with all of them she had an ultrasound at that point or earlier and could see something.

A.

Assuming that your dates are correct (which they are not at least one-third of the time), then a sonogram should most definitely have shown what we call a "gestational sac." Rather than wait three weeks, a much better strategy is to have an HCG blood test with a repeat two or three days later. If the level is doubling during that time, a normal, albeit quite early pregnancy is very likely. If it's going down, the pregnancy has miscarried. If it goes up, but only by a small amount, this increases the likelihood of an ectopic pregnancy.

Q.

I am in the 17th week of pregnancy, and for two days I have had vaginal itching in my vagina and a burning sensation when I urinate. What could the reason be? It's my first pregnancy and I am 23 years old.

A.

Obviously, there is some form of inflammation of the vulvar/vaginal tissues. By far the most common cause of this during pregnancy is Candida, more commonly known as a yeast infection. It is reasonable to try using one of the over-the-counter treatments for a few days, but if this fails, you'll need to be evaluated by your caregiver.

Q.

I'm 35 weeks' pregnant and have lower-stomach pain. I woke up with a pinching pain on the lower left side of my stomach. Since then, it has been about three hours. I have had a constant tight feeling...not like a contraction, just constant tightness that doesn't go away.

A.

No, that wouldn't be a contraction. Those are intermittent, not steady. This sounds more like the stretching of one of the supporting ligaments of the uterus. This is a very common event once the uterus becomes heavy. It usually results from a sudden change of position, such as getting out of bed in the morning. As long as fetal activity is unchanged and you don't have worrisome symptoms such as vaginal bleeding or fever, this is not dangerous and will resolve with a few more hours rest.

Q.

My sister went to the doctor today and was told that she had no amniotic fluid around her baby. They told her she had to have an DNC or go home and wait for the baby to die. They told her that the baby is healthy but will die due to lack of fluid. She is only 19 weeks' pregnant and this is her first child. Is there anything she can do to save her unborn child? I love my sister very much and do not want to see her go through a horrible outcome.

A.

This is truly a tragic and not uncommon situation. There is, unfortunately, not a thing that can be done. It may be some consolation to know that it's not likely this baby would have survived anyway, as this situation is often associated with severe kidney problems that would have produced the same outcome.

Q.

I went for an ultrasound last week, and my doctor had me down for ten weeks' pregnant (I did not feel I was this far along). My first day of my last period was 1/16/09; however I am sure that I didn't conceive until 2/14/09. I found out I was pregnant 3/3/09. The ultrasound was completed, and the doctor asked me if I could be off by four weeks. I said yes. He said he saw the sac, but it may be too early. He didn't say there wasn't anything in there, but I think there was concern. I had HCG levels done that day and then 48 hours later. My levels are good, the doctor said. I go back for another ultrasound in four days. Should I be concerned that we didn't see the baby? I was probably around six weeks instead of ten. My periods have never been normal or every 28 days, more like 35 to 40 days or longer. I have no symptoms of a miscarriage, but am worried because I have had miscarriages before. I am worried I won't see the baby in the sac next time! I am overweight, and don't know if that is part of the problem.

A.

What you are describing is a very common situation and is not worrisome. Clearly,your ovulation pattern is irregular, making it hard to determine when you got pregnant. At your next sonogram, you should easily see the baby.

Q.

I am 22 weeks' pregnant. When I'm lying down and put my hand on my belly I can feel my own heart beating so strongly. I am not worried about it, but was wondering why.

A.

The reason you can feel your pulse so easily when you lie down is that your uterus has enlarged to the point where it is sitting directly over the aorta, the body's major artery. Every time your heart beats, the impulse is transmitted directly to the back of your uterus, which causes it to move just enough for you to feel. As your uterus gets still larger and heavier, this will become less noticeable.

Q.

I am 21 weeks' pregnant and have been having some bleeding for a month now. The blood starts off black, then lightens up to dark brown, then light brown and usually stops after a day or two. What could be the problem? After having been to ER around four times for this problem, I was told the ultrasound looked good a week ago, and the doctors are unsure of what the problem could be.

A.

So long as everyone is satisfied that your placenta is in the safe location and is not in the process of separating prematurely, there shouldn't be much risk. It's not uncommon for blood to accumulate behind the placenta and gradually leak out. The best approach is to follow this with serial ultrasound to be sure that this situation is remaining stable.

Q.

I have had three blood tests, all neg quantatative 1. The Ultrasound shows the sac, but no fetus of five weeks. I have not had a period in two months. Going for another ultrasound Monday. The nurse said my chances are good that it's a blighted ovam since all the tests are negative. Can you advise me?

A.

I agree with what the nurse is telling you. This is a failed pregnancy (there are lots of terms we use, but basically, it's an early miscarriage). In most cases, the body takes care of this by a combination of expelling the tissue and reabsorbing it. If that fails to occur, the tissue is easily extracted by a brief suction procedure.

Q.

Can it be dangerous for the baby if I don't take medication for a UTI?

A.

Yes, it can be. The baby is not in danger of contracting the infection, but you are in danger of having the infection ascend up to the kidney, which dramatically increases the risk for a premature birth.

Q.

I am 31 weeks' pregnant and having vaginal cramps. Is this normal?

A.

Yes, it is. The baby is beginning to press downward and will impinge upon the ligaments that support the vagina. Lying down should reduce this sensation, but it is not a worrisome matter.

Q.

I am 34 weeks' pregnant and keep feeling sick, but I never actually get sick. I'm losing all my energy. What can I do?

A.

These are completely normal symptoms in the late third trimester. Your digestive tract is working slowly, creating a constant feeling of fullness and queasiness. Your best bet at this point is to reduce your activity level as much as you can and make sure you are taking in a good volume of liquids.

Q.

I went to my OB today and when the baby got measured she was measuring five weeks bigger. Can there be anything wrong? What are the possibilities?

A.

To a large extent, this depends on how far along you are. In the first trimester, it would be significant and might suggest twins. Uterine size after about 32 weeks, however, is of little or no significance, so long as it's not getting smaller. If your doctor felt that your uterine size was of significance, he would have said so and ordered tests to be sure there wasn't an excessive volume of amniotic fluid, which does carry with it some worrisome hazards, including digestive and/or kidney disorders.

Q.

Does no morning sickness during my first trimester of pregnancy mean that my baby's growth is not going well? I'm in my seventh week but have no nausea.

A.

There is no problem with not having nausea during pregnancy. There are no symptoms which occur in every pregnancy. So long as your uterus is growing with each obstetrical visit, your pregnancy may be assumed to be progressing normally.

Q.

This is my first pregnancy, and so far it had been a delight. However, since week 34, I have been experiencing dull, lower-back pains that never cease, even when I change activities, rest or drink water. Associated with these backaches is nausea (but I never actually vomit). My doctor has been out of town for the delivery of his first child for the past two weeks, so that leaves me sort of in a bind. I am now at 36 weeks, and the pain seems to stay for longer periods of time now, but has not intensified. Is there a source for concern, and should I just make an appointment with another doctor or go to the emergency room?

A.

There has never been a pregnant woman who hasn't had this sort of discomfort by the 34th week. It is a pressure phenomenon, due to the growing fetus. It is also your body's way of trying to send you a message that it's time to start slowing down your activities. By the way, your doctor being out of town should never be a problem. He has someone covering for him 24/7.

Q.

Is it safe to travel by train for 24 hours in the 33rd week of pregnancy?

A.

In an uncomplicated pregnancy, there should be no problem with a 24-hour train ride, so long as you remember to get up and walk around every two to three hours, so as to reduce the risk of having a blood clot form in your legs.

Q.

I normally have regular periods. I took a pregnancy test, which was slightly positive. Could I be pregnant? I had the same result in 2005 and found out that I have PCOS. What should I do?

A.

There is, of course, no such thing as being "slightly" pregnant. Your test result showed that the hormone is present, but at a low level. From here, it will either go up or down. Blood tests for the hormone called HCG will resolve this question.

Q.

I am four to five weeks' pregnant with my sixth baby. I have had all my babies by C-section, and last one was delivered June 2007. Yesterday I started having some cramping and groin pain, and today some lower-back aches as well. I am not bleeding or spotting, but I am really worried this could be a miscarriage. I have had two miscarriages between my second and third pregnancies. I am 35 years old.

A.

While it certainly could become a miscarriage, the symptoms you are having do not suggest that. Any woman who has had five C-sections is bound to have scarring in the pelvis from all that surgery. The pain is most likely from stretching of these adhesions. The situation changes, of course, if you begin to have bleeding.

Q.

I have polycystic ovaries, but for the last two years I have had my period regularly. My period is a month late, and a milk-like substance is coming out of my breasts. I took a pregnancy test, which was negative. Could this be a hormonal imbalance, or am I pregnant and the test is not reading it?

A.

This is a hormonal imbalance, but, unlike most of them, this one could be dangerous. Leaking of milk from the breasts in a woman who is not currently nursing a baby can be a sign of a pituitary tumor. While not cancerous, it can press on the optic nerves and affect vision. Your doctor can run a prolactin blood test to further evaluate this situation.

Q.

I'm looking for the right prenatal vitamin. I have received mixed information regarding where to get them and what needs to go into them. Do I have to take a prescription prenatal, or will an OTC with the correct levels of vitamins suffice? And what are the levels of each vitamin that I need to have in a prenatal vitamin?

A.

There are up to 12 components to prenatal vitamins. They consist of all the major vitamins, including A,D,E,C,B1,B2,B3,B6 and folate as well as calcium, iron and zinc. The one we consider most important is folate, which, for some reason, requires a prescription in order for it to contain the needed 1 mg (as opposed to 600 to 800 ug in the OTC brands). As to the amounts of each of each of the rest, you will notice at the drugstore, that all the brands are fairly similar in these quantities and the differences are not considered to be important. It is, however, important not to exceed the recommended daily amount.

Q.

I am 26 weeks' pregnant and have marginal placenta previa. I have had three scans for this and I haven't had any movement up at all (currently at 1.3 cm) in six weeks. The placenta is at the back. Due to its location, is there any chance that it will move at all?

A.

There's an excellent chance the placenta will move. You are still relatively early regarding this condition. Its final status will not be clear until at least 36 weeks, so, for now, the best plan is to follow with ultrasound every three to four weeks.

Q.

I can feel something hard like an elbow or heel about to come right out. I am 34 1/2 weeks. Should I be worried?

A.

At this stage of pregnancy, it is common for the fetal head not yet to have descended into the pelvis. Instead, the foot or arm may be occupying that area, creating the symptoms you are feeling. You may expect that to change by 37 weeks in all likelihood, as the head, which is becoming the heaviest part of the baby, descends into the pelvis.

Q.

I had what I thought was implantation bleeding on February 22, and then nothing but a lot of heavy discharge. I feel nauseous in the morning but do not vomit. I have mild cramps like my period is coming, but it doesn't. I had sex on the 17th. What is happening?

A.

By now you would have to be late for a period, so you are to be considered pregnant until proven otherwise. A pregnancy test should provide the answer, and, if it is negative, you should arrange for a visit to your doctor.

Q.

I am 23 weeks' pregnant and have a UTI for which I'm taking medication. I have pain on my back, my ribs and legs are week and I have a fever of 101.7. What should I do?

A.

Those are very worrisome symptoms, suggestive of a kidney infection, and should be brought to your caregiver's attention right away. Urinary tract infections in pregnancy carry great potential to ascend into the kidney and trigger premature labor.

Q.

My daughter is having a baby and we were told by friends that you should not rub the bottom of the feet. Is it true and why? Also at night after a shower her feet are very warm and red. Is this normal?

A.

I seriously doubt if any other field of medicine is as rich in mythology as obstetrics. There is no reason not to rub the bottoms of your feet if it makes you feel better. The redness and warmth of your daughter's feet is the result of congestion which occurs from the combination of the warm water and an upright posture. It is harmless.

Q.

My doctors told me take iron pills, and I got 50-mg slow-release iron, which I take every morning. Can the pills harm my baby?

A.

Iron pills are taken by most, if not all, pregnant women as the blood count normally does drop during pregnancy. They may cause you a little constipation, but are harmless to the baby.

Q.

I am seven weeks' pregnant and having mild period pain/shooting pain, but no blood. I don't have sore breasts. Is this normal?

A.

The type of pain you describe is quite common and reflects stretching of the uterine and supporting tissues. Sore breasts is a common, but not universal, symptom.

Q.

I have HPV and have had abnormal cells (the most severe grading of them, is it 3?) removed from my cervix using laser surgery in the past. I am now pregnant and would like to know if there are any risks I should be aware of, either because I have HPV, or because I have had the cervical laser surgery.

A.

The condition you had, which currently goes under a variety of names, most commonly CIN III, does not itself pose risks to the pregnancy. However, the treatment you had, laser surgery, does carry with it a small risk of weakening the cervix such that a premature birth could occur. Under these circumstances, frequent ultrasound, about every four to six weeks once you're in the second half of the pregnancy, will show if the cervix is shortening, a sign that prematurity is becoming more likely. In the absence of this sign, there should be no other hazards.

Q.

I am 18 weeks', 4 days' pregnant, and have not yet felt any fetal movement. I've had tremendous stress these last few weeks. My stomach also feels tender. I've got a tiny bump and it doesn't look as if my tummy is growing. Is my baby safe inside me, or is there something wrong? I've experienced no bleeding.

A.

It would actually be a bit unusual for you to be feeling fetal movement yet. For most women, it begins at 19 to 21 weeks. If this is a first pregnancy, as I suspect, you may still be a few weeks from feeling movement or detecting visible growth of your uterus. There will be little doubt about these things soon enough.

Q.

I thought I might be pregnant back in early January, but I got my period and had a negative pregnancy test. Now I'm urinating frequently, with a weird smell that I've had since January. There is no pain, though I have a twinge in my lower abdomen a few times a week. I'm also having irregular bowel movements. I have a slight fever pretty often, and my bladder is kind of weak. I urinate myself in very little amounts. I have a lot of discharge too. I'm tired. Could it be a UTI? What could be happening?

A.

Assuming that your menstrual cycle is remaining regular and that pregnancy tests are remaining negative, I would focus upon the possibility of a urinary tract infection. This should be quite easily determined at your doctor's office.

Q.

I'm in my seventh month. Is there any risk if I travel by car (three hours) during this period?

A.

There should be no problem with a three-hour car ride at this point, so long as your pregnancy has not been complicated. It is important to stretch your legs often during the ride to ensure smooth blood flow and avoid the formation of clots in the leg veins.

Q.

I had a doctor appointment on Monday. Before I went, I was having extreme contractions that actually brought tears to my eyes. I also had them the following day with quite a bit of mucus that was tinged brown. At times I find it very difficult to walk. The bones in my vaginal area feel like they are about to break. It has also been increasingly difficult for me to roll over in bed without feeling similar pain. Are any of these signs that the baby could come at any time?

A.

You didn't indicate how many weeks pregnant you are, but assuming you are the final month, these are all normal symptoms. They indicate that the tissues of the vagina and cervix are starting to stretch as are the bones of your pelvis. All this makes for an easier delivery. You should also think of them as a message from your body that it is time to be off your feet as much as possible.

Q.

I am 30 weeks' pregnant and don't feel my baby move as much. Is there something wrong?

A.

Probably not, but your are now at a point in pregnancy where you should be performing daily kick-counts to help assure yourself that your baby is doing well. You should sit quietly each evening after dinner and count how long it takes for your baby to move ten times. If this takes more than two hours, you need to evaluated at the hospital.

Q.

I am 12 weeks' pregnant and got treatment for a UTI: Nitrofurantoin-Macro. My doctor wants me to stay on the antibiotics for the rest of my pregnancy (one capsule a day). My husband and I are concerned about side effects.

A.

There is no reason for concern. This antibiotic has a long and safe track record. UTIs in pregnancy are potentially quite dangerous. Your doctor's advice sounds appropriate to me.

Q.

I am in the sixth month of my pregnancy and experiencing pain in my vagina. Is this common or do I have to take any precautions? I have also started eating ice excessively. Will this harm my baby?

A.

These sorts of pains are quite common and do not ordinarily signify any problems. They reflect the stretching of tissues which is beginning to occur now. Eating ice is a common side effect of pregnancy and is not harmful.

Q.

What are the risks and what can be done if the water has broken at 18 weeks and there is no fluid around the baby? Is this a sure miscarriage?

A.

If it has indeed been confirmed that your water has broken at 18 weeks and that there is little or no fluid surrounding the baby, the outlook is not good. The absence of the amniotic fluid will lead to a situation in which the fetal lungs fail to develop, so that even if the pregnancy were able to proceed on to term, which is quite unlikely, the baby would not survive without functioning lungs. Understand that your risk of having this happen again are no more than the general population, i.e., quite unlikely.

Q.

I have asthma and would like to know if I can breastfeed while I take my medications. Also, since I have been sick I haven't been eating that much. What is good for the baby, as I'm feeling ok now?

A.

It is quite safe for you to continue to take your asthma medications while you nurse your baby. It is also important that you continue to take in a balanced diet similar to what you consumed during the pregnancy. Remember that nursing a baby consumes around 700 calories per day, so your daily intake must take that into account.

Q.

I had a miscarriage on January 13; it is now March 17 and still no period after the bleeding stopped. I did try to get pregnant when the bleeding stopped. I have sore breasts and feel tired but the pregnancy tests are coming back negative. I have cramps as well. What's going on?

A.

You are now at what we consider to be the upper limit of the normal time duration for the resumption of menses after a miscarriage. If you go another one to two weeks without a period, you should consult your ob/gyn. You didn't indicate whether or not you required a D+C to remove the failed pregnancy tissue at the time of the miscarriage. If not, there is a small possibility that the pregnancy tissue never passed or got absorbed and is still, therefore, in the uterus. This situation is correctable, but would require a D+C.

Q.

My period is very late, about three weeks. I have a white discharge, cramps, bloating, tender breasts, moodiness and frequent urination. I had a negative pregnancy test. I had a miscarriage five months ago and haven't missed a period since. Could I be pregnant?

A.

Not likely. Pregnancy tests are amazingly reliable these days. Much more likely is that ovulation is delayed or has failed to occur this month. This will nearly always resolve itself over the coming month. If the menses fail to occur for more than four weeks and pregnancy tests remain negative, you should consult your physician.

Q.

For the past few days I've been experiencing a brown discharge; dark and spotty at first, now light brown and milky. I have taken a HCG blood test and it has came up negative. I am also experiencing lower-back tightness, very slight cramping and some loss of appetite. Also, if I happen to be pregnant, the estimated date of conception would be ten days ago. Would it have been to early to have taken the hcg test?

A.

Assuming that you took the HCG test just in the past day or two, then it would not be considered too early if the date of conception was ten days ago. Based upon this information, you should see menses within the next three or four days, and, if this does not occur, then another HCG test would be advisable. If it is negative, then delayed or missed ovulation is the most likely situation and one which will nearly always resolve itself.

Q.

I am 33 weeks' pregnant with my fourth baby. A week ago I fell after slipping on the ice, and was taken to the hospital and given a non-stress test for the baby. They said it was fine, but I've had a very heavy discharge since. Could something be wrong?

A.

Very unlikely in the absence of other symptoms. Discharges late in pregnancy which are not terribly odorous, irritating, or bloody are usually a sign that cervical effacement is occurring, which a normal event and actually makes labor easier and shorter. At 33 weeks, you are still significantly premature, so you should pay close attention to contractions and be sure to report if they become strong and regular.

Q.

I recently lost 15 pounds, and am not sure if that would affect my body so I would think I'm pregnant. I've been having really bad backaches since about a week after my period last month. My period this month was not the same: It started off spotting and then got a little bit heavier, but not like normal, and only lasted a day and a half, then went back to spotting. I haven't been hungry, and everything smells to me. I have been trying for five years and have never been pregnant, so I'm not sure how to tell if I am. I tested negative, but continue to feel this way. What can it be?

A.

In the absence of a positive pregnancy test, it is almost certainly not pregnancy. However, we know quite well that a sudden and dramatic weight loss can interfere with the release of hormones from the pituitary gland which regulate the menstrual cycle. This is often manifested by just the sort of symptoms you describe, which are, basically the result of hormones which are temporarily out of balance. When your weight and any other stress conditions stabilize, the cycle should return to normal. If pregnancy still does not occur, you should see a fertility specialist.

Q.

I am due April 16th. But every time I go to the doctor, he tells me that my baby and I are underweight. Now I am eating very well but just is not putting on the weight. My body feels like how it feel when it is fighting off a cold or something? Why is my body not taking to the baby? What affects will it have on my baby?

A.

The growth of your fetus at this stage is not necessarily related to your dietary intake. Mostly, it has to do with how much blood, oxygen and nutrients are being delivered to the baby by the placenta. There are tests available that will indicate whether any of this is having an adverse effect upon the baby.

Q.

I am currently 39 weeks' pregnant and experiencing a lot of vaginal/pelvic pain. This pain comes and goes and usually intensifies when I'm laying down trying to sleep or walking around. I think I lost my mucus plug two weeks ago (clear/white mucus that came out in chunks). I'm currently having an increased yellow/white vaginal discharge. Does this all mean I'm close to delivery? Last my doctor checked I was fingertip-dilated and 50 percent effaced.

A.

It doesn't really indicate whether labor is near or not. Undoubtedly, you are having contractions, so that would be part of the explanation. Also, the bones of the pubic area are starting to separate, which can cause a sharp sensation. At 1 cm and 50 percent effaced, it's likely there's still a few days before labor will begin.

Q.

My daughter had a sonogram today at 36 weeks. The doctor said that the baby's stomach measures 40 weeks and the legs at 36 weeks. What can be wrong?

A.

Most likely, nothing is wrong. This sort of measurement has no meaning at this stage of pregnancy. I'm wondering if it was really your doctor, and not a technician who told you this, as your doctor would know this is a meaningless finding. There would be no reason to obtain a sonogram at 36 weeks other than to determine things like fetal presentation, location of placenta or amniotic fluid volume. I suggest you ask your doctor to interpret the sonogram for you.

Q.

I am 19 weeks' pregnant, constantly feel hungry and am eating much more than usual. I'm also very busy in my studies, as my final exam is near. I'm worried that overeating and stress could affect my baby, even if the hunger is a result of the pregnancy.

A.

The kind of stress you are describing is not capable of causing your baby any harm, although your dietary changes may result in a lot more weight gain than you wish to have. If you see to it that your diet remains sound, it should provide you with the energy you need to get you through this demanding time without adding unnecessary weight.

Q.

Is there a difference between typical post-ovulation mucus and the mucus during pregnancy?

A.

No, there isn't, other than that the volume is likely to be heavier during pregnancy. The mucus which is produced by glands in the cervix are a direct result of hormone production, and these levels will be much higher when you are pregnant.

Q.

I'm in my second trimester. When the baby first started moving I was able to feel it quite often. I haven't felt anything for the past two days. Could something be wrong?

A.

It is certainly not normal to feel fetal activity on a regular, daily basis and then to have those sensations disappear. My advice would be to see if you can get in to see your clinician and have them check for fetal heart tones, and, if these are absent, to do a sonogram.

Q.

I am 26 weeks' pregnant with my fifth, and I've had bad cramps on my lower left side that last about one to two minutes, then come back in about three to five minutes. It didn't happen during my other pregnancies. Is this a signal to slow down?

A.

First, it is necessary to be sure that you are not having premature labor, although I suspect that this would be apparent to someone having a fifth baby. What you describe sounds a lot more like what we call "ligament pains," i.e., the stretching of the round ligaments which is typical of the late second trimester. It is directly related to activity levels, and, although not considered harmful, may be considered as a sign that your body is sending asking for a little less activity.

Q.

I am six weeks' pregnant. Up until this morning, my breasts were so sore that every movement hurt. Now they are hardly sore at all. My nipples, which had been standing out all the time, are lying flat again. I'm not having any bleeding or intense cramps, just occasional pains that I've been having throughout. Should I be concerned about a miscarriage?

A.

One of the distinguishing features of the early first trimester is wildly fluctuating hormone levels, which is what this sounds like. As you are describing something that only began this morning, it's too soon to judge whether this hormone drop is harmless and typical or whether it reflects a pregnancy that is failing. The next few days should help determine where this is going.

Q.

I had my baby on February 6. Since then my episiotomy has really hurt. My husband said that some tissue seems to be sticking out of the area, and when I touch the area it feels really painful. I feel as though something is wrong.

A.

Something definitely is wrong. A properly performed and repaired episiotomy should not be particularly painful for more than two weeks unless there was some unusual feature to it such as an extension into muscle or rectal areas. Clearly, you should arrange to be seen by your caregiver. The most likely possibilities are infection, breakdown of the incision, a collection of blood beneath the skin (known as a hematoma) or a reaction to suture material. All of these are treatable and correctable.

Q.

My 14-year-old daughter said she had unprotected sex for the first time. I got the plan b pills for her the following day. Her period is six days' late. Her areola has changed from pink to brown, is larger and she is experiencing bouts of morning sickness. She has had four negative pregnancy tests. Her periods have always been like clockwork every 28 days. Could she be pregnant?

A.

Not likely, as these tests are quite reliable assuming you are doing them correctly. At age 14, cycles are not likely to be all that predictable, particularly when a woman is under stress about having started sexual activity and being worried about pregnancy. Run another pregnancy test in five to seven days if the period has not come.

Q.

I am 16 weeks' pregnant and the past two days I have had pink urine. Do i need to rush to the hospital or wait to see my ob/gyn?

A.

If you are free of pain or fever and the color is only light, you may wait for your checkup assuming it is in the next few days. Keep a close watch on this, however, as urinary tract infections are much more dangerous in pregnancy than otherwise.

Q.

I am 30 years old and 23 weeks' pregnant. I have hair growth on my face. Is it normal? I am underweight also. Is there any chance that my baby is also underweight?

A.

Hormonal changes of pregnancy often result in hair growth and skin blemishes. Also, you do need to focus your attention upon your diet so as to provide your baby with enough nutrients. At only 23 weeks, your baby will not yet be underweight, but growth problems may begin as early as 28 weeks.

Q.

I am 30 years old and 23 weeks' pregnant. I have hair growth on my face. Is it normal? I am underweight also. Is there any chance that my baby is also underweight?

A.

Hormonal changes of pregnancy often result in hair growth and skin blemishes. Also, you do need to focus your attention upon your diet so as to provide your baby with enough nutrients. At only 23 weeks, your baby will not yet be underweight, but growth problems may begin as early as 28 weeks.

Q.

I am 23 weeks' pregnant. I have to travel by crowded train and bus to and from the office. I can get three months' maternity leave from my office. From which week it safer to take leave and stay at home? And which position is safer to sleep in at night?

A.

It does not sound like you have a problem here. A crowded train or bus is not dangerous, and, hopefully, as you get larger, you will be offered a seat. At this point, plan to take leave at the customary 36-week point, barring other problems. You are not far enough along to be concerned about the position in which you sleep. Sleeping on the left side is important after 32 to 34 weeks.

Q.

I took pregnancy tests that came out negative. I had a ultrasound done and that was negative. I still think I'm pregnant though. I can't lay on my stomach. It's really uncomfortable. I had a missed period. I get nauseous at times. When I lay on my side it hurts. This has been going on for a few months now.

A.

Pregnancy is not the cause of your symptoms; you may depend upon those results. Much more likely is a hormonal imbalance that is associated with failure to ovulate and which can cause all of these symptoms. Give it a little time, such as another month, then go to see your doctor if the cycle and the symptoms are not resolved.

Q.

I am due to LMP and had an ultrasound! Could it be possible that I am actually 25 weeks and the ultrasound tech missed that, or does the the ultrasound automatically refigure due date when they take measurements?

A.

Assuming that your ultrasound was done by a qualified tech or physician, you may depend upon those results. Your due date will be recalculated based upon that sonographic information.

Q.

I have felt two kicks and my discharge is becoming more frequent and white. What is the deal?

A.

There is not enough information here to provide an answer. If you are doing kick counts, which all women should do from about 30 weeks onward, your baby should move 10 times in not more than 2 hours after you eat dinner. If this does not happen, you should be evaluated at the hospital. There is nothing abnormal about a white discharge, so long as it isn't causing discomfort or severe itching.

Q.

I am 35 weeks' pregnant and have continuous cramping, mild diarrhea and a small amount of grayish discharge. Is this normal?

A.

These symptoms are very common at 35 weeks and are not likely dangerous. A bit of diarrhea results from partial bowel obstruction due to the large uterus, and discharge is usually mucus that is being released as the cervix begins to ripen.

Q.

How long into my pregnancy can I fly? I am beginning my sixth month and I travel frequently. When is it not safe to travel?

A.

The airlines generally permit women to fly up to 36 weeks, although I would recommend ceasing air travel by 30 weeks, especially if the flights are more than two hours. There is a serious risk of blood clots in the legs. Also, no one who has had episodes of preterm labor should fly at any time.

Q.

My husband and I have been trying for three years to get pregnant. I have PCOS and just did two home pregnancy tests on the weekend. They both came up positive. I went to the doctor today and had a blood test done, but cannot wait for the results. After trying for three years, and being disappointed each month, am I pregnant with two positive tests?

A.

Almost certainly, you are pregnant. Tests are rarely in error. Your blood test results should not take more than 24 hours.

Q.

Unknown to me, my daughter had the possibility of the placenta being behind her scar tissue from a former C-section. All is well now, as it has moved up. What could the complications have been if it had not moved?

A.

When the placenta implants over a C-section scar, there is a small but definite risk of it embedding itself into the scar, sometimes so deeply that it may be all but impossible for it to pass or be removed at birth. This can result in excessive bleeding and often transfusion and hysterectomy. We call this placenta accreta. It becomes a greater risk with each succeeding C-section. It is a powerful reason to try to avoid unnecessary C-sections.

Q.

I am 36 weeks along in my pregnancy and have a constant menstrual cramp feeling in my lower back that lasts two to three minutes at a time and does not improve with changing position or resting. It comes about every five minutes. I am also feeling pains in my vagina that are so intense they stop me in my tracks. If I am walking, lying down or sitting, it takes my breath away. I also feel a sort of dripping/leaking feeling from time to time and my underwear will actually be wet when this happens. Could these besigns of early labor?

A.

They certainly could. First, you need to be examined to be sure your membranes haven't ruptured, as that would increase the risk of infection. Second, if your membranes turn out not to be ruptured, then your best plan is to get off your feet and rest on your left side with feet on a pillow. This will maximize blood flow to the uterus and help bring on labor if it's time.

Q.

I am 31 weeks' pregnant. It's my first. I have generally been walking a lot throughout my pregnancy but this week I was walking and it felt like the baby was pushing down and wanted to come out. It was such a severe ache, and I find it difficult to stand as well. What does this mean?

A.

This is not abnormal. It is your body's way of sending you a message that it's time to cut way back on the walking. You should consider the third trimester as a time to be at rest so as to permit maximum blood flow to the rapidly growing fetus. Although it's not dangerous, a lot of walking will cause the supporting ligaments of the uterus to stretch, sometimes rather painfully. Listen to your body!

Q.

I had a miscarriage approximately two months ago. I just found out that I am pregnant again (about five weeks). I am concerned because now I am not experiencing the same symptoms as before. For instance, I don't have the nausea or breast soreness that is common. Should I be concerned?

A.

It's still a bit early for the hormone level to be high enough to produce these symptoms. However, if they remain absent for another two weeks, I would consider it worthwhile to request an early sonogram, given your past history of miscarriage.

Q.

I was told I am at risk for preterm labor. At 30 weeks I was dilated 1 cm and 50% effaced. At 32 weeks I lost my mucous plug. Now at 33 weeks I feel like my pubic bone is spreading apart and it pops. This is my second pregnancy. Does this mean I may go into labor soon? And if so how long? Do I have a few weeks or should I be concerned?

A.

None of this constitutes significant risk for preterm labor. Separation of the pubic bone area is not only normal, but actually makes delivery easier. Naturally, onset of labor cannot be predicted, but it is fairly rare for a woman to labor prematurely in a second pregnancy if she delivered at term in the first.

Q.

My partner is six weeks' pregnant, and when we had sex she noticed a brown tint on the discharge afterwards. Should we avoid sex for a while?

A.

You do not need to abstain. Blood vessels in the cervix and vagina tend to become thin and fragile during pregnancy. As long as there is no pain and the flow is light, there is no danger.

Q.

Is it normal to feel cold chills and body aches throughout my first trimester?

A.

Yes, it is. Your female hormone levels are not stable during the first trimester, so body temperature and regional blood flow may fluctuate. This should end with the more stable second trimester.

Q.

I am currently trying to track my cycle because we want to try to get pregnant soon. This month I spotted a week before my period was due. Is this normal? Also, does this count as my period?

A.

No, it's not normal to spot a week before your period, and this does not count as your period. Most likely, the spotting was caused by a brief drop in your hormone level and is not likely to be of importance. If it does not occur again, you need not be concerned. If, however, you see this sort of thing often, your doctor can evaluate your hormonal status, which is, of course, closely tied to fertility.

Q.

I am 32 weeks' pregnant and I have been having slight cramping in my lower abdomen for the majority of the day. It also feels like I have to go to the bathroom I am constipated. The baby's movement has changed in the past couple of days from kicking all the time to just rolling every now and then. What should I do?

A.

First of all, be sure to report these symptoms to your caregiver. It is likely that these do not represent a problem, but this cannot be determined with certainty without a physical exam. Also, you should, by now, have begun the daily performance of "kick counting," which is a reliable way of assessing fetal status. Your OB caregiver can fill you in on the details of how this is done.

Q.

I am 17 years old and have always had a normal period the same time each month. My period is seven days late, and I've had three negative pregnancy tests. Could I still be pregnant?

A.

Not likely. Menstrual periods are commonly late in young people, particularly when they are under the stresses of having recently initiated sexual activity. Pregnancy tests these days are very rarely incorrect. More likely is that there has been absent or delayed ovulation this month.

Q.

Two years ago, I had a miscarriage at three and a half months, followed by a D&C. I have been desperately trying to get pregnant for six months, with no result. Is this normal?

A.

Six months is not considered to be an abnormal amount of time to achieve pregnancy, although we do occasionally institute some preliminary forms of fertility testing in, for example, a patient who is over the age of 35. Another consideration is whether or not this is the same partner or not. If not, a semen analysis might be considered if he has not fathered children before.

Q.

I am 19 weeks' pregnant with my first baby. When I woke up this morning, I felt a sharp pain (needles) from my vaginal area, which comes and goes. Is this pain normal, and could this be a sign of my cervix opening?

A.

It is most unlikely that this is anything other than the same sort of ligament stretching we discussed in the prior question. So-called "silent" cervical opening is most unusual in a first pregnancy. Pay attention to whether it seems to relate to changes in position, and do report to your caregiver if there develops any associated vaginal bleeding.

Q.

I am 11 weeks' pregnant and have been having sharp cramping that shoots into my vagina, with a little soreness between the right side of my pelvis and my thigh. There is no blood. Is this normal?

A.

Most likely it is normal. You're at a point where there is a lot of rapid ligament stretching going on. This is especially common in a first pregnancy, when these tissues have never been stretched before. The ligaments that hold the uterus in place attach to the side of the pelvis and are easily stretched with sudden changes of position, such as rolling over in bed. As long as there is no associated vaginal bleeding, such symptoms are not worrisome.

Q.

My sister, who completed her seventh month, has had a continuous fluid discharge during the last week (it's still happening) and was admitted to the hospital. She was told it was the placenta. A sonogram shows no more fluid. She is on complete bed rest and the doctor says to wait and watch. She is not in pain, and the baby is normal. Should the baby be delivered in the eighth month by C-section if there is no placenta?

A.

I'm afraid this question cannot be answered in its current form. My best interpretation is that your sister has ruptured her membranes prematurely. This has nothing whatever to do with the placenta, which is certainly still there and functioning. Clearly, hospitalization and close observation are needed, but one also does not want to deliver a baby two months early. So, this will have to be judged on a day-to-day basis and delivery proceeded with only if the risk of maintaining the pregnancy outweighs the benefits.

Q.

I am 32 weeks' pregnant with my first baby and have been having cramps followed by a little diarrhea. Is this normal? The baby is also not moving as much as before. Is it because she doesn't have much room to move anymore?

A.

Although this may well be just a harmless episode of gastroenteritis, pre- term labor can begin this way. Also, it is not normal for your baby's movements to be decreasing; the opposite should be happening. I would encourage you to bring this matter to your caregiver's attention in the next few days if these symptoms don't resolve.

Q.

I took clomiphene citrate to get pregnant but, unfortunately, I was told I didn't ovulate this time. I am eight days' late and took two pregnancy tests, which were weak positives. Could I be pregnant even though I didn't ovulate?

A.

Yes, you could be, but if you are, then the information you were given about not ovulating had to have been incorrect, as one cannot become pregnant without ovulation occurring. This just points up the need to be skeptical about all lab results. For the moment, I suggest you just continue to observe the situation; things will become clear soon enough.

Q.

I had an ultrasound a month ago and found out I was nine weeks' pregnant. Now at 13 weeks, I was told that I have a wide separation between the chorion and amnion at yesterday's appointment. Is this a danger to my baby? The heartbeat was strong, at least.

A.

No, it isn't a danger. This separation is quite common and does not reflect any increased risk of miscarriage. Most likely, your next ultrasound, which I suspect will be done between 18 and 22 weeks to evaluate organ development, will show the two layers fused once again.

Q.

I am 19 weeks' pregnant and I have received a call from my midwife saying that I need to come in because she detects an abnormal pregnancy. Should I be concerned, and is it possible that my baby can still be normal?

A.

My suspicion is that your midwife has said that she suspects an abnormal pregnancy rather than that she has actually detected one. This may reflect an abnormal alpha feto protein level, which you probably have had done in the past week or two. This blood test cannot diagnose an abnormal pregnancy. It requires additional testing, such as ultrasound and amniocentesis in order to provide definitive results. You should, of course, be concerned, but, at this point, the odds should be favorable for having a normal baby.

Q.

I'm 28 years old and oddly regular. My period is 11 days late as of today. I had very light pinkish/brownish spotting that occurred a week before my period was due. I have taken several HPTs, and all have been negative. I've also taken ovulation tests daily, and all have been negative. Is there a chance that the very light spotting was implantation bleeding, even though my period was not due to arrive yet? Is there still a chance that I could be pregnant?

A.

Pregnancy is quite unlikely under the circumstances you describe. More likely is that you have failed to ovulate. This can cause the spotting and would be consistent with the test results. While implantation bleeding is certainly a possibility, the pregnancy tests would have to be positive by now. If your cycle tends to be regular, however, your chances of conceiving in the next month or two should be good.

Q.

I am four or five weeks' pregnant, I think (I've taken four tests), and I'm experiencing periodlike cramps. I am also seeing a brownish color sometimes. My nipples are sore, and I sometimes feel dizzy. Do these symptoms seem normal? I am headed to a doctor soon.

A.

These symptoms are not normal. The brown discharge is often a sign of early miscarriage. The easiest way to settle the question at this early stage would be to measure the blood level of the pregnancy hormone known as HCG. Two tests are taken, two or three days apart. If the level is decreasing, miscarriage has occurred. If the level is rising, then the pregnancy is likely still viable, but careful observation remains necessary in order to rule out an ectopic pregnancy.

Q.

I am 21 weeks' pregnant. I feel fine and the docs say everything is ok, but my belly is barely obvious, and a lot of people still cannot tell I am pregnant. I'm working a lot and haven't told anyone at work. Is it normal that my belly is so small?

A.

At 21 weeks many pregnant women do not show, particularly if this is a first pregnancy. In these situations, the abdominal wall may be quite firm. When you lie down on an exam table, however, your doctors should have no trouble measuring the height of your uterus. You may be assured that you will begin to show very soon.

Q.

I had a positive home pregnancy test and tested negative at family planning. Got the same home and clinic results the next day. Had my Implanon removed two weeks later. My test is still positive, theirs, negative. I have sore breasts and have had cramping. Took four additional pregnancy tests with the same at-home and clinic results. The doctors tried to take blood for a blood test but couldn't, so they gave up! Some say I am pregnant, others don't. What is your opinion?

A.

The matter will be resolved easily by having a blood test for pregnancy done. It sounds like you may not have very favorable veins as you indicate that your doctor's office gave up on trying to draw blood. This should really not be a problem. Most clinical laboratories have employees who do nothing other than draw blood all day long. You may be assured that they will manage to get the specimen from you.

Q.

I am nine days past ovulation and an IUI following a round of 50 mg of Clomid. I have had fatigue, extreme bloating, cramping, sharp shooting pains in my lower abdomen, nausea, mild motion sickness and vertigo. I also feel my breasts are fuller to the point that I need a larger bra. However, my fertility specialist told me the results of my 7 dpo progesterone test were 4.4. Can I still be pregnant with the progesterone that low? I am most certain I ovulated as I have a positive LH surge and more mucus discharge than normal.

A.

Pregnancy would be quite unlikely with a progesterone level that low. Far more likely is that the Clomid has caused you to form a follicular cyst on one of your ovaries, which could produce all the symptoms you describe, including the breast swelling due to an increase in your estrogen level. I would advise that you run a pregnancy test in the next few days, which should answer your question.

Q.

I am in my second trimester and have had a very brown, odorous discharge that looks like dark blood. I had an infection when I first got pregnant and was given something for it, so I am wondering if this problem could be because I still have the infection, and, if so, what can be done about it?

A.

Dark brown discharges during pregnancy usually reflect blood that has been discolored by the acids of the vagina. It is not usually the result of infection. Most likely, there has been disruption of a small blood vessel, which not a matter of serious concern and would not, by itself, pose a risk. If it does not resolve over the next few days, sonographic imaging might provide the answer, so be sure to bring it to the attention of your caregiver.

Q.

I am 34 weeks' pregnant and have been experiencing a lot of lower back pain, especially on my right side. My ob/gyn prescribed a muscle relaxer, but the pain is increasingly worse. I have had a herniated disc between lumbar four and five for several years now. Could this be the cause of the pain, and what can I do about it?

A.

Back pain in the third trimester of pregnancy is almost universal and is usually the result of the changes in posture that result from carrying the rapidly increasing weight of the baby. Certainly, a herniated disc will make that situation worse. A muscle relaxer is not likely to improve things and will just make you drowsy. A better idea is to reduce activities as much as possible and to apply heat to the area.

Q.

I am almost seven months' pregnant, and I have been taking a prenatal vitamin every day. However, I was told that taking DHA supplements are beneficial for the fetus. Is it too late to start taking the DHA supplements now? If not, can I continue to take the same prenatal pills and just purchase the DHA supplements separately, or do I have to purchase both together?

A.

DHA, which is a fish oil derivative, is a substance that may be beneficial, but, like all such additives, has not been subject to anything approaching scientific analysis. It is most unlikely that it carries any risk to your pregnancy. There is no reason why you can't start it at anytime and simply take it along with your prenatal vitamins.

Q.

I am 28 weeks' pregnant, and the site of my episiotomy from my last pregnancy is swollen. Is that normal?

A.

Most everything below the waist will tend to retain water by the third trimester, including the perineum, which is the anatomical location of the episiotomy. You can reassure yourself about this simply by noting the times of day during which this occurs. If this is least noticeable in the morning, then that tells you that this is nothing more than a "postural" event related to gravity. Also, be aware that any tissue in which there is a scar will be less flexible, so that even a small amount of swelling becomes more noticeable and uncomfortable. Most likely, there is no reason for concern, but just a reminder to look for ways to be off your feet more and more as time progresses.

Q.

I spend at least 12 to 14 hours per day in front of the computer and/or TV. I am nearly six months' pregnant and am worried that the rays from the computer screen and TV might harm my baby. Is there any merit to this concern?

A.

None whatsoever. Women who work with computers have been thoroughly studied and do not show any evidence of a higher than normal risk for developmental disorders of their babies.

Q.

I had a C-section in mid-June of this year. After that I had two regular periods. My period was due September 30 and is late. A pregnancy test was negative. (Also, I have a UTI, and joined a gym 15 days ago.) What could be the reason for a delayed period?

A.

Regular menstrual cycles require that the ovulation process be fully operational, which very often is not the case by four months following a C-section. Also, the ovulation process is greatly impacted by breastfeeding. In addition, your new, increased level of physical activity will tend to inhibit ovulation. The UTI, while important, is not likely playing a role here. If the period fails to occur in the next two weeks and the pregnancy test remains negative, your caregiver may wish to have you take a few days' worth of progestin, a synthetic hormone which is quite safe to take and which should result in a resumption of the menses.

Q.

I am 16 weeks' along in my fourth pregnancy. I have been feeling slight movement in my lower abdomen, which I know is the baby, but sometimes I can feel a hard lump/knot just below my ribcage on the right side. Any clue as to what it might be?

A.

It's actually not typical for you to be feeling fetal activity as early as 16 weeks. Usually, that occurs at closer to 19 weeks. What is common is for women at this gestation to be feeling movement of their intestines as they become more bulky. Most likely, this accounts for the sensation below your ribs as well. If you increase your dietary intake of liquids and roughage, this sensation should decrease.

Q.

I am 27 years old and 14 weeks' pregnant (my first pregnancy). Almost every night I have stomach pains, except for the last two nights. I'm worried. What are the signs of a miscarriage?

A.

You are right at the point in pregnancy where the uterus begins to grow rapidly. As it does so, it stretches certain ligaments that hold it in place. This is especially noticeable in a first pregnancy, as these ligaments have not previously been stretched. In most cases, resting quietly with a heating pad will tend to resolve it. Miscarriage is not at all likely as you are past the first trimester, in which most of these occur. Also, you would expect there to be bleeding. So long as that does not occur, miscarriage is quite unlikely. By 14 weeks your caregiver should be able to reassure you by letting you listen to your baby's heartbeat.

Q.

I am 20 weeks' pregnant with my second child. Over the past few days I haven't felt the baby move that much. Should I be concerned?

A.

Not immediately. Fetal movement is not very noticeable that early and is affected by things such as the position of the baby and your own level of activity. The best advice is to focus attention on fetal movement each evening after you've had something to eat and while you're not distracted or busy. As the next couple of weeks go by, the movements should become more and more noticeable. If, by 22 weeks, you experience 24 hours in which there is no movement whatever, this becomes of great concern and should be brought to the attention of your caregiver.

Q.

I am ten weeks' pregnant, and on Friday I had a large discharge of blood. It is now Sunday and in the last three days there has either been no spotting or very little spotting. To add to this I have had blood in my urine since Saturday, which is also intermittent. I have polysistic kidneys. Am I having a miscarriage?

A.

Miscarriage sounds fairly unlikely, but the matter very much requires some detailed evaluation by your obstetrician. I say it's somewhat unlikely because at ten weeks of pregnancy, the bleeding would be expected to continue and be accompanied by significant pelvic cramping. It's quite common for there to be an isolated episode of vaginal bleeding in the first trimester that reflects nothing more than a small ruptured blood vessel and carries with it no increased risk of either miscarriage or fetal problems. The question can usually be resolved by ultrasound testing. Blood in your urine, however, is something altogether different. This is an urgent matter given your history of significant kidney disease. Both of these matters require that you be seen by your physician as soon as possible.

Q.

I am 28 years old and have never missed a period. I'm on day 40 of my usual 28-day cycle. A pregnancy test was negative. Why is this happening, and how can I calculate my next ovulation?

A.

Other than pregnancy, the commonest reason for a period to be late is failure of ovulation which, in turn, is usually a response to some form of stress. It can be expected to resolve itself.

Q.

I am seven weeks' pregnant. My crl is 10.2. My doctor says the heartbeat is good and strong, but during the ultrasound he says he saw a line of blood. What does this mean? Could I have a miscarriage? I have had ivf with two blastocysts implanted, and it shows one.

A.

The most likely explanation for this is that both blastocysts initially implanted, but one has been lost to miscarriage. This is a common occurrence and does not pose an increased risk to the remaining embryo.

Q.

Is it safe to have amniocentesis in my eighth month?

A.

Amniocentesis is often done in the eighth month if, for example, there is developing a need to consider delivering your baby early for some reason. It is actually one of the safest times to do amniocentesis as the pocket of fluid tends to be large and easy to locate.

Q.

I am 11 days' late but have had a negative pregnancy test. I have a clear discharge and sharp pain in the lower abdomen and the right side of my navel. Could I be pregnant?

A.

Not unless the conception occurred in the past 4 or 5 days; pregnancy tests are very accurate and sensitive these days. Much more likely is that you have failed to ovulate. This often results in one of the ovaries becoming swollen and your estrogen level remaining high enough to produce a mucus discharge. The period will likely occur in the next few days, at which point the symptoms should resolve. If this does not happen, consult your physician.

Q.

I am 38 weeks' pregnant and have pains that make me feel as though there is something in my vagina "scraping." I have not seen my doctor in two weeks, and he is out of the country. Should I be concerned?

A.

What you are likely feeling is your cervix, which has descended into the vagina as a result of its weighty burden. As you move about, the cervix may rub against the back wall of the vagina. It's just one of many messages your body tries to send to encourage you to rest more.

Q.

During my first trimester I used a hot water bottle with boiling water to ease the discomfort from nausea and vomiting. I didn't think this might be bad for my baby, but I have since read not to do this. Could my child potentially be in trouble?

A.

There is no known fetal hazard from applying a heating device to the abdomen of a pregnant woman. What you may have read about is some concerns about the potential hazards during the early months of raising one's body temperature by immersion in hot water, such as a Jacuzzi.

Q.

Can having sex help me go into labor?

A.

Although there is no possible way to meaningfully study this question, it does stand to reason that having sex will noticeably increase the frequency and strength of uterine contractions. Male semen is loaded with a substance called prostaglandin, which is commonly used to induce labor. For this reason, I have often advised late-term pregnant women that this approach is worth a try. Anecdotally, many of them have told me over the years that they had very gratifying success with this technique!

Q.

I am 38 weeks' pregnant. My baby has a strong heart and is said to weigh about five pounds. When my midwife measures me she always gets worried because I measure at 35 weeks, even though baby on ultrasound measures at 38. My mother had been told she had a small uterus. Is it possible to have a small uterus due to genetics?

A.

Centimeter measurements at term are of very little value; there is too much individual variation. If your pregnancy is otherwise normal and you do daily kick counting, you should be reassured. There is no such a thing as a small uterus, although there used to be such wives' tales in the past. The size of your nonpregnant uterus is not at all related to how well a fetus grows.

Q.

I am almost 8 months' pregnant and I had a really painful tailbone cramp three times this morning. What could be the cause?

A.

The most common explanation would be the stretching and straining of joints and ligaments of the lower back, which is quite common at this stage. There is nothing harmful about it. It represents your body's effort to send you a message that it's time to slow down and rest more.

Q.

I am 22 weeks' pregnant and have been spotting. I feel tired all the time like I can't get out of bed and dizzy during everything I do. I can't even drive any more. Is this normal?

A.

These sorts of symptoms are definitely not normal. Most women at 22 weeks feel great with lots of energy and a good appetite. Your caregiver should be advised of this. A common reason would be anemia, which is easily diagnosed and treated in most cases.

Q.

Yesterday's sonogram showed the baby has a very small right kidney, and the abdomen is only 28 weeks even though this is week 32. The doctor said we will repeat the sonogram in three weeks and if the baby's abdomen still isn't growing we may need to take the baby early. Should I get a second opinion?

A.

This sounds like a somewhat dangerous situation in which the fetus may not be receiving the nutrients and/or oxygen that it needs and is therefore not growing adequately. Repeating the sonogram in three weeks is appropriate, but it would also be advisable to have the baby's overall status monitored closely in the meantime by a process called antenatal testing. Your doctor can explain the details.

Q.

I am 39 weeks' pregnant and have been in early labor for four days, which is very painful. Friends have said I could go to the hospital and ask to be induced. Is is this a good idea? I would like to have my baby now.

A.

What you are experiencing is something called dysfunctional labor. The cause is unknown, but probably relates to a combination of fatigue, dehydration and stress. It involves a situation in which your uterus contracts in an uncoordinated fashion and little or no cervical dilatation occurs. You would be well advised to seek care at the hospital as this process can lead to exhaustion and dehydration. It is, however, a correctable condition and labor can usually be established in a safe and effective manner.

Q.

I am allergic to dairy. My husband and I are talking about having a baby, and everything I have read talks about the importance of calcium and getting it from dairy products, not supplements. How can I get enough calcium without putting extra stress on my body? Are there precautions I can take to avoid passing on my dairy allergy to my child?

A.

There is actually no disadvantage in taking calcium supplements as opposed to dietary sources. If you are allergic to dairy, you will not adequately absorb the calcium anyway, so supplements are your only option. Many experts feel that allergies of all sorts can be reduced by the simple act of breastfeeding. This appears to transmit protection to the newborn.

Q.

I am in my first pregnancy. In my third week I had lower abdominal pain, then bleeding around week four, followed by a big lump of blood.

A.

Bleeding during pregnancy is never considered normal and reflects an increased risk of miscarriage. That said, flow of the sort you describe is often of a harmless nature. If there are recurrences, the health of the pregnancy should be evaluated.

Q.

My partner and I have been trying for some time to conceive. Yesterday I noticed milk coming from my breast and took a home pregnancy test, which was negative. I recently had a contraceptive implant removed from my arm (which had run out three years ago), followed by a very light period. Could that implant be preventing conception?

A.

Even though your implant expired three years ago, it may well still have enough hormone to be preventing pregnancy. Under these conditions, your cycles may still require a few months to regulate enough to reflect that ovulation has resumed. The long-term outlook, however, should be excellent as regards your chances of conceiving.

Q.

Is a fetal heartbeat normal at 176 at 8 weeks? Also, does the heart rate give any indication of the baby's gender?

A.

There is no normal heart rate established for that early in pregnancy. Rates below 100/minute, however, are often associated with pregnancies which go on to miscarry. There is no association between fetal heart rate and gender.

Q.

I am 19 weeks' pregnant and have gained 20 pounds. Is that the right amount?

A.

There is no right amount of weight gain during pregnancy. The amount of weight a pregnant woman can be expected to gain depends to a large extent on what her starting weight is as compared to her ideal weight for her height. A reasonable rule of thumb is that if a woman starts at close to her ideal weight and consumes a healthy, well-balanced diet, she will gain between 25 and 35 pounds by the time she delivers. This is not to imply that there is something dangerous about gaining more or less than that amount.

Q.

Can the anxiety medication Xanax cause birth defects, and is there a certain time during pregnancy that it is safe?

A.

Xanax is contraindicated during pregnancy, as it is strongly believed to have adverse effects upon fetal development. It should definitely not be taken during the first trimester and would be advised against even at later stages.

Q.

I'm more than two weeks' late. I've been off birth control for about sevenmonths, and have been regular ever since. I don't have any PMS symptoms. I haven't been throwing up, but anytime I smell something strong it makes mesick to my stomach. I've also been extremely tired the past week or so, andusing the bathroom a lot more. Normally, I take medication to help preventdaily headaches. However, I still seem to get at least one daily headache. Iwent to the doctor, and took a home pregnancy test, which was negative.Could I be pregnant?

A.

While pregnancy is always possible, your test should be showing positive by two weeks late, so a more likely explanation is that you have failed to ovulate (release an egg) this month, which has led to an imbalance in your hormone levels. This can create most of the symptoms you describe. My advice would be to repeat your pregnancy test in another week. If it is still negative, your doctor can evaluate your hormonal status for you. Failing to ovulate is not at all uncommon and nearly always corrects itself.

Q.

I am 30 weeks'pregnant and went to the hospital the other day because of bad abdominal pain. The doctor told me I was having contractions but was not dilated. He also told the nurse I was 20 percent effaced and said I could have the baby that night or in a week. He advised 48 hours of bed rest and avoiding taking my normal walks. At my ob/gyn appointment the next day the doctor said it wasn't a big deal, that I was dehydrated and a lot of first-timers can't tell the difference between abdominal cramps and abdominal pain. I don't know if I should be worried, or if everything will be ok. Just wondering what it all means.

A.

I believe you are getting the correct information and advice from your ob/gyn. By far, the commonest reason for pre-term contractions with little or no cervical change is dehydration. If you can significantly increase your fluid intake and the pains tend to diminish, it is not at all likely to be due to pre-term labor, in which case you do not have anything to worry about.

Q.

If my estimated due date is September 14, 2008, what could the date of conception be?

A.

Date of conception is always an estimate, but the closest date, assuming a 28 day cycle, would be December 22.

Q.

I missed my period by 14 days. I had one negative pregnancy test, and a slightly positive one a week later, followed by light bleeding. The doctor also said that the test is a weak positive. Could I be pregnant?

A.

Although a normal pregnancy is still possible, the weak positive test along with the bleeding point toward an early miscarriage. The easiest way to clarify the situation is to perform the HCG blood test at a 48 hour interval so as to determine whether it is rising or falling.

Q.

We are planning to have another baby in a year or two, but what happened during my first pregnancy scares me. I was induced one week before my due date, as my blood pressure was high and my body was releasing a lot of protein through my urine. Unlike my first pregnancy it is already full term. If I got pregnant again and had pre-eclampsia and my baby was not yet full term, what would happen? And what are the chances of my having pre-eclampsia again?

A.

Pre-eclampsia, now more commonly referred to as pregnancy-induced hypertension, is much more common in a first pregnancy, but is still occasionally seen in a patient who has had the condition before, so there is some risk of recurrence. If the condition occurs prior to term, it depends upon the severity. If it's mild, it can be observed with bed rest while the baby reaches maturity. In severe cases, however, delivery is needed as soon as possible so as to avoid complications such as seizures.

Q.

I have a history of getting a UTI following sexual intercourse. My doctor prescribed one Nitrofurantoin following intercourse in order to prevent future UTIs. My husband and I are trying to conceive and I wondered if taking the medicine could affect our chances. Should I stop taking it while trying to conceive, or modify the dosage?

A.

Nitrofurantoin is a very harmless urinary antiseptic. You should continue to use it while attempting pregnancy and even during the pregnancy as urinary infections can be quite dangerous while pregnant.

Q.

Monday I was 14 DPO. HCG was 71, progesterone, 47. Today, 16 DPO, HCG was 181 and progesterone was 39.2. Should I be concerned that my progesterone has dropped? What can affect progesterone levels, and do they normally fluctuate from day to day? I am scared since I had a miscarriage only three months ago.

A.

By DPO, I assume you mean "days post-ovulation." The figures you provide are actually quite reassuring, especially the more than doubling of your HCG level in 48 hours. The drop in the progesterone level is very minimal and is probably not of significance as this is quite variable from day to day. In another week, your HCG level should be above what we call the "discriminatory level" of 1,200, at which time a gestational sac should be visible on ultrasound. If these things occur, the outlook for successful pregnancy should be greater than 90 percent.

Q.

My breasts started leaking milk recently, and the other evening my right breast hurt so much. I also had major chills and body aches. I was freezing even though I'm normally very hot at night. I took Tylenol. The same thing happened the next day. A huge, hard lump is taking up about half the breast and the skin on the outside is discolored. The pain subsided the third day, but the lump is definitely still there with some soreness. Also, I had an elevated temperature last night when I stopped taking the Tylenol every four hours. I'm worried about this, thinking it could be an infection of some sort that could spread to the baby. My baby is still moving though, so I have not gone to the ER yet. What could this be? Should I seek medical attention?

A.

Painful breasts accompanied by a large lump and a fever is a pattern consistent
with mastitis, a breast infection. It is quite rare prior to birth, but is a serious matter which can lead to abcess formation if not treated. Your ob/gyn should be able to make this diagnosis. It is urgent and should be attended to immediately.

Q.

I'm five days' late. Pregnancy tests have been negative, though I have sore breasts and some pregnancy symptoms. What could the problem be?

A.

A common explanation for what you describe can be failure to ovulate, which is
quite common and frequently due to stress. If your period does not come in the next ten days and your pregnancy tests remain negative, your doctor can provide a simple
and harmless hormone treatment which should bring on your period.

Q.

A week ago I woke up with intense pain in my left breast and soreness in my right. I noticed a milky discharge in my left nipple. My doctor ordered an ultrasound and bloodwork to check my hormone levels. Everything was normal. I had a positive home pregnancy test. My last period was June 4, although it was very light. Can the hormone test provide info on pregnancy? Could I have tested too soon?

A.

Breast tissue is extremely sensitive to the hormones of pregnancy, so it is not
at all uncommon for both the pain and the discharge to be due simply to rapidly
increasing hormone levels, thus not dangerous. The hormone test (HCG) is valuable
by showing that it is going up as it should. At this point, I would suggest you
go in to see your ob/gyn when you are two to three weeks late for your period. The findings should be clear by that time.

Q.

I get my period every 28 days. It lasts for four days. How can I know which are my ovulation days?

A.

The only way to know your ovulation day with any degree of reliability is to perform daily urine tests available in kit form from pharmacies. If your goal here is to determine your best chances of conceiving a pregnancy, it is reasonable to assume that your highest fertility will occur from days 10 to 14 days following the onset of your period.

Q.

I am 7 weeks' pregnant, experiencing very bad cramps with sharp pains, followed by diarrhea. This has been happening five days now, off and on eight to ten times a day. I have IBS, for which I can't take anything. What helps, and should I worry about these cramps throwing me into preterm labor?

A.

It's not true that you can't take anything safely for Irritable Bowel Syndrome.
Bentyl (dicyclomine), which reduces gastrointestinal spasm, is considered quite
safe for pregnancy, even in the first trimester. Surely, what very minimal risk
there may be is much less than the risk of becoming dehydrated from all that
diarrhea. It is always important to balance risks and take into consideration
the hazards of not treating an illness. That said, the cramps you are experiencing
are not related to preterm labor.

Q.

I am 42 weeks' pregnant. My doctor tried to induce labor three times, but with no progress. It has now been two weeks since I have been checked. I was 1 cm, 50 percent effaced and -2 station and my cervix was anterior. Why am I not going into labor? I don't want a C-section.

A.

The commonest reason for women not going into labor by 42 weeks is incorrect
menstrual dates, so first, be sure the dates are accurate. A first trimester
sonogram is the best way to be sure about this. Even with correct dates,
however, about 3 percent of women will go past 42 weeks. The danger here is that the blood vessels in the placenta start to age and deliver less oxygen to the baby.
As your cervix is unripe, there is the possibility of using a method of causing
it to become more dilated and softer by use of a medication called Misoprostol
before the induction is started. It will work in the vast majority of instances.

Q.

I've been unable to sleep because my ribs hurt so much. What can I do?

A.

Report that symptom to your doctor. Most of the time, this is simply the
result of the uterus pushing against the ribs as term gets near. However, rib
fractures have occurred in pregnancy and are potentially dangerous as a sharp
edge of bone can puncture a lung. If findings are negative, direct heat to the
area will loosen and soften the muscles and should be of help.

Q.

I tried to get pregnant on June 3, 8 and 15, and have had negative pregnancy tests. My period is five days late. Should I take another test?

A.

I would wait another four to five days, then run another pregnancy test. If this is
negative, consult your physician to determine why your period has been missed.
It's not usually anything of a serious nature, commonly just due to imbalance
of the female hormones.

Q.

Is yogurt with live active and probiotic cultures safe for pregnant women?

A.

There is no evidence to suggest anything harmful to mother or baby about
yogurt.

Q.

I am 32 weeks' pregnant. Is it safe to bleach unwanted body hair, especially on my belly? Also, I started getting bald around the fourth month of pregnancy and it is getting worse. Is it related to pregnancy?

A.

There is absolutely no evidence that hair coloring or bleaching has any impact upon the developing fetus. One must, however, understand that it is not possible to study this sort of thing in enough detail to be certain, so a reasonable approach is to avoid any unnecessary exposure to chemicals during the first trimester. After that, it would not be a worrisome matter. It is very common for there to be hair loss during pregnancy, primarily as a result of hormonal influences upon the hair follicles. With almost no exceptions, this is reversible; the hair pattern will return to normal following the birth.

Q.

On June 10 I found out I was pregnant. My last period was May 15 and prior to that it was consistent. I had intercourse on May 24 with someone other than my boyfriend (we used a condom, which he said didn't break, but you never know). I had sex with my boyfriend on May 27 and May 31(we did not use a condom). The fertility calculator states that I am most fertile from May 29 to June 3. My menstrual cycle length is about 31 days. I am hoping that my boyfriend is the father, since he is delighted about the pregnancy. If my boyfriend is the father, why was the pregnancy test positive at such an early stage, giving it basically a two-week notice?

A.

Based upon this information, your boyfriend is most likely the father. Your calculations as to your fertility dates are correct, making a May 24 date of conception extremely unlikely. Bear in mind, however, that we're dealing with statistical likelihood here and not certainties. It is not surprising that your pregnancy test was positive by as early as June 10, even if the date of conception was as late as May 31. The tests on the market today are extremely sensitive, and usually turn positive by eight to ten days following conception.

Q.

I'm 43 years old and 16 weeks' pregnant with my first child. I tried to have an amnio but it hurt too much. The doctor did quad screening and said there is a two-percent chance that the baby could have Down syndrome. Are the odds pretty good? At 12 weeks I had a sonogram for the flap on the neck and everything was fine. If I need to have an amnio is there any way I could be put in a twilight sleep?

A.

This question raises a number of important issues. First, I would agree that your risk of a Down syndrome baby is two to three percent. That may not appear high, but the risk in the general population of pregnant women of all ages is only about 0.1 percent, so your risk is 20 to 30 times higher. Second, although the risk of an amniocentesis is small, with miscarriage occurring only about 0.5 percent of the time, you should carefully consider what you intend to do in the event you are diagnosed with carrying a Down syndrome baby. If abortion is not an acceptable alternative for you, then there is no purpose in having the test in the first place, unless you feel that just having the information is worth the risk, cost and discomfort. All that said, I have very rarely found women to experience much discomfort with the amniocentesis. You might wish to discuss with your obstetrician whether local anesthesia is available; I believe it is quite helpful. As to the question of "twilight sleep," there would be no harm whatever from providing a rapid-acting intravenous medication for the purposes of sedation and pain reduction.

Q.

I had sex 20 days ago and am wondering if I'm pregnant, even though I had a negative pregnancy test. I missed my period except for spotting one day.

A.

Being late for a normal period is always considered to be pregnancy until
proven otherwise. If the date of conception was 20 days ago, pregnancy tests
should be positive by now. If it is negative and a period does not occur by two
weeks from now, you should see your doctor.

Q.

I'm seven weeks along in my second pregnancy. During the fourth month of my first, I started having terrible pain behind my belly button, couldn't straighten up and walk, and was basically on the couch for ten weeks. I saw a surgeon who said it was a ligament that was a bit shorter than usual so it was really stretching. The pain went away at seven months, and I felt great for the remainder of the pregnancy. Will this happen again, or could the ligament now be stretched to where it won't hurt again?

A.

Ligament pain is very common and generates a lot of questions because it can
be quite painful, although harmless, so long as more serious problems are
ruled out. You are quite correct in assuming that it most likely will not
occur in a second pregnancy, or at least will be much less severe precisely
for the reason you mention: The ligament is pretty much stretched out already.

Q.

At which week will my baby go into a head-down position?

A.

Babies begin to go into a head-down position as the head becomes heavier.
By 34 weeks, about 2/3 are head-down. By 38 weeks, 96 percent are. As a matter of
obstetric practice, we start evaluating for presentation at 36 to 37 weeks,
as the vast majority should be properly positioned by then.

Q.

I'm 16 weeks' along, and my stomach is big. Is this normal?

A.

Your abdomen may look and feel large even as early as you are now, but this has little to do with the actual size of your uterus, which, at 16 weeks would be about the size of a grapefruit and would be above the pubic bone by only two or three inches. It has much more to do with the fact that the hormones you are producing, primarily progesterone, cause the muscles of the abdomen (and everything else) to relax. In addition, this muscle relaxation also slows digestion, so the intestines are fuller and more protruding.

Q.

In December I thought I was pregnant. My stomach was hard and I felt sick, but I had my period. Actually, it could have been spotting, since it only lasted three or four days, and it was three weeks late. In my first ultrasound my doctor said I was 12 weeks, but my baby looks way too big to be 12 weeks. Could I have gotten pregnant in December?

A.

Ultrasound at 12 weeks is very reliable when it comes to determining the length of pregnancy, so I would consider that to be a dependable piece of information. If there's anything that is unreliable, it's trying to remember dates at which some flow occurred that might or might not have been a menstrual period. It cannot be overstated how valuable early ultrasound is in finding out this critical information, so that when you get near term, there can be no question when you are either premature or post-dates. We can use this information to make the important decisions about whether to try to stop a premature labor or induce someone who is truly late.

Q.

I'm experiencing really sharp pains in my pelvic area that shoot through my vagina. It's a really fast pain and I don't think that it's a contraction but it does stop me in my tracks. What's wrong?

A.

Most likely, nothing is wrong. I'm assuming you are at least into the second trimester, as this is the time when it's common for the ligaments that hold the uterus in place to begin to stretch. As they carry nerve fibers, the stretching can cause quite sharp pains, but this is quite different from contractions, which are generally perceived as more dull and crampy. In any case, heat, such as a hot water bottle, and lying down will usually shorten the duration of these harmless episodes.

Q.

I'm 19 weeks' pregnant and I was wondering if Nitrofurantoin macro 100 mg is ok for me to take. I've had microscopic blood in my urine the past three ob/gyn visits. When they cultured it, they found no bacteria present. Now my latest incident has landed me in the E.R. I had/have pain and pressure on my right side and back. They said I have hydronephrosis, water around my kidneys. They did a UA there as well. There's still blood in my urine. I don't know if the culture is back. Do you have any suggestions?

A.

While Nitrofurantoin is a very safe and commonly used antibiotic during pregnancy, there is no benefit to taking it if your urine cultures are negative, and taking an unnecessary antibiotic at any time increases the risk of causing bacteria to become resistant to treatment. Most pain and pressure syndromes during pregnancy are the result of stresses to bone, joints and ligaments as the uterus enlarges and posture changes. These are certainly a nuisance, but are not harmful. In addition, with the relaxation of smooth muscle that occurs in all pregnancies, the ureters and kidneys dilate, so a limited amount of hydronephrosis is seen in all pregnancies. The commonest cause of microscopic hematuria (blood in the urine) is a kidney stone, but as it is not easy or entirely safe to X-ray the urinary system during pregnancy, this evaluation can most likely be delayed until after your baby's birth, so long as you are not having serious discomfort. Otherwise, you may need urologic consultation.

Q.

I'm seven months' pregnant and not yet showing. The doctors say everything is great, but no one can tell I'm pregnant. Is this normal?

A.

"Showing" is a very subjective phenomenon and can be quite difficult to appreciate to the casual observer. It is not at all unusual, especially in a first pregnancy, for firm abdominal muscles to hold the uterus back so tightly that it is not noticeable to others. For just that reason, we can only determine the precise level to which the uterus has grown by having the patient lie back flat and using a measuring tape. Don't worry: In later pregnancies the showing will be much more obvious.

Q.

I'm 23 weeks' pregnant, and my feet are already swollen. Is this normal?

A.

In general, leg and foot swelling are third trimester symptoms, so this would be about three to four weeks earlier than is customary. On the other hand, it may be normal if you are spending a great deal of time standing still during the day. My advice would be to get off your feet and elevate your legs for a few hours during the day. If this does not promptly improve the swelling, you should bring this to the attention of your caregiver.

Q.

I had a miscarriage two months ago, and the other day I saw a spot of blood (it's not time for my period). I am feeling as though my uterus is contracting. Could I possibly be pregnant again?

A.

A new pregnancy is certainly a possibility. Usually, when a miscarriage occurs, the next menstrual period is seen within six weeks of the event. So, if it has now been substantially more time than that and you have not seen what you consider to be a normal period, this should be investigated.

Q.

Is it safe to have a Pap smear when I'm 24 weeks' pregnant?

A.

Yes, it is safe to have a Pap smear at that gestation, although you are likely to experience a little bit of bleeding due to the fragility of blood vessels at that advanced stage of pregnancy. As you know, a Pap smear requires some gentle scraping of the cervix, so it is not unusual for some bleeding to occur. This, however, is not dangerous and will usually resolve within a few hours.

Q.

I'm 23 weeks' pregnant as of May 20. When could the baby have been conceived?

A.

While it is not possible to determine a precise date of conception from that information, the greatest likelihood is that conception occurred during the interval from December 20 to December 30.

Q.

I'm in my first trimester, and fish does not sound good right now, except tuna, which I know I need to limit. Can I take my supplement omega-3 EPA/DHA? I heard it's good for the baby, but I am not sure if taking it is ok, or if I should get it in food.

A.

Fish is a valuable pregnancy nutrient for reasons in addition to the omega-3 content. It is an excellent source of protein as well, so you should look for fish known to be low in mercury (see the CDC Web site, www.cdc.gov, for the current list) and continue to eat it. Certainly, omega-3 supplements are safe to take in pregnancy, so you may employ that option if you cannot manage to consume fish.

Q.

I have a a urinary tract infection, and my doctor prescribed Nitrofurantoin-macro 100 MGMYL, which I started taking today. I also started bleeding old blood. Is this normal?

A.

Blood in the urine is a common feature of bladder infections, but is a sign that it is of more than average severity and should be watched closely. If the blood becomes bright red and/or heavy, it is likely you will have to be changed to a more powerful antibiotic.

Q.

I'm six to seven weeks' pregnant. When will my headaches go away?

A.

The most common reason for headaches in early pregnancy is inadequate fluid intake, or dehydration. Most women fail to realize the large water requirement in early pregnancy, what with bothersome nausea and fatigue. In general, the headaches will improve in severity with increased water intake and should disappear entirely when the first trimester is over.

Q.

I have an eight-month-old and have been on birth control (loestrin 24) for about three months. I forgot to take a couple of pills. My LPN was March 23 to 27. I had no MP in April. I was ten days late. On May 6 I started my period but it wasn't normal, pinkish with very little clotting. I took HPT and a urine test and both were negative. I feel as I did when I was pregnant with my first child. I'm bloated, sick and tired. My stomach is itchy and I can feel my c-section scar stretching. Please help me figure this out. Should I ask for a blood test?

A.

There is not really enough information here to provide a conclusive answer to this question. Although pregnancy is always a possibility, it appears unlikely. By missing your pills, your hormone level would drop and become out of proper balance, which will tend to produce the sort of symptoms and events you describe. Certainly, running a blood test for pregnancy would be worthwhile. If, as expected, it is negative, the best plan would be to just stay on your pills and anticipate a gradual resolution of these symptoms as your hormone levels return to proper balance.

Q.

I'm 20 weeks' pregnant. I have a really bad sore throat, and a yest infection that won't go away. What is safe to take at this time, especially for the cold?

A.

With very few exceptions, sore throats are due to viruses and are controlled by things like decongestants and antihistamines, which are safe during pregnancy. Yeast infections are usually quite easy to clear with very safe over-the-counter medications. If the infection won't go away, it should be brought to your doctor's attention, as it may be that it's not really a yeast infection at all.

Q.

I'm 30 weeks' pregnant, and labor is near. If I tell my doctor (and everyone else when I'm in labor) that I don't want an episiotomy unless the baby has to come out quickly, do they all have to respect my choices?

A.

You should discuss the episiotomy issue in detail with your doctor. It's not quite as simple a matter as doing it only if a baby needs to be delivered quickly. While it is certainly not done as a routine any longer, it is a procedure that can, in selected circumstances, prevent lacerations which can be difficult to repair and painful in healing. In addition, if an instrumental (forceps or vacuum) technique is employed, an episiotomy is customary for the same reasons.

Q.

Can my husband use prenatal vitamins?

A.

Prenatal vitamins contain nothing the least bit harmful, so your husband could certainly take them safely. On the other hand, if he has a reasonable diet, they would offer him no benefit either.

Q.

I get my period every 28 days, and it lasts for 4 days. On which days would I be ovulating?

A.

If you have a dependable 28-day cycle, you may assume that you will ovulate at or about mid-cycle. As we count cycles as beginning on the first day of flow, this would suggest days 12 to 14 as the most fertile time. That said, most women cannot detect when they ovulate. Some get a mild twinge of pain in one side or the other, and some are able to perceive a watery vaginal discharge. If, for some reason, you really need to know when you are ovulating, your best bet is to purchase an ovulation detection kit, available in most pharmacies without a prescription.

Q.

My period ended nine days ago, and I had sex. The condom broke. Will I get pregnant?

A.

If your period ended 9 days ago, then it probably began about 14 days ago, thereby putting you at or near ovulation time, assuming you usually have a 28- to 30-day cycle, like most women. So there is a very high risk of pregnancy in this situation. This is precisely why the morning-after pill (now also known as Plan B) was introduced. If taken within 72 hours of the event, it will prevent pregnancy in 85 percent of cases.

Q.

Is it safe to have a manicure and pedicure during pregnancy? Is the chemical in the nail polish safe for my baby?

A.

It is considered safe to have manicures and pedicures during pregnancy. No harmful chemicals have been detected in these processes. I would generally advise against nail polish, however, not because it is dangerous, but because in the chance that you may be in a hospital and be put under anesthesia, the nail polish could make it more difficult for the anesthesiologist to read the instrument they nowadays put on your finger to monitor your oxygen level during surgery.

Q.

I think I'm having my period, but it's not normal bleeding. Can I be pregnant even though I'm having blood clots?

A.

Abnormal flow is often associated with early pregnancy, so be sure to test for that right away. If you are pregnant, give it a few days to resolve, then see your doctor if it has not done so. The matter becomes urgent if it is associated with significant pelvic pain.

Q.

My last period lasted almost two weeks and I was spotting. I have my period again, which was five days late. I've been throwing up in the mornings. I thought I was pregnant, but four pregnancy tests have been negative. What could be happening?

A.

Abnormal menses as you describe is usually the result of failure of the ovulation mechanism, which often results from stress. When this happens, your ovaries release estrogen, but not progesterone, often resulting in nausea, which simulates pregnancy symptoms. See your doctor if this does not resolve within the coming month.

Q.

I'm 13 weeks' pregnant and have terrible acne on my face. During my first pregnancy I experienced acne, too, but not as bad as this time. (After I stopped nursing my first child, my face cleared up.) My doctor told me glycolic face wash was safe so I used it and broke out even more. Is there anything I can do to clear my skin?

A.

Acne is quite common in pregnancy and is a result of dramatic changes in hormone production. As the hormones tend to stabilize after 13 weeks or so, you can expect this matter to resolve itself soon. In the meantime, most face soaps are safe. Just do what you can to reduce oiliness for the time being.

Q.

If your water doesn't break by your due date, does the doctor break it for you?

A.

Not necessarily. The doctor will intervene by inducing labor if it is felt to be necessary. Breaking the water artificially is one method of accomplishing that. Certainly, there is nothing at all abnormal about going as much as two weeks past the due date, so long as the situation is watched closely. Induction of labor carries risks (and is associated with as much as a 50-percent C-section rate) and should not be undertaken without a definitive need.

Q.

I'm 20 weeks' along and today my breast started leaking enough to soak three shirts. Should I see my doctor?

A.

There is nothing abnormal about producing breast milk during pregnancy. It is simply a reflection of your particular hormone production and the sensitivity of the breast milk glands to these hormones. It is actually good news as it would predict you will produce milk well after your baby's birth.

Q.

Is it normal to develop a bad taste in your mouth? I'm wondering if other pregnant women suffer from this, or if it's just me.

A.

A wide variety of taste sensations is reported by most pregnant women and appears to be due to hormonal influences. It is harmless and should not adversely impact nutritional needs. Iron, which is often prescribed to pregnant women, may also create a metallic taste sensation. Discuss with your physician whether you need iron supplements or perhaps can ingest enough through dietary approaches.

Q.

I keep hearing about postpartum blues and depression — is there anything a pregnant woman can do to avoid it?

A.

First, it is very important to distinguish between postpartum blues and depression. The former is a mild and generally harmless condition. The latter is extremely serious. While the blues will have only an intermittent effect and wear off within a few weeks, postpartum depression is marked by almost a complete inability to carry on daily activities, including newborn care. As this condition is now much better recognized and understood than in previous times, strenuous efforts are made to diagnose and treat it early, nearly always with a good outcome. For this reason, mothers of newborns must be vigilant about their feelings during this period of time and report if symptoms are worsening instead of improving promptly. While it is unlikely that the blues can be prevented entirely, depression certainly can and should be so long as careful self-awareness is employed and good communication exists between mothers and caregivers.

Q.

Can I go for a massage during pregnancy, and can I see a chiropractor for backaches?

A.

There is no prohibition against massage during pregnancy, provided the masseuse is properly trained and experienced. The same advice applies to the use of chiropractic manipulation. It would be advisable, however, to research this carefully and certainly to keep X-rays that might be recommended to a minimum.

Q.

I have been having cramps/sharp shooting pains. I thought it was ligaments stretching but it seems to continue. When will it go away?

A.

Cramps and shooting pains during pregnancy are common and harmless, usually reflecting ligament stretching and fetal position change. In the days leading up to labor, they tend to occur as a result of the bones of the pubis rubbing together during walking. They may actually serve the beneficial purpose of getting a woman off her feet as labor nears. This will encourage uterine contractions and reduce foot and ankle swelling, not to mention providing much needed rest and relaxation.

Q.

I'm craving carbs. What else can I eat to take away or at least satisfy that craving?

A.

Carbohydrate craving is almost universal in pregnancy and is not considered harmful, so long as there is a reasonable balance among the food groups. Carbohydrates are absorbed slowly from the stomach, so they serve the useful purpose of reducing the otherwise bothersome hunger pangs that are so frequently reported and rarely result in excessive weight gain. Protein drinks often serve as a good substitute if you are concerned about the caloric intake.

Q.

I have had back labor for my past two pregnancies. What causes it, and am I likely to have it again?

A.

Back labor is considered to be the result of a fetus in what is called an “occiput posterior” position – when the back of the baby’s head, which is relatively hard and bony, presses against the mother’s sacrum and tailbone. Most babies position themselves so that the much softer face contacts the sacrum, which is less uncomfortable. It is not known why babies settle into one position or another, but there has been some success in avoiding back labor by having the mother assume a hands-and-knees position during the weeks near term. Presumably, this permits gravity to bring the back — or heavier — side of the baby’s head around to the front of the mother’s pelvis.

Q.

What is micro-deletion testing that can be done when having chorionic villus sampling (CVS), and do you recommend it?

A.

Micro-deletion is a test to determine the status of a single gene as opposed to chromosome testing, which is accomplished by CVS or amniocentesis. It is designed only for women who are known to be at high risk for a specific genetic disorder, and cannot be done via CVS.

Q.

Do you recommend having a 13-week anatomy scan and a 20-week anatomy scan?
Insurance will not cover the 13-week scan, but some doctors are recommending it these days.

A.

I would not, at this moment, encourage a 13-week anatomy scan. Despite notable improvements in ultrasound technology, organs are very tiny so that abnormalities could still be missed that would be evident by the time of the 18- to 22-week scan.

Q.

How many sonograms should you have throughout your pregnancy?

A.

Sonograms in a pregnancy believed to be normal are customarily done twice: once in the first trimester to confirm viability and establish dates, and again at the 18- to 22-week window to evaluate anatomical development. They may be done at other times as well in specific situations.

Q.

Can I get a flu shot while pregnant? Is it safe for the baby?

A.

Flu shots are not only safe in pregnancy, but are strongly encouraged for all women who are or who expect to become pregnant during the flu season, November through March. No adverse effects have ever been reported for either mother or baby.

Q.

I’m five weeks’ pregnant and I’ve had spotting. Is it a danger to my baby? A friend of mine experienced some bleeding during her pregnancy and everything turned out fine. I’ve called my doctor – what else do I need to do?

A.

Bleeding – even a small amount – during the first trimester is considered to be a threatened miscarriage. However, a light amount this early in most cases turns out to be of no consequence and is presumed to be due to the rupture of small blood vessels in the cervix. We recommend reduced activities until the matter is resolved, mostly to permit bleeding to cease if it is indeed of a harmless nature.

Q.

When my husband and I have sex, I can feel my uterus squeezing and the baby moving. It takes my mind completely off being with my husband. Is this squeezing normal, and is it bad for the baby?

A.

During the third trimester, orgasm causes the uterus to contract, occasionally strongly enough to be noticed. This has never been shown to have anything to do with labor or to subject a woman to an increased risk of premature labor. However, if a patient is at high risk for premature labor, having had a previous pre-term birth, it is generally recommended that she not experience orgasm, even though there is no clinical evidence of hazard. It’s all but impossible to truly study this question in a scientifically credible fashion.

Q.

I’ve taken Lamaze with my husband, but he doesn’t seem very interested in the whole breathing and imaging thing. Are there other people who might be able to help me through labor?

A.

It is very common for husbands/partners to have a difficult time immersing themselves in the preparation for childbirth, regardless of the method. Remember that the birth of a first baby constitutes an often frightening event, as it carries with it the most life-changing implications most people will ever encounter. My experience tells me that most partners become more interested and enthusiastic as term approaches. If you truly believe that this is not happening by around 36 weeks, you may wish to seek the services of a doula, who is knowledgeable and experienced in the labor process and will be at your bedside throughout labor to offer advice and encouragement. Doulas can be located through childbirth educational organizations such as ICEA (International Childbirth Education Association).

Q.

At my 23rd-week appointment, my doctor told me that the ultrasound taken at the 20th week showed that my baby boy's kidneys were dilated. What does this mean, and is it anything to be worried about?

A.

First, it’s important to understand that at 20 weeks a baby’s kidneys are very tiny, so any ultrasound finding of that sort cannot be considered definitive. That said, dilation of the kidneys raises the suspicion of an obstruction to the flow of urine and must be viewed with great concern. If such an obstruction were to be confirmed, the pressure buildup would likely destroy kidney function. The obvious plan will be to follow this situation very closely with repeated ultrasound examinations until a definitive diagnosis can be made.

Q.

I’m almost seven weeks along in my pregnancy. My breasts are not sore or growing, and it seems that everything I read says they should be. Is something wrong?

A.

Breast soreness is, indeed, the commonest symptom of early pregnancy, reported by more than 90 percent of patients. However, by no means should its absence be considered worrisome. More important is the determination that your uterus is growing as it should, which implies a normal development process. Your doctor should be able to reassure you that this is happening at your next prenatal visit.

Q.

Is it safe to have sex during pregnancy?

A.

For the vast majority of women, sex during pregnancy is not at all harmful. For some, however, it is not comfortable. There are some conditions in which it would be prohibited, such as bleeding, infections and cases in which premature labor is considered to be at high risk. Your obstetrician will be glad to provide more detail. We know this is on your mind, so don’t be hesitant to bring up this issue.

Q.

My baby is due next month, and I’m huge. In my childbirth education class, I was told not to sleep on my back. I can’t sleep on my stomach, and I’m uncomfortable sleeping on my side. Any advice?

A.

Sleeping on one’s back is an issue about which there is much misunderstanding. Certainly, it is not an issue at all during the first two thirds of pregnancy. However, by the third trimester, the uterus becomes heavy enough so that it might push backwards against the large vein of the abdomen (called the inferior vena cava) and cut off blood flow to the heart. For this reason, women are encouraged to recline on their left sides instead of their backs. As a practical matter, lying on one’s back during late pregnancy is usually reported as very uncomfortable for the woman and so it is most unlikely that anyone would elect to lie in that position. The best position for a woman in very late pregnancy if side lying were uncomfortable would be a semi-sitting position in a recliner.

Q.

My mother advised me to stop having my hair highlighted during my pregnancy. The colorist said it’s perfectly safe to color my hair. I don’t want to jeopardize my baby’s health, but if there’s no risk, I want to continue to color my hair. Is there a real reason to stop?

A.

There is no evidence to support any prohibition on hair coloring during pregnancy on the basis of known risks to the fetus. It must be understood, however, that there are only a relatively few substances that have been studied adequately to provide complete reassurance – and hair dye is certainly not one of them.

Q.

I’m eight weeks’ pregnant, and I’m experiencing what felt like menstrual cramps before the pregnancy – without the bleeding. What does this mean?

A.

It is very common to experience sharp, shooting pains in the low abdomen during the first eight to ten weeks of pregnancy. In most cases, this is due to ligament stretching and is not hazardous. If, however, this symptom is accompanied by bleeding, it is not normal and you must report it to your clinician immediately.

Q.

I just found out that I’m pregnant and, as thrilled as I am about the baby, I’m nauseated much of the time. I really can’t keep anything down these days, and I’m worried about not providing the proper nutrition for my baby. Is this nausea temporary, and does it pose a risk to my child?

A.

Nausea of pregnancy is quite normal and rarely presents a hazard to the pregnant woman or to her baby. Small, frequent meals with carbohydrate foods such as crackers will usually be of some help. There are, however, some extreme cases in which dehydration occurs. This is never considered normal and may even require intravenous fluids for a few days in the hospital. In almost every case, the condition resolves by 12 weeks of pregnancy.

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DISCLAIMER: The contents of You & Your Family/youandyourfamily.com are for informational purposes only and should never replace the advice and care of a licensed healthcare professional. Neither CW Publishing Group nor its consultants guarantees the accuracy, completeness or timeliness of any information contained in the publication/on the Web site, and neither shall be liable for any loss, damage or injury directly or indirectly caused by or resulting from such information or its use. The consultants¹ participation in this publication/Web site shall not in any manner be interpreted to constitute an endorsement by them of any products or services that may be advertised or referenced herein. Sources: References made within articles are available on written request from the Publisher.