Q. What type of medical coverage does one need to make an appointment with a ob/gyn?

A. There is no insurance coverage that is required for someone to make an appointment with any doctor, with the exception that some insurance plans, such as HMOs, may limit the choices of doctors available to you. If, however, you are inquiring as to whether or not your appointment will be a covered benefit, the best approach is to inquire from wherever you got the plan, i.e., your employer’s benefit office or a private insurance broker.

Q. I love drinking at least 1 cup of coffee daily. Is my unborn child at risk of birth defects? Do you recommend no coffee at all?

A. Your baby is not at a significantly increased risk of birth defects, although caffeine is a drug which constricts blood vessels, thus reducing blood flow to your baby. One cup per day should not be a concern, but I wouldn’t encourage any more than that.

Q. I had my period after missing it for ten months, and took medroxyprogesterone and Clomiphene. Ten days after my period stopped I had light pink spotting for two days on and off, with cramping and nausea. Now I am tired all the time and nauseous, with pain in the abdomen. I am urinating all the time, especially at night. I have difficulty sleeping, and have hot/cold flashes. I cry at the drop of a hat, have a runny nose, breast tenderness, am always hungry and have had a headache every day for a week. What could this mean?

A. These are pretty typical symptoms of someone whose hormones are out of balance. If you’ve been given Clomiphene, then your doctor has presumably concluded that your ovulation process is not working properly. Clomiphene is designed to induce ovulation, but it may have to be raised to a higher dose in order to effect the desired result.

Q. My girlfriend had spontaneous bleeding a little over a month ago. On the same day she have undergone a D&C. After two weeks she suffered from measles and started to feel an abdominal pain, which she still has. The doctor said it was normal, but I can’t accept what he says. What shall I do? Today I am giving her a pain reliever.

A. First of all, you should not be deciding what is or is not correct about what the doctor told your girlfriend. That is her business and should be taken up by her. Moreover, let her decide if she needs a pain reliever. If there are unresolved issues regarding her health, she should discuss this with her doctor. I can’t reach any conclusions about her status based upon this information.

Q. I usually get frequent severe headaches, and have been using ibuprofen for the pain. Is this safe? If not, what should I use?

A. Ibuprofen is considered safe in pregnancy, but a good many pregnant women get headaches because they don’t hydrate well enough. Your fluid demands are very great, so try increasing significantly the amount of water you drink each day.

Q. Is it safe to take asthma medication during pregnancy?

A. Yes, it is and one must remember that it is important to permit as much oxygen as possible to get to your baby. Be sure to be vigilant in treating episodes of wheezing or shortness of breath.

Q. I fractured my pelvis about three years ago and am now pregnant. If I have pain, can I take painkillers? OTC pain relievers have not helped.

A. Yes you may. There is no evidence linking narcotic pain relievers with any form of birth defect.

Q. I was just told that I may have an ectopic pregnancy. I’m definitely pregnant, but my uterus is empty and there is some formation on my right Fallopian tube. Right now, I’m experiencing dizziness, cold hands and feet, and my belly button is pulsating. I don’t have a babysitter for my one year old, and I would feel stupid going in to the ER, because the staff there think I’m paranoid. They have sent me home countless times when my baby was sick. I guess I just would like to know this: at what point do I need to go in anyway?

A. At this moment, you do not need to go to a hospital unless you have serious abdominal pain. However, the matter needs close and careful follow up, which your doctor can provide via the use of sequential hormone testing and ultrasound.

Q. Is there anything I can use or do to prevent the appearance of stretch marks?

A. Lot’s of things have been tried, but none have been shown to work reliably. My suggestion is that you work during the first 20-22 weeks at keeping your abdominal muscles toned and fit. The extra blood flow to the area which will result may be of benefit. Some people have claimed benefits from topical Vitamin E, but there is no scientific evidence to support that.

Q. Is it safe to get acupuncture/massage during pregnancy? I have back pain and cannot sleep because of it.

A. There is no evidence to suggest that there is any danger to pregnancies from acupuncture/massage as long as it is carried out competently by a practitioner who knows that you are pregnant and has experience treating pregnant women.

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 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 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. I have had a Mirena IUD in for almost three years. For the last four days I have been feeling nauseous all day, bloated, and feeling pressure and sometimes cramps in my private area. Could I be pregnant?

A. Very unlikely. The Mirena has a failure rate of well under 1 percent. Also, the progestin hormone in the Mirena is not likely to be producing these symptoms. Most likely this is unrelated to your device, but should be reported if it does not resolve in a few days.

Q. I made a pitiful attempt at breastfeeding three years ago. How do I do well the second time around?

A. Groups like La Leche League and various guidebooks will provide you with a lot of suggestions, but one I’ve found helps a lot is to realize that a baby’s appetite can vary greatly from day to day, so that some days your breasts have more milk than they need and other days, not enough. When they seem to be too full, applying ice packs will reduce the volume, while when they’re not full enough, you can increase production and flow by the opposite: applying warm compresses. The other thing to consider is to work at thickening the nipple skin by massaging them with a coarse towel. This will reduce nipple tenderness. You may hear it said that this could threaten early onset of labor, but no data to confirm that concern has ever been produced.

Q. I had my baby three weeks ago and was having some light red/yellow bleeding. Yesterday, I started bleeding dark red blood like a light to medium flow period. Is this normal? Should I call the doctor?

A. Some amount of vaginal bleeding is considered normal throughout the first six weeks after birth. What you describe does not read abnormal. If it seems to be getting heavier, try to rest more and increase your fluid intake. Then notify the doctor if you see no improvement.

Q. I’m 20, with a two-year-old girl. When I had her, I had no pain medication whatsoever. Talk about serious pain. I am having a girl on June 1. Everyone is advising me to get an epidural this time, but I’m scared of the needle. Also, some people talk about back problems after that. Not sure if I should suffer this one or get the shot. Please advise.

A. I am so glad for this question to come up as I have seen far too many patients suffer unnecessarily during labor out of entirely unfounded fears about epidural anesthesia. There’s a reason why everyone you know is advising you to have an epidural, and that’s because it’s a spectacularly safe and effective anesthetic. The only caveat: It’s best to have it done in a hospital where there is 24- hours-on-the-premises anesthesia coverage as the process does have to be monitored closely.

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. 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 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.