Questions & Answers

A. Traditional Caesar salad is made with romaine lettuce, croutons, Parmesan cheese, lemon juice, olive oil, Worcestershire sauce, raw egg and black pepper. Raw eggs carry the potential risk of salmonella bacterial contamination, which can cause food poisoning.

A. If you drink herbal tea when you’re pregnant, you need to use caution. In general, you can have teas made from foods you can safely eat, such as oranges, apples and ginger. Even then, you shouldn’t have multiple cups, since the ingredients are very concentrated. Stay away from some of the more esoteric herbs, since their safety in pregnancy is unknown. Herbs can be drugs, so just because they are natural does not mean they are safe in pregnancy. Some ingredients, such as rasp-berry leaves, are known to be uterine stimulants and should be avoided.

A. Preterm labor means that there are contractions that lead to cervical dilation and, eventually, in some cases, to premature delivery (prior to 37 weeks). This is in contrast to premature contractions, in which the uterus contracts, but there’s no dilation, and thus no preterm delivery. The best way to lower your chance of preterm labor is through regular prenatal care, so that problems can be identified and treated early.

A. When twins are both head down (vertex position), they may be delivered vaginally. However, if either of the babies is in a bottom-down (breech) or transverse position, then your ob/gyn or midwife will need to discuss with you if having a C-section may be the safer option for you and your babies.

A. Most pregnancies are very low risk, and complications are rare. Complications do happen, however, and a previously uncomplicated pregnancy or labor can quickly change to one needing urgent medical attention. Because of this, experts agree that the safest setting for labor, delivery and the immediate postpartum period is the hospital, a birthing center within a hospital complex that meets the standards jointly outlined by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology, or a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, the Joint Commission or the American Association of Birth Centers. These various settings allow for women and their partners to have a birth experience that meets all of their needs and desires, and yet emergencies can be handled quickly.

A. Speak to your husband to find out what is causing him to be reluctant. It may be that he is afraid, worried about his ability to help you, or concerned about seeing you in pain. Try telling him that you really need and want his support, and that going to classes will help him know how best to help you. Make it clear that no one expects him to be an expert — that is exactly why we have childbirth classes! If he is simply not sure he can go through with it, then perhaps you might be better off with a trusted family member or friend. Your husband can then play a more secondary role, yet still be involved in a way in which he feels more comfortable. Most Labor and Delivery units (check with your hospital or birthing center) will allow two sup- port people in the delivery room — so that both he and your primary support person can be present.

A. It probably depends upon how much time you spend in the truck with the stereo very loud. Noise is everywhere in our environment. In adults, loud noise has been associated with numerous health eff ects, including noise-induced hearing loss and high blood pressure. Noise also has the potential to damage fetal and newborn hearing. Studies on pregnant women and noise have been in the workplace, where the noise exposure is consistent over time. These studies suggest that fetuses and newborns exposed to excessive noise may suffer noise-induced hearing loss. It is likely that occasional exposure to loud noises will do no harm, but regular high levels of noise for extended periods have the potential to damage your baby’s hearing.

A. There is nothing easy about bed rest. It is hard work. Th e best way to cope is to make a schedule of activities that you can follow while in bed. For example, you may have a time when you read books, write letters, answer e-mails or spend time with your family. Your doctor may also allow you to do some isometric exercises, in which you can tighten and relax the muscle groups in your body, combining this with breathing techniques. Try not to nap during the day, and stay on a regular sleep schedule — getting up at the same time and going to bed at night at the same time — to help with sleeplessness.

A. Several studies do suggest that very high cholesterol levels during pregnancy can have adverse effects on both fetus and mother. Studies in both humans and animals reveal a tendency toward atherosclerosis (hardening of the arteries and heart disease) in the children of women with high cholesterol during pregnancy. It is, however, important to understand that these are very high levels of cholesterol, and not the mildly elevated levels that are actually a normal part of pregnancy changes. Currently, lipid-lowering drugs (statins) are not used in pregnancy due to worries about safety, although the evidence with statin use in pregnancy is scant and conflicting. For now, it is best to consume a heart healthy diet rich in fruits, vegetables, and healthy fats such as olive oil, canola oil and omega-3 fatty acids.

A Gestational diabetes can run in families. Th e best way to avoid it is to maintain a healthy weight during pregnancy. Women who are overweight or obese are at a higher risk for developing gestational diabetes. Foods that can help control blood sugar levels are those that are broken down more slowly by the body — whole grains, brown rice, whole-wheat breads — instead of sugary foods like soda, fruit juices, white bread, white rice and white potatoes. Finally, staying physically active can also keep glucose levels in the blood stream at a normal level.

A. Toxoplasmosis comes from cat feces. You should avoid handling the litter by having your partner change it. Cats are very clean, though, and touching your cat or close contact with your cat will not spread toxoplasmosis, so it is fine to cuddle with your kitty.

A. I don’t believe there is evidence that a person’s activity level has any more bearing on the likelihood of success after IUI than after more traditional insemination, so, unless you are counseled otherwise, I don’t feel that you need to change your travel plans.

A. You’ve already exceeded by a full year the amount of time that a woman should try unsuccessfully to conceive before seeking help. With the sort of irregular,abnormal bleeding you describe, a good possibility is that your ovulation mechanisms are not operating properly. A fertility specialist can explain to you how that sort of thing is addressed.

A. Assuming you have the customary 28 day cycle and that if you conceived, it occurred on your “fertile days”, which would likely be around July 9-10, then you should start testing around July 19-20, which would be 5 days prior to your next anticipated menses and 2-3 days following likely implantation. As there are a lot of assumptions implicit in this sort of analysis, do not be discouraged by initially negative results. Certainly by the time you are 3-4 days late for menses, test results should be positive.

A. There’s very little reason to worry about your long-term fertility, even though your cycle has been temporarily disrupted as a result of using the BCP. This is a problem which will resolve itself, although it may take a few months. It has nothing to do with your recent UTI.

A. No, it will not. Vitamins will not affect the results of a pregnancy test.

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.

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.

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.

A. It’s not possible to make a reliable diagnosis of what might be causing this array of symptoms, but it is safe to say that none of them sound normal. One would want to start by ruling out such conditions as urinary infection, vaginitis, ovarian cysts and hormonal imbalance. So, a visit for a gynecologic evaluation is clearly in order.

A. What you are referring to is the “double bubble sign.” This means that fluid is not moving properly through the digestive system. This suggests a condition called “duodenal atresia,” which is not normal, but can be corrected surgically. Also, there is a correlation between this finding and chromosome disorders. There is reason to be concerned, and your pregnancy will need additional evaluation right away.

A. These are both clearly abnormal findings which must be taken seriously. The kidney may be obstructed and there may be a spinal abnormality. Your OB physician will be able to refer you for a detailed evaluation and should be done as soon as possible.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.