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Ask the Expert is not a substitute for professional medical advice, diagnosis or treatment. Never delay or disregard seeking professional medical advice from your physician or other qualified health provider because of something you have read here. Preconception
Preconception
At-home genetics testingQ: I've seen at-home genetic tests advertised. What are they, and are they reliable? A: In recent years, companies have begun advertising and offering genetic tests directly to consumers, usually on Web sites. This is called at-home or direct-to-consumer genetic testing. These tests may provide some information about the health risks a woman may face over her lifetime. They can also tell a woman if she is the carrier of certain genetic diseases that can be passed on to a child. But at this time, these tests provide little useful information for women or their health care providers. The American College of Obstetricians and Gynecologists discourages the use of at-home genetic testing. Read more at about the risks of at-home genetics tests. If you are interested in genetic testing, read about genetic counseling. — From the March of Dimes Getting pregnant after birth controlQ: How long should I be off my birth control before I start trying to get pregnant? A: If you’ve been using contraception and are ready to have a baby, talk to your health provider about stopping your use of birth control. There are no hard-and-fast rules about how long you should wait to start trying to get pregnant after stopping birth control. You can begin trying right away. But if you don't have regular periods, it may be more difficult to determine the right time for conception.
It takes two to get pregnantQ: I've done everything I can do to prepare myself for pregnancy. Are there things my husband can do as well?
The best time to try to get pregnantQ: My period is irregular. How can I tell the best time to get pregnant?
If you use the temperature or cervical mucus methods, begin tracking changes a few months before you want to conceive. If you're using an ovulation predictor kit, begin using it about 10 days after the start of your last period. — From the March of Dimes Getting pregnant after birth control |
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| Ethnicity | CF Carrier Rate in People with No Family History of CF |
| Caucasian | 1 in 25 individuals |
| Ashkenazi Jewish | 1 in 26 |
| Hispanic | 1 in 46 |
| African American | 1 in 65 |
| Asian | 1 in 90 |
— Elissa Morris, M.S., CGC, Board Certified Genetic Counselor, Southwest Washington Medical Center
Genetic Counseling
Q: Our first child was born with a genetic birth defect. We would love to have more children, but we are concerned about having another child with special needs.
— Elissa Morris, M.S., CGC, Board Certified Genetic Counselor, Southwest Washington Medical Center
Testing for Down syndrome
Q: I’ve heard a lot about testing for Down syndrome. Nobody in my family has Down syndrome. Why am I being offered testing?
— Elissa Morris, M.S., CGC, Board Certified Genetic Counselor, Southwest Washington Medical Center
Birth control and conception
Q: How soon after stopping birth control can I get pregnant?
— Margaret Griffith, MD, The Woman’s Clinic of Vancouver
Fertile days
Q: How can I identify my most fertile days?
A: Each woman’s menstrual cycle is different. In order to determine your fertile days with accuracy it is first important to determine whether your menstrual cycles are normal. Take notice of certain physical and emotional symptoms (premenstrual symptoms) that occur just prior to your period, and usually subside several days into your period. These symptoms include breast tenderness, bloating, cramping, and mood changes (irritability, anxiousness). The presence of these symptoms usually indicate that you have ovulatory cycles, which means you are ovulating normally. Another important finding you can get from your menstrual calendar is your cycle length. Average cycle lengths are 28-30 days. Cycles less than 21 days or greater than 35 days are not normal and require further evaluation as these are probably anovulatory cycles (meaning, you are not ovulating). Once you have determined whether you have ovulatory cycles, you can then perform easy tests to best determine your fertile days.
The body undergoes a tremendous surge in the reproductive hormone LH, known as the LH surge. This increased hormone level is required to induce ovulation. This surge occurs approximately 12 hours to 1 day before ovulation. Your greatest chance (%) of achieving pregnancy is about 1 day before ovulation.
On average, your fertile days start approximately 14 days after your first day of your period. There are two additional tests that you can perform with little expense to identify your most fertile days: track your basal body temperature, and evaluate your cervical mucus. A more expensive, but more accurate determination of your fertile days would involve the use of LH surge kits available at most drug stores.
Basal body temperature involves tracking your temperature every morning, immediately upon awakening and before any activity. Purchasing "special" thermometers is unnecessary, though you want to use a thermometer that will distinguish a few degrees. Your temperature will rise approximately two days after your LH surge, or one day after ovulation. It is a retrospective view of determining when you ovulate therefore you must have absolute cycle regularity. Tracking your temperature over several months will give you an approximation of when the LH surge occurs, and therefore when you most likely ovulate. A small percentage of women will have monophasic graphs (meaning, no change in basal body temperature) during their ovulatory cycles. Scheduled intercourse should occur 3-4 days prior to and 2 days after ovulation. Keep in mind, scheduled intercourse should not occur more frequently than every 36-48 hours.
Your cervical mucus changes in quantity and character in response to your reproductive hormones. Your cervical mucus can easily be checked with your fingers after using the restroom. During your fertile days, the mucus is abundant, clear, and stretchy.
LH surge kits are urine tests that measure the LH urge. The test, like a pregnancy test, provides a qualitative + or – value. It is best to perform these tests with your first urination of the day. Remember, the LH surge usually occurs 12 hours to 1 day before ovulation. Therefore, scheduled intercourse should occur when the test becomes positive and over the next several days.
— James Carleo, MD, FACOG, The Woman’s Clinic of Vancouver
Preconception medical tests
Q: What medical tests should I have before getting pregnant?
A: It is recommended to make an appointment with your medical provider prior to conception. Here, based on your medical history, habits and physical exam findings, your provider can order tests tailored to your specific needs. Several tests are commonly ordered and include a pap smear, rubella titers, complete blood count, chicken pox titers and hepatitis B status. An HIV screen, while optional, is also strongly encouraged.
— Michael S. Farber, MD, The Woman’s Clinic of Vancouver
Taking supplements while trying to conceive
Q: Is it safe to take megavitamins and herbal supplements while trying to conceive?
A: Megadoses of certain vitamins and minerals can hurt you and your developing baby. If you’re trying to get pregnant, your best bet is to eat a well-rounded diet and take a prenatal vitamin with folic acid every day. The prenatal vitamin should have at least 400 micrograms of folic acid and DHA, which is an omega 3 fatty acid. The folic acid can prevent some birth defects, and the DHA helps with brain and eye development.
— Allison Higgins, MD, The Woman’s Clinic of Vancouver
Pregnancy in older women
Q: I‘m 39. What risks are associated with getting pregnant at a later age?
How to prepare for pregnancy
Q: How long before becoming pregnant should a woman start preparing for pregnancy? What are the five most important things she should do before pregnancy for her and her baby’s health?
A: Every man and woman should prepare for pregnancy before becoming sexually active, or at least three months before conception. Women should begin some of the recommendations even sooner – such as quitting smoking, reaching healthy weight, and adjusting medications. Planning for pregnancy is also a good time to talk about other concerns. Issues such as intimate partner domestic violence, mental health, and previous pregnancy problems need to be discussed. Although men and women can do much on their own, a healthcare provider is necessary for finding and treating existing health problems. They can also help a woman improve her health before pregnancy.
The five most important things a woman can do for preconception health are:
- Take 400 mcg of folic acid a day for at least 3 months before becoming pregnancy to reduce the risk of birth defects.
- Stop smoking and drinking alcohol.
- If you currently have a medical condition, be sure these conditions are under control. Conditions include but are not limited to asthma, diabetes, oral health, obesity, or epilepsy. Be sure that your vaccinations are up to date.
- Talk to your healthcare provider and pharmacist about any over the counter and prescription medicines you are taking, including vitamins, and dietary or herbal supplements, you are taking.
- Avoid exposures to toxic substances or potentially infectious materials at work or at home, such as chemicals, or cat and rodent feces.
Pregnancy
Finding the right provider
Q: Now that I'm pregnant for the first time, how can I find the right healthcare provider to help me through this new journey?
A: You can choose either a doctor (physician) or midwife to take care of you during your pregnancy and to deliver your baby.
- An obstetrician (OB) is a doctor who specializes in the care of women during pregnancy, childbirth and recuperation from delivery. About 8 in 10 pregnant women choose obstetricians.
- A family practice doctor is a doctor with training in all aspects of health care for every member of the family. A family practice doctor can be your health care provider before, during and after your pregnancy, and your baby's doctor, too.
- A certified nurse-midwife is a registered nurse with advanced, specialized training and experience in taking care of pregnant women and delivering babies. Certified nurse-midwives are licensed to provide care before, during and after delivery.
- A maternal-fetal medicine specialist is an obstetrician with special training in the care of women who have high-risk pregnancies. If you have risk factors that could complicate your pregnancy, your prenatal care provider may refer you to a maternal-fetal medicine specialist.
What You Can Do
Choose a health care provider who makes you feel comfortable and who listens to you. Questions you may want to consider include:
- Does the provider have a good reputation?
- Does the provider listen to you and take the time to explain things clearly and thoroughly?
- Are you comfortable with the gender and age of the provider?
- Does the provider make your partner feel comfortable, too?
- Is the office staff pleasant and respectful?
- Is the location of the office convenient? Do the hours fit your schedule?
- What hospital is the provider affiliated with? Does the hospital have a good reputation? Is its location convenient?
- Is the provider in a solo, group or collaborative practice?
- Will you always be seen by the same provider during your office appointments?
- Who covers for the provider when he or she is unavailable?
- Who handles phone calls during office hours? Does the provider charge for phone consultations? How are calls and emergencies handled after hours?
- Does your insurance cover this health care provider?
Seat Belts During Pregnancy
Q: Now that I'm pregnant, what is the best way to wear a seatbelt?
A: Experts agree that everyone, including pregnant women, should wear a seat belt when riding in a car. When used properly, seat belts save lives and lower the chances of severe injury during car crashes.
Depending on how severe the car accident is, pregnant women could be at risk for miscarriage, preterm labor and other serious complications. In fact, the more injuries a mother has during a car accident, the greater the risk to her unborn baby. If the pregnant woman is wearing her seat belt properly at the time of the accident, she and her baby will face fewer injuries.
There are nearly 170,000 car crashes involving pregnant women every year. So it’s important for moms in all stages of pregnancy to properly wear seat belts at all times when traveling in a car.
Guidelines for Wearing a Seat Belt
- Always wear both the lap and shoulder belt.
- Buckle the lap strap under your belly and over your hips.
- Never place the lap belt across your belly.
- Rest the shoulder belt between your breasts and off to the side of your belly.
- Never place the shoulder belt under your arm.
- If possible, adjust the shoulder belt height to fit you correctly.
- Make sure the seat belt fits snugly.
Other Helpful Tips
- Driving can be tiring for anyone. Try to limit driving to no more than 5-6 hours per day.
- Never turn off the air bags if your car has them. Instead, tilt your car seat and move it as far as possible from the dashboard or steering wheel.
- If you are in a crash, get treatment right away to protect yourself and your baby.
- Call your health provider at once if you have contractions, pain in your belly, or blood or fluid leaking from your vagina.
Drugs, herbs and dietary supplements
Q: I currently take a number of herbal supplements. Should I be concerned about these during my pregnancy?
A: Street drugs, over-the-counter drugs, prescription drugs, dietary supplements, herbal preparations, and some medications can hurt your baby. Some can cause birth defects. Others can cause your baby to be born too small or very sick. A woman who is pregnant or thinking about getting pregnant should tell her healthcare provider about any drugs she takes to make sure they are safe for pregnancy.
Street Drugs
Illegal drugs, including cocaine, marijuana and Ecstasy, may cause birth defects. Pregnant women should not take street drugs and should tell their providers if they need help to quit. For information about drug treatment in your area, go to the Substance Abuse Treatment Facility Locator.
Before You’re Pregnant
A woman taking any of the following drugs should talk to her provider before getting pregnant. She may need to switch to a safer drug for pregnancy:
- ACE inhibitors (enalapril or captopril)
- Androgens and testosterone by-products
- Anticancer drugs
- Antifolic acid drugs, like methotrexate or aminopterin
- Carbamazepine
- Levothyroxine
- Lithium
- Phenytoin
- Streptomycin and kanamycin
- Tetracycline
- Trimethadione and paramethadione
- Valproic acid
- Warfarin and other coumarin by-products
Prescription Drugs During Pregnancy
If you are pregnant and taking any of the following drugs, stop taking the medicine immediately and call your health care provider:
- Isotretinoins such as Amnesteem, Claravis, Accutane and Sotret and other retinoids
- Soriatane (acitretin)
- Thalomid (thalidomide)
- Revlimid (lenalidomide)
If you are pregnant and taking any other prescription drugs, talk to your provider before stopping the medication. Sometimes stopping a drug suddenly can have a health risk.
Even some nonprescription medications may carry a health risk, although it is generally small. For example, if a woman takes aspirin shortly before the day the baby is born, it can increase the risk of heavy bleeding in the mother and baby.
Herbal Products and Dietary Supplements
The March of Dimes does not support the use of herbal or dietary supplements by women who can become pregnant, by pregnant women, or by children, without approval by a health care provider. While some supplements and herbal ingredients have undergone extensive testing, the safety and effectiveness of many have not been shown.
More Things You Can Do
- Don't take someone else's prescription drugs.
- Take only medications prescribed for you or recommended by a health care provider who knows you are pregnant.
- Check with your provider before taking any over-the-counter drugs (including aspirin), pills, herbal products or dietary supplements.
Vaccines and autism
Q: Is there a relationship between vaccines and autism? I’ve heard so much about it lately, I don’t know what to believe!
A: I can understand how confusing and worrisome this is. Autism and related conditions such as Aspergers Syndrome may be increasing in frequency. Because of this, researchers have thoroughly sought to find a connection between specific vaccines (e.g. Measles) or preservatives such as Thimerosal. The information currently available overwhelmingly finds no link between vaccines and autism. Regardless of these negative findings, Thimerosal is no longer used in infant vaccines.
In a way vaccines are a victim of their own success, since most parents no longer recall seeing these vaccine preventable diseases. These germs are still out there, however, so we say: “Go the safe route and get the shots.”
Knowing where to get reliable, unbiased information is important. Here are some good resources I use and recommend.
The Children’s Hospital of Philadelphia is one of the nation’s top children’s hospitals. Their website provides a wealth of details regarding vaccine safety and the research and data to back up the information. Find out more from the Children's Hospital of Philadelphia >
What to Expect Guide to Immunizations. You can download this free booklet that answers parents’ many question about vaccines and vaccine safety in an easy to read format. Download the guide in English or Download the guide in Spanish
Risks of C-Section
Q: I had surgery on my uterus several years ago, and now that I’m pregnant for the first time, my doctor recommended that I deliver by c-section. What are the risks?
A: When c-sections are done, most women and babies do well. But c-section is a major operation with risks from the surgery itself and from anesthesia.
The National Center for Health Statistics estimates that 1 in 3 babies in the United States are delivered by c-section. Over the past few years, the rate of cesarean birth has increased rapidly. Some health care providers believe that many c-sections are medically unnecessary. When a woman has a cesarean, the benefits of the procedure should outweigh the risks.
Risks for baby include:
- Anesthesia: Some babies are affected by the drugs given to the mother for anesthesia during surgery. These medications make the woman numb so she can't feel pain. But they may cause the baby to be inactive or sluggish.
- Breathing problems: Even if they are full-term, babies born by c-section are more likely to have breathing problems than are babies who are delivered vaginally.
Concerns for mothers are include:
- Women who have c-sections are less likely to breastfeed than women who have vaginal deliveries. This may be because they are uncomfortable from the surgery or have less time with the baby in the hospital. If you are planning to have a cesarean section and want to breastfeed, talk to your provider about what can be done to help you and your baby start breastfeeding as soon as you can.
- A few women have one or more of these complications after a c-section:
- Increased bleeding, which may require a blood transfusion
- Infection in the incision, in the uterus, or in other nearby organs
- Reactions to medications, including the drugs used for anesthesia
- Injuries to the bladder or bowel
- Blood clots in the legs, pelvic organs or lungs
– Courtesy of the March of Dimes
Finances of going back to work
Q: My husband and I are trying to decide if we can financially afford for me not to go back to work after baby is born. What can we expect to pay for daycare, and what resources are available to help us find the right daycare provider?
A:Both Oregon and Washington have Child Care Resource & Referral Networks, grass roots programs that provide child care costs, referrals and parenting information. They not only provide information about daycare costs, but you can also find our about tax credits, get referrals to licensed daycare providers in your area, and learn about selecting a daycare provider that is right for you. Find out more at the Washington State Child Care Resource & Referral Network and the Oregon Child Care Resource & Referral Network.
Diabetes and pregnancy complications
Q:Does diabetes cause other pregnancy complications?
A:Women with diabetes (pregestational and gestational) are likely to have an uncomplicated pregnancy and a healthy baby, as long as blood-sugar levels are well controlled. However, women with poorly controlled diabetes are at increased risk for certain pregnancy complications. These include:
- Preeclampsia: This disorder is characterized by high blood pressure and protein in the urine. Severe cases can cause seizures and other problems in the mother and poor growth and premature birth in the baby.
- Polyhydramnios: This is a condition where the mother makes too much amniotic fluid. Polyhydramnios can increase the risk for preterm labor and birth
- Cesarean birth: When the baby grows too large, providers often recommend a cesarean birth
Gestational diabetes
Q:What causes gestational diabetes?
A:Gestational diabetes occurs when pregnancy hormones or other factors interfere with the body’s ability to use its insulin. An affected woman usually has no symptoms. This form of diabetes generally develops during the second half of pregnancy and goes away after delivery.
Foods high in folic acid
Q:I know I’m supposed to take at least 400 micrograms of folic acid while I’m pregnant, but I’d also like to eat foods high in folic acid to supplement my multivitamin. What kinds of foods should I be looking for?
A:Your decision to incorporate vegetables, fruit, legumes and other healthy foods into your eating plan before and during pregnancy will give your baby a strong start in life. In addition to preventing neural tube birth defects, folic acid helps increase your blood volume and prevent anemia. Here are some common foods high in folic acid:
- Dark green leafy vegetables: collard, turnip and beet greens; spinach, dark-leaf lettuce, cabbage, broccoli, asparagus
- Fruits and juices: orange, strawberry, lemon, mango, tomato, grapefruit, kiwi, melon
- Grains: whole grain breads, cornmeal, oatmeal, fortified cereal, enriched pastas
- Legumes: split peas, red and white kidney beans, black beans, navy beans, black-eyed peas, chick peas (garbanzo beans)
When pregnant women should not exercise
Q:Are there any pregnant women who should not exercise?
A:Exercise is good for pregnant women, except in certain circumstances. Women should not exercise while pregnant if they have:
- Heart disease that compromises blood flow
- Preterm labor
- Incompetent cervix, a defect of the cervix that can cause pregnancy loss or premature birth
- Restrictive lung disease
- Multiple gestation (twins, triplets or more), which increases the risk for preterm labor
- Persistent vaginal bleeding in the second or third trimester
- Ruptured membranes (bag of waters)
- Preeclampsia, a pregnancy-related form of high blood pressure
- Placenta previa, a low-lying placenta that covers part or all of the opening of the cervix during the third trimester
Women with a history of medical problems—such as severe anemia or poorly controlled high blood pressure, diabetes, thyroid disease or seizure disorder—should exercise only with the approval of their health care provider. Pregnant women who are obese or extremely underweight also should seek medical approval before starting an exercise routine.
How can dad-to-be can support his wife
Q:My wife is pregnant for the first time, and I’m thrilled. She seems tired, and even irritable, at times but doesn’t ask me for help. How can I best support her?
A:What a great question because this is only the beginning of sleep deprivation for your wife!! Sometimes it is difficult for women to step up and ask for help. Being tired and being irritable are symptoms of being pregnant; however you can support her by just pitching in and helping out. Do a load of laundry, bring home dinner one evening, rub her feet, and tell her everyday how beautiful she is. Go shopping with her to by an outfit. Women tend to feel fat and undesirable during this time. This is the time to reach out to her.
Also find ways that you can unload your frustrations due to her irritability and being tired. It may take its toll. Go for a run, take a walk, lift weights but also recognize that it is not you it is her hormones doing double duty.
Trying to avoid being overwhelmed
Q:I’m pregnant with our third child. Between work, raising our family and trying to keep up with housework and family commitments, I feel overwhelmed all the time. I find myself crying over the smallest things, and just feel out of control for the first time in my life. How can I get my life back?
A:Being pregnant is the most rewarding, yet most difficult time. I truly believe you will be fine because you recognize that you are overwhelmed. So first, learn to only have five commitments at one time. Second, ask for help right now. Being pregnant is a job. LOL!! Seriously, reach out to a girlfriend, your mom or your husband and tell them how you feel and ASK. For me, asking was really, really tough for awhile until I did it and now I realize how much weight is lifted when I do ask for help. Are your children able to help clean? Can you minimize some of the family commitments for awhile until things feel in more control? Take advantage of this time to let some things go and spend more time with your family. A wise woman of six once told me, cherish these times and let the small things go because they do go away and you will miss them.
Maternal fetal medicine services
Q:I just learned that I’m pregnant. Should I consider maternal fetal medicine services as part of my care?
—John Buckmaster, MD, Southwest Maternal Fetal Medicine Clinic
Unpasteurized foods
Q:I’ve been craving cookie dough during my pregnancy. Is it safe to eat?
Joe Chang, MD, The Women’s Clinic of Vancouver
Depression during pregnancy
Q:Now that I’m pregnant, I expected it to be a happy time for me so why am I so depressed?
A: Experiencing depression while pregnant is not uncommon. In fact, women are as likely to experience prenatal depression as they are the more widely reported postpartum depression.
Why the link between pregnancy and depression? First, many woman suffer from depression before becoming pregnant. Second, about one in seven women experience a new episode of depression during pregnancy. Possible triggers could be the psychological or hormonal stress of this major life change or the mood-lowering effect of lessened activity.
So, the good new is that you have plenty of company. The bad news is that pinpointing depression during pregnancy can be tough because pregnancy triggers some of the same symptoms, notably fatigue and mood swings.
Discuss your concerns with your doctor. His or her recommendation will probably depend on the severity and the length of your depression. Treatments may include prescribing specific antidepressants, behavioral modifications, and/or counseling or psychotherapy.
And, reach out to other expectant and new moms on YourBabyYourWay.com. Learn more about depression during pregnancy >
— Wendy Draper, MD, Vancouver Clinic
Maternal serum screen
Q:The results from my maternal serum screen (Triple/Quad, First or Sequential Screen) came back abnormal/screen positive. Should we see a genetic counselor?
A: Absolutely. You are probably very concerned about the implications of the test. A genetic counselor can review the results with you that indicated an increased risk for one of a few conditions such as Down syndrome or Spina Bifida. These tests are screening tests, which means the results come back as a percent risk and depending on the percent, are put into either a high risk (screen positive) or low risk (screen negative) group. The test never comes back with a 100% risk, so keep in mind high risk doesn’t mean the baby has a condition, but that it is more likely to have a condition. When results come back as high or abnormal, you will be given the option to have a diagnostic test, such as an amniocentesis, which will give a yes/no answer if the baby has a condition such as Down syndrome. Thus, a genetic counselor will explain in detail how an amniocentesis works as well as the risks, benefits and limitations of such testing. Learn more about genetic counseling and prenatal testing >
— Elissa Morris, M.S., CGC, Board Certified Genetic Counselor
Braxton-Hicks and Contractions
Q: How can I tell the difference between Braxton-Hicks and real contractions?
A: Braxton-Hicks contractions are quite common. You can follow these guidelines to help you determine if you should call your doctor:
The Real Thing (True Labor)
- After timing the contractions, you determine that they are coming consistently and getting closer together. Another good guide is if you are experiencing more than 6 contractions per hour.
- Each contraction is lasting anywhere from 30-70 seconds and getting longer.
- The contractions do not go away even if you change your level of activity.
- Usually with true labor, the contractions have a radiating feeling in your lower back and upper abdomen.
- The intensity of the contractions becomes greater as time progresses.
False Start (False Labor)
- The contractions continue to be irregular.
- There is no consistent length or intensity of contractions and no pattern develops.
- No clear change or increase in the intensity of the contractions.
- May feel the contraction lower in abdomen without the radiation feeling.
- Changing activities effects the contractions.
If you’re still unsure, call your physician or go to the hospital for guidance.
— Joe Chang, MD, The Women’s Clinic of Vancouver
Drug-free labor options
Q: I’d like to try to have my baby drug-free. Is using acupuncture during labor an option at Southwest Washington Medical Center?
A: Having a baby without pain medicine is, of course, a choice any woman can make. If you are concerned about medicines hurting your baby, discuss your concerns with your doctor. Often you will find your concerns are not necessary. If you would simply like a more natural experience, that is certainly fine. Acupuncture is one of many alternative relaxation methods that include music, whirlpooling, and doulas. If you considering any of these techniques, discuss it with your doctor as soon as possible so you can be sure you are on the same page. We all want you to have a labor experience that is safe and consistent with your desires.
— Joe Chang, MD, The Women’s Clinic of Vancouver
Pre-eclampsia
Q: What is pre-eclampsia?
A: Pre-eclampsia is a form of high blood pressure brought on by pregnancy. It is also known as pregnancy-induced hypertension (PIH) or toxemia. Eclampsia is seizures or convulsions caused by a severe form of pre-eclampsia.
Because it causes your blood vessels to constrict, pre-eclampsia reduces the amount of oxygen and nutrients delivered to your baby and can lead to low birth weight. Left untreated, it can also cause your liver, lungs, and kidneys to fail. Despite intensive research, no one knows exactly what causes the condition, and it continues to affect roughly 7 out of 100 pregnant women, humans are the only species that are known to get this disease, so animal research has not been helpful. Learn more about pre-eclampsia >
— Joe Chang, MD, The Women’s Clinic of Vancouver
Shoulder dystocia
Q: I’ve heard of situations where the baby’s shoulders can get stuck in the birth canal. Can this be predicted before labor starts? How is it treated?
A: Shoulder dystocia—when the baby's head is delivered but the shoulders cannot progress because they’re too wide beyond the mother's pubic bone—is usually unpredictable and is first noticed during delivery. If your health care provider suspects that you are at risk for shoulder dystocia, he/she may recommend an ultrasound scan before you go into labor. The ultrasound scan can help determine how big the baby is and whether the baby's size might be a problem during delivery.
Should dystocia can be caused by:
- A baby is unusually large. Women who are overweight or have gestational diabetes are more likely to have large babies.
- The opening of the mother's pelvis is too small for the baby's shoulders to come out.
Some techniques that might be used if shoulder dystocia occurs during labor include:
- The opening of the mother's pelvis is too small for the baby's shoulders to come out.
- Perform a large episiotomy to widen the opening of the vagina.
- Move the baby's shoulder by pressing downward on the baby's head.
- Have the mother raise her legs up and push them back against her stomach to widen the pelvic opening.
- Put pressure on the baby's shoulder above your pubic bone.
- Try to turn the baby's shoulder.
- Reach into the mother’s vagina, put pressure on the baby's arm, and deliver the arm, then the shoulder and rest of the baby.
- Break the baby's clavicle (collarbone) to make the shoulders narrower so they fit through the opening.
For more information, watch this informative video on C-sections.
— Joe Chang, MD, The Women’s Clinic of Vancouver
Trimesters
Q: If a pregnancy takes 40 weeks, why do they call it trimesters?
Yoga and exercise during pregnancy
Q:How long into my pregnancy can I practice yoga?
Q:Is it ok to lie on my back to practice yoga when I am pregnant?
A: The answer to that varies. However, there is no medical proof that you cannot perform some supine yoga poses. We always encourage you to listen to your body, check with your physician and do what feels right. If something hurts or does not feel comfortable we have modifications that will support your body. A healthy pregnant woman can perform most any pose with the proper guidance from a certified yoga instructor. Prone positions, (on the belly) are modified with Cat/Cow, Spinal Balance and Kneeling Side Plank. Twists and inversions should be avoided during pregnancy. Be sure to attend a class that is taught by an instructor who is certified specifically in Prenatal Yoga.
Learn more about exercise during pregnancy >
— Dana Layon, E-RYT, Satsang Yoga, Vancouver, WA
Labor & delivery anesthesia
Q:What choices do I have for pain control during labor and delivery?
- Relaxation/breathing/Lamaze techniques, offered through childbirth education classes, are designed to help you manage discomfort.
- Pain medications, intravenously or intramuscularly, are helpful and generally considered safe, although, they may make you and your baby sleepy, have declining effectiveness and usually do not provide total relief.
- Epidural, Spinal, Intrathecal or Combined Spinal/Epidural are regional techniques, involving care by an anesthesia provider, that use local anesthetics and/or narcotics, on or around spinal nerves, to block the pain sensation of labor and delivery
A: An Epidural is a regional anesthetic technique in which an epidural needle is passed, between the vertebra of the spinal column, into the epidural space, just outside a membrane (dura), that surrounds the spinal cord, spinal nerve roots and the spinal fluid. A thin plastic tube (catheter) can be placed, through the epidural needle and the needle removed, to allow continuous infusion of anesthetic medication through the catheter. This can provide labor and delivery pain relief for long periods of time or can be intensified and used for cesarean section, if required.
A Spinal is performed when a thinner needle is advanced, a small way past the epidural space, and through this dural membrane, into the spinal fluid. Because the anesthetic medication is placed directly into the spinal fluid, less drug is required to produce an effect. Spinal doses, however, produce very intense numbness with loss of lower body movement and are usually reserved, in labor and delivery practice, for cesarean section.
An Intrathecal uses, basically, the same technique as a spinal but, with lower concentrations and amounts of anesthetic medications. This often provides quick pain relief, without undue numbness or loss of movement, and allows effective pushing with delivery. Because it is a one shot technique, however, it usually lasts for only 1-3 hours. This makes it most useful nearer the end of a rapidly moving labor.
A Combined Spinal/ Epidural (CSE) is another regional anesthetic technique, that would be better named Combined Intrathecal/ Epidural, because it truly combines those two techniques. Its main advantage is overcoming the time limits of the intrathecal technique alone. The epidural needle is positioned in the epidural space, a longer spinal needle is inserted through the epidural needle, the intrathecal dose is give, the spinal needle removed, an epidural catheter is threaded in and left in place as the epidural needle is removed. This allows a quick onset of pain relief, with the intrathecal dose, and a continuous infusion, via the epidural catheter, to provide pain relief for as long as it is needed.
Q: How painful is it to place an epidural/ spinal/ intrathecal/ combined spinal/epidural?
A: Many patients say that these regional techniques are no more uncomfortable than placing an (IV) intravenous line. Some say it is similar to having a tooth prepared with Novocain at the dentist. There is, routinely, a small pinch or sting as the local anesthetic is injected then, primarily, a feeling of dull pressure. Rarely, there may be a “funny bone” sensation (parasthesia), down the leg(s), as the needle or catheter is placed. Your anesthesia provider will make every effort to ensure your comfort during the procedure by providing verbal support, communicating each step of the process and appropriate use of local anesthetic. Each patient’s perception and pain threshold is different but, in general, these procedures are not painful.
Q:Can all patients in labor have an epidural and/or other regional techniques?
A: Not always. You may not be a candidate for an epidural or other regional anesthesia if you (a) are allergic to certain narcotics or local anesthetics, (b) have a nervous system (neurological) disease, (c) have a bleeding tendency or coagulation disorder, (d) take aspirin routinely,(e) have an infection in the lower back area, (f) have a psychological disorder or fear of needles that prohibits, (g) are morbidly obese, (h) have a spinal deformity, (i) are unable to cooperate by holding still and getting into proper position, (j) are too early in your labor, (k) are progressing too rapidly, or (l) have an abnormal labor or fetal monitoring pattern. Please discuss any potential problems, you are aware of, with your healthcare and anesthesia provider.
Q: Will an epidural have an effect on my baby?
A: Considerable research has shown that epidural anesthesia can be safe for both mother and baby. The baby is exposed to medications that are present in your blood stream and the amount of medication present is related to the dose. The spinal and epidural techniques use small doses; the local and IV techniques use larger amounts. The doses of medication used in labor epidurals typically will not cause an effect in you baby’s Apgar scores or behavior.
Q: Will the epidural slow down my labor?
A: There has been much debate and research on this topic. Generally, epidural anesthesia does not dramatically affect the progress of labor and delivery. Each patient is unique and will respond somewhat differently to the various epidural medications. Occasionally there will be a short period of decreased uterine contractions. Often times the epidural relaxes the patient and their labor may actually progress more quickly.
Q: What are the side effects and risks of an epidural/ spinal?
A: The most common side effects of epidurals/ spinals are: (a) A decrease in blood pressure due to relaxation of blood vessels and relief of pain. This is counteracted with increased IV fluids and/or medications to increase blood pressure. (b) Itching and/or nausea are possible side effects of the pain medications mixed in with the local anesthetic. (c) Shaking/ shivering are very common secondary to labor and/or the epidural medication’s effects. (d) Slight soreness, at the site of epidural insertion, may occur for several days.
When you drive a car, you know there is always a possibility of mechanical difficulties or an accident, but most of the time you reach your destination safely. The same is true with anesthesia for labor and delivery. Epidural/spinal risks do exist but are uncommon.
- Approximately one in every four hundred patients receiving spinal/epidural anesthesia gets a spinal headache. This is caused by a leakage of spinal fluid through a hole created, by the needle, in the dural membrane. This headache can be treated either with conservative measures (increasing oral intake of fluids with caffeine, lying flat, pain medications) or with an epidural blood patch (injection of some of your own blood into the epidural space to form a patch and stop the leak).
- Allergic reactions to local anesthetics/narcotics in the epidural/spinal are rare but possible.
- There are blood vessels in the epidural space. Rarely the needle or catheter may enter one and if local anesthetic is injected you may have symptoms ranging from a metallic taste, ringing in the ears, lightheadedness, numbness around the lips, to very rarely, loss of consciousness or seizures.
- The level of numbness, from the epidural/spinal, can very rarely, rise too high requiring breathing assistance or intubation.
- Infections or bleeding, in the epidural space or spinal fluid, again very rarely, can occur.
- Persistent numbness or pain, after a epidural/spinal, is also a very rare risk.
- While extremely rare, cardiac arrest, major organ damage or death may result from any anesthetic.
A: These techniques very often provide excellent labor and delivery pain relief and, if needed, surgical quality anesthesia for other procedures such as cesarean section or tubal ligation. It is possible, however, that they may not eliminate any or all of your pain. The catheter or needle must be placed in the proper position for the medication to work. Discomfort from labor and pregnancy and anatomic characteristics can make it difficult or impossible for you to get into an appropriate position for reliable needle and catheter insertion. Individuals vary in their response to the medications. Epidural catheters can be migrate or move out of position as you move. Variations in your anatomy, epidural space and back may not allow placement of the needle or catheter. It is possible, even with correct placement, to get pain relief in only some body areas and not in others (windows) or only on one side of your body (one sided block). Repositioning, redosing, or replacement of epidural catheters may be required. Your anesthetist will do everything possible to make you comfortable, but sometimes complete pain relief is not possible.
Q: How long does it take for the epidural to work?
A: Once the epidural catheter is placed, taped to your back securely, dressing applied, and tested for proper position, the starting, bolus dose is given. This dose usually takes 5-10 min. to begin working and 10-20 min. to get full effect. The first sensations you notice are often a feeling of warmth or tingling along with some numbness and heaviness in your legs. The goal is to block the sensation of contraction pain while leaving a feeling of pressure at the peak of contraction. You won’t be able to stand or get out of bed but there is usually adequate ability to turn and move your legs and good pushing ability at the time of delivery.
—Kip Bland CRNA, MSN, ARNP, Southwest Washington Medical Center, Family Birth Center, Department of Anesthesia
Postnanatal & Parenting
Buying used baby items
Q: I would love to buy new items for our new baby, but my budget just won't stretch that far. What should I look for when buy used baby items?
A: If possible, you should buy a new car seat and, if you can afford it, a new crib. If you buy these items used, or borrow them, be sure they meet current safety standards.
If you get a used crib, make sure:
• It was made in 2000 or later. Look on the label for the date.
• It does not have any broken, missing, or loose slats, spindles, cornerposts, or hardware.
• Cornerposts are less than 1/16 inch. Otherwise, clothing could get caught and your baby could be strangled.
• The paint is not peeling or cracking.
• There are no splinters or rough edges.
• It does not have cutout designs in the headboard or footboard.
If you get a used infant car seat, make sure:
• It is not more than 6 years old. Look for a label on the seat that indicates the date it was made.
• It has never been in a crash. It’s important to know the history of the seat.
• It has not been recalled. You can check at http://www.recalls.gov/.
• It has labels explaining proper installation and the seat’s weight and height limits.
• It has the instruction manual.
• Learn more about car seats.
You can also use a dresser as a changing table:
• Choose a dresser that is wide and low.
• Use a pad with a safety strap.
• Follow the directions for attaching the pad to the dresser.
• Attach the dresser to the wall so that it does not tip over. You can use an “anti-tipover restraint” to do this.
For used clothing:
- Check out the following listings from the YourBabyYourWay.com local resources page:
- Piccolina —New, used and resale clothing for kids size 0-8 and maternity by consignment. (2700 SE Clinton St, Portland, OR 97202 | 503-963-8548)
- Boomba Toomba —A family boutique, carrying a large variety of quality used clothing, cloth diapers, baby slings, maternity items and toys. We also carry new items, which are all handcrafted by work-at-home moms. (1705 Broadway | Vancouver, WA | 360-607-4552)
- Find a local Once Upon a Child used clothing store.
- Can find what you're looking for locally? Try online resources like Swap Mamas , Zwaggle , Hand Me Downs (you can look for local items here).
Mommy makeovers
Q: What is the difference between plastic surgery and cosmetic surgery?
A: A plastic surgeon receives special training for reconstruction of facial and body defects due to birth disorders, trauma and disease. For example, an oncoplastic surgeon specializes in cancer-related surgery, such as reconstruction after breast cancer.
Many plastic surgeons also become adept at cosmetic procedures. Cosmetic surgeons may have a background in head and neck, dermatologic, plastic or general surgery. Their practices, however, focus mainly on enhancing people’s appearance.
If you are considering plastic or cosmetic surgery, you should talk to more than one doctor about what you're hoping to achieve. Different physicians may suggest different techniques, and those techniques may come with different risks, benefits, recovery time and results.
It’s important to feel comfortable with the doctor and staff and to get answers for all your questions. Be clear about where the doctor will perform your surgery, what risks are involved, how much it will cost, what recovery time will be involved, and what results you can expect.
Selecting a Plastic Surgeon or Cosmetic Surgeon
Here are some tips for selecting a plastic surgeon or cosmetic surgeon.
Four Questions to Ask
- Ask for referrals. People you know may be able to recommend a doctor. But keep in mind that a physician who is highly skilled in one procedure may not be so skillful at another.
- Check the doctor’s credentials. Don’t hesitate to verify the physician’s medical license or to look into his or her certifications or memberships in professional societies. Each state has a medical board that can confirm your doctor's license. The board may also be able to tell you about any complaints lodged against the doctor or any disciplinary action taken.
- Inquire about the doctor's experience. Just because a physician is certified, it doesn’t necessarily mean he or she is proficient. So it’s good to ask how often the doctor has performed the procedure you’re considering and whether the doctor has before-and-after photos that demonstrate his or her work. (Realize, however, that photos from someone else’s procedures do not guarantee the results you’ll achieve.)
- Consider all of your options. Remember, it’s OK to talk to more than one doctor about what you’re hoping to achieve, and it’s important to feel comfortable with your doctor. The doctor should be willing to answer your questions; offer alternatives, when appropriate, without pressuring you; and ask for your reactions to recommendations.
Four “Red Flags” to Avoid
According to the American Academy of Cosmetic Surgery, these are some “red flags” about a doctor that should concern you:
- The doctor is impatient or rushes you to make decisions.
- The doctor refuses to answer your questions or provide requested information.
- The doctor's work area does not appear to be sterile.
- The doctor is willing to combine several major procedures into one operation. That may be less expensive for you, but it's not necessarily safe.
— Allen Gabriel, M.D., Breast & Aesthetic Surgery, Southwest Medical Group Plastic Surgery
Crying and Fussiness
Q: I'm a first-time mother, and my newborn seems to cry a lot. What should I do?
A:All babies cry, but some cry more than others. They cry when they're hungry, bored, uncomfortable, frightened. They also cry when they need a diaper changed, hear a loud noise, meet a new person—or for no apparent reason. Crying is one of the few ways your baby can communicate with you.
His crying is no reflection on your parenting. But it can be very frustrating when you baby cries and, despite your best efforts, doesn't stop. You can try to soothe a crying baby by feeding him, changing his diaper, swaddling, dimming the lights, rocking, singing and walking.
Some studies show that premature babies are more likely than term babies to be fussy. They may be harder to soothe, cry often, and have irregular eating and sleeping patterns. But each child is different, so this may or may not apply to your baby.
If your baby is fussy, it may be comforting to know that you are not alone. Your baby will soon outgrow this difficult phase.
Some babies who have been in the NICU have trouble adjusting to the quiet of home. Your baby may sleep better with some background music or a low level of noise.
As you get to know your baby, you'll learn how much crying is normal for him and what you can do to soothe him. If your baby cries longer than usual, and nothing you do soothes him, call your baby's health care provider to see if there is a medical reason.
If Your Baby Won't Stop Crying
If your baby won't stop crying, try the following:
- Check to make sure he isn't hungry.
- Check to make sure he has a clean diaper. If not, change it.
- Look for signs of illness or pain. Examples: Fever over 100.4 degrees, swollen gums or an ear infection.
- Rock the baby, or walk with him. But if you begin to feel stressed, put him down right away.
- Sing or talk to the baby.
- Offer him a pacifier or a toy.
- Take him for a ride in a stroller.
- Swaddle the baby snuggly in a blanket.
- Turn on the stereo or TV. Be sure the sound is low and soothing.
- Run the vacuum cleaner, put on the clothes dryer, or run water in the bathtub or sink. Some babies like these rhythmic noises.
- Hold the baby close to your body. Breathe calmly and slowly.
- Call a friend or relative. Ask them to care for your baby while you take a break.
- If nothing else works, put the baby in his crib on his back, close the door and check on him in 10 minutes.
If you have a fussy baby or a baby who cries a lot, choose your baby-sitters carefully. Find people:
- Who have lots of experience with small babies
- Who have spent time with crying or fussy children
- If you are not sure that the person has the patience and maturity to care for a crying baby, do not leave your child alone with her.
— Courtesy of the March of Dimes
Questions about premature births
Q: I've already had a premature birth. What can I do to help get my full nine months of pregnancy?
Q: Why was my baby born too early?
Q: Do I need to go to a special doctor for care?
A: Talk to your healthcare provider about getting a second opinion from a specialist. The specialist is a doctor who is trained to care for women who are more likely to have a baby born too early. These doctors are sometimes called maternal-fetal medicine specialists. Your provider can help you find this special doctor.Q: Why are some women more likely than other women to have a premature baby?
Preparing for flu season
Q: As the parent of a young child, how can I prepare for the flu season?
A: As a parent of a young child, you probably already know that children under 5 years of age are at increased risk of complications from influenza (flu) – both seasonal flu and H1N1 flu. This is due to small children having small airways, a developing respiratory system, and a developing immune system. Infants under 6 months of age are particularly vulnerable because they are too young to receive the seasonal flu vaccine, and are too young to receive the 2009 H1N1 vaccine (both of which can prevent the flu or reduce the impact of the flu).
Talk to your early childhood program and school about their pandemic or emergency plan. At this time, state and local public health officials recommend that students can—and should—continue to go to child care, as long as they are not sick and do not have flu symptoms. CDC also recommends that people in contact with certain groups of children get a seasonal flu vaccine in order to protect the child (or children) in their lives from the flu.
You can prepare by:
- Plan for child care at home if your child gets sick, your usual early childhood program closes, or school is dismissed. Check with your employer to find out if you can stay at home to care for your children, work from home, or set up a flexible work schedule. If this is not possible, find other ways to care for your children at home (such as care by relatives, neighbors, co-workers, or friends).
- Plan to monitor the health of your children and others in the household by checking for fever and other symptoms of flu.
- Identify if you have children who are at higher risk of serious disease from the flu and talk to your healthcare provider about a plan to protect them during the flu season. Children at higher risk of serious disease from the flu include: children under 5 years of age and children with certain chronic medical conditions, such as asthma and diabetes.
- Update emergency contact lists.
- Collect games, books, DVDs and other items to keep your family entertained if early childhood programs are closed, school is dismissed, or your child is sick and must stay home.
— Courtesy of the March of Dimes and the Center for Disease Control
Caring for children with the flu
Q: What should I do if my child gets the flu?
- Keep your child home. It is very important that your child does not go to child care, school or other places where they could spread the flu virus to other people, such as group childcare, after school programs, the mall, or sporting events.
- Call your doctor’s office and let them know your child’s symptoms and history. Your doctor will advise you whether you should come to the office. It is best to call ahead so that you help prevent spreading illness to others.
Plastic surgery for children
Q: My child needs plastic surgery to correct a facial malformation. What should I take into consideration when looking for a plastic surgeon?
Most pediatric facial plastic surgery is reconstructive, not cosmetic, and is intended to restore “normal” form and function to the areas of concern. At Southwest Medical Group Plastic Surgery, we are able to treat children with the following procedures:
- Brow/eyelid lift
- Facelift and necklift
- Facial fractures
- Nose surgery (rhinoplasty)
- Cleft lip and palate
- Mole removal and skin lesions
- Ear reconstruction and otoplasty
- Vascular malformations
Working and breastfeeding
Q: I’d like to continue to breastfeed my baby after I go back to work. What should I consider?
Ask if your employer will give you a private place and time to express milk. Talk to your boss about working from home a few days a week or easing back into work part-time.
You will probably need to pump two to three times in a full-time workday, for about 10 to 15 minutes each time. Most working women find an electric double breast pump easy to use and most efficient.
Your child care provider should support you and your baby by feeding her expressed breastmilk—and by welcoming you to feed your baby during the workday.
Postnatal care for diabetics
Q: Do women with diabetes require special care after delivery?
After delivery, blood-sugar levels return to normal for most women with gestational diabetes. The American Diabetes Association (ADA) recommends that women with gestational diabetes have their blood-sugar level checked 6 to 12 weeks after delivery to make sure levels are normal. Because women who have had gestational diabetes have about a 50 percent chance of developing diabetes in the future, the ADA recommends a blood-sugar check at least every 3 years. These women can help reduce their risk by starting a weight-loss and exercise program after delivery.
Folic acid after delivery
Q: Now that I’ve had my baby can I cut down on my folic acid supplements?
As an added benefit, a recent large study showed that women who consumed more folic acid had a significantly reduced risk of developing high blood pressure (hypertension). Doctors at Boston’s Brigham and Women's Hospital examined medical records for more than eight years from more than 150,000 women ranging in age from 23-70. They found that those who took folic acid supplements had a reduced risk for the development of hypertension. Since no clinical trials have been conducted, this study does not prove that folic acid supplements can be used to treat high blood pressure. But the results are encouraging and indicate that women of all ages should take folic acid supplements, especially since they are inexpensive, available without a prescription and are considered safe.
— Joanne Rogovoy, State Director of Program Services, March of Dimes, Greater Oregon Chapter
Slow development in infants
Q: My 14-week-old baby doesn’t seem to be reaching some of the development milestones I expected to see several weeks ago (Child Growth Calculator). When should I attribute these variations to slow development, and when should I be concerned that they might be early signs of a more significant problem such as autism?
A: If your baby is slow in one or two areas of developmental growth but otherwise seems to be growing and developing normally, then autism is likely not a concern. There is such great variability in development that it’s extremely difficult to diagnose autism in infants. Among the early signs and symptoms that parents and pediatricians look for to alert them that a child needs further evaluation for autism include:
- not smiling by six months of age
- not babbling, pointing or using other gestures by 12 months
- not using single words by age 16 months
- not using two word phrases by 24 months
- having a regression in development, with any loss of language or social skills
Infants with autism might also avoid eye contact, and as they get older, act as if they are unaware of when people come and go around them. Keep in mind that autism usually isn't diagnosed until about age three, although some experts believe that some children begin to show subtle signs as early as six months of age.
For toddlers and older children, you might want to take the Autism Screening Quiz developed by the National Institute of Child Health and Human Development.
If you are concerned, trust your instincts and be specific with your doctor, with information such as “She isn’t making eye contact” or “He doesn’t track or reach for moving objects.”
New parents try to get the intimacy back
Q: My wife and I have a new baby three months ago, and I feel like we’ll never have sex again. I want to be supportive, but this is getting ridiculous. What advice can you give me?
— Sharla Vellek, Life Coach, Empowering Grace
Mom tries to find time
Q: My baby is six weeks old, and I still feel totally overwhelmed with baby care. I don’t seem to have time for my husband or myself. How do new moms find time for anything?
A: I so remember those times and it will get easier. I was encouraged to swap baby time with another couple, that way both couples can get time alone that they so desperately need. I encourage you to do this once per week. Another idea is go over to a girlfriend’s house and hang out with your baby and hers while she gets a few things done. You can hang out with each other while she cleans or even paints her toes! Another idea is to go to a moms group. I found A LOT of encouragement and support by doing this. I also gleaned so many tips and shortcuts from other moms. You might want to check out YourBabyYourWay.com classes and events, there are many opportunities for new mom’s, including a weekly Mother’s Share class for new moms.
— Sharla Vellek, Life Coach, Empowering Grace
Newborns’ vision
Q: My newborn keeps his eyes closed most of the time. Is this normal?
A: Usually this is very normal. Newborns are adjusting to their new environment. They are often very sleep and nap between feedings. The vision of the newborn needs to adjust to bright lights and many new visual stimuli. Your newborn’s job is to feed, urinate, stool and bond with you. If your newborn isn’t meeting these goals or your have further concerns talk to your pediatrician.
An eco-friendly baby
Q: I want to use organic and eco-friendly products for my new baby, but they can be so expensive. Where is it important that I buy all-natural products, and where can I skimp a bit?
A: As a baby planner when I provide advice to my clients I always recommend that they choose non-toxic, all-natural items for their baby that go into baby's mouth, touch baby's skin or may affect the air that their baby is breathing. Products such as certified organic crib bedding, baby clothing and non-toxic feeding gear are important areas to go "green" in. These types of green products not only keep baby safe from nasty chemicals but also help to preserve our earth.
Items such as teething toys and pacifiers should also be non-toxic and all-natural since baby will place these in her mouth quite often. Additionally, using low-VOC paint is also vital when painting baby's nursery so baby isn't breathing in toxic fumes.
Melissa Moog, Itsabelly Baby Concierge
Losing baby weight with yoga
Q: I gained a few extra pounds during my pregnancy. When can I come back to yoga after I deliver?
Dana Layon, E-RYT, Satsang Yoga, Vancouver, WA
Baby’s first check-up
Q: When will my baby have his first check-up?
— Carol Bunten, MD, The Vancouver Clinic
Bathing Baby
Q: How often should I bathe my baby?
A: Unlike older children and adults, babies don't require daily bathing. While it is important to thoroughly clean your baby after each diaper change, a bathing 2 to 3 times a week is plenty.
— Carol Bunten, MD, The Vancouver Clinic
Cradle cap
Q: My baby has a crusty, scaly patch on his head. What is it?
A: This scaling, crusty, oily scalp is called cradle cap. It may appear on your baby's head during the first few months and is caused by oil glands that are working overtime. Although is doesn't look good, it doesn't itch, and it can be treated by washing the baby's head with a baby shampoo every few days. A baby brush and oil may help to loosen and remove cradle cap as well.
— Carol Bunten, MD, The Vancouver Clinic
Hemorrhoid relief
Q: I just returned home from the hospital and I think I might have hemorrhoids. What should I do?
A: One of the most common after effects of pushing during labor is a hemorrhoid, or swollen blood vessels around the anus that may bleed and be painful. Depending on the severity of the swelling, you may want to soak your bottom in a few inches of warm water in the bath or wear a cotton pad soaked with cold witch hazel cream in the anal area. Eating foods high in fiber will help to alleviate constipation, which may exacerbate hemorrhoids. If the pain is unbearable, you may need prescription medicine.
— Carol Bunten, MD, The Vancouver Clinic
Predicting future health
Q: Does the Apgar test determine the future health of my baby?
A: In general the Apgar score alone does not predict the future health of the baby. A low 5-minute Apgar score has been associated with a slight increased risk for cerebral palsy in full-term infants. However, 75% of children who develop this central nervous system disorder had normal Apgar scores. Read more about Apgar tests and scoring >
— Carol Bunten, MD, The Vancouver Clinic
Siblings and a new baby
Q: How will my older child do with a new baby?
A: Most kids do great when the new baby gets home, but there is often some transition. The older child is used to the routine that was present before the new arrival. The baby changes many things in their world and often the older sibling feels some displacement from mom. Many times parents tell me that their three year old wants to take the baby back to the hospital and get a baby that does not cry.
Expect some regression from the older child. They will want to be changed like the baby or misbehave. These actions are the older child trying to get attention that they perceive is being directed to the new arrival. If the child realizes that misbehaving does not get them attention, then the behaviors will stop. The other important tip is to focus on the older sibling when they do things that are positive. If the older child sees that being kind to the new baby and helping gets lots of praise, they will continue with those behaviors.
Make sure visitors who come to see you pay attention to the older child as well as the new baby. Special time and trips alone with the older sibling will show the child that being the big brother/sister is great because you get special privileges.
Infant Eczema
Q: My newborn has a scaly, itchy rash that I believe is eczema. How can I be sure it’s eczema, and if so, how can I treat it?
Eczema can rob the affected skin of moisture, so keeping newborns’ skin adequately moisturized can be the most effective treatment. Limiting baths to two to three a week using a very mild soap helps to keep the skin moist. Avoid anything with perfumes or dyes. Dove unscented soap is manufactured without harsh fragrances, oils, alcohols, or chemicals. Pat the skin dry, never rub, and immediately apply a mild, unscented thick moisturizer such as Eucerin or Vaseline petroleum jelly. Apply the emollient or cream again four or five times a day to help keep the skin moist.
Another important component of an eczema treatment routine is to prevent scratching. Cold compresses applied directly to itchy skin can help relieve itching. Keep fingernails well trimmed; you may also need to put mitts and socks on hands and feet while baby is sleeping.
The following may help reduce the severity and frequency of flare-ups:
- Try to remove environmental factors that may trigger allergies (e.g., pollens, molds, mites, and animal dander)
- Moisturize frequently with a cream or ointment as instructed by a physician
- Avoid sudden changes in temperature or humidity
- Avoid sweating or overheating
- Avoid scratchy materials (e.g., wool or other irritants) and use natural-fabric clothing (such as cotton) whenever possible
- Avoid harsh soaps and detergents
- In older babies, be aware of any foods that may cause an outbreak and avoid those foods
Vaccines and autism
Q: Is there a relationship between vaccines and autism? I’ve heard so much about it lately, I don’t know what to believe!
A: I can understand how confusing and worrisome this is. Autism and related conditions such as Aspergers Syndrome may be increasing in frequency. Because of this, researchers have thoroughly sought to find a connection between specific vaccines (e.g. Measles) or preservatives such as Thimerosal. The information currently available overwhelmingly finds no link between vaccines and autism. Regardless of these negative findings, Thimerosal is no longer used in infant vaccines.
In a way vaccines are a victim of their own success, since most parents no longer recall seeing these vaccine preventable diseases. These germs are still out there, however, so we say: “Go the safe route and get the shots.”
Knowing where to get reliable, unbiased information is important. Here are some good resources I use and recommend.
The Children’s Hospital of Philadelphia is one of the nation’s top children’s hospitals. Their website provides a wealth of details regarding vaccine safety and the research and data to back up the information. Find out more from the Children's Hospital of Philadelphia >
What to Expect Guide to Immunizations. You can download this free booklet that answers parents’ many question about vaccines and vaccine safety in an easy to read format. Download the guide in English or Download the guide in Spanish
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