Health Services
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Great River Medical Center’s Obstetrics Unit offers professional, caring help combined with advanced technology to give you the best birthing experience possible. Today, all family members share in the joy of the birthing process. Fathers participate in prenatal classes and take an active part in the birth itself. Besides Dad, the "company" may include: big brothers and sisters who attend Sibling Preparation Class to learn about their changing roles in the family; grandparents, who can spend time cuddling the new infant while still in the hospital; and the mother's obstetrical team — the physicians and nurses who encourage and support the family.
The following provides information about your pregnancy, labor and delivery. It also contains suggestions and hints about how to prepare for the baby’s arrival, and how to cope after the baby is here.
Eating For Two
"You're eating for two," when you are pregnant is an adage you have undoubtedly heard before and will hear again in the months ahead. However, you should be aware that this advice pertains to nutrients in the food you eat — not the amount of food you consume. Excessive weight gain is not good for you or your baby and makes it more difficult for you to return to your normal weight after delivery.
No matter what your weight requirements are, it is important that you follow a balanced, nutritious diet that will keep you healthy and assure the proper growth and development of the baby inside your body. For specific information about your diet and weight gain, consult your physician.
A general guideline, however, calls for gaining no more than 9 pounds during the first 20 weeks of pregnancy. A total weight gain of 25 to 35 pounds, put on gradually beginning about the fourth week, is often recommended.
As an example, here's how a weight gain of 33 pounds is distributed:
| • | Baby -- 8 pounds |
| • | Blood -- 3 pounds |
| • | Breasts -- 1 pound |
| • | Maternal stores (fat, calcium, protein and other nutrients) -- 9 pounds |
| • | Other fluid -- 6 pounds |
| • | Placenta -- 2 pounds |
| • | Uterus -- 2 pounds |
You will probably require about 2,500 calories a day for a balanced diet consisting of the proper proportions of protein, fats, carbohydrates, vitamins, minerals and roughage. You should discuss with your physician and/or dietitian what constitutes a balanced diet. This is especially important if you had special dietary needs before you became pregnant, such as diabetes, food allergies or digestive problems.
Planning meals and snacks from the USDA Food Guide Pyramid is one of the best ways to make sure you receive the nutrients that you and your baby need each day. Following are the food groups and recommended requirements:
Milk group
Eat four to five servings a day while you are pregnant or breastfeeding, and two to three servings daily after pregnancy if you are not breastfeeding. This provides nutrients needed to develop your baby's bones and to maintain strength in your own bones and teeth. Other basic components of the milk group are riboflavin (vitamin B2) and protein, which is vital for tissue growth, building hormones that regulate your body and developing antibodies that fight infection.
Examples of one serving from this group include:
| • | 1 cup milk |
| • | 1 cup of pudding made with milk |
| • | 1 cup yogurt |
| • | 1 to 1 3/4 cups frozen dairy dessert |
| • | 1 1/2 cups cottage cheese |
| • | 1 1/2 oz. natural cheese |
Meat group
Eat three to four servings daily while pregnant and two to three servings daily after pregnancy. Meat is a primary source of protein that also provides iron, niacin, zinc, Vitamin B6 and B12, iodine, phosphorous and riboflavin. Included in the meat group are animal and vegetable protein foods, ranging from beef, fish, liver, eggs and shrimp to kidney beans, nuts, pork and beans, tofu and sunflower seeds.
Examples of one serving from this group include:
| • | 1/2 cups flaked tuna |
| • | 1 cup cooked dried beans and peas |
| • | 2 oz. cooked meat, fish or poultry |
| • | 4 T peanut butter |
| • | Two eggs |
Vegetable group
Eat three to five servings a day. Vegetables are an excellent source of vitamins, minerals and fiber that are low-fat, low-sodium and cholesterol-free. Vegetables such as broccoli, asparagus, Brussels sprouts, carrots and spinach are rich in vitamin A.
Examples of one serving from this group include:
| • | 1/2 cup raw or cooked vegetable |
| • | 1/2 to 3/4 cup juice |
| • | 1 cup leafy raw vegetable |
| • | One medium potato |
Fruit group
Eat two to four servings a day. Using the Food Guide Pyramid recommendations for fruits and vegetables will ensure that you get nearly all the vitamin C and more than half of the vitamin A your body requires. Oranges, grapefruit, cantaloupe, strawberries and tomatoes have vitamin C. Other vitamins and minerals provided by these two groups include riboflavin, folacin, calcium and magnesium. Examples of one serving from this group include:
| • | 1/2 cup dried fruit |
| • | 1/2 cup raw, canned or cooked fruit |
| • | 1/2 grapefruit or 1/4 cantaloupe |
| • | 1/2 to 3/4 cup juice |
| • | One medium apple, banana or orange |
Grain group
Eat six to 11 servings a day. This supplies fiber, carbohydrates, vitamins and minerals. Grains are usually low in fat and stimulate the brain, nervous system and muscles. For extra fiber, include whole grain foods such as whole wheat bread, oatmeal, shredded wheat, bran and granola. Examples of one serving from this group include:
| • | 1/2 cup pasta, rice, grits or cooked cereal |
| • | 1 oz. ready-to-eat cereal |
| • | One slice bread or 1/2 hamburger bun, bagel or English muffin |
| • | One tortilla, muffin or roll |
| • | Three to four plain crackers |
Exercise During Pregnancy
Exercise is very beneficial while you are pregnant. It enhances your sense of well being; it can increase muscle strength in the areas that may be stressed by pregnancy, such as the back, abdomen and pelvis; and it improves flexibility and promotes good posture. Regular exercise during pregnancy aids in labor and postpartum recovery and the mother's comfort.
It is important to consult your physician before you begin or continue an exercise program while you're pregnant. Exercise regularly to achieve the benefits listed above. Walking, swimming and bicycling are excellent, especially when combined with specific exercises for pregnant women.
Tips for exercising while pregnant
| • | Avoid jumping, twisting or turning quickly. |
| • | Do not lie on your back while doing exercises after the fourth month of pregnancy. |
| • | Don't become overly fatigued and always warm up and cool down gradually. |
| • | Maintain your accustomed physical activity but modify your exercise routine according to how you feel, both before and after exercise. |
Suggested exercises
Pelvic tilt — Kneel on all fours on a padded surface. Make sure that your back is straight (not swayed) and is parallel to the floor. Inhale. As you exhale, curve your lower back up and contract your abdominals. Inhale as you lengthen your spine by returning your tailbone to the original position. Pelvic tilts help to strengthen abdominal muscles. They also help relieve backache and improve posture. Be careful to keep your back straight; swaying your back puts too much pressure on the lower back.
Foot exercises — Point your toes toward you, then point them down and rotate your ankles. This will help improve circulation.
Kegel exercises — These strengthen the pelvic floor muscles and tighten the muscles in the pelvic floor as if stopping urination in midstream. Progressively increase the degree of tightening and release the tightening very slowly. Do this in a series of five and hold each for five seconds. This exercise can be practiced almost anywhere, any time. Kegel exercises also increase sexual enjoyment.
Leg stretch — Sit with your legs straight and spread comfortably apart. Feet should be relaxed or flexed. With your right arm overhead and your left arm straight, breathe out and stretch down over your left leg. Hold while you count to three, then sit up with your back straight. Repeat with your left arm overhead, stretching your right arm down your right leg. Sit up. Keep your back straight and your head up. Breathe out and stretch arms and upper body forward for three counts. Repeat the entire sequence. This exercise stretches your back, trunk and leg muscles. It helps relieve backache, loosen the area between the vagina and rectum and prevent leg cramps. If your legs are spread too far apart, the joint at the pelvic bones can be strained. Spread your legs only far enough to feel a slight stretch. If it hurts, you have spread them too far.
Many of these exercises also will be helpful after you have your baby to help you get back in shape. Practice them now so your body will be in better shape during your pregnancy and childbirth. Be sure to talk with your physician about your exercise program.
Maternity Clothes Can Be Fashionable And Functional
Shop for comfort and style. During your pregnancy, you will not want to wear clothing that is tight and binding. Keep in mind that your rate of metabolism is increased, and you will feel warmer than usual. Lightweight fabrics may be the best choice.
Maternity undergarments provide comfort and convenience and are a good investment. A nursing bra can be worn as a regular bra before delivery. As your breast size increases, a well-fitting supportive bra is very important.
Fluid retention may cause your feet to swell, so be sure that your shoes are comfortable and give you enough room for increased swelling during the day. You may find that your feet expand a whole shoe size! Invest in some comfortable shoes, with heels no higher than an inch or two.
Pregnancy and Fathers
During the course of pregnancy, a woman's partner also may experience a variety of symptoms such as nausea, vomiting, diminished appetite, indigestion and other pains. It is important to realize that this is an expression of empathy and may soon pass. If the problems persist, he may need medical advice.
Pregnancy usually draws a couple closer together. However, both partners need understanding and sharing. As the unborn child grows, the mother to be experiences emotional ups and downs. It's helpful if fathers understand this and are considerate and accepting. The two of you should:
| • | Attend childbirth classes together |
| • | Discuss how the child will be fed |
| • | Plan the birth of your baby together |
| • | Read prenatal educational information together |
| • | Share your feelings |
| • | Shop together for items for the child |
A mother may feel the baby is taking over her life. Her partner may feel threatened by the baby, and he may fear the changes occurring to her body. Flexibility, a sense of humor and a willingness to share will enable both partners to enjoy this pregnancy.
Sexual Activity During Pregnancy
A woman's sexual desire may decrease during pregnancy due to nausea, breast tenderness, fatigue and a fear of harming the baby. On the other hand, some women may experience increased desire. Normal sexual activity will not harm the fetus. Near the end of the first trimester, vaginal lubrication sometimes increases, making intercourse more comfortable.
How Are You Feeling?
No two women who are pregnant feel exactly alike, nor do they experience the same degree of discomfort. However, certain symptoms during the first three months seem to be common. Here are some tips that may help:
Morning sickness
Hormones that stimulate the baby’s growth have no doubt made you feel queasy and fatigued. Your appetite has probably diminished. If you're bothered by nausea, it's nice to know that it usually isn't a problem after the 12th week. Suggestion: Keep some dry toast or crackers at your bedside and eat them about half an hour before you get out of bed in the morning. Eat five or six small meals daily rather than three larger ones and avoid greasy, hard-to-digest foods.
Frequent urination
This is due to pressure on the bladder from the growing uterus. This condition usually subsides by the third month and returns in the eighth month. Suggestion: If "dribbling" becomes a problem, wear a panty liner. Kegel exercises, which involve tightening and relaxing perineal muscles, will improve control. Ask your physician about them.
Breast tenderness
Your enlarged breasts are making preparations for the baby’s arrival. They may be tender, and the area around the nipples, called the areola, may begin to darken as a result of hormones being produced by your body. Suggestion: Wear a well-fitting, supporting bra. Cold compresses may help relieve discomfort.
Fatigue
This usually diminishes by the end of the third month and returns in the ninth month. Suggestion: Tune in to your body and do what's natural. If you're tired, get more rest and pace yourself. Mild exercise, such as walking, helps.
Good Health for You and Your Baby
You must consider your infant's health besides your own now. If you smoke, it's time to stop. Smoking is associated with fetal injury, premature birth and low birth weight. Also limit your caffeine intake; drink decaffeinated coffee and pop while you are pregnant.
Drinking any amount of alcohol during pregnancy is not safe. Alcohol passes through the bloodstream to the fetus. Over-the-counter, prescription and street drugs also pass to the fetus. Consult your physician before taking any kind of medicine.
When to Call Your Physician
It is reassuring to know that most women go through their pregnancy without experiencing any serious complications. Modern medical care can prevent many problems from becoming serious. You should discuss your concerns and symptoms with your physician so that you are confident about your health.
However, you need to call your physician if you experience a persistent headache, nausea and vomiting; fever of 100 F degrees or higher; burning, frequent urination; abdominal pain; a bloody discharge or fluid leaking from the vagina.
Blood Pressure Checks Are Important
Pregnancy-induced hypertension (PIH) is a term used to describe high blood pressure conditions that may occur during pregnancy. PIH occurs in less than 10 percent of pregnancies but is still the leading cause of death in pregnant women in the United States. Ninety percent of hypertension is related to pre-eclampsia, a form of high blood pressure related to pregnancy. The signs of pre-eclampsia are edema (swelling), especially in the hands and face, a rapid weight gain and protein in the urine.
Your physician will be constantly checking you for any of these symptoms. Edema is experienced by many pregnant women and becomes noticeable when fluid builds up and causes swelling in fingers, feet and ankles, and puffiness under the eyes. It becomes significant if it does not disappear after 12 hours of bed rest. Edema also may be classified by the addition of three or more pounds of weight gain a week.
Bed rest is the usual treatment for PIH. Pre-eclampsia usually doesn’t recur in subsequent pregnancies. You may wish to discuss this condition with your physician.
Growth of the Embryo/Fetus
The First Month -- Amazing things have been taking place inside your body since the fertilized egg divided and became an embryo (it's called a fetus after the 12th week of pregnancy). By the end of the first month, your baby is smaller than a grain of rice. Within the next few weeks, the embryo will begin to develop a heart, brain and spinal cord, digestive system and sensory organs. Pits have formed that will become the baby's eyes and ears. Limb buds are developing, as well as a system of blood vessels.
The Second Month -- By the end of the second month, the embryo is a little over one inch long and weighs about one third of an ounce. All internal organs are now present, and most major structures have been formed. Its heart is beating. Although its body is beginning to elongate, the head still appears disproportionally large in comparison with the rest of the body.
The Third Month -- In the third month of life the fetus is three inches long and weighs about one ounce. The fingers and toes are separated, the teeth are forming under the gums, and the sex of the child is evident. More organs are developing. You can hear your baby's heartbeat for the first time (10 to 12 weeks) using a special instrument called a Doptone. For the rest of your pregnancy, all of the fetus’ body organs will mature, and it will gain weight.
What Are the Chances for Twins?
Twin births occur in one out of 90 births. The chances for multiple births increases if the mother is taking fertility drugs or the tendency for twins runs in her or the father’s families.
There are two types of twins: identical and fraternal. Identical twins come from a single egg that divides to form two embryos early in development. Identical twins make up about one-third of all twin births. They will have the same genetic makeup, sex and blood type and will look very similar.
Fraternal twins come from two eggs that have been fertilized. They may be of the same or different sex. The infants will have no more in common that other siblings would. Fraternal twins tend to recur in families.
The diagnosis of twins may be easy or difficult. Following is a list of indications of multiple pregnancies:
| • | The uterus may be larger than expected for the gestational age, indicating a more rapid growth. |
| • | Ultrasound may reveal two or more fetuses. This may be detected as early as 10 weeks, but it is more clearly evident after 28 weeks. |
| • | The physician may detect two fetal heart rates or palpate two heads and more small parts. |
| • | The mother may feel more fetal movement than can be attributed to only one baby. |
If you're concerned about a multiple pregnancy or have a family history of twins, please discuss this with your physician.
A Time to Learn for Both of You
Great River Medical Center offers free prenatal education opportunities throughout your pregnancy.
Best Beginnings
Best Beginnings is a program taught by a childbirth educator and a dietitian. Best Beginnings is for mothers in their first or second trimesters of pregnancy and is offered monthly.
The class provides you with timely information about exercise, diet, weight gain, the mother’s physical and emotional changes, the father's role, development of the baby, breastfeeding vs. bottle feeding and the importance of prenatal care. To register, call (319) 768-4000.
Prenatal Series
Most pregnant women look forward to attending a class for expectant parents with their partner or a friend. Combined with advice given by the physician, these classes help prepare the couple for the birthing process and infant care.
Women who are in the last three months of pregnancy may attend prenatal classes at Great River Medical Center. These classes are taught by a childbirth educator and include topics such as breathing and relaxation techniques, what to expect during labor and how to care for your newborn. You'll also have an opportunity to tour the Obstetrics Unit. The unit’s rooms are specially designed so women may experience their labor and delivery in a homelike setting. The birthing rooms are equipped with beds that adjust easily to a delivery position, so there’s no need to move to a delivery room when your baby’s birth is imminent.
Most couples who are expecting say they enjoy the prenatal classes — and you probably will, too. Besides receiving lots of valuable information, you'll have an opportunity to meet other expectant parents and compare notes with them about the upcoming happy event.
Even though it's a few months away, feel free to call soon to register for the six-week prenatal class. Call (319) 768-4000.
Recommended Reading
Pregnancy, Childbirth and the Newborn. Penny Simkin, Janet Whalley, Ann Deppler (Meadowbrook Press).
What to Expect When You're Expecting. Arlene Eisenberg, Heidi Murkoff, Sandy Hathaway (Workman Publishing).
Labor and Birth—A Guide For You. (Second Edition). Linda Todd (International Childbirth Education Association).