Do you recommend a specific prenatal vitamin?
Any vitamin that has been FDA approved and is sold in stores as a “prenatal vitamin” should have the required nutrients for pregnancy. We recommend finding one that includes DHA as a source of omega-3 fatty acids for neurological development.
Through Dr. Rainvilles research on prenatal vitamins she recommends Shaklee Vitalea multi vitamin as an excellent choice.
Do I need a fish oil supplement?
We do recommend including a supplement that includes omega-3 fatty acids, often in the form of fish oil. These healthy oils help with your baby’s neurologic development. If you have trouble tolerating this in your first trimester due to nausea, you can start it at any point in pregnancy.
Why do I need to supplement vitamin D?
Vitamin D deficiency is common in our geographic area. Research into the effects of vitamin D deficiency in pregnancy is ongoing, but it is suspected to have an important role in normal fetal development.
Should I stop taking my prescription medication when I’m pregnant?
This should be addressed on a case by case basis. Some prescription medications are safe to continue during pregnancy, whereas others are contraindicated. Please call our office to discuss further with a provider.
Can I take any natural supplements or drink tea?
Natural supplements are not studied and regulated in the same way as over the counter and prescription medications. Although some may not impact a pregnancy, the safest approach is to avoid these supplements during pregnancy. If you have a question about a specific supplement, please call or ask at your next appointment.
You should be taking a prenatal vitamin daily
Omega-3 fatty acids found in fish oil and other DHA supplements are safe to take during pregnancy, and are often combined within a prenatal vitamin
Vitamin B6 can help with nausea and is safe to take in pregnancy
We may recommend you start vitamin D or iron supplementation depending on lab results
Herbal teas are generally safe in moderation during pregnancy. You should avoid drinking too much caffeinated tea, keeping total caffeine intake to less than 200mg daily.
Blue and black cohosh should absolutely be avoided in pregnancy.
What kind of iron supplement should I take?
Over the counter iron pills are adequate for most women in pregnancy
Ferrous Sulfate (FeSO4) 325mg is a standard dose, taken twice daily
Slow-Fe is a slow-release supplement than can be easier to tolerate and cause less constipation, taken once daily
Some women have trouble tolerating iron pills and benefit from a liquid source of iron
Floradix is a plant-based iron supplement found at health food stores, taken once or twice a day
When will I have an ultrasound?
We routinely order the following ultrasounds:
Dating ultrasound in the first trimester of your pregnancy, approximately 8 weeks from the first day of your last normal menstrual period.
“Fetal survey” ultrasound at 20 weeks in the pregnancy to screen for abnormal fetal development (this is when you can learn your baby’s gender).
If you have a risk factor that warrants additional ultrasounds, here are some common times when those might occur:
10-12 weeks – confirm continued normal pregnancy, screen for miscarriage
24, 28, 32, 36 weeks – screen for appropriate fetal growth
36 weeks to delivery – monitor for complications at the end of pregnancy
Is ultrasound safe for my baby?
Yes, routine prenatal ultrasounds are safe for you and your baby.
Is cramping normal?
Mild cramping throughout pregnancy is normal. It is often caused by dehydration or fatigue. Try drinking more water and taking a shower or bath to see if cramps resolve.
If the cramping ever becomes severe or is accompanied by vaginal bleeding, call the office. If the cramps are mild but come in a regular pattern that is suggestive of preterm labor, call the office.
What can I do for low back pain?
Physical treatments are most likely to be successful to treat back pain in pregnancy. We recommend:
Heat therapy and stretching
Maternity support belts, or “belly bands”
Chiropractic or osteopathic manipulation
If you need medication for pain, start with Tylenol per bottle directions and call us if this is ineffective
How much weight should I gain in the pregnancy?
If you start pregnancy at a normal weight, you should expect to gain 25-35 pounds in the pregnancy. Most of this weight gain will occur in the second half of your pregnancy.
If you start the pregnancy overweight, you do not need to gain as much during your pregnancy. It is not a time to focus on weight loss, but healthy eating and exercise. It is safe to keep weight gain to 10-20 pounds depending on your starting weight.
We will monitor your weight at your prenatal visits and make recommendations accordingly. If at any point you would like to speak to a nutritionist, we can set up a referral.
Is it safe to fly during pregnancy?
We recommend abstaining from flying once you reach 34 weeks in your pregnancy.
You are at increased risk for blood clots during your pregnancy, and periods of prolonged sitting (such as on a flight) increase that risk further. We recommend taking a baby aspirin (81mg) the day before, the day of, and the day after flying. Fidget and move your body, particularly your legs, in your seat. Take frequent bathroom breaks and stretch your legs to keep blood flowing.
Observe for signs of a blood clot, and call us if you have any of the following:
Red, hot, tender area in your calf
Pain in your calves when flexing your feet or walking
Shortness of breath
What should I do if I fall when I am pregnant?
Call the office to create an evaluation plan. This will depend on the nature of the accident and how far along you are in your pregnancy. We may have you come to the office or go to the hospital for evaluation.
Can I go in a hot tub?
No. Hot tubs can raise your core temperature to a level that is not safe for the baby.
Can I take a bath?
Yes. Make sure that the bath water is at a comfortable temperature, but not too hot (like that of a hot tub). Stay hydrated and avoid overheating.
If you are in early labor at home and think your water might have broken, do not take a bath.
Can I ski?
We do not recommend skiing during pregnancy – even if you are safe on the hill, you may be hit by someone or have an accident that could harm the pregnancy.
What kind of exercise is safe?
If you were exercising before pregnancy, it is generally safe to continue your normal activities with modification to accommodate your changing body as the pregnancy progresses.
Exercises to avoid:
Contact sports, horseback riding, skiing, scuba diving, rock climbing, bike riding
Heated yoga (will raise your core body temperature)
Activities that involve prolonged time flat on your back (affects normal circulation)
Anything that you do not feel comfortable doing – you do not want to strain or risk injuring yourself during exercise
If you have questions about the safety of any exercise outside of those listed please call or discuss at your next appointment
Can I have sex?
Yes. If there is any reason you should abstain from intercourse we will tell you. It is common to have some light pink spotting after intercourse, but please call to discuss if this happens.
Should I be performing daily fetal kick counts?
You should be monitoring your baby’s movement every day. As long as your baby’s pattern of movement is normal for him or her, you do not need to perform a formal “kick count.” If, for any reason, your baby is moving less than usual, you should monitor more closely. Drink some ice cold water, juice, or have a snack, and lay on your left side. Feel for movement with your hands on your belly as well as what you can feel from the inside. Your baby should move at least 4-5 times in an hour after doing this. If your baby does not respond well to this stimulation, or if the movement still feels abnormal even if fitting this guideline, then call the office and we will decide where you should be evaluated.
A baby’s movement is the best indication of his or her well-being without additional testing – decreased movement can be a sign of stress, so don’t ignore it
What should I do if I’m at risk of being exposed to a virus?
Generally, good personal hygiene with a focus on frequent hand washing is the most important and effective way to protect yourself from disease. Here are some recommendations for specific cases.
Pertussis – You have most likely been vaccinated against pertussis as a child, and may have received a booster vaccine in the recent past. Avoiding direct exposure and using good personal hygiene techniques will hopefully prevent you from contracting pertussis. We recommend all women receive a Tdap vaccination for pertussis in the 3rd trimester of pregnancy to decrease risk of exposing the baby before he or she can be vaccinated. In addition, some of the immunity that you will develop will pass to the baby through the placenta and breastmilk. We do not recommend receiving this vaccination before the 3rd trimester because that is the ideal time to maximize protection for your newborn.
Parvovirus (Fifth Disease) – This is a common childhood disease that many people have been exposed to over the course of their lives. At our practice, we screen for immunity to Parvovirus in early pregnancy as part of your initial lab work. These results determine if you have been exposed in the past and developed immunity – if you are not immune, we would have discussed this with you at some point. If you are not immune, good personal hygiene and avoiding known cases of Parvovirus is your best protection. If you are concerned about possibly coming in contact with the virus, call our office and we can discuss additional lab testing.
Chicken pox – Most women have either had chicken pox as a child, or received vaccination, and therefore are not at risk for having chicken pox in pregnancy. It is still best to avoid exposure when possible, especially to open sores. If you are not sure if you are immune to chicken pox, please let our office know so that we can determine immunity status with lab work. The greatest risk to you and your baby is contracting chicken pox in the third trimester, close to delivery. Please call the office if you have any concerning symptoms after exposure to someone with chicken pox.
What is your recommendation regarding the Zika virus?
When pregnant or anticipating conception, we advise against traveling to an area where you would be at risk of contracting Zika virus. The mosquitos that carry Zika virus cannot survive in our climate, so you are not at risk of contracting the disease by that route in Maine. There is some evidence that it can be spread via sexual contact, however, so we recommend using condoms if there is a possibility that your partner has been exposed.
The Center for Disease Control and Prevention (CDC) has up to date information on the spread of the virus and areas that are high risk, as well as the most current knowledge about the disease. You can find that information at their website, www.CDC.gov/zika. Research on this disease and its effects on pregnancy are ongoing, so if you have concerns please call or discuss with us at one of your appointments.
When can I start exercising again after I deliver?
We recommend waiting until you’ve had your 6 week postpartum visit before beginning exercise, at which point you should start slowly and increase gently.
Should I use birth control while I’m breastfeeding?
Yes. Exclusive breastfeeding (no pumping, no supplementing) is protective against pregnancy in the first 6 months but not 100% effective. You can even conceive again before having a period after delivery. We recommend having an additional method of protection during this time.
When you are breastfeeding it is best to use either non-hormonal methods, or methods with progesterone only. These include the Paragard IUD, Mirena IUD, Nexplanon implant, Depo Provera injection, or a progesterone only pill. You may also use barrier methods such as condoms but they are not as effective. We can discuss this at any time during your pregnancy or at your postpartum visit.
Where can I go for more information about lactation and breastfeeding support groups?
Maine Medical Center has lactation consultants for individual consultation, as well as breastfeeding support groups. More information can be found on their website: http://www.mmc.org/breastfeeding
Birth Roots is a local nonprofit organization that creates a guide full of resources pertinent to pregnancy and parenthood (including breastfeeding support). They also host classes for pregnancy and beyond. A link to the online version of their booklet can be found through their website: https://www.birthroots.org/resource-guide/.
Additional reliable online resources:
La Leche League: http://www.llli.org
Kelly Mom: http://kellymom.com
What is the difference between the “baby blues” and postpartum depression?
Pregnancy and childbirth are wonderful yet challenging times in a woman’s life. After you deliver, it is normal to feel a flood of new emotions. Physical recovery from delivery, sleep deprivation, hormonal changes, and adaptation to a new family dynamic are all factors that can contribute to the sensation of feeling overwhelmed. When these emotional challenges are strongest in the first two weeks after delivery but then begin to dissipate, they are more likely to be categorized as the “baby blues.” If these symptoms persist past a few weeks or dominate your day to day life, you may be experiencing postpartum depression. Depression is often accompanied by a difficulty in enjoying daily activities, an inability to motivate, thoughts of worthlessness, overwhelming anxiety, or prolonged periods of crying, among other symptoms.
Determining whether you are experiencing a normal period of adjustment versus postpartum depression is a challenging task. If at any point you are concerned about your emotions or just don’t feel like yourself, please call our office for further discussion and evaluation. Each woman’s experience is unique, and it is always better to reach out for assistance than to struggle at home. If you are feeling thoughts of hurting yourself or others, or are contemplating suicide, please call 911 immediately for emergent assistance. Alternatively, numbers for State of Maine Crisis Hotlines can be found here: http://www.maine.gov/dhhs/ocfs/hotlines.htm
Postpartum Support International (PSI) is an additional resource: http://www.postpartum.net/ (1-800-944-4773)
What is pelvic floor rehab, and why might I need it after I deliver?
Pelvic floor rehabilitation, or pelvic floor physical therapy, is therapy targeted at the muscles and tissues of the pelvis. Just like any other muscle group in your body, you can have symptoms in your pelvis that result from problems with these muscles. Physical therapists are trained in several techniques to diagnose and treat your symptoms with in-office therapies and exercises for home.
Pregnancy (regardless of the mode of delivery) can cause changes to the muscles and tissue in your pelvis. After delivery you may experience symptoms that can be improved with pelvic floor physical therapy.
Incontinence – If the strength of the muscles in your pelvis decreases after delivery, you may have difficulty controlling urination. Working with a physical therapist, you can learn exercises intended to improve this muscle tone and hopefully decrease incontinence.
Pain with intercourse – There are several possible reasons for pain with intercourse after delivery. If you had a vaginal delivery, you may have stitches that need to heal completely before intercourse will be comfortable. Sometimes there is scar tissue that develops that can be painful. Breastfeeding also changes the hormonal environment for your vaginal tissue leading to dryness and discomfort. Other times there is not a clear origin of the pain, but intercourse becomes painful. Some of these problems can be addressed in our office, while other times physical therapy can be helpful.
Pelvic pain – You may notice discomfort in your pelvis after delivery. Physical therapists can help evaluate and treat pain that may be related to musculature.