Heinz sight is 20/20, but when I first noticed that I put the ketchup in the freezer, it didn’t occur to me that I might be pregnant. When I attended a parent ed lecture and was talking to a mom I’ve known for over two years when another mom I have been in class with twice a week since September walked up, I couldn’t remember either of their names to introduce them to each other for the life of me. And I beelined for frozen yogurt after the class at 8pm. By myself. Sure, there’s THE boobs, but I really thought I was starting to see results from my chest presses in my weight class. Nonetheless, I FINALLY decided to take a prego test and to my pleasant surprise, I am pregnant for the FOURTH time… And now, we just found out we are having TWINS (yep, that makes FIVE kids). As I prepare to dust off my maternity clothes from 2003 AGAIN, I realized that my knowledge is likely out of date, too. Breezy Mama turned to Dr. Jason Rothbart to find out what has changed medically in the last two years and what I can expect as a geriatric (yep, over 35 = OLD) pregnancy. Plus! Whether gender prediction kits really work and helpful tips for nausea.
What’s new NOW? Any new testing in the last two years?
There is always new research going on and this slowly leads to changes in what is the standard of care for prenatal care. In the last 5-10 years, the first trimester screening has come into play, which has been an important addition in helping to identify the risk of chromosomal abnormalities in a non-invasive way. Over the past 5 years, and perhaps even more in the last two years, the advent of umbilical cord blood collection for the storing of stem cells has become integrated into the options for expecting parents. It is still the woman or couple’s choice to collect and store it or not, but it is now at least important that every obstetrician or midwife is offering it to their patients. There is also a relatively new treatment/prevention option involving weekly progesterone injections for women during a second (or more) pregnancy who have a history of preterm labor and delivery with a previous pregnancy.
Any new concerns for women in general?
The newest concerns for women in pregnancy and prenatal care are really just a stressing of what we already know and do. With the increase rise in the national c section rate, there are ever evolving new concerns for the abilities and choices for woman involving vaginal birth after cesarean (VBAC), risk of uterine rupture, scarring, etc.
Any new concerns for women over 35/ any new tests for over 35ers?
There are many more pregnant women over 35 today than there were twenty years ago, due to the increased desire of women to postpone childbearing until a career is established, as well as the technological advancements and success rates for in vitro fertilization (IVF) and assisted reproduction. But the “35” age as a cut off for certain tests is becoming antiquated, as all of the screening and diagnostic tests available today are and should be offered to women of every age. The age of 35 was important because that is the age where the risk of down’s syndrome approximates the risk of miscarriage from an amniocentesis. With the addition of the non-invasive first trimester screening test, the second trimester screening maternal blood test, as well as chorionic villus sampling (CVS) to get chromosomes analyzed much earlier in pregnancy than an amniocentesis, the age of 35 is no longer a true cut off.
Can siblings visit the hospital again –I know some hospitals stopped letting them because of The Swine Flu– what is the latest?
I can only speak for the hospital I am affiliated with, Cedars-Sinai Medical Center. The latest there is the hospital wide rule allows children over 12 to visit the hospital. The wonderful and neccesary exception is the obstetrics floor, where children (siblings) of all ages are allowed to visit.
Any new tips for helping deal with nausea?
Nausea in pregnancy can be severe and debilitating, even if there is no actual vomiting. There are very effective and strong medications that can be prescribed to treat nausea in pregnancy. In addition, there are excellent over the counter methods that are a great place to start. Vitamin B6 taken at the same time as Unisom (yes, the sleep aide) three times a day can be very powerful at treating nausea and vomiting. The motion sickness wrist bands work very well also, as does simple ginger. The easiest adjustment to make is to eat smaller meals more consistently throughout the day, and to really be always eating or drinking something. Larger meals can make a pregnant woman feel miserable.
In the first trimester, sometimes prenatals can make a prego more nauseous. Is it okay for her to stop taking them? Is there a great substitute?
If one type of prenatals makes a woman feel worse, it is always best to first try to change the time of day she is taking it, as well as alter if she is taking it with food or not. If that doesnt work, the next step is to try a different brand, there are many. If she still is feeling worse, she can limit it to just taking folic acid and DHA/omega 3 suppliments, as these are important for spinal cord formation, as well as brain and eye development.
What month can’t pregnant women lie on their back?
In the third trimester, the best position to allow the maximum blood flow through a pregnant woman’s body is to lie on their left side. But if a woman truly cannot sleep on that side, then it is more important for her to find a position she can sleep better in, while still trying to sleep/lie as much as she can on her left and not on her back. This usually is not difficult as lying on her back can make a pregnant woman feel very short of breath and truly not be that comfortable.
First it was too dangerous to jog. Then it was “fine to jog”. What is the general precautions when it comes to exercise and is weight bearing/aerobic exercise okay?
Exercise and weight bearing exercise are very helpful and recommended in pregnancy. But it is important that a woman stay within her means. If a marathon runner gets pregnant, she is absolutely okay to continue running. Her body will tell her when it is time to slow down to a more low impact work out. If a woman has never ran or jogged in her life on the other hand, pregnancy is not the time to get a trainer. For her, a good 20-30 min walk three or four times a week will be enough to get the benefits of exercise.
Sugar substitutes: again, first they were considered cancerous. Then it came out they were okay. What is the latest — are they bad or okay for an expectant mom? Should they be avoided in the first trimester?
Sugar substitutes, like most foods in question around pregnancy, are okay to consume, within reason. There has been no data to show that they cause birth defects or affect a pregnancy in anyway. But as always, its important to use everything in moderation.
Still okay to get your hair dyed or highlighted?
Yes. With common sense and logic. It would probably not be okay to get hair colored every day. At that rate then maybe yes, some of the color could get into the blood stream and maybe cross the placenta and maybe do some harm. This is again something that cannot be studied, therefore no definitive answer can be given. But a few hours of hair color every so often will likely have no affect on a fetus.
Heard ginger helps with nausea, okay to have it as an herbal tea?
Yes and yes!
Do all of the above answers apply if a woman is carrying twins?
Pretty much actually. Twins get a little closer monitoring for growth and signs of preterm labor, but all else is the same.
I feel like there’s this new wave of gender prediction kits. Do they really work? How?
Gender prediction kits are 100% a waste of hard earned money. There is NO way, I repeat, NO way to identify the gender of an unborn fetus without doing a test that removes the chromosomes (CVS or amniocentesis) or waiting until the genitalia can be seen on ultrasound. This goes for all the other wives’ tales as well. A fast heartbeat, the baby being “carried in front”, changes in maternal skin tone……don’t be fooled, they tell nothing. Please save that money for diapers and a babysitter!
Anything that I’m forgetting? Anything else you’d like pregnant women to know?
Basically, that pregnancy is not a disease. There is nothing wrong with a woman when she is pregnant. And overwhelmingly a woman’s body knows exactly what to do. Good prenatal care is there to make sure that mother nature is doing it right, and to step in for a little nudge here and there when she is not. Always ask your doctor or midwife any question you may ever have. Out of 100 questions, the answer to 99 of them will be “that’s normal”, “that’s normal”, “that’s normal”, “do this more”, “do that less”, etc. But that one question out of a hundred may actually require an ultrasound, exam or blood test to make sure everything is okay. And that burden is on us, on me, on the woman’s doctor or midwife to decide what is normal and what needs to be checked on. So ask us everything, that’s why we are here!
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(Note: Always talk to your own doctor to make sure these answers apply to your pregnancy).
About Dr. Rothbart
Famously flown to Namibia to deliver Brad Pitt and Angelina Jolie’s baby Shiloh in 2006 as well as appearing on Tori Spelling’s reality show, Jason A. Rothbart, M.D. is an Obstetrician/Gynecologist in Los Angeles. He attended college at the University of California at Davis, and medical school at The Chicago Medical School. He was trained in obstetrics and gynecology at the University of Southern California in the Los Angeles County Medical Center. He is back home practicing minutes from where he grew up, and has a wonderful practice with all ages, and is currently on the surgical and obstetric staff at Cedars-Sinai Medical Center.