1. My obstetrician has told me that I have a low-lying placenta. What exactly does that mean? Will I need to have a cesarean section?

    • In the early stages of pregnancy, as the embryo settles into the uterus, the placenta usually forms in the upper portion of the uterus. This area is called the fundus. With a lowlying placenta, however, the placenta forms in a lower portion of the uterus. This is a problem only if the placenta covers all or part of the cervix. If the entire cervix is covered, the condition is called placenta previa. It is not safe to deliver the baby vaginally when the mother has placenta previa, since the passing of the placenta first could cause serious bleeding in both mom and baby. In this case, a cesarean is needed. Generally, however, a low-lying placenta moves up and away from the cervix as the uterus expands. Although the placenta is attached to the uterine wall, the expanding uterine muscle shifts the placenta upward.

      Because a low-lying placenta can cause bleeding, your doctor may have already placed you on “pelvic rest.” You will have an ultrasound scan later in your pregnancy to determine where your placenta is positioned. If it is out of the way of the cervix, you can resume your normal activities, including sex, and you can expect to deliver your baby safely vaginally.

  2. I’m 14 weeks pregnant, and I have a bad cold. Can I take any type of over-the-counter antihistamine or decongestant to stop my nose from running? Please help – it’s driving me crazy!

    • Getting sick while you are pregnant isn’t fair! Colds can be especially bothersome if your sinuses are already feeling stuffy from the extra blood flow you now have. You mentioned both antihistamines and decongestants. Let me differentiate them. An antihistamine relieves the itchy, watery eyes, sneezing, and other symptoms of environmental allergies such as hay fever. Diphenhydramine (Benadryl) is an example of an antihistamine. A decongestant relieves the stuffy nose and ear congestion frequently caused by a common-cold virus or sinus inflammation (sinusitis). A typical decongestant is pseudoephedrine, which comes under a variety of brand names. Pseudoephedrine is considered safe for use during pregnancy. Until recently, this drug was readily available on grocery and drugstore shelves.

      Currently, pseudoephedrine products are kept out of reach of shoppers and available only on request. This is because pseudoephedrine is used in the illegal manufacturing of methamphetamine. Although no prescription is necessary in most states, you will have to show your driver’s license or other personal identification to buy the drug. Some cold medication manufacturers have replaced pseudoephedrine with phenylephrine, but many people feel that the replacement does not work as well. Nor has the use of phenylephrine during pregnancy been as well studied as that of pseudoephedrine.

      Please talk to your doctor or midwife before taking any of these medications. If you are having aches or a fever, your practitioner may suggest that you take acetaminophen instead. In any case, you should rest as much as possible.

  3. I have been diagnosed with pregnancy-induced hypertension, and I have been placed on “strict bed rest.” What exactly does that mean?

    • Pregnancy-induced hypertension is an older term that is sometimes used interchangeably with preeclampsia. If you have high blood pressure and not the other symptoms of preeclampsia (swelling and protein in the urine), your doctor may refer to your condition as chronic hypertension. Any of these terms means that your blood pressure is too high.

      One in five pregnant women spends a week or more of her pregnancy on bed rest, as treatment for any of several things—preterm labor, vaginal bleeding, placenta previa, preeclampsia, chronic high blood pressure, sciatic pain. A milder treatment for some of the same conditions is “decreased activity”—staying home most of the time, avoiding exercise, and putting your feet up for a while several times a day. Bed rest is usually prescribed with a qualifying term—partial, moderate, or strict:

      Strict bed rest. You must remain in bed (or on the couch, if your doctor approves) at least 23 hours a day. You are allowed a shower only every other day, and you must remain on your side throughout all your meals. Your food, drink, and anything else you may need must be brought to you. You can get up very briefly to use the bathroom or a bedside commode, but not for any other reason. If you are at home on strict bed rest, remember that your next stop is the hospital! Knowing this may help you follow the rules at home.

      Your doctor or midwife may have his or her own particular rules regarding bed rest. Follow your practitioner’s specifications; your health and your baby’s health may depend on it.

  4. I’m having a little girl, and I’m very excited! My question is a little embarrassing: When my baby urinates or has a bowel movement, where does this waste go? Is it floating around in the sac with her?

    • The truth about embarrassing questions is that they often are the ones everyone has. Anything that passes through the baby’s body ends up being part of the amniotic fluid. Your baby’s urine is made up of products different from ours. The more urine your baby produces, the more amniotic fluid you have. Since your baby is not digesting any food, she is not yet having any bowel movements. Shortly before birth, however, your baby may pass a bowel movement in your womb. This first stool, called meconium, is very sticky and dark green. Meconium is ordinarily first passed in the initial few hours after birth. A baby’s passing of meconium before birth can mean that she is postmature (past 41 weeks’ gestation) or has been under some kind of stress. If you notice a greenish or dark yellowish vaginal discharge, please let your practitioner know. This could mean that your water bag has broken and that the baby has passed meconium. Your doctor or midwife will want you to come into the hospital or birth center, so that you can be checked.

  5. I had twin girls four years ago. When I was pregnant, I was told they were in separate sacs and therefore not identical. Once they were born, the doctor said they might be identical, because they had the same blood type. They look very much alike, and I am asked all the time if they are identical. Is there any way to know for sure whether they are identical or fraternal?

    • Identical twins occur when one egg divides into two, so that the babies have the same genetic makeup. Fraternal twins occur when two separate eggs are fertilized. Like fraternal twins, identical twins normally have two separate amniotic sacs. It is extremely rare for these twins to share one sac, and dangerous, too, since the babies’ umbilical cords could get entangled during the pregnancy. Your girls could indeed be identical, especially if they look a great deal alike. The fact that they have the same blood type isn’t a clear indication, as it is quite common for siblings within any family to have the same blood type. The only way to know for certain is to have the girls genetically tested. Their doctor should be able to help you find out how to do this and the costs involved.

  6. I’ve been receiving conflicting opinions concerning childbirth classes, specifically Lamaze. I am 61/2 months pregnant with my 170 first baby and would like to know your views on the subject. Is a program like Lamaze helpful if I’m planning to use an epidural? I am from Sweden, and in my country, this doesn’t seem to be such a big issue. I don’t want to take the classes just because it’s expected.

    • All labor involves some pain. Even though you wish to have an epidural, it is very important to learn about alternative ways of dealing with labor pain, and books simply cannot teach you the coping skills the way a class can. Whether your childbirth class involves Lamaze breathing and relaxation techniques or other approaches to childbirth, the class should incorporate discussions of natural methods of coping with pain as well as medication options.

      As with all types of education, childbirth classes are taught by some great teachers and some not-so-great teachers, but in general these classes are extremely helpful as preparation for labor and birth. Your course should help you understand what will happen with your body in labor and how to work with this natural process. Your teacher should tell you what you need to know so that you won’t be afraid of what your body is going through and so that you can make informed choices in labor. The classes provide this information in an open, accepting atmosphere in which you feel your questions are welcome. A good instructor will teach you to be flexible, because labor is always somewhat unpredictable, and will help you to feel supported, confident, and capable. By taking the classes, you will be better prepared to have a positive birth experience, whether you end up giving birth vaginally with an epidural, having a non-medicated birth at home, or having a planned or unplanned cesarean. Finally, by emphasizing that there is no right or better way to give birth, your instructor will dispel any anxiety or guilt you may feel about your choices.

  7. My mother, who is now in her sixties, delivered all of her children by cesarean section. Now my doctor says it is safe for me to have my baby vaginally, even though I have had one C-section. My mother says vaginal birth would be dangerous for me. I am confused.

    • Cesarean sections are performed differently today from when your mother had her babies. The surgery requires two incisions, one through the mother’s skin and the other in the mother’s uterus. When your mom had her cesareans, her uterine incision was probably vertical, or classical. Today, cesareans are performed with horizontal uterine and skin incisions. A horizontal uterine incision is called low transverse. As several studies confirmed in the early 1990s, this type of incision makes it safe to attempt a vaginal birth after cesarean (VBAC) with a second pregnancy. More recent studies have found a small risk—1 chance in 200 to 400—of the uterus’s tearing during VBAC with a horizontal incision. (The risk is much greater after multiple cesareans.) Because of these latter findings, the trend toward repeat cesarean sections has increased in recent years. Yet many women still choose VBAC, and 70 percent of those who do elect this type of delivery succeed in delivering vaginally.

  8. My wife has said that she wants to check into the possibility of having a doula with us at our baby’s birth. I am not familiar with the use of doulas, and I would like to know more about them. I am afraid that I won’t be as involved if we have one. What are your thoughts?

    • A trained labor assistant, or doula (from a Greek word for “woman’s helper”) provides continuous physical, emotional, and informational support to mothers and their partners during labor and birth. Studies have shown that continuous labor support decreases the use of pain medication, epidural anesthesia, episiotomies, and cesarean sections and provides greater feelings of control and satisfaction for women in labor.

      A doula would play a unique role on your birth team. She would not replace your own loving support for your partner. Instead, she could help both of you by offering suggestions about comfort measures—such as relaxation, visualization, breathing, massage, aromatherapy, use of a birthing ball, and spending time in the tub or shower—and assistance in carrying out these measures. She would not influence any medical decisions that you and your partner may need to make, but she could help you figure out what questions to ask of your practitioner and your nurse to help you in making these decisions. Each person on the birth team has different responsibilities, and everyone working together makes the amazing dance of labor a very positive experience for the mother and her partner.

      The cost of using a doula can vary a great deal. The community hospital in my neighborhood provides free doula services to women who have no partner, friend, or relative to accompany them in labor. Doulas usually charge for their work, however, and I have seen fees ranging from $350 to more than $1,000. Fortunately, some insurance companies are reimbursing couples for a portion of a doula’s fee. You may want to check with your insurance provider.

  9. Help! This is my first pregnancy, and I have been miserable for the last several days with a terrible rash and itching. My doctor has diagnosed me with a skin condition called PUPPP. What is this, and is it dangerous?

    • PUPPP stands for pruritic urticarial papules and plaques of pregnancy (say that ten times quickly!). Among the many skin rashes that can develop during pregnancy, this one most commonly occurs in abdominal stretch marks but can also occur on the buttocks, thighs, and arms. As you know, PUPPP is itchy, itchy, and itchier. Its cause is unknown, but PUPPP is not a serious condition; it poses no danger to you or your baby. It lasts about six weeks, on average, and disappears within two weeks after birth. It generally doesn’t recur, even in subsequent pregnancies.

      To lessen the itching, you can try taking oatmeal baths or use an over-the-counter anti-itch cream containing 1 percent hydrocortisone. If this doesn’t help, your doctor or midwife may suggest an antihistamine or, if the itching is very severe, a corticosteroid.

  10. Help! My mother was recently exposed to fifth disease. I’m seven months pregnant, and I have been advised to stay away from my mother. I had never heard of fifth disease before; it’s not even mentioned in the books I’ve looked at. What are the symptoms, how dangerous could it be to my baby, and what should I do now?

    • Fifth disease, caused by a parvovirus, is so called because it is the fifth in a group of six childhood diseases that cause rash and fever. The symptoms of rash and fever are generally mild and frequently go unnoticed. It is uncommon to develop fifth disease during pregnancy. Most women are in fact immune, having been infected as children without being aware of the infection.

      Very rarely, infection with fifth disease during pregnancy increases the risk of an early miscarriage or a rare form of fetal anemia. It is best to follow your practitioner’s advice in your situation, but you and your baby are likely to be completely unaffected.

  11. Thank you Shannon — and congratulations on your new book! I would be happy to read it over. Please send the PDF to me as well as any media info at tori@thejoyofpregnancy.com. If you need an address you can find all my contact information at http://www.torikropp.com

    Warmly, Tori Kropp

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Ask Tori RN®, by registered nurse and resident author of The Joy of Pregnancy, is a helpful and reassuring resource for parents-to-be.

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About Tori Kropp

Tori Kropp

Known as "the Dear Abby of pregnancy," Tori has been interviewed on national television and radio and in national print publications, including CNN, The Wall Street Journal, New York Post, Washington Times, Atlanta Journal Constitution and Chicago Sun-Times.

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