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The thought of miscarriage is always frightening, and a little information can cause much needless worry. Very often, a brief description of a pregnancy complication in a book or on the Internet turns out to be more upsetting than useful. Although second-trimester losses do occur, they are unusual, and they are very often related to an already known problem with the pregnancy.
One possible cause of late miscarriage is preterm labor. The symptoms of preterm labor can be subtle, since the cervix can dilate, or open, and efface, or thin, with or without painful uterine contractions. But usually, these cervical changes are accompanied by frequent, rhythmic uterine contractions that feel like menstrual cramps or are more painful. Any such contractions before your 37th week of pregnancy should be reported to your practitioner. Feeling pressure from your growing uterus is quite normal.
After about 30 weeks, so are mild contractions, called Braxton-Hicks. You may also feel your uterine (round) ligaments stretching, or you may notice some fetal movement that seems different, or “tight.” These normal feelings are sometimes mistaken for labor contractions. Try not to worry about every new sensation during pregnancy. If you are concerned, talk with your doctor or midwife. He or she is a far better source of information and reassurance than your next-door neighbor or the woman in front of you in the grocery line.
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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.
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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.
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I am 23 weeks pregnant. A couple of weeks ago, I lifted my four-year-old and had a very painful, stretching feeling in the middle of my abdomen. I called the doctor, who said that it was probably the ligaments that hold up my uterus stretching. A few days later, the pain happened again, several times, when I would stretch or move in an unusual way. Now it happens when I walk the dog or reach for something, or even when I am sitting still. It feels like a spasm, and it actually makes me jump! Do you think I should call the doctor again?
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It sounds to me as if you are experiencing round-ligament pain. On both sides of your uterus are ligaments, called round ligaments, that help to support it. As your uterus grows, these ligaments stretch. The stretching may cause a sharp twinge or pain when you move suddenly, turn, cough, or sneeze. The pains often occur over a period when a baby is having a growth spurt. Round-ligament pain is perfectly normal and nothing to worry about. It is another one of those uncomfortable conditions of pregnancy that will go away as soon as the baby is born.
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My husband and I are scheduled to fly for three hours to visit his family. I will be 17 weeks along, and I’m scared to death that something may happen, like turbulence on the plane, or that I’ll just feel lousy the whole time. The visit will be only for a weekend, but even at home, I am uncomfortable and have trouble sleeping.
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If your pregnancy is normal and your practitioner hasn’t told you otherwise, flying at 17 weeks should be safe. Doctors and midwives discourage air travel after 36 weeks, but this is only because of the risk that a woman could go into labor during her trip.
Your letter implies, though, that either you dislike flying or you just don’t want to take this trip. Only you can decide what you’ll be comfortable doing. Discuss your feelings with your husband, and if you decide to go, be sure that he will give you the support you need. Plan to take a lot of deep breaths during the flight, allow plenty of time for rest once you arrive, and relax as much as you are able. If talking with your husband doesn’t relieve your anxiety, perhaps it is best to postpone the visit until after the baby is born.
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I was told by an ultrasound technician that I have an anterior placenta. What exactly is this? Is it why the baby’s heartbeat is sometimes hard to find, and why I don’t feel as much movement as other women who are 19 weeks along? Also, does my being overweight make it harder to feel the baby kicking?
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A placenta can implant in any number of places, including at the top of the uterus (the fundus), at the back of the uterus (posterior), or, in the case of placenta previa, in the lower portion of your uterus, covering your cervix. Having an anterior placenta means that it has implanted along the front portion of your uterus, directly under your belly button. An anterior placenta is perfectly normal, and yes, it is the reason you do not feel the baby’s movements as much as other women do. Instead of kicking directly against your abdominal muscles, the baby is kicking and pushing against the placenta. This softens the impact for you, as if you were cushioned by a pillow inside. This is also why it is sometimes hard to locate your baby’s heart-beat. My Alexander had an anterior placenta, and I was a bit disappointed that I did not feel him moving around much. If you have a layer of fat on your abdomen, this further cushions the baby’s movements.
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Yes, you should get the flu shot this year. Pregnancy can decrease your immunity and so put you at increased risk of getting the flu. Pregnant women are also at greater-than-average risk of developing serious complications of the flu, such as pneumonia. If you were to get the flu when your baby was a newborn, your baby might get it, too. The vaccine contains three influenza viruses that have been identified as likely to cause widespread infection in a given year. Your body takes about two weeks after you receive the vaccine to develop antibodies to the influenza viruses. Knowing that the flu season is at its height from December through March, the Centers for Disease Control and Prevention recommend that pregnant women be vaccinated in September or October.
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I am 18 weeks pregnant, and I have been having some vaginal bleeding and contractions. I am scheduled for an ultrasound check next week. My doctor told me that in the meantime, I should decrease my activities at home. He said something about “pelvic rest,” which I thought meant no sex, but now I am not sure. I am too embarrassed to call and ask him what it means. Can you help?
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You are certainly not alone in wondering what “pelvic rest” means, or feeling uncomfortable about asking a doctor for details of what you may and may not do sexually. Being on pelvic rest means you shouldn’t do anything that might cause or increase bleeding or contractions. That means you need to adhere to the following guidelines: Nothing in the vagina. This includes tampons, penis, or fingers; No orgasms (for you). They can cause contractions, so even oral sex and masturbation are out; No breast stimulation. Stimulating the breasts releases the hormone oxytocin, which can cause contractions. Once you have your ultrasound, your doctor will learn more about what may be causing the bleeding.
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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.
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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.
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About 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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I have recently heard some frightening stories about miscarriages occurring in the fourth or fifth month. I thought my miscarriage worries were over after 12 weeks! I’ve read that sometimes the initial symptoms are very subtle, just a slight pressure and a slightly heavier discharge. Well… how slight? I’m in my seventeenth week, and my abdomen sometimes feels heavy. I find myself wanting to hold it up. Is this just a normal symptom of pregnancy?