Transcription:
Tips for a Healthy Pregnancy and Delivery

Melanie Cole (Host): If you’re thinking about getting pregnant or you already are, you probably know some of the basics of taking care of yourself and the baby. Don’t smoke, don’t drink, get your rest, but for more healthy pregnancy tips, my guest today is Dr. Heather Crawford. She’s an Obstetrician/Gynecologist at Our Lady of Lourdes Medical Center. Welcome to the show, Dr. Crawford. Let’s start with your best bit of advice. If a woman is planning to get pregnant and she is thinking about it, what do you tell her she should do, and how should she start?

Dr. Heather Crawford (Guest): Yes, well, thank you for having me. I try to summarize a healthy pregnancy in a fun way using a pregnancy pneumonic. We’re going to go through each letter and talk about it quickly to get a really brief idea of the best way to go about having a healthy pregnancy.

P, for Plan. Ideally, the first thing you want to do is you want to get in; you want to meet with the doctor, go over medications you may be on. You want to stop over the counter medications that may be harmful to the pregnancy. You want to stop herbal medications, and you just want to get a baseline clinical assessment.

I used the first three letters of pregnancy, PRE, because it’s a very important topic, called Pre-existing Medical Conditions. A lot of people have a lot of medical issues aside from just being pregnant. They have asthma, high blood pressure, diabetes, and you just want to make sure that those medical issues are very tightly controlled. A lot of times, when you’re pregnant, these medical conditions can worsen, or need to be altered, or the medications need to be stopped, or new medications need to be started that will be safer for the pregnancy. That’s very important.

G, for Gut. That’s weight gain, which is a very common question that I get from a lot of moms. It all goes to your BMI. A normal BMI is between 18 to 25, and in that population, you only really want to gain between 25 and 35 pounds. If you’re underweight, which definitely happens, that person could maybe gain up to 40 pounds. If you’re a little bit over weight with a BMI over 25, you should really only be gaining 15 to 25 pounds. If you’re obese with a BMI of over 30 pounds (sic), that person really only needs to gain 10 to 20 pounds of that pregnancy. It’s really about figuring out where you are in the beginning and let’s be safe and careful of how much we’re gaining throughout the whole pregnancy. Again, it goes back to the P with Plan and making sure that you’re watching your weight gain as the pregnancy goes along.

Also, your caloric intake only increases by 300 calories a day, so this whole saying that people are eating for two really isn’t true. It’s really only one extra yogurt a day, so that’s something to keep in the back of your mind. Also, I’m all about -- you’re making a human. If you want a treat, treat yourself. Definitely, have the donut, but just everything in moderation.

And then we’re going to go to N. I talk about Nesting with N. All pregnant moms typically do this at some point during the pregnancy. This, to me, is just getting the environment that the baby is going to be in, to be safe. It’s basically baby-proofing the house. Check for lead paint. If homes are built in the 70s, they still do have lead paint on the doors and things like that. Install baby gates early. Do it now while you’re pregnant and you have time. Don’t wait for the baby to start to walk and start to tumble and have a fall. Have the gates up while you’re pregnant and you have time to look around and figure out where you want things.

This is also the time when I say to stock up on the Tylenol and the thermometers – whatever the baby would need if you would need it once the baby is home. And also, the car seat. Get the car seat ready. Have dad do that, and that can be his thing, and he can set the car up, so you're ready, so if you have a baby early or you need to go in for whatever reason, you have that car seat stress done.

Okay, and A is for Appetite. Basically – we already talked about weight gain, but this is to do with diet. These are things to think about – your diet has to change. One of the main things -- and why you would want to go back to the P, for Plan, again -- is that you would want to be at that planned visit, you would want to start a multivitamin. You want to make sure that you have folic acid in addition to the multivitamin, about 400 mcg a day. Typically, and ideally, this would be starting a whole month before you’re pregnant. That always doesn’t happen, and that’s okay, but as long as you get that multivitamin in your diet and incorporate it throughout the pregnancy, you’re okay.

You also want to remove raw meats and undercooked meats. You want to avoid certain fish with high mercury. Some of those fish are shark, and swordfish, and king mackerel, tilefish. Those are things you want to keep out of your diet. Caffeine – this was a big one for me when I was pregnant. You have to limit that to one to two cups a day. My rule of thumb is I tell patients, “Okay, you can have your one cup of coffee, but try to replenish the water in your system by two.” A one to two ratio if you have a caffeinated beverage during pregnancy.

Also, with the A with appetite, just make sure that all of your foods are washed and cleaned. Typically, stay with the natural, vibrant-colored vegetables are usually the good, nutritious ones. Keep with that. Keep them clean and fresh, and you're good.

N was Needles to me. That was going back to vaccines. You want to make sure when you go on your visit that all your vaccines are up-to-date before the pregnancy. It’s not a big deal if you can’t get there or if you already are pregnant, but just know in mind that these are something that we too – we can. If you are planning on getting pregnant, you would go and get vaccinated. If you get infected by a disease, and you're not vaccinated for it, not only you, but your baby could also be affected by the disease.

C is Cocktails. That was the funnest thing I could think of to talk about drinking because basically, you have to stop. You have to stop drinking. You have to stop doing any kind of drugs, and you really have to stop smoking. The first ten weeks especially is when organogenesis is happening with the baby, and that's the most critical time for fetal growth. That first couple of weeks – the first ten weeks are very important, and you have to stop and limit all of your drinking, alcohol, and drugs.

And Y is the best way I could bring in mental health because it's Y, for Yourself. This is a life-changing event for a mom, and they really have to be mentally ready, I think. There’s a stigma -- and I’m passionate about it – there’s a stigma around moms feeling sad. New moms – everyone thinks that new moms should not feel sad, but that really isn’t the case. About 15% of all moms have some degree of depression and sadness after they have the baby and they’re afraid to tell anybody. What I tell moms with this mental health issue is that they should start rapport. Get a rapport with the doctor. Get a safe place that you feel you could tell somebody anything that you felt you needed to tell them and just feel safe and know that there is no judgment.

The first place, I would say, would go to your doctor. I can't tell you how many patients I've seen, and they've come here for small, little issue, and when we start talking they’ll just break down and cry because they feel, for the first time, that they have a place that they can open up and talk about this. Once you talk about it, it's out there. We're here; we want to help you. Come to Our Lady of Lourdes. That’s what we’re here for. We want to help you.

Melanie: So then let’s – one of the E’s that you used didn’t include exercise, and I’m wondering --

Dr. Crawford: Yes, I could have put that in my PRE, yes.

Melanie: You could have, and so what do you tell women, because ACOG suggests that if you have never been an exerciser, being pregnant is not the time to start a whole, hard routine. If you have, you can keep it up or do something just a little tailored to yourself. Speak about what you tell your patients about exercising during pregnancy.

Dr. Crawford: I say it’s definitely a good thing to get up and walk around and move. I don’t think, and I agree, that you definitely shouldn't start anything new when you're pregnant. You shouldn't start weight lifting when you're first pregnant. This is something that walking and being active is great, but I would not start a new regimen. If you already have a huge regimen, sometimes – not all the time, but we do have to decrease it a little bit depending on how the pregnancy is going. But overall, just being active and out there and walking is the best thing you can do.

Melanie: And what about things that happen to women while they’re pregnant. We get stretch marks. We leak a little bit. Do you tell women to practice Kegel exercises, or to use any creams on their belly? What about those things?

Dr. Crawford: The cream thing, it really isn't – there isn't anything that's been proven that one cream over another is going to decrease stretch marks. I'll be honest; it is genetic. It seems like if somebody in your family has stretch marks, typically, you would get them. There's nothing that we can do to stop it. I think to moisturize yourself – being moisturized, but there isn't one specific thing out there that's going to make it not happen.

Kegels, I say go for it. Do your Kegels when you’re going to the bathroom in the morning. When you go to pee, that’s the best time just to practice your Kegels. That’s always going to help you pregnant and not pregnant. Just as a gynecologist, that would be what I’d say for that [LAUGHS].

Melanie: And what about things like sunscreen. When you're pregnant, your skin could be more sensitive to sunlight, so you're more prone to sunburn. What do you tell people?

Dr. Crawford: Honestly, sunscreen is just an overall important thing to use every day, pregnant or not pregnant. We recommend that to everybody all of the time.

Melanie: I’m going to throw you a little bit of a curveball because we hear a lot about Zika, and women are afraid of DEET if they’re pregnant. What do they do? How do they walk that line between insect repellant and worrying about things like Zika?

Dr. Crawford: We’re just telling patients to avoid areas with known mosquito transmission of Zika, to adhere to all mosquito protective measures – that's including DEET – and protecting against sexual transmission of Zika, as well. As long as you adhere to those measures – you can always ask a doctor any questions you have, or you can always refer back to the CDC website.

Melanie: Wrap it up for us, with your best advice, Dr. Crawford, about that healthy pregnancy -- including exercise, healthy eating, Prenatal Vitamins, and a woman taking care of her own mental health -- so that when she gives birth she can then be the caregiver that we know all women are, but we need to put on our own masks first. What do you want to tell women about the importance of taking care of themselves when they’re planning to or becoming pregnant and Our Lady of Lourdes Medical Center?

Dr. Crawford: I would definitely say have a plan and know that you’re not alone. Have a place and rapport with a physician that you know that you can come and talk to that person. Have a support system ready before and during your pregnancy, so they are there. Know that it's okay to be sad, it's okay to be stressed, and it's okay to be tired, and as long as you have that system of support that we’re all here to help you.

Please come here. I'm here to help you. I've given people my times when I'm here, and they've come here just to speak with me. We're here, that's our job, and what's what we want to do. Just get that relationship with somebody, and you will be better off. It can go on the spectrum where you may need just a little bit of support versus you might need to have a little bit of medication. Either way, it's fine, and you just have to know that it is okay, and that's what we're for.

Melanie: Thank you so much, Dr. Crawford, for such great information. You’re listening to Lourdes Health Talk, and for more information, you can go to LourdesNet.org, that’s LourdesNet.org. This is Melanie Cole, thanks so much for listening.