Frequently Asked Questions
How much should I eat during pregnancy?
During pregnancy your intake on average should be increased by 300 extra calories.
On average, weight gain of 20-30 pounds is ideal (0-5 pounds in the first 12 weeks, and ½ pound-1 pound a week after that). Some patients may gain more than this and some patients may gain less but the key is to eat a healthy balanced diet. Especially during early pregnancy when nausea can be significant, eating small more frequent meals can be healthful to prevent heartburn and maintain an even glucose level.
Eat what you enjoy, but make healthy choices with minimal amounts of fats and sweets to prevent excessive weight gain and possible gestational diabetes.
What should I eat or not eat during pregnancy?
Certain fish can accumulate high levels of mercury from swimming in polluted waters. The FDA recommends avoiding those fish that are highest in mercury, including shark, tilefish, swordfish, and sea bass. Shellfish, shrimp and smaller fish such as snapper, tilapia, catfish and salmon are lower in mercury, and up to 12 ounces a week is safe. Canned tuna is low in mercury and can be included in the total of 12 ounces a week. Note tuna steak is higher in mercury than canned tuna, and should be limited to 6 ounces a week http://www.epa.gov/waterscience/fishadvice/advice.html.
Unpasteurized dairy products and deli meats can carry Listeria, a bacterium that can cause miscarriage and fetal infection. For this reason we recommend abstaining from unpasteurized dairy products and heating any lunch mean in the microwave prior to consumption.
All fish and meat should be fully cooked since raw fish and meat can carry parasites and other bacteria that could cause harm to the mother and fetus.
There is no safe limit of alcohol in pregnancy. Complete avoidance is the best policy.
Caffeine is safe in small quantities (1-2 8 ounce caffeinated beverages daily). Increased amounts of caffeine can be associated with miscarriage and low birth weight.
Pregnant women are at increased risk for constipation so eating foods rich in fiber can be helpful.
Can I diet during pregnancy?
No. Making healthy choices is good during pregnancy but maintaining a new strict diet is not. Both you and your baby need proper nutrients and calories for a healthy pregnancy.
Can I exercise?
Maintaining an active life style is wonderful for you and the baby. If you have an uncomplicated pregnancy you can continue your current exercise regimen with a few modifications. With your activity keep a maximum heart rate of about 140 beats per minute. Avoid exercises that require you to lay flat on your back.
If you are not a regular exerciser, walk for 20-30 minutes 3-5 times a week, and consider a prenatal yoga. Pregnancy is not the time to start a strenuous exercise regimen.
Those patients with complications such as bleeding, preterm labor or high blood pressure should not exercise.
What about sex?
Sex is safe in pregnancy unless you have complications such as bleeding, preterm contractions or a low-lying placenta. After intercourse you may experience mild uterine contractions or light bleeding. The contractions will resolve and should not induce labor in a normal preterm pregnancy. Light bleeding can be normal but heavy bleeding like a period is not. Unless we tell you otherwise, continue your normal sexual practices if you want to.
Can I get my hair colored?
Hair color, including highlights, are safe during pregnancy. No chemical are absorbed into your bloodstream.
Can I paint my baby’s room?
Inhaling paint fumes, especially if prolonged, is not good for anyone whether pregnant or not. If you pursue painting the nursery, do so in a well-ventilated room with frequent breaks and consider wearing a mask or delegating the task.
Can I take a bath?
Normal temperature baths, less than 98 degress are safe during pregnancy and can be soothing. Exposure to higher temperatures for prolonged times can be associated with birth defects such as spina bifida. If you are concerned, consider a bathtub thermometer.
Can I travel?
Flying is safe during pregnancy but pregnant women are at increased risk for blood clots so in any travel greater than 2 hours make sure you get up and walk. You can consider wearing compression hose as well. During an uncomplicated pregnancy it is safe to fly. We recommend no travel unless urgent after 32 weeks.
What if I have a cat?
Cats can be carriers of Toxoplasmosis, that can be passed to humans through feces. If possible have another family member change the litter box during pregnancy or if you must, wear gloves.
What medications can I take?
Please see the list below to see safe choices for medications in pregnancy. If you need a medication that is not on the list or receive a prescription from another physician, please call us during business hours prior to starting new medication. There are some medications that we know are safe and there are other medications that we cannot assure safety during pregnancy. The general consensus is to take only medication that you need and do so sparingly.
- Cold, Flu, Congestion - Tylenol 650-1000 mg, Actifed, Sudafed, Benadryl, Tylenol Cold & Sinus, Mucinex
- Allergies - Claritin, Allergra, Zyrtec, Flonase, Benadryl
- Cough - Robitussin, cough drops, throat spray
- Fever or Headache - Tylenol 650-1000 mg
- Heartburn - Tums, Maalox, Mylanta, Zantac, Pepcid, Prilosec
- Constipation - Metamucil, Fiber supplement, Miralax, Dulcolax suppositories, Colace
- Diarrhea - Immodium, Lomotil, Kaopectate
- Hemorrhoids - Tucks, Preparation H, Anusol
- Backache - Heating pad on low setting, Tylenol 650-1000 mg, Bengay, Icy Hot
- Nausea - Vit B6, unisom, ginger
- Gas - mylicon, mylanta
Do I have to lie/sleep on my left side?
When lying flat on our back with a pregnant uterus, the blood vessels coursing from the lower body back to the heart can be compressed which can decreased the blood flow to your baby. For this reason we recommend sleeping on your side or at a tilt with a pillow wedged behind your back. This is most important in the third trimester.
Is ultrasound safe?
Obstetric ultrasound has been extensively studied and found to be safe for the baby, however it is recommended to limit the number of ultrasounds to that which is medically indicated.
At Progressive Women’s Care this includes an average of 3-4 ultrasounds. The first ultrasound is done to confirm an intrauterine pregnancy, check the heartbeat and confirm your due date.
An optional ultrascreen to assess statistical risk for downs syndrome and trisomy 18 can be done between 11 and 13 weeks.
An optional gender scan can be done at 16weeks for a $75 charge.
A comprehensive anatomy ultrasound is done around 20 weeks.
A final ultrasound is done around 36 weeks for growth and fetal wellness.
Can I go to the dentist?
Routine dental care is safe and important during pregnancy. Usually your dentist will require a note from our office prior to your appointment. If you need extensive or invasive dental work, we will work with your dentist to assure the medications are safe.
Where will I deliver?
Dr. Bertles has privileges at Methodist West Houston and Memorial Hermann Katy. In most circumstances you can choose from these two where you would like to deliver. We recommend checking with your insurance company and taking a tour of the facilities before you decide.
How do I register at the hospital and take a tour?
You can register online on the hospital websites and schedule a tour through them. Most patients register in the beginning of their third trimester.
When will I deliver?
Most people deliver close to their due date. About 10% of women deliver preterm, before 37 weeks. If you are not delivered before, we generally recommend induction at 41 weeks. We cannot perform induction of labor before 39 weeks unless we have a medical reason.
If you are planning a C-section, we generally will schedule it at about 39 weeks.
How long will I stay in the hospital?
After a routine vaginal delivery most patients are discharged after 2 days. After an uncomplicated C-section most patients are discharged after 3 days. Some patients may be eligible for an earlier discharge or later discharge depending on the hospital course.
After your discharge, you will have a follow up appointment with us in the office at 2 weeks after a C-section and 6 weeks after a vaginal delivery.
Who will my baby’s doctor be?
You will need to find your own pediatrician. We can provide a list of recommendations for you if needed. If your pediatrician does not have privileges at the hospital, there are neonatologists that will take care of your baby while you are in the hospital.
Some patients like to meet and interview the doctor before delivery. After discharge, the first visit with the pediatrician is at 2 weeks but may depend. It is good to schedule this appointment while you are still in the hospital.
Should I take a childbirth class?
If this is your first baby you may benefit from a childbirth class. Both Methodist West Houston and Memorial Hermann Katy offer a variety of classes and times. Most people enroll in classes during their third trimester so the information will be fresh in their minds.
Should I get an epidural?
This is a personal decision but the majority of patients do get an epidural for pain control. They are a safe and effective way of providing pain control without medication exposure for the fetus. Complications are rare and the anesthesiologists are available to answer questions.
Do I need a birth plan?
Patients do not need a birth plan. Our birth plan is for a safe and healthy pregnancy, delivery, and postpartum course. Since there are often events that are unpredictable during the labor process, it is important to keep an open mind and accommodate changes that may result from an unexpected labor event. The safety of you and your baby are our priority. If we recommend a C-section we expect your full cooperation even though we know a C-section was not your desire. If you have specific wishes it is best to discuss those early in your prenatal care to assure they can be met and you do not need a referral elsewhere.
Can I deliver vaginally after a C-section?
Vaginal birth after C-section (VBAC) is generally not offered in our practice. There is a risk of the scar on the uterus opening up during the labor process which can be catastrophic and result in hemorrhage, hysterectomy, permanent fetal disability, fetal and/or maternal death.
Will I get induced?
If you desire induction of labor, this can be scheduled during your 39th week. There are often unpredictable complications of pregnancy that may warrant induction such as high blood pressure, poor fetal growth, low amniotic fluid, or being more than a week past your due date. The decision to induce will be for maternal and fetal well-being.
If we recommend a medically necessary induction we expect your full cooperation even if induction was not your desire.
Will I have an episiotomy?
The decision for episiotomy is individualized to each patient. During the crowning process, if you look like you are going to tear, an episiotomy will be cut as it is much better to repair a straight line than jagged edges. With successive pregnancies, episiotomies are less common.
Should I have my baby boy circumcised?
The American Academy of Pediatrics does not recommend circumcision for any medical indication therefore this is a personal decision. If you desire circumcision, this will be performed after the pediatrician has cleared the baby but before you are discharged from the hospital.
Should I collect my baby’s cord blood?
This is a personal decision. Cord blood contains stem cells which can be collected and stored for possible use in the future. There is extensive research that is ongoing with stem cells and new uses are frequently discovered. At this time there are no public banks in the Houston area however private banking can be done at a cost to you. For more information please visit the following websites.
How do I prepare for breastfeeding?
If you wish to prepare for breast feeding before delivery, in addition to books, the hospitals offer breast feeding classes which can be scheduled through their websites. The hospitals also employ lactation consultants to assist you after your delivery while you are in the hospital.
During my pregnancy when should I call the doctor?
You should call the doctor under the following circumstances.
- Heavy vaginal bleeding, more than spotting
- Painful and persistent cramping
- Inability to tolerate food and drink
- Breaking of water like a gush of fluid or persistent leakage
- Decreased fetal movement
- Regular painful contractions about 5 minutes apart for more than 1 hour.
- If you aren’t sure about your symptoms you are always welcome to be evaluated at the hospital.
How do I contact my doctor in an emergency?
When you call our main number after hours, you will be prompted and connected to the answering service who will contact Dr. Bertles. Please reserve these calls for urgent matters that cannot wait until the next business day.
How often are my appointments?
In an uncomplicated pregnancy your visits will be every 4 weeks until your gestational diabetes screening sometime between 26 and 28 weeks, every 2 weeks thereafter until 36 weeks, and weekly after that.
During a routine visit you will have a urine screen, weight, and blood pressure measurement performed. We will also listen you the fetal heart beat and measure fetal growth.
What if I have other questions?
Keep a list of your questions and bring them to your appointments to review. If you have a more urgent question please call the office during office hours.