Whatever may be the arguments, the fact is that weight loss supplements have earned a reputation of themselves in the market and they are now widely used by people who want easy ways to shed the weight. Most weight supplements promise that one need no exercise to get rid of weight if people use their products. If you are willing to use any weight loss supplements, then you should take advice from doctors. An advice from my side is that whatever product you use; never give up the idea of exercising! Weight can have adverse effect on mens health.

Breathlessness

The hormone progesterone affects how you breathe while you are pregnant, making your breaths deeper and more rapid than normal. A common side effect of these changes is a feeling of breathlessness. Shortness of breath increases with exertion, such as walking up a flight of stairs. This feeling is normal, and does not mean that you are out of shape, too old to have a baby, or that you have a problem with your heart or lungs. As your baby gets bigger, you are likely to notice you become more and more breathless, and may get worse when you try to lie flat. Some women find that they need to sleep partially sitting up toward the end of pregnancy.

Indigestion

Progesterone, the hormone of pregnancy, relaxes the smooth muscle of the uterus, allowing your pregnancy to grow. At the same time, other smooth muscle is relaxed. One of the unpleasant side effects is the relaxation of the opening between your stomach and your esophagus (the tube between your mouth and stomach). Combine this with slowly increasing pressure on your stomach from your growing uterus and you have the potential for raging indigestion. Contrary to common belief, what you eat has only a small effect, although eating a large meal may make your symptoms worse. The main factors that worsen indigestion are the acidity of your stomach contents and your position (for example, lying down or standing).

Antacids are good for reducing the acid content of your stomach. Most over the counter antacids are safe to take during pregnancy and products that contain calcium are especially good. However, many women need stronger antacids or histamine receptor antagonists which you can buy from drug stores or by prescription. You can also help ease indigestion by not lying down or bending over immediately after a meal.

What’s Safe to Use

Histamine receptor antagonists antacids containing calcium carbonate or magnesium carbonate.

Abdominal Plan

Almost all pregnant women will have some abdominal pains during pregnancy. The trick is knowing if the pain is a sign of something more serious. Early in pregnancy, many women feel uterine cramping, pelvic pressure, and generalized mild abdominal discomfort. This results from a combination of your uterus reacting to the pregnancy and the effects of the rising levels of the hormone progesterone on your intestines. As you enter the second trimester, nonspecific abdominal pains are common. Most are from gassiness and bloating. Pains along the sides of your uterus, caused by stretching of the uterine supports (round ligament pain), are also common. As you progress in your third trimester, it is common to have an increase in uterine activity, or braxton-hicks contractions. These contractions are felt as a tightening across your uterus and should not be particularly painful. If you have painful contractions across the front of your uterus, or you have lower back pain that comes and goes, call your care provider especially if you are less than 34 weeks in to gestation.

What’s safe to use

Acetaminophen

Gas Pains And Bloating

The action of progesterone slows down the workings of your intestines and can lead to bloating. Most of the gas comes from the action of bacteria on carbohydrate in your diet, the slower your intestines move food through, the more time bacteria have to digest the food and the more gas is produced. If you are having problems with gas, don’t eat foods that are more likely to produce gas, such as beans, cauliflower, broccoli, and cabbage. If you are lactose intolerant but want to consume milk during pregnancy switch to lactose reduced products. Avoid carbonated beverages that may increase the amount of gas in your intestines, but increase the amount of water you drink. Taking a walk after meals may help to stimulate your digestive tract naturally.

What’s safe to use

Over the counter medications containing simethicone are thought to be safe.

Yeast Infections

Although pregnancy is not associated with an increase in vaginal yeast infection, many women who suffer from recurrent yeast infections are concerned about using antifungal medications during pregnancy. Over the counter yeast creams are safe during pregnancy. If your care proyider has asked you not to put anything into your yagina because YOU haye a placenta preyia, you can ayoid using the applicator and place the cream on the yulYar lips and the lower part of your yagina. If your yeast infection does not get better, your doctor may want to confirm a yeast infection and treat \v’ith stronger, prescription drugs.

Urinary Incontinence

Up to half of women have a problem with involuntary loss of urine during pregnancy. Certainly, in the first trimester you will notice you have the urge to urinate often. This urgency decreases by the second trimester, but you will , still have to use the bathroom more often than before you were pregnant. Incontinence is most common in the third trimester, especially if you have had problems with urine loss in the past or if you have been pregnant before. Usually the amount of urine lost is small and wearing a pad should be enough to catch any accidents. Women who have incontinence while pregnant are more likely to have problems later.

If you suddenly start leaking and have been fine before, make sure your care provider rules out a urinary tract infection, which may be causing the incontinence. If your symptoms don’t resolve by 3 months after delivery, consider seeing a specialist. In some cases of overactive bladder, medication to relax your bladder spasms can reduce accidents. In other cases, surgical or nonsurgical treatment is needed.

Constipation And Hemorrhoids

The slowing action of progesterone on your large intestine increases water absorption, leaving you with harder stools. Pressure from your uterus also slows blood flow from the blood vessels around the rectum and anus, increasing hemorrhoids. This is not a good combination. The best way to combat these problems is to decrease constipation because straining can make hemorrhoids worse. The first step is to soften your stools by increasing water intake and by taking bulking agents. If this does not work, you can add stool softeners, reserving laxatives for serious cases of constipation. If hemorrhoids develop despite maintaining normal stool consistency, try to clean carefully after each bowel movement with a pad soaked in witch hazel. Hemorrhoid creams may also help to reduce swelling and are safe in pregnancy.

What’s safe to use

Fiber or other bulking agents, stool softeners, most laxatives, creams for hemorrhoids.

Keeping hydrated

By drinking plenty of water is the best way to prevent constipation while you are pregnant.

Warning Signs

• In the first trimester, abdominal pain that is accompanied by any of the following should prompt a call to your doctor:
• Vaginal bleeding that is more than spotting.
• Fever greater than 100.4°F (39°C).
• History of ectopic pregnancy or you currently have an IUD in place.
• Burning when you pass urine.
• In the second trimester, call your doctor if abdominal pain occurs with.
• Any vaginal bleeding, even spotting.
• A noticeable increase in vaginal discharge, especially a lot of watery or mucous discharge.
• A fever higher than 100AoF (39°C).
• Vaginal pressure.

If appropriate, you should check to determine whether birth at a birthing center will be covered (it usually is since these births are less ex­pensive, relying on fewer technological interventions and with shorter stays). A home birth is less likely to be covered again, if this is the option you want, you must check in advance with your insurance company.

We discussed previously that you might have a preference for a particular physician or midwife or place for birth. Remember, some plans only provide coverage if you use a provider within the plan’s network. If you can only use in-network providers, get the list of your plan’s obstetricians, midwives, or family practitioners who provide maternity services and see what information you can find out about them, including where they attend births. You might want to make an appointment to have a gynecological visit with a potential obstetrical provider or group and find out something about the philosophy of the provider or members of the group. You might want to ask women (or men who’ve participated in a birth) whose opinions you value and whose philosophy is similar to yours.

If your health plan allows you to use out-of-network physicians or mid­wives, but pays only a percentage of their fees, then find out what these fees are. Determine whether or not you can afford the percentage of the fees for which you will be responsible-often 20 percent, up to a maximum out­of-pocket expense, beyond which you will be reimbursed for the whole fee, if the insurance company determines that it is reasonable and customary. If the insurance company deems the fee beyond its usual and customary reimbursable fee, which varies by state, city, or even county, then you will be responsible for any amount above the usual and customary. The provider’s office can provide you with its standard maternity service fee. Maternity services are generally covered in a package-one fee for the entire prenatal care, the birth, and the 6-week postpartum visit. You can call your insurance company to see if your provider’s fee is usual and customary. You may need to send in a form. Remember, of course, that tests such as ultrasound, blood work, and amniocentesis, for example (see Chapters 8 and 17), will have additional fees. The services of additional team members, such as genetic counselors, radiologists, anesthetists or anesthesiologists, will be billed separately. It is up to the insurance company to set each usual and customary fee and decide how much it will pay.

Another concern is whether you need to pay any of the provider’s fee up-front. Insurance companies will often pay for only the prenatal care at the start of the pregnancy, not paying for the birth until it has occurred. In-network providers cannot bill you for anything except your standard co-pay, but those out-of-network may ask you to pay before your insurance company is willing to reimburse. Generally, hospital fees are billed directly to the insurance company as are fees for services rendered at the hospital, such as anesthesia.

With the change in laws to assure that “pre-existing conditions” are covered, it is not as imperative as it was previously to get the coverage you want before you are pregnant. However, in many places of employment you can only change plans at certain times of the year. If you marry, or have a baby, you can update your plan to reflect this changed status-a baby need not wait until the usual change of plan time to be put on your insurance. But in ordinary circumstances, where there is no major life change, you must change during the weeks set aside for this. In smaller places of employment, you may not have a choice. In this case, you may choose to have your partner’s plan cover you. Again, these are things that should be investigated as soon as you are thinking about a pregnancy. Even before it seems like a reality, check the maternity coverage of your plan so you are not taken by surprise in the event of an un­planned pregnancy, or even a planned one.

Perhaps an even more far-reaching change is the option of choosing a birthing center to have a baby, or to birth at home. In the middle of this century, home birth was considered something to do only if you were very poor and couldn’t afford the hospital. The hospital was the place for educated, middle and upper class women. More recently, however, as women have been seeking more control in the conduct of their births, women in these socioeconomic categories have opted to deliver in out of hospital settings. Several large studies published in major medical journals have shown that with careful selection of women for these births and with the births attended by educated providers, birthing center and home birth can be as safe as hospital birth for mother and baby. Readily accessible medical consultation and a back-up hospital are essential. Currently, the overwhelming majority of babies in the U.S. are delivered in hospitals.

Women and their partners should think about what it is they want for their birth. They should talk to friends and family members who have had babies about the quality of their experience. They should discuss with their physician or midwife his or her views on the use of routine fetal monitoring or other technologies. Before pregnancy women should talk to current gynecologic care providers to see if they attend births. If so, find out where your physician or midwife delivers and something about his or her approach to pregnancy care and birth.

The abdominal and pelvic examinations are to measure your uterus and compare its size to the size expected for how pregnant you are, based on your last menstrual period. If you are less than 12 weeks pregnant, your uterus is still too small to be felt in the abdomen, so it can only be measured by feeling it through the vagina. A nurse, midwife, or doctor will check your weight and blood pressure, as they will on all prenatal visits. Your urine also will be checked.

Some practitioners routinely perform clinical pelvimetry on a first prenatal care visit. This means they feel, with their fingers, the size and shape of the pelvic cavity by palpating, through the vagina, the circle of bones that create the pelvis. This makes the vaginal examination slightly longer and a bit more uncomfortable. It alerts the practitioner to any structural abnormalities and gives a rough estimate of the likelihood that a normal­sized baby will fit through. Many practitioners, however, have given up this practice in prenatal care, believing that pelvic bones loosen and expand in labor and that the strength and frequency of contractions as well as the position of the baby are more important indicators of whether the baby will pass through the pelvic cavity. Pelvic abnormalities were more common in the days-long gone in this country-when women suffered in childhood from rickets, a vitamin D deficiency. Yet many physicians and midwives still feel that knowing that a woman has an adequate pelvic size can be reassuring if labor proceeds slowly, and simply do not wish to lose this old-fashioned skill. A history of a fractured pelvis or structural abnormality is certainly a reason for your physician or midwife to perform clinical pelvimetry. Otherwise, this assessment is optional.

Whether or not you have had a preconception visit, one of the goals of the first pregnancy visit is to determine your due date-once known as the expected date of confinement and now called the expected date of childbirth (EDC) or expected date of delivery (EDD). At the end of your first prenatal visit, you will usually know how pregnant you are and approximately when you can expect to deliver. Remember, of course, that this date is only an estimate. It is really the midpoint of 4 week period. The baby can be born any time two weeks before or two weeks after this date.

Of course, the first prenatal visit is a time for you to ask all the many questions that have come to mind since you discovered that you are pregnant. These may include questions about prenatal care, fetal growth and development, exercise, sex, work, childbirth education, discomforts you might be experiencing or expect to experience, medications, infant feeding, maternity clothing-just about anything. Many of these should have been answered in advance if you had a preconception visit.

Other family members, including your husband or partner, your children, and your parents, may have questions. They can ask these if they come with you to the visit or you can ask for them if they are unable to attend or if you prefer coming by yourself or with only one family member.

Whether or not you ask questions, your physician or midwife may raise certain issues with you. These include physiologic and emotional changes of pregnancy, nutrition, vitamin and iron supplementation, the important option of in-depth HIV counseling and testing, safer sex, avoidance of toxic substances and drugs, giving up smoking and drinking, activity and exercise, and early pregnancy danger signs.

Routine Testing in Prenatal Care

The following table of laboratory tests utilized routinely in pregnancy, or within a year prior to pregnancy, was adapted from the recommendations of the Expert Panel on the Content of Prenatal Care. Some tests are advised for all women, others only for women at risk for particular problems. Most of these are performed to look for conditions that share a number of characteristics: these conditions are found somewhat commonly in young women yet most often have no obvious symptoms and they may affect pregnancy, the developing fetus, or the newborn. Some physicians or midwives may choose to alter the specific tests used or the timing of such tests. Some women may need additional tests.

You may notice that ultrasound, which has become widely used in pregnancy care, does not appear in the table of routine tests. Although generally considered a safe procedure whose benefits usually outweigh any possible adverse effects, its safety cannot be totally assured. For this reason, neither the National Institutes of Health nor the American College of Obstetricians and Gynecologists recommends routine ultrasound in pregnancy. Its use is reserved for selected reasons, of which there are many.

Subsequent Prenatal Visits

At all prenatal visits, your physician or midwife will review how you are feeling and whether you have experienced any danger signs. A nurse or your doctor or midwife will weigh you and take your blood pressure. Blood pressure measurements are especially important in the second half of pregnancy (after week 20). The growth of your uterus will be assessed abdominally; most physicians or midwives measure the height of the fundus (the top of the uterus) at each visit. They may measure with their fingers, using fingerbreadths above or below certain body landmarks, such as your navel, to ascertain whether or not your uterus is growing appropriately. They may measure with a tape measure in centimeters; there are 2.2 centimeters in 1 inch. From 20 weeks of pregnancy, when the fundus just about reaches the navel, to 36 weeks, the uterine measurement should approximately equal your weeks of pregnancy, plus or minus two centimeters. So, if you are 28 weeks pregnant, your uterus should measure 28 centimeters, or between 26 and 30 centimeters.

At about 20 weeks of pregnancy, the fetal heart can be heard with a special stethoscope called a fetoscope and will be listened to at each visit. If the tubing on the fetoscope is long enough, you might be able to hear your baby’s heartbeat, especially as the baby grows larger. Your partner can listen also, so can your other children or anybody who accompanies you to a prenatal visit. Many practitioners today use a Doptone or Doppler to hear the fetal heart; this instrument uses ultrasound (or sound waves) to amplify the fetal heart tones so that you can hear them loudly and earlier in pregnancy. The intensity of ultrasound used with this type of Doppler is so far below the level considered dangerous in humans, and the duration of exposure at each visit so short, experts have not questioned the safety of this application of ultrasound. The fetal heart can be heard quite early with a Doppler-sometimes at 10 weeks of pregnancy or even before. The value of this remains uncertain as not hearing it doesn’t mean there is a problem; it may just make you and your provider nervous.

Vaginal examinations generally aren’t necessary during the normal course of pregnancy, except to take a specimen for screening or when infection is suspected, or if you show signs of premature or preterm labor. Although some women like to know whether their cervix is thinning out or opening as their due date approaches, this doesn’t provide much useful information. The state of the cervix in late pregnancy is not a reliable predictor of either the onset of labor or its duration, but if pregnancy has exceeded the due date by at least 1 or 2 weeks, a cervical check may help decide the advisability of induction.

Several additional activities are important in prenatal care. Time should always be made available for you and your partner to ask questions. No topic should be considered silly or taboo. Danger signs appropriate to the timing of pregnancy should be reviewed at each visit. Plans for infant feeding and the conduct of labor should be discussed by the third trimester (approximately 24-26 weeks). Information should be provided to you about the signs of labor, including preterm labor; what to do when labor begins; and choices available for pain relief in labor, with discussion of their advantages and disadvantages. Information about childbirth education classes should be given fairly early in pregnancy. While most classes begin at the eighth month or thirty-second week, some types of childbirth education start earlier in pregnancy and these options should be made available.

National survey results estimate that most American women eat foods containing about 0.2 mg of folic acid daily. The additional recommended 0.2 mg can be achieved through diet.

Foods high in folic acid include -

• Leafy green vegetables

• Liver

• Yeast

• Other green vegetables

• Legumes

• Nuts

• Whole grains

• Fortified foods, such as cereals anad breads

At least one serving of these foods a day in the preconception period and during pregnancy is recommended.

Several factors may interfere with folic acid intake -

• Much of the vitamin’s activity can be lost in storage and cooking.

• The hormones in oral contraceptives may interfere with absorption and metabolism of folic acid, so women who have been on oral contraceptives over long periods may have slight folic acid deficiencies.

• Excessive alcohol intake can also lead to a folic acid deficiency.

If you are uncertain whether your diet gives you an adequate amount of folic acid you should take an over-the-counter supplement of 0.4 mg (400 micrograms) of folic acid or a multivitamin tablet containing the same amount of folic acid. Read the label. To­day, just about any vitamin that calls itself a prenatal supplement has 0.4 mg of folic acid.

For women who have already had a baby with a neural tube defect, the CDC recommends taking 4 mg (4000 micrograms) of folic acid per day from 4 weeks before conception through the first 3 months of pregnancy. If there is a chance that you may have a vitamin B-12 deficiency (pernicious anemia), discuss having a B-12 blood level drawn before you start taking such a high dose of folic acid. A vitamin B-12 deficiency sometimes occurs in strict vegetarians or vegans or after prolonged antibiotic therapy. The folic acid can mask the diagnosis of this condition, which can cause you to have neurologic damage unless treated. A 4 mg dosage of folic acid is available only by prescription. Do not take extra multivitamins to get more folic acid as there is a possibility that vitamins A and D can be harmful to the developing fetus if taken in too high doses.

A variety of easy-to-use home kits that demonstrate the fertile time in a woman’s cycle through urine testing are now available. They are expensive, however, and for most couples, unnecessary. You may want to try one for a cycle or a few cycles if several months of “leaving it to nature” prove unsuccessful.

If you are under 35 years old and have regular menstrual cycles, you should wait for at least a year after first planning a pregnancy before you become worried about not becoming pregnant, unless you know that you or your partner has a particular problem. If you are 35 or over, you might consider seeking the advice of a fertility specialist after six months of consciously trying to become pregnant.

If you have not been keeping a record of your menstrual periods, this is a good time to start. Physicians and midwives use the first day of your last menstrual period to determine how pregnant you are. The more exact you are about this date, the easier it is to date your pregnancy. Your menstrual pattern, especially your cycle length, may also influence when you will have your baby. Cycle length is the number of days from the first day of one period to the first day of the next. Although the date your baby is due can never be determined exactly, women who usually have short cycles-less than 28 days apart-may have their babies a bit before their due date. Women who usually have long cycles-more than 28 days apart-may have their babies a bit after their due date. Menstrual record keeping is a good health practice not only when you are planning a pregnancy, but for your entire life.