Most women will find out the baby’s sex at the anatomy ultrasound that is scheduled usually between 18- 20 weeks. However, if you decide to do some of the advanced genetic testing, the sex can be revealed as early as 9-10 weeks. There may be additional fees associated with this testing.

First Trimester (7-10 weeks) – Blood work that includes: blood count to screen for anemia, immunity to some childhood diseases, blood type & Rh factor, and some genetics. Urine culture will be collected, as well as bloodwork for STD’s, HIV, hepatitis B, syphilis, blood type, immunity to Measles, Mumps and Rubella (an infection that may harm the fetus). Cystic Fibrosis, Sickle Cell disease/trait or hereditary anemia diseases can be screened for.

Second Trimester (11-29 weeks) – Screening for gestational diabetes with glucose testing.

Third Trimester (30-34 weeks) – STD and anemia screening is repeated in blood. (34-36 weeks) – Vaginal swab to check for Group B Streptococcus (GBS), bacteria that normally live in a woman’s vagina. Some women have more growth than others, which is nothing to worry about in non-pregnant women. However, if a baby is exposed to GBS during delivery he/she could get very sick. If you are positive for GBS, you will be administered antibiotics during labor.

The amount of weight you should gain during pregnancy varies based on your pre-pregnancy health and body mass index (BMI). Those who were underweight before becoming pregnant are advised to gain more, while individuals who were overweight or obese are encouraged to gain less. The rate of weight gain also changes throughout the pregnancy:

In the first trimester (the initial 12 weeks), it’s common to gain between 1 to 5 pounds, or sometimes none. For those who began pregnancy at a healthy weight, gaining approximately half a pound to 1 pound each week is typical during the second and third trimesters.

(Information shared according to guidelines provided by American College of Obstetricians and Gynecologists: https://www.acog.org/womens-health/about-acog/permissions)

There are three main food-borne bacteria of concern for pregnant women:
Toxoplasma, Listeria monocytogenes and Salmonella enterica.

These organisms can be passed to the fetus and increase the risk for spontaneous abortion, stillbirth or perinatal complications. Pregnant women are more vulnerable to these infections because the immune system is compromised/less effective during pregnancy. Therefore, it is best to avoid raw fish, raw meat and unpasteurized dairy. Heating deli meats for 10 seconds is recommended. Sushi is commonly eaten by pregnant women in Japan and there is much controversy surrounding the recommendation that it should be avoided by American women. It is always best to act on the side of caution. Avoid high mercury fish such as shark, tilefish, king mackerel, and swordfish. Avoid CANNED albacore tuna.

Avoid consuming alcohol during pregnancy as there is no scientific research that establishes a safe level of alcohol intake during pregnancy. Alcohol consumption is known to increase the risk of miscarriage, premature birth, and fetal alcohol syndrome. Fetal alcohol syndrome is associated with mental impairment, learning disabilities and other deformities.

There is no medical evidence that sugar substitutes such as aspartame (Equal) or sucralose (Splenda) are harmful in pregnancy. However, it is best to consume a real food diet while pregnant and most products with artificial sweeteners are not the most nutrient dense choices. Save these foods for special occasions.

Caffeine in moderate amounts during pregnancy appears to be non-harmful; no studies have shown caffeine to be linked with miscarriage. Again, act on the side of caution and try to limit coffee to one cup per day. We do not recommend soda consumption (diet or non-diet) during pregnancy due to the high sugar and low nutrient profile.

The benefits of exercise during pregnancy have been well documented. Not only does a regular exercise program strengthen and tone the muscles, it helps relieve tension, as well as the aches and pains many women experience during pregnancy. Exercising while pregnant has also been shown to promote an easier delivery, a more rapid recovery, and maximizes metabolism. The aim of an exercise program during pregnancy is to establish and maintain a level of general good health and fitness. It should not be used as a means of weight loss. Pregnancy is never a good time to diet. There are, however, some activities that should be completely avoided during pregnancy. They include risky activities such as surfing, scuba diving, rough terrain mountain biking, skydiving, snow skiing, platform diving, and high-altitude mountain climbing. Activities that carry a high risk of falls or injury should be avoided. They include horseback riding, contact sports such as basketball, baseball, football, and volleyball, inline or ice-skating and racquet sports such as racquetball, tennis or squash.

If no exercise was practiced before becoming pregnant, consult your CHOICES provider before beginning an exercise routine. Almost any type of exercise is safe if done in moderation. Keep in mind, however, that pregnant women are more susceptible to injury due to hormonal influences that cause joints and ligaments to become more lax than usual. There are several recreational activities that are excellent for beginner exercisers. They include yoga, brisk walking, golf, swimming, and stationary bicycling.

The following exercises should be avoided:

• Exercises that require jumping, jarring motions or rapid changes in direction
• Exercises done lying flat on the back should be avoided after the first trimester. This position could allow the uterus to compress the large blood vessel returning blood to the heart. This situation can interfere with blood flow to the uterus and fetus.
• Strenuous exercise should be avoided in hot, humid weather, or during illness.
• A pregnant woman’s temperature should not exceed 100.4 while exercising. To ensure this, she should drink plenty of water and avoid running outside in the heat of the day.

There are certain conditions in pregnancy, which would make it unwise to engage in an exercise program. Therefore, it is best to consult your CHOICES Provider for guidelines.

• Hypertension (high blood pressure)
• History of fetal growth restriction

If any of the following conditions are present, exercise should be avoided completely:

• Ruptured membranes
• Preterm labor
• Vaginal bleeding
• History of 3 or more spontaneous miscarriages
• Heart or lung disease

Hormone levels are rapidly rising in early pregnancy, which may cause some unpleasant side effects. Most women have extreme breast tenderness or fullness and it is common to feel extremely tired. Nausea is very common and can be associated with unpleasant smells/tastes. Women will find that a food or smell they liked before suddenly becomes very displeasing or revolting. If excessive vomiting occurs, there are several safe medications that can be prescribed to help minimize this occurrence. Many women will experience unpleasant gastrointestinal problems such as bloating, feelings of fullness, gas and constipation. Small, frequent meals may help. Drink LOTS of water! This will help for many reasons. If you are constipated, try a stool softener or magnesium citrate powder. Increased fiber in the diet may also help.

Do not put too much pressure on yourself in the first trimester. Eat healthful food as tolerated, but there may be days when nothing sounds appealing. Protein shakes are another good option if tolerable.

Bleeding when you are pregnant is usually not a good sign, but it does not always mean something terrible is happening. Always call us at 718-786-5000 ASAP if you experience bleeding during any stage of pregnancy.

First trimester bleeding/spotting in pregnancy can be common and does NOT always mean a miscarriage is imminent. Bleeding during implantation can be common and may resolve on its own. Also, the cells on a woman’s cervix change during pregnancy and bleed easily when touched, especially during intercourse.

When calling your CHOICES provider, be prepared to answer the following questions: Are you having severe cramps/pain with bleeding? Is the bleeding bright red or brown? Have you soaked any pads or is it just spotting? Have you recently had intercourse? More than likely we will have you make an appointment, so we can monitor the pregnancy and make sure you and the baby are still ok. If the bleeding starts after office hours, you may be instructed to go to the Emergency Room.

Second/Third Trimester bleeding may indicate a few things: the placenta could possibly be near your cervical opening, the placenta could be detaching, or possibly even early labor. Always call your doctor immediately if you experience any bleeding at this point.

Yes! You can continue having sexual intercourse if you have an uncomplicated pregnancy. Check with your provider if your pregnancy is considered high risk or if you have any concerns. In most cases, sex can be enjoyed throughout your pregnancy.

Some couples fear that intercourse will harm the pregnancy or cause a miscarriage; however, the baby is very well protected by the uterus and the amniotic sac (bag of water). Intercourse will not cause the bag to break or hurt the baby. It is always best to consult your CHOICES provider for specific information, but, in general, comfort should be the determining factor in regard to sexual activity.

It is best to observe the following precautions:

• Avoid full body weight on the woman’s abdomen. Intercourse with both partners lying on their side is frequently more comfortable.
• Do not have sexual relations if you are bleeding, leaking fluid from the vagina, or having pre-term labor.
• Do not have sexual relations if you know your membranes are ruptured.
• Nipple stimulation can cause the uterus to contract and may initiate preterm labor.

AFTER THE BABY: Intercourse is best postponed until after your postpartum visit with the physician. This will give the vaginal wall time to heal. In most cases, it is safe to resume intercourse after 4-6 weeks.

Occasional pain during pregnancy is a normal thing; the whole body is growing and stretching as the pregnancy progresses. Many women experience round ligament pain in the pelvic area as early as the second trimester. These ligaments keep the uterus attached to your pelvic area; as your uterus and baby grow bigger these ligaments will stretch and pull. They attach near your pelvic bone so this pain can be felt from the vaginal area to mid abdomen. Your rectus muscles (abdominal muscles) will also be stretched apart to make room for a growing uterus. This pain can be felt in the pelvic area and sometimes around the top of the abdominal area. It is completely normal for the above pains to come and go throughout pregnancy. If you are ever concerned about the intensity of your pain call your CHOICES provider.

Back pain in pregnancy is another normal occurrence because the spine naturally curves more during pregnancy and puts more strain on your back. You can try to wear a belly band or use Aspercreme to help alleviate this. We can help order a back/belly band for you to receive support!

Hemorrhoids are common during pregnancy, especially in the third trimester. Hemorrhoids are swollen blood vessels in and around the anus and lower rectum. They can become painful, itchy, and irritated. You’re more likely to get hemorrhoids if you’re constipated, because straining to have a bowel movement swells your veins. Your growing baby also puts pressure on the large veins behind your uterus. You should call your doctor if it bleeds or hurt a lot. Hemorrhoids usually go away soon after your baby is born.

Leg pain/nerve pain is also normal. As the uterus grows it compresses many nerves in your pelvic area that travel to your legs. Most women will have pain in one leg more than the other depending on how your baby is sitting.

Carpal tunnel syndrome is common during pregnancy due to the swelling of the tissues around your wrists. You may experience hand or finger pain and tingling, sometimes even numbness. Wearing a wrist splint at night may be helpful.

Varicose veins can occur during pregnancy, usually in the lower half of the body. This is because the uterus is compressing the veins that allow the blood from the lower half of your body to drain back up into your heart causing the blood to back up in the veins. This tends to get worse with each pregnancy. Some women may even get varicose veins in the vaginal region. These veins are usually harmless, although their appearance may be upsetting. Try wearing compression socks or tights to relieve the pressure. These will typically go away after the pregnancy is over.

Swelling in the legs and arms is very common during pregnancy. Your blood volume and tissues are all expanding as your baby grows and this may cause swelling. Some women swell earlier than others. Try to get off your feet as much as you can and wear compression socks or tights. Tell your doctor about this at your next visit to make sure it’s a normal occurrence.

Typically, women will start to feel regular fetal movements around 20-24 weeks. It may be earlier depending on the number of pregnancies and size of mom and baby. After 24 weeks you should typically feel fetal movement at least one to two times per hour.

Most women will not need to worry about labor until after 37 weeks. Braxton-Hicks contractions may happen long before; these cause the uterus to tighten and are often painless. Your stomach may feel hard like a bowling ball for a few seconds and then go away. A labor contraction will feel unlike anything experienced before; most women describe it as a really bad menstrual cramp. It can start near your back and travel to your pelvic area. Labor contractions will be timed at regular intervals and progressively get stronger and closer together. Each woman will interpret labor pains a little differently; some women even say it feels like indigestion.

A physician or nurse can always be reached by calling 718-786-5000. After hours and on Sundays, an answering service will connect you with a CHOICES provider for emergencies. Please limit after-hour calls to emergencies only. Prescription refills, test results, and general questions should be directed to 718-349-9100 EXT. 105 during office hours: 8:00 am-5:00 pm Tuesday- Saturday.

The following concerns warrant a call to your doctor regardless of the time or day:

• Contractions that are still present for more than 2 hours, are getting closer together, or are painful enough where you cannot speak through them. You may also proceed straight to the hospital. However, if you go to the hospital before true labor has begun there is a high chance you will be sent back home.
• Your water breaks – call us or go to hospital as soon as you can!
• Any vaginal bleeding
• Absence of fetal movement as described above in the "How often can I expect to feel the baby move" answer. 

You may want to pack two small bags for the hospital or birth center: one for the items you’ll need during labor, and another for items that you won’t need until after you give birth.

Picture ID, insurance card and copy of your health records

Eyeglasses, if you wear them. Contact lenses may be difficult while you’re in the hospital but are fine to wear.

Whatever will help you relax. Some possibilities include: your own pillow (use a patterned or colorful pillowcase so it doesn’t get mixed up with the hospital pillows), music and something to play it on, a picture of someone or something you love, anything else you find reassuring. If you’re going to be induced, think about bringing something to read or watch because it may be a while before labor is underway.

After Delivery:

• A fresh nightgown if you prefer to wear your own after delivery
• Snacks! After many hours of labor, you’re likely to be hungry, and you may not want to rely solely on hospital food. So, bring your own –fresh or dried fruit, nuts, healthy protein bars such as Primal Kitchen, Epic beef jerky or whatever you think you’ll enjoy.
• Toiletries: Pack a few personal items, such as a toothbrush and toothpaste, lip balm, deodorant, a brush and comb, makeup, and a hair band or barrettes. Hospitals usually provide soap, shampoo, and lotion, but you might prefer your own.
• Comfortable nursing bras or regular bras. Whether or not you choose to breastfeed, your breasts are likely to be tender and swollen when your milk comes in, which can happen anytime during the first several days after delivery. A good bra can provide some comfort, and breast pads can be added to help absorb leaks.
• If you are planning to breastfeed, a nursing pillow may be helpful to have in the hospital.
• Several pairs of maternity underpants. Some women love the mesh underwear usually provided by the hospital, but others don’t. You can’t go wrong with your own roomy cotton underpants. The hospital will provide sanitary pads because you’ll bleed after delivery. Make sure you have a supply of heavy-duty pads waiting at home!
• Baby book of your choice
• A going-home outfit for you. Bring something roomy and easy to get into (believe it or not, you’ll probably still look 5 or 6 months pregnant) and a pair of flat, comfortable shoes.
• A going-home outfit for a baby. Pack something special, but easy to slip on a newborn, for those precious first pictures. A cute hat and blanket is also helpful.

*Your infant safety seat must be in place before you will be allowed to take your baby home.

*Do not bring jewelry, excessive cash, or credit cards or other valuables with you.

Please remember that CHOICES is part of this process and will expect a photo of your fabulous Little One on your first postnatal visit with us to add to our wonderful collection!