What NOT to Do While Pregnant. . .Part 1

Congratulations! You are pregnant!

Most women either already know, or receive a great deal of information of the things they should do to maintain a healthy pregnancy and help their baby grow

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well and healthy, too.

Today we will be looking at some of the things to avoid while pregnant. Some of these may seem obvious, but I have learned in 30+ years of obstetrics, some patients will think it everything is OK that has not been specifically spelled out as harmful to them or their baby.

We begin by looking at external things to avoid. The first thing we will look at is Pets.

DOGS

If this is your first baby, your dog has probably been treated like the baby in the house. Now is the time to encourage other family members to develop a close relationship with your pet. If you plan to deliver in a hospital or birthing center, another family member will need to care for your pet until you come home.

If your pet is in the habit of jumping on your tummy or sleeping in your lap, you will want to use the time of early pregnancy in changing these habits.

If your dog still bites or nips, you will need to be very active in changing this behavior as you would not want your dog to bite or nip the baby.

Before your new baby comes home, be sure your dog is up to date on all vaccinations and has had a check-up from the veterinarian.

CATS

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All of the issues with dogs apply to cats as well, but they present other problems for the pregnant woman.

Cats can transmit the parasite Toxplasma gondii through their feces, causing toxoplasmosis. This can occur when the pregnant woman changes the cat's litter box. You can also get toxoplasmosis by touching dirt where cats might have been, such as garden soil. You can also get it from eating undercooked meat, especially pork, lamb or deer meat. This illness can cause serious complications in pregnancy, such as birth defects or miscarriage, although many people who get toxoplasmosis never develop any symptoms.

If a pregnant woman becomes infected with toxoplasmosis for the first time just before or during pregnancy, she has a 50% chance of passing the illness to her baby.

Symptoms include:

• Muscle aches
• Swollen glands
• Flu-like symptoms (fever,fatigue, sore throat)

To reduce your chances of getting toxoplasmosis:

• Ask a non-pregnant family member to clean out the litter box every day

  Image via Wikipedia

• Keep your cat indoors.
• Stay away from stray cats.
• Wash your hands thoroughly with running water and soap after coming in contact with cat’s stool or after gardening.
• Cover the children’s sandbox to stop cats from using it as a litter box.
• Avoiding undercooked mea, use a meat thermometer to guarantee doneness.
• Thoroughly wash kitchen utensils and counters.

RODENTS

Some people have hamsters, guinea pigs and mice as pets. These pets can carry a virus called lymphocytic choriomeningitis (LCMV). People become infected with this virus through contact with the rodent's urine, blood, saliva, droppings or nesting materials. Even breathing the dust or

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droplets that have been generated by cleaning out the cage can spread this virus. Pregnant women who become infected can pass this infection to their unborn baby. LCMV can cause sever birth defects or loss of pregnancy.

LCMV symptoms include:

• Fever
• Headache
• Neck stiffness
• Fatigue
• Lack of appetite
• Muscle aches
• Nausea
• Vomiting
  

You can lower your chances of getting LCMV by:

• Keeping pet rodents in a separate part of the home
• Asking another family member to care for the pet and clean its cage
• Washing hands with soap and water after handling pet rodents
• Keeping rodent cages clean and free of soiled bedding
• Having the cage cleaned in a well-ventilated area or outside
• Keeping pet rodents away from your face
• Avoiding contact with wild rodents
• If a house has rats or mice, taking care of the problem quickly with either mouse traps or calling a professional pest control company.
  

Talk to your health care provide before using any chemicals in your home, especially those designed for pest control.

REPTILES AND EXOTIC PETS

Lizards, snakes and turtles also present the risks for infection to the pregnant woman. These animals can carry salmonella. This is a bacteria which comes from food sources, such as poultry,

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meat and eggs, but is also linked to reptiles.

A reptile can test negative for salmonella, but still be infected with the bacteria. It could mean that the animal was not shedding salmonella on the day it was tested. When cared for by pregnant women, all reptiles should be considered to be infected. Children under the age of five and pregnant women are especially at risk for salmonella.

Salmonella symptoms include:

• Nausea
• Vomiting
• Abdominal pains
• Diarrhea
• Fever
• Chills
• Muscle aches

You can decrease your risk of getting salmonella by:

• Staying away from reptiles.
  
• Washing hands with soap and water after coming in contact with reptiles or animal stool.
• Keeping reptiles out of the kitchen and other food preparation areas, including sinks.
• Cleaning surfaces that have been touched by reptiles.
• Avoiding undercooked food.

Remember that even though some of these changes with our pets may be inconvenient or even difficult for us, a healthy mother and healthy baby are the goals for which we are striving. The medications that can be given to a pregnant woman are limited and she is much more likely to become dehydrated than a non-pregnant person. Take every measure possible to keep yourself, and your baby, healthy.

Next time we will look at substances to avoid while pregnant.

The Audience

Almost as soon as you have announced that you are pregnant, you will have well-meaning family and friends declaring their intention to be present during the birth of your child. Some may maintain a degree of politeness and actually ask you, but some, especially the more maternal in nature, may just inform you that they will be there.

These family members and friends may have temporarily forgotten -- or just don't seem to mind the fact -- that you will be greatly exposed during this event. In fact, the part of your anatomy that you usually try the hardest to keep covered with not only be uncovered, but most likely have spot lights shining upon it. As much as your "audience" may promise "not to look", the lure of baby hair and the excitement in the voice of your nurse is enough to make even the most trustworthy break their promise.

Remember, those persons who are present with you during delivery are determined by YOU. The two of you must make that decision and it is better if you make it early on so that everyone knows the ground rules. If you want your baby's birth to be an intimate event between the two of you, you have the right to have it that way. It doesn't matter how much Aunt Dot wants to be in there. THIS IS YOUR BODY AND YOUR DELIVERY AND YOUR BABY!

If you don't want anyone else in with you for delivery, don't be swayed or persuaded to do something you really don't want to do. There is one excellent reason to have someone in with you (I'll tell it later). Here are some reasons to ignore:

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• ____ was in my sister's delivery
• ____ has never seen a baby being born before
• ____will be mad at me if she isn't in there
• ____can never have babies of her own
• ____is traveling hundreds of miles to be here for the baby

Also, think about the personalities involved before you offer "invitations" to your delivery. If the thought of having a particular person in your delivery makes you tense now, it will make you feel even more so the day of delivery. If a person irritates you when you don't feel well now, this is likely to be much heightened during delivery.

Remember that once an "invitation" to attend delivery is offered, it can not be rescinded without hurting feelings. Talk together about your decision several times before you decide.

The one good reason to have someone with your for the birth of your child is because when you think of them being there, it makes you smile.

Choose who you want, or choose no one, but make sure it is YOUR choice.

Instrumental Delivery: Forceps

Forceps are instruments designed to aid delivery by allowing the physician to apply traction to the baby's head. Forceps themselves are usually two pieces, which are separately placed into position to cradle the baby's head and then the handles are articulated together. There are many different types and shapes of forceps and some are specifically designed for certain obstetric situations.

INDICATIONS

The indications for using forceps are identical to that of vacuum extraction:fetal intolerance of labor, maternal exhaustion, shortening of the second stage of labor and lack of progress in the second stage of labor.

CONTRAINDICATIONS

The contraindications for forceps are also the same as that of vacuum extraction. The reasons when forceps would not be appropriate include:

• Fetal gestation of less than 34 weeks
• Unengaged fetal head, or station in the pelvis above 0 station
• Incomplete cervical dilation
• Cephalopelvic disproportion - the baby's head is disproportioned to the mother's pelvis
• Malpresentation of the fetal head
• Presentation other than the fetal head
• Large fetal head
• Known or suspected blood clotting defects in the baby

HOW ARE FORCEPS APPLIED AND USED?

The most important point of forceps delivery is knowledge of the presentation position of the baby. The physician must also have an understanding of their own abilities and the limitations of the procedure.

Before beginning the application, adequate anesthesia should be provided and the mother's bladder emptied. Her cervix must be completely dilated and effaced and the baby's head should have descended well into the pelvis.

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The physician will feel the edges of the bones of the baby's skull as landmarks for placement of the blades. (The bones in the baby's skull are not joined together as are adults. Feeling the edges of these bones, or "suture lines" gives the physician a good indication of where on the fetal head the forcep is being applied. The second blade is applied using the same technique.

The physician will bring the handles of the forceps together and the two actually lock into place. Then traction is applied with the mother's pushing efforts. When delivery of the baby's head is imminent, the physician will remove first one and then the other blade.

RISKS OF FORCEPS DELIVERY

Forceps delivery can result in complications for either mother or baby. Risks to the mother include: lacerations and resulting bleeding, nerve damage or reduced sphincter function.

Risks to the baby include forceps marks -- reddened areas usually along the baby's cheeks which will resolve over several hours or a day or two; bruising on the baby's face. These injuries are usually short-term and resolve with no long-term sequelae. There are injuries that are less common which can lead to long-term disability or permanent facial nerve injuries. These occur in 0.5% of forceps deliveries. In one in 4500 forceps deliveries, skull fractures can occur.

Some site intracranial bleeding as a risk of forcep delivery, but other studies indicate this may be more related to dysfunctional and abnormal labor than to instrumental delivery.

WHY FORCEPS INSTEAD OF VACUUM EXTRACTION?

Since there are two vehicles for vacuum extraction, one might ask why a physician would choose forceps in place of vacuum extraction. It is usually a matter of physician skill, experience, expertise and comfort. The physician will choose whichever method they feel most comfortable and competent using and the method which they feel will give them the most likely chance of success.

BEFORE FORCEPS DELIVERY

Unless the indication for forceps is jeopardy of the fetus, the couple should be given an opportunity to discuss the procedure with their health care provider, to ask questions and have their questions answered fully.

This is also a conversation you can have with your health care provider well before labor ever begins to get a greater understanding of how he/she feels about this particular intervention. Do not be afraid to ask questions, and be sure that you fully understand the answers. This is your labor and your baby!