Weeks 1 & 2—Pregnancy Begins (part 2) - How Your Actions Affect Your Baby’s Development

4. Your Healthcare Provider

The health care you receive can affect your pregnancy and how well you tolerate being pregnant. You have many choices when it comes time to choose your doctor or other healthcare provider. An obstetrician is a doctor who specializes in the care of pregnant women, including delivering babies. Obstetricians are medical doctors or doctors of osteopathic medicine who have graduated from an accredited medical or osteopathic school and have fulfilled the requirements for a medical license. Both have completed further training after medical school (residency).

Dad Tip

You may find you’ll need to make some changes in your life during your partner’s pregnancy. You may have to change how often you participate in various activities or when you do them. You may not be able to travel as much for work or pleasure. But remember—pregnancy only lasts 9 months. Supporting your pregnant partner can make both of your lives better.

Perinatologists are obstetricians who specialize in high-risk pregnancies. Few women require a perinatologist (only 1 out of 10). If you’re worried about past health problems, ask your healthcare provider if you need to see a specialist.

An added credential is board certification. Not all doctors who deliver babies are board certified. It’s not a requirement. “Board certification” means your doctor has put in extra time preparing for and taking exams to qualify him or her to care for pregnant women and to deliver their babies. If your doctor has passed his or her boards, you will see the initials F.A.C.O.G. after the doctor’s name. This means he or she is a Fellow of the American College of Obstetricians and Gynecologists. Your local medical society can also give you this information.

Some women choose a family practitioner for their care. In some cases, an obstetrician may not be available because a community is small or in a remote area. A family practitioner may serve as internist, pediatrician and obstetrician/gynecologist. Many family practitioners are experienced at delivering babies. If problems arise, you may be referred to an obstetrician. This may also be the case if a Cesarean section is needed to deliver your baby.

Pregnant women sometimes choose a certified nurse-midwife, an advance-practice nurse or a physician assistant for their prenatal care. These healthcare professionals have additional training and certification in a medical specialty.

Communication Is Important

It’s important to be able to communicate with your healthcare provider. You need to be able to ask any questions you have, such as those listed below.

• Do you believe in natural childbirth (if this is your interest)?

• Can I get an epidural?

• Are there routines you perform on every patient? Does everyone “get” an enema, fetal monitor or more?

• Who covers for you when you’re away?

• Are there other healthcare providers I will meet or who will take care of me?

Your healthcare provider has experience involving many pregnancies and is drawing on this for your well-being. He or she has to consider what is best for you and your baby while trying to honor any “special” requests you may have.

You should be able to express your concerns and talk about what’s important to you. Don’t be afraid to ask any question; your healthcare provider has probably already heard it. A request may be unwise or risky for you, but it’s important to ask about it ahead of time. If a request is possible, you can plan for it together, barring unforeseen developments.

Find the Best Caregiver for You

How do you find someone who “fits the bill”? If you already have a healthcare provider you’re happy with, you may be all set. If you don’t, call your local medical society. Ask for references to professionals who are taking new patients for pregnancy.

There are other ways to find a healthcare provider you’ll be happy with. Ask friends who have recently had a baby to suggest someone. Ask the opinion of a labor-delivery nurse at your local hospital. Various publications, such as the Directory of Medical Specialties or the Directory of the American Medical Association, are available at most U.S. libraries. In Canada, refer to the Canadian Medical Directory. Another healthcare provider, such as a pediatrician or internist, may also provide a reference.

When you pick a healthcare provider, you usually also pick a hospital. Keep the following in mind when choosing where to have your baby.

• Is the facility close by?

• What are the policies regarding your partner and his participation?

• Can he be present if you have a Cesarean delivery?

• Can you have an epidural?

• Is it a birthing center (if that’s what you want)?

• Does your HMO (health maintenance organization) or your insurance cover the healthcare provider and the hospital?

You will find many boxes in each weekly discussion; they provide you with information you will not find in the text. Our boxes do not repeat information contained in a discussion. Each box is unique, so read them for specific information.

5. How Your Actions Affect Your Baby’s Development

It’s never too early to start thinking about how your activities and actions can affect your growing baby. Many substances you normally use may have negative effects on your baby. These substances include drugs, tobacco, alcohol and caffeine. Below are discussions of cigarette smoking and alcohol use. Either of these activities can harm a developing baby.

Cigarette Smoking

Smoking cigarettes raises your blood pressure because it narrows blood vessels, reducing the amount of oxygen and nutrients your baby receives. Smoking also causes blood to clot. These two effects are the reason smoking cigarettes is especially harmful during pregnancy.

Over 10% of all pregnant women smoke; some experts put the number at 20%. Smoking is higher among pregnant women under 20 years old and those over 35. A pregnant woman who smokes 20 cigarettes a day (one pack) inhales tobacco smoke more than 11,000 times during an average pregnancy! Cigarette smoke crosses the placenta to the baby; when you smoke, so does your baby!

Nicoderm Patch, Nicorette Gum and Zyban

You may be wondering if you can use the patch, gum or stop-smoking pill during pregnancy to help you stop smoking. We don’t know specific effects on a baby if a woman uses any of these devices.

Nicotrol, available as an inhaler, nasal spray, patch or gum, is sold under the brand names Nicoderm and Nicorette; it’s also sold generically. Nicotrol preparations contain nicotine and are not recommended for use during pregnancy.

Zyban (bupropion hydrochloride) is an oral medication that is a nonnicotine aid to help a person stop smoking. It’s also sold as the antidepressant Wellbutrin or Wellbutrin SR. It’s not recommended for pregnant women.

Chantix (varenicline tartrate) is a relatively new prescription medication available to help someone stop smoking. It doesn’t contain nicotine, but it’s not recommended for pregnant women. Studies show it may reduce a fetus’s bone mass and also cause low birthweight.

Nicotine-replacement therapy may be suggested if a woman can’t stop smoking on her own. Studies show the benefits of these products may outweigh the risks, but some experts disagree. They don’t believe nicotine addiction can be stopped by nicotine, which is contained in sprays, inhalers, patches and gum. Discuss the situation with your healthcare provider if you have questions.

Tobacco smoke contains over 250 harmful substances. These substances may be responsible for damaging a developing baby.

Smokers may have more complications during pregnancy than nonsmokers. Infants born to mothers who smoke weigh less by nearly half a pound.

Some people believe it’s OK to use smokeless tobacco during pregnancy. It’s not! Use of any smokeless tobacco product contributes to nicotine in the bloodstream, which is one of the main causes of problems.

How Smoking Affects Your Baby and You. Cigarette smoking during pregnancy increases your risk of problems. Smoking also increases risks to your baby. The incidence of SIDS (sudden-infant-death syndrome) after birth may be higher, and babies may be more excitable as infants. The nicotine you take in during pregnancy could lead to nicotine withdrawal in baby after birth.

Smoking during pregnancy has been associated with overweight in the child later in life. In addition, children of smokers are more likely to suffer acute ear infections and respiratory problems. And studies show if you smoke during pregnancy, your child may be a smoker as an adult—babies born to moms who smoke during pregnancy may lean more toward nicotine addiction in the future.

Even if you don’t smoke, you may be at risk. Some studies show a nonsmoker and her unborn baby exposed to second-hand smoke (cigarette smoke in the air) are exposed to nicotine and other harmful substances. In addition, researchers are now talking about a new threat—third-hand smoke. Third-hand smoke occurs when tobacco toxins stick to fabric, hair, skin and other surfaces, such as walls, carpets and floors, even after smoke has disappeared. It can be just as harmful as second hand smoke. A clue to the presence of third-hand smoke is smell—if you can smell it, it’s still there.

If baby’s dad smoked before conception and smokes during pregnancy, the child has a higher risk of developing problems. If both parents smoke while a child is growing up, that child may have an increased risk of developing leukemia.

Stop Smoking Now. What can you do? The answer sounds simple but isn’t—quit smoking. In more realistic terms, if you smoke, cut down or stop smoking before or during pregnancy. Nearly all health insurance policies provide full coverage for at least one type of stop-smoking program. Call your insurance company for further information.

Withdrawal symptoms from smoking are normal, but they’re a sign your body is healing. Cravings may be strongest during withdrawal, but after a few weeks, symptoms will decrease.

Maybe your pregnancy can serve as good reason for everyone in the family to stop smoking!

Tips to Quit Smoking

• Make a list of things you can do instead of smoking, especially activities that involve using your hands, such as puzzles or needlework.

• List things you’d like to buy for yourself or your baby. Set aside the money you normally spend on cigarettes to buy these items.

• Identify all your “triggers”—what brings on an urge to smoke. Make plans to avoid triggers or to handle them differently.

• Instead of smoking after meals, brush your teeth, wash dishes or go for a walk.

• If you always smoke while driving, clean your car inside and out, and use an air freshener. Sing along with the radio or a CD. Listen to an audio-book. Take a bus, or carpool for a while.

• Drink lots of water.

• If you continue to have trouble stopping, one study determined that using a “quitter’s hotline” for help is twice as effective as going it alone. You can talk directly to someone who has been through the same experience. If you’re interested, call the National Partnership to Help Pregnant Smokers Quit at (866) 66-START.

Alcohol Use

If you drink alcohol, it carries many risks. In fact, some experts believe alcohol may be one of the worst substances a developing baby can be exposed to.

Moderate drinking has been linked to an increase in problems. Excessive drinking of alcohol during pregnancy may result in birth defects. Alcohol targets central-nervous-system development; a baby may also be born with physical defects. Babies born to mothers who drink while they’re pregnant may suffer the effects of their mother’s drinking for the rest of their lives.

Drinking during pregnancy has been linked with behavior problems in a child—the more alcohol a woman drinks, the more problems the child may have. Drinking during the first trimester may lead to facial disfigurement. Drinking during the second trimester can interrupt brain development. In the third trimester, drinking alcohol can interfere with development of baby’s nervous system.

Taking drugs with alcohol increases the risk of damage to baby. As a safeguard, be very careful about over-the-counter cough and cold remedies. Many contain alcohol—some as much as 25%!

Some pregnant women want to know if they can drink socially. We don’t know of any safe amount of alcohol a woman can drink during pregnancy. For the health and well-being of your baby, don’t drink any alcohol.

Fetal Alcohol Disorders. Your use of alcohol in pregnancy can lead to fetal alcohol syndrome and fetal alcohol exposure in your baby. Both are discussed below. They are considered part of fetal alcohol spectrum disorder (FASD), which covers the range of effects that can occur.

Fetal alcohol syndrome (FAS) is characterized by smaller growth before and after birth; heart, limb and facial problems are often seen. An FAS child may also have behavior, speech and motor-function problems. Fifteen to 20% of them die soon after birth. Most studies indicate a woman would have to drink four to five drinks a day for FAS to occur.

Mild defects are the result of fetal alcohol exposure (FAE). This condition can result from intake of very little alcohol. The condition has led many researchers to conclude there is no safe level of alcohol consumption during pregnancy. For this reason, all alcoholic beverages in the United States carry warning labels similar to those on cigarette packages that advise women to avoid drinking alcohol during pregnancy.

Other Substances to Avoid

Marijuana use by you can disrupt your baby’s brain development and can cause many problems. Medical marijuana use during pregnancy is not recommended. Because of known risks, pregnant women should avoid all marijuana use.

Cocaine can affect a fetus as early as a few days after conception. It can cause various types of deformities. Amphetamines, including methamphetamine, have been blamed for various birth defects. Babies born to mothers who used amphetamines experience withdrawal symptoms.