Your Nutrition

Your nutrition is very important during pregnancy. You will probably need to increase your caloric intake during pregnancy to meet demands. During the first trimester (first 13 weeks), you should eat a total of about 2200 calories a day. During the second and third trimesters, you probably need an additional 300 calories each day.

Extra calories give you energy to support your growing baby. The extra calories keep you going while your body goes through changes. Your baby uses the calories to create and to store protein, fat and carbohydrates. It needs energy for its body processes to function.

You can meet most of your nutritional needs by eating a well-balanced, varied diet. The quality of your calories is important. If a food grows in the ground or on a tree (meaning it’s fresh), it’s probably better for you than if it comes out of a box or can.

Alcohol in Cooking

Most pregnant women know they should avoid alcohol during pregnancy but what about recipes that call for alcohol? A good rule of thumb is it’s probably OK to eat a food that contains alcohol if it has been baked or simmered for at least 1 hour. Cooking for that length of time evaporates most of the alcohol content.

Be cautious about adding the extra 300 calories to your nutrition plan—it doesn’t mean doubling your portions. A medium apple and a cup of low-fat yogurt add up to 300 calories!

7. You Should Also Know

Prenatal tests are of two types—screening and diagnostic. Screening tests assess your risk of having a baby with a certain birth defect. These tests can provide basic information to determine if more testing is necessary. Diagnostic testing can provide nearly definite results. Unfortunately, some prenatal diagnostic tests carry a very small risk of miscarriage. These various tests are described in some of the following weeks.

Healthcare Professionals Who May Care for You

Certified Nurse-Midwives. Many doctors in the United States have certified nurse-midwives on staff. A certified nurse-midwife (CNM) is a registered nurse (RN) who has received additional training delivering babies and providing prenatal and postpartum care to women.

In a normal, uncomplicated pregnancy, many or most of your prenatal visits may be with a CNM, not the healthcare provider. This may include labor and delivery. Most women find this is a good thing—often these healthcare providers have more time to spend with you answering questions and addressing your concerns.

A CNM will consult with a physician about specifics of a particular pregnancy and about the labor and delivery of a woman. Most midwives can help you explore birthing methods, including natural childbirth, and pain-relief methods for labor and delivery, including the use of epidurals.

If it’s important to you, a midwife may be able to help you make your baby’s birth one the entire family can participate in or experience. A certified nurse-midwife can also address issues of family planning and birth-control counseling and other gynecological care, including breast exams, Pap smears and other screenings. CNMs can prescribe medications; each state has specific requirements.

A word of warning—Not all people who call themselves midwives are certified nurse-midwives. Some are not even registered nurses. Be sure to check the credentials of any nurse-midwife you are considering for your care.

In the United States, the profession of nurse-midwifery was established in the early 1920s. Before then, midwives had attended births; however, often they were not trained medical professionals. Nurse-midwifery in this country grew out of the Frontier Nursing Service, which provided family health services to rural areas.

The first school for nurse-midwifery graduated its first class in 1933. Today there are over 7000 certified nurse-midwives practicing in all 50 states; they attend nearly 10% of all births, mostly in hospitals. Certified nurse-midwives work in private practice (usually associated with a physician), hospitals, birthing centers and clinics.

To receive certification, a person must hold a bachelor’s degree and be a registered nurse. He or she must complete a master’s degree or doctorate program from an accredited institution, which usually takes 1 to 4 years. CNMs can be men or women—about 2% of all certified nurse-midwives are male.

Advance-Practice Nurses. An advance-practice nurse, also called a nurse practitioner (NP), has received postgraduate education in a medical specialty and holds either a master’s degree or a doctorate. To be licensed to practice, an NP must be nationally certified in an area of specialty, such as women’s health, family health, pediatrics or some other specialty. An NP is licensed through a state nursing board.

Nurse practitioners focus on individualized care, a person’s condition and the effects a condition or illness may have on one’s life. In a normal, uncomplicated pregnancy, many or most of your prenatal visits may be with a nurse practitioner, not the doctor. This may include labor and delivery. Most women find this is a good thing—often these healthcare providers have more time to spend with you answering questions and addressing your concerns.

Priorities of nurse practitioners include prevention, wellness and education. NPs may also be involved in research.

To be a nurse practitioner in obstetrics and gynecology, a person must be nationally certified and educated to care and treat women’s health issues (WHNP). Nurses may also be certified as certified registered nurse anesthetists (CRNAs) and administer anesthetics for various procedures, including pain relief for labor and delivery.

In the United States, state regulations determine whether NPs work independently of doctors or must work with them. Some of the areas in which nurse practitioners work include providing prenatal care and family-planning services, diagnosing and treating illness and disease, doing physical exams, ordering and interpreting medical tests and prescribing medications.

A nurse practitioner may work in various institutions. Some places you may find them include private medical practices, clinics, health centers, urgent-care centers, health maintenance organizations (HMOs) and walk-in clinics.

Physician Assistants. A physician assistant or physician associate (PA) is a qualified healthcare professional who may take care of you during pregnancy. He or she is licensed to practice medicine in association with a licensed doctor. In a normal, uncomplicated pregnancy, many or most of your prenatal visits may be with a PA, not the doctor. This may include labor and delivery. Most women find this is a good thing—often these healthcare providers have more time to spend with you answering questions and addressing your concerns.

A PA’s focus is to provide many health-care services traditionally done by a doctor. Most PAs work in doctors’ offices, clinics, urgent care facilities and/or hospitals.

Physician assistants care for people who have conditions (pregnancy is a condition they see women for), diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, perform some procedures, assist in surgery, write prescriptions and do physical exams. A PA is not a medical assistant, who performs administrative or simple clinical tasks.

The PA profession was created by a physician at Duke University Medical Center in the mid-1960s because of a shortage of doctors in some areas of the United States. Today, there are over 140 accredited physician-assistant programs in our country.

Physician-assistant training lasts 2 to 3 years after receiving an undergraduate degree. Many schools do not differentiate between the first-year PA students and first-year medical students; they all take classes together.

A graduate of a physician-assistant program receives a master’s degree. Some programs also offer a clinical doctorate degree (Doctor of Science Physician Assistant or DScPA). There are also specialty programs or residencies some PAs choose to take to specialize in a certain area. They usually last an additional year.

A PA is licensed by the medical board of each state. After graduating from an accredited program, a PA must pass a qualifying exam-administered Physician Assistant National Certifying Exam (PANCE) before being certified.

8. Weekly Exercises

Each weekly discussion contains an exercise description and an illustration, if one applies, for safe exercises to do during pregnancy. If you’re healthy and have no pregnancy problems, experts agree you can probably exercise moderately for at least 30 minutes three to five times a week. Studies show active pregnant women often have fewer problems during pregnancy and don’t increase their baby’s risk for problems.

If you exercised before pregnancy, continue exercising during pregnancy, at least at moderate intensity. You’ll get the same benefits you did before you became pregnant.

Discuss exercising at your first prenatal appointment. Your healthcare provider may have suggestions for your particular situation.

Do these exercises to condition, strengthen and tone various muscle groups, many of which you’ll want to strengthen for your comfort during pregnancy. In addition, some of the exercises strengthen muscles you use during labor and delivery. It’s never too early to get started!

You may decide to set up a routine of exercises to do, adding and deleting some as you get bigger. Some of the exercises are done standing, some sitting, some kneeling and some lying down. We suggest you leaf through each week and choose the exercises that appeal to you.

We advise every pregnant woman to read and practice the Kegel exercise (Week 14) to help strengthen pelvic-floor muscles. Practicing throughout pregnancy can help in lots of ways, especially with incontinence during and after pregnancy. Actually, it’s an exercise every woman, no matter what her age, should practice every day.

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