Traveling creates additional concerns if you are pregnant. You have an increased risk of some medical problems, for example:
- increased blood clot formation because of prolonged sitting during travel;
- exposure to infections that could lead to miscarriage or serious illness; and
- unexpected miscarriage or pregnancy complications while away from home.
Avoid long car trips and airplane flights, if possible. If you must travel, stretch your legs and walk around at least every hour or two. Your doctor will generally permit you to travel by air until 32 to 34 weeks, unless you are at high risk for premature labor. After that time, most airlines may not let you board the flight if you appear obviously pregnant because of the possibility of an unexpected delivery on the plane.
If you will be away from home for a long time, your doctor may recommend a local obstetrician where you are visiting for you to contact. Be sure to take a copy of your prenatal records with you.
For foreign travel, check with the Centers for Disease Control and Prevention (CDC) for recommended vaccinations or preventive medications for the area you are visiting. Avoid drinking unpurified water, unpasteurized milk, and inadequately cooked meat or vegetables.
Movement is an important sign that the fetus is doing well. As your pregnancy progresses and your fetus gets larger and larger, the type of movement can change. Instead of your fetus punching you or doing flips, the baby may roll more or stick an arm or leg out. Pay attention to these movements. If your fetus is not moving as much as normal, keep track of its movements. Eat a meal and then lie down on your left side. If the fetus does not move 10 times in the next two hours, call your provider. There are many ways to count fetal movement; ask your doctor/provider how she wants you to count. If the fetus is not moving, your doctor will order a non-stress test, a contraction stress test, or a biophysical profile (BPP).
Lap and shoulder belts should be worn at all times when riding in a motor vehicle, particularly in the front seat. Being an unrestrained passenger during a major automobile accident is dangerous, whether or not you are pregnant.
Generally, women in their third trimester are encouraged not to sleep on their backs. When you are on your back, your heavy uterus can reduce blood flow to the uterus and fetus.. Most women aren't comfortable lying flat on their backs during the third trimester. Most experts, including The American College of Obstetrics and Gynecology (ACOG), recommend sleeping on your side. The left side is considered the best choice because the uterus naturally rotates to the right during pregnancy and left-sided laying will bring it more to the center and improve blood flow. A pillow placed between your legs and/or a long body pillow to support your back are often helpful.
Pregnancy is usually not affected by most occupations. Particular occupational hazards include prolonged exposure to lead-based paints, working in a poorly ventilated setting with noxious fumes (anesthetic gases, volatile chemicals), and unregulated radiation exposure.
Before you stop working in a potentially worrisome site, you should check with your supervisor about OSHA (Occupational Safety and Hazards Administration) standards for your workplace. Pregnancy is not a true disability, but if you stop working without a valid statement from your physician, workmen's compensation for disability pays only a fraction of your normal wages.
It may be difficult to change jobs during pregnancy, but you may want to do so before you become pregnant. An understanding employer may reassign you to a position that involves less risk, but employers are not under any obligation to do so.
Some obstetrical conditions require bedrest during pregnancy, such as preterm labor, incompetent cervix, placenta previa, and preeclampsia. If you have any of these conditions your doctor may complete disability forms for you, so that you can take time off from work.
There is no medical reason to prohibit working up until delivery, and most women can. Some employers allow time off before your due date. Most employers allow six weeks maternity leave after a vaginal delivery and eight weeks following a cesarean delivery. If you want more time, you may need to use vacation time or take time off without pay.
In recent years, several commercial companies have advertised a service that banks ?leftover? umbilical cord blood after birth for potential use by the baby or other family members for a possible future illness that could require stem cell transplantation. There is a significant cost associated with processing and cryopreservation of this blood (approximately $1,500 initially and then $100 per year for storage).
The American College of Obstetrics and Gynecology considers this a speculative investment that cannot be supported with scientific data. It is not known what happens to the blood after long-term storage or if the amounts of blood saved would be enough to treat someone. It has also been estimated that the probability of a person needing a stem cell transplant is exceedingly rare (between 1 in 1,000 and 1 in 200,000 by age 18) and these for-profit companies may be playing on the fears of the general public. However, in very rare families that have certain hereditary anemias, it may be important for fresh stem cells to be obtained from cord blood for a sibling of the baby. This requires special advance arrangement.
X-rays in moderation and with appropriate lead shielding over the abdomen are quite safe during pregnancy. Many serious conditions can develop or worsen during pregnancy if diagnostic x-rays are not used, such as pneumonia, tuberculosis, or broken bones. Sometimes, x-rays of the pelvis and baby may even be required to determine whether or not the baby can be delivered safely (for example, if the baby is in a breech position). Remember, some babies need multiple x-rays immediately after birth to assess their health. The judicious use of x-rays of the baby inside or outside the womb is not cause for alarm.
Epidural anesthesia is an excellent option for pain management. It is usually not available for either a home birth or at a birth center. Pain management in these settings may include Lamaze techniques, sensate focusing, hypnosis, or mild narcotics/sedatives. However, if pain management is important to you, labor and delivery in a hospital gives you access to epidural anesthesia. Most doctors decide when you should receive epidural anesthesia on an individual basis. Some doctors do not place an epidural anesthetic until you are at least 4 centimeters dilated. Talk with your doctor about your wishes and your doctor's epidural preferences as your due date approaches. Complications of epidural anesthesia are rare, but include headache, bleeding, and infection. There is disagreement about whether or not epidural anesthesia slows labor. However, this type of pain control does not cross the bloodstream to the baby. Other types of pain medications do cross the bloodstream and may potentially make the baby sleepy at birth.
The third trimester is a good time to consider whether you want to breast-feed or formula feed your baby. Pediatricians and dietitians generally recommend that you breast-feed your baby for the first year of life. Exceptions are women with HIV or AIDS, active tuberculosis, and some forms of hepatitis. Talk to your health care provider if you have any concerns about being able to breast-feed.
Breast-feeding has benefits for the mother, including:
- your uterus and stomach return to prepregnancy size faster;
- you return to your prepregnancy weight faster;
- no bottles to wash or carry and no formula to prepare or carry;
- no money spent on formula;
- decreased risk of breast and ovarian cancer;
- decreased chance of getting pregnant (breast-feeding suppresses ovulation);
- decreased risk of osteoporosis; and
Breast-feeding has benefits for your baby, including:
Call the labor and delivery department or the nursery at your hospital. Most hospitals let you tour the facilities before your labor and delivery, if you want.
In addition to calling your health care provider, you should also call your health insurance company. Each insurance company has its own rules about this. Most allow you to notify them within 24 hours of admission. Talk to your health insurance company representative to check on their requirements.
You, your doctor, and your health insurance company decide what is best for you. If there is a medical reason for you to stay in the hospital, your health insurance should allow it. Many insurance companies encourage women to leave the hospital 24 hours after delivery. For some women, this is safe and appropriate; it is not appropriate for others. If you feel that you need to stay in the hospital longer than your insurance company allows, call the company and negotiate more time. By the way, most health insurance companies cover the cost of a semi-private room postpartum. Check with your hospital to see if you can up-grade to a private room and what the difference in cost is.