The journey from pregnancy to motherhood is full of monumental physical and emotional changes. We asked several doctors at some of the city’s best hospitals to share advice for staying healthy during this transformative period—from the early stages of pregnancy to after you’ve brought your little angel home from the hospital.
PRENATAL ADVICE:
During pregnancy it is important to stay active and exercise regularly within the limits provided by your physician. Studies show that women who are active during their pregnancy tend to have easier labors.
–Silvana E. Ribaudo, MD, Attending Obstetrician and Gynecologist, NewYork-Presbyterian/Columbia University Medical Center
Thinking about pregnancy is an exciting time and there are some excellent ways to optimize your health before you get pregnant. As obstetricians one of our main goals is to guide women through all aspects of their reproductive years, so come see us before you are planning to get pregnant! Improve your nutrition, make sure your vaccinations are up to date, modify your lifestyle by increasing exercise and changing behaviors that could adversely affect your pregnancy and start taking a prenatal vitamin.
We are here to help you achieve these goals to ensure that you have the best start to this very special time in your life. Once you are pregnant, we are here to help you navigate through these important prenatal months. There is a lot to learn and think about and it can be stressful at times. Each pregnancy and birth is a unique experience and your obstetrician is there to be your compass. The internet does not always provide accurate information, so use our specialty training to your advantage to get up-to-date and accurate medical information.
–Szilvia Nagy, MD, Attending Obstetrician and Gynecologist, NewYork-Presbyterian/Lower Manhattan Hospital
You don’t need to eat for two. Most normal weight women only need one additional snack a day. Bed rest does not prevent miscarriages or premature labor. Prenatal vitamins are not critical for healthy pregnant women who are eating a well-balanced diet, so don’t stress if you forget to take them. If you decide to create a birth plan, remember to be flexible. Don’t get upset if things don’t go as planned, as they often do in labor. Plan ahead on who should be with you during labor. You may want to encourage others to visit after the baby is born. -Anna Burgansky, MD, Assistant Professor of Obstetrics and Gynecology at NewYork-Presbyterian/Columbia University Medical Center, Director of Obstetrics and Gynecology, NewYork-Presbyterian/Lawrence Hospital
Purchase an abdominal binder and wear it like a girdle around your hips for support when wearing dresses or skirts. Keep flip-flops around if pregnant in the summer for when your shoes do not fit at the end of a long work day that was too hot to wear compression knee-high stockings. Also important—do prenatal yoga—it helps one stay connected to one’s changing body and focus on breathing and staying limber while one’s ligaments are naturally relaxing. -Geeta Sharma, MD, Attending Obstetrician and Gynecologist, NewYork-Presbyterian/Weill Cornell Medical Center
Eat healthy, take your prenatal vitamins, and exercise to the same extent that you did prior to becoming pregnant. If you are not one who exercised in the past, just take a daily walk. Later in the pregnancy, pay attention to fetal movement (a minimum of four distinct fetal movements per 60 minutes of observation twice a day). -Michael Divon, MD, Chairman of Obstetrics and Gynecology, Lenox Hill Hospital
Plan your pregnancy and start prenatal care before you are pregnant. Seeing your OB-GYN provider while you are thinking about pregnancy supports having optimal obstetrical outcomes. Medical problems can be optimized, medications can be reviewed and discussed (some medications are necessary and can be taken while pregnant), immunizations can be up-to-date and vitamins can be started to reduce the risk of birth defects.
–Janet Stein, MD, Director of Obstetrics, Mount Sinai Beth Israel
Start acting like you are pregnant now while you are trying. Stop smoking, minimize alcohol, and stop illicit drug use. Take a multivitamin every day and eat a healthy, balanced, and varied diet that includes lots of fruits and vegetables. Sit down with your doctor and review any chronic medications you take to ensure that you are using medications that are safe in pregnancy. Make sure your doctor has sent a prenatal panel of blood tests to determine if you are immune to rubella and chickenpox, because you want to be immune going into pregnancy. Since immunity often wanes with time, even if you’ve had past boosters of MMR, get checked. If you are a healthy carrier of a cystic fibrosis mutation (as are approximately 1 in 30 Caucasians), and you happen to marry someone who also is a healthy carrier, you have a 1/4 chance of having a baby with cystic fibrosis.
Getting tested prior to conception will give you time to fully investigate available options to mitigate risk of having an affected baby. Currently genetic testing should include at least cystic fibrosis, spinal muscular atrophy, and fragile X for everyone. Anyone whose genes are from a warm climate (Asians, Africans, Mediterraneans, Hispanics)—which is pretty much everyone except Northern Europeans—should have hemoglobinopathy testing to see if they carry thalassemia (Mediterranean anemia) or hemoglobin S or C disease. And Ashkenazi Jewish people need a testing panel which includes the above plus Tay Sachs disease and several others.
Although we all like to think we’re perfect, it is likely that each and every one of us carries a number of significant recessive mutations. These will only cause a problem if our partners have matching defects.
-Peter G. McGovern, MD, Chairman, Department of Obstetrics and Gynecology, Mount Sinai Roosevelt and Mount Sinai St. Luke’s.
Exercise during pregnancy can help reduce some of the common physical complaints of pregnancy, and also help keep you from gaining too much weight. Stay well-informed about how to maintain as healthy a pregnancy as possible, but don’t drive yourself crazy. Eat well, exercise, and most of all, enjoy the pregnancy! -Joanne Stone, MD, Director, Maternal Fetal Medicine, The Mount Sinai Hospital
Healthy weight gain is important. The woman who starts her pregnancy at an appropriate weight should gain about 25-30 lbs during her pregnancy. The woman who is overweight should gain less—about 20 lbs—and the obese patient should gain about 15 lbs. So the average patient needs to increase her intake by 150 calories. This equals a glass of skim milk. I always stress to the patient to continue eating as she did prior to conception and add a glass of milk or yogurt. It’s best to think about trying to get in 5-6 protein portions per day. Meat, fish, and eggs—but also consider whole wheat bread, pasta, and nuts. Nuts are a great source of protein and omega 3 fatty acids.
What are the risks associated with gaining too much weight? Yes, it is hard to lose after. But gaining too much weight increases the risk of gestational diabetes and hypertension. Gestational diabetes can contribute to increasing the size of the baby and increasing the risk of shoulder dystocia and cesearean section. Hypertension can increase the risk for preterm birth induction and placental blood flow compromise.
Life is a balance and exercise can offset the calories consumed. I encourage exercise during pregnancy and suggest 150 minutes per week. The patient should adjust their exercise to keep their pulse less than 140 beats per minute. The patient needs to keep herself hydrated during her exercise.
-William Schweizer, MD, Clinical Associate Professor, Department of Obstetrics and Gynecology at NYU Langone Medical Center
BIRTH ADVICE:
When thinking about the birth experience, it’s important have a birth plan, but to also stay flexible. Most labors are without complications, but the nature of obstetrics can be unpredictable. The goal at the end should be a healthy mother and baby, but the journey to that endpoint cannot be written ahead of time. -Silvana E. Ribaudo, MD, Attending Obstetrician and Gynecologist, NewYork-Presbyterian/Columbia University Medical Center
Each birth experience is unique and not one labor is the same. We encourage our patients to come with an open mind and understand that we are there to be your advocate through the labor and delivery process. Talk with your obstetrician prior to labor and discuss with them your thoughts, desires, and wishes for your birth experience. We are there to provide you with a memorable encounter, as well as to ensure that you and your baby are safe and healthy. Having a Cesarean section may not be on your list of “top wishes,” but we will only recommend it if there is a medical reason. If you need a Cesarean delivery you can still have most of the same experiences that mothers with uncomplicated vaginal deliveries have. Your obstetrician is there to be your advocate. -Dr. Szilvia Nagy, MD, Attending Obstetrician and Gynecologist, NewYork-Presbyterian/Lower Manhattan Hospital
An epidural is the best method for controlling pain, and it is very safe. An epidural does not slow down labor. If you plan to get it, don’t wait until you are in agony. Pushing the baby out may require hard work: That’s the part we call “labor.” Make sure you leave some energy and mental power for this part. -Anna Burgansky, MD, Assistant Professor of Obstetrics and Gynecology at NewYork-Presbyterian/Columbia University Medical Center, Director of Obstetrics and Gynecology, NewYork-Presbyterian/Lawrence Hospital
Bring lip balm and popsicles. Keep an open mind, keep your pelvis relaxed, and connect with the experience. Feel the little one move down the birth canal and welcome the contractions with deep breaths—they will get you to your prize! -Geeta Sharma, MD, Attending Obstetrician and Gynecologist, NewYork-Presbyterian/Weill Cornell Medical Center
It is very important to be as prepared as possible for your delivery. Preparation takes away the fear, especially for first-time mothers. Recognizing the signs of labor and getting to the hospital in time are paramount. One does not want to make unnecessary trips to the hospital either, as it is quite a disappointment to be sent back home. Reading about delivery in books or on the internet is not the same as taking a childbirth preparation class for both you and your partner. It is essential to know what to do during and in-between contractions. Just reading about childbirth is not always enough. Childbirth preparation classes will explain the process and have you do practice exercises, which makes couples much more relaxed and “in-the-know” during labor. A C-section is a major surgery. All surgical procedures have associated risks as well as an extended recovery period. An elective C-section should not be the answer to your fears. -Michael Divon, MD, Chairman of Obstetrics and Gynecology, Lenox Hill Hospital
A healthy mother and baby are the goal of every pregnancy. Labor and delivery care is provided by a team, which includes the patient and her family, obstetrician or midwife, nurses, and other support team members, such as an anesthesiologist. Many women have a “birth plan” in mind, and your ideal birth should be discussed. However always remember that safety is the first priority and obstetrical emergencies, while rare, can be serious.
–Janet Stein, MD, Director of Obstetrics, Mount Sinai Beth Israel
The most important thing to do when contemplating actually giving birth to a child, is to relax and remember that this is a natural process. It is very important for couples to be educated, for the known is always less anxiety-provoking then the unknown. In the prenatal period couples should be educating themselves on the process of labor that leads to delivery. They should become familiar with the procedures that could be done at that time of birth, remedies available for pain relief, and possible complications. This is best accomplished through childbirth educational classes, reading appropriate literature, and discussing their questions and concern with their provider, rather than family or friends. It has been shown in the literature that a prepared and organized childbirth education progress has a beneficial effect on a woman’s performance in labor and delivery, no matter how much she “thinks” she knows.
–Peter G. McGovern, MD, Chairman, Department of Obstetrics and Gynecology, Mount Sinai Roosevelt and Mount Sinai St. Luke’s
There are no brownie points for suffering in labor. An epidural is a great form of pain relief and very safe. Of course if you want to do it without pain medication, it’s totally your choice. Just don’t feel like you are “giving in” to receiving an epidural. Most of the labor process is long and can be boring—the real work comes during the time you are pushing! Both you and your partner can be involved in helping you push most effectively. -Joanne Stone, MD, Director, Maternal Fetal Medicine, The Mount Sinai Hospital
Birth is a journey that makes a couple a family. If you think of travel sometimes there are delays and lost luggage. I always give my patients a birth plan early on in pregnancy and have them complete it in the last trimester. Some couples are committed to a natural medication-free labor. It is important for me to know this. The contractions are “pain with a purpose,” and I need to be enthusiastic, positive, and encouraging. Other couples are unsure about whether they want assistance with the pain of labor. I want to reassure them about how I will evaluate their labor and report to them the progress. They need to know I will be respectful of their decision to work with the pain or get an epidural. The third group of couples have a clear idea of when they want help with the labor pain, and I need to reassure them about the ease of access to epidural and what benefits and risks exist.
The birth plan is an opportunity to discuss and reassure the mother that episiotomy is rare, but sometimes an option worth considering. I’d also want to discuss delayed cord clamping and cord blood banking. Forceps and vacuum deliveries should be discussed, as sometimes these can be valuable techniques used to avoid a Cesarean section. I feel it is important to discuss Cesearean section and why it would be suggested. Should a C-section become necessary, the mother needs to believe that she is part of this decision, and a full explaination is her right. -William Schweizer, MD, Clinical Associate Professor, Department of Obstetrics and Gynecology at NYU Langone Medical Center
POST-NATAL ADVICE:
The first few weeks with a newborn are the toughest. Despite exhaustion and feeling as though you have no time for yourself, aim for a 10- to 15-minute brisk walk daily. Wrap the baby in a carrier or stroller or get a babysitter. You won’t regret the time to yourself! -Silvana E. Ribaudo, MD, Attending Obstetrician and Gynecologist, NewYork-Presbyterian/Columbia University Medical Center
After your baby arrives the adventure really begins! The bond between babies and their parents is a deep and special one. We encourage our patients to breastfeed as breast milk is easy to digest and has the immune system boost that can protect your baby against infections. The early post-partum period is a critical time to establish breastfeeding and your obstetrician is there to support you. Our goal is have mothers and their newborns have skin-to-skin contact as soon as possible after an uncomplicated delivery, and then to have the babies room-in for at least the majority of the post-partum period spent in the hospital.
The post-natal period can affect women in various ways. Some women can experience post-partum blues or post-partum depression. As many as 70-80 percent of new mothers experience feelings of sadness in the immediate post-partum period. New mothers are surprised by how drained they feel after delivery. This in no way is a reflection of how much a new mother loves her infant! It is important to talk to your doctor about all of the feelings you are experiencing in the post-partum period. Treating post-partum blues and post-partum depression is just as important as treating high blood pressure or high cholesterol!-Szilvia Nagy, MD, Attending Obstetrician and Gynecologist, NewYork-Presbyterian/Lower Manhattan Hospital
Breast milk is the best nutrition for your baby, but breastfeeding may be harder than you think. Take advantage of post-partum nurses and the lactation consultant in the hospital to make sure you are comfortable with this new skill. You need to have more calories and vitamins when you’re breastfeeding, compared to when you’re pregnant. So add another snack and continue your prenatal vitamins. Take a nap anytime you have a chance, and avoid sleep deprivation. Keep your feet up as much as possible to help reduce leg swelling. It may get worse after delivery before it starts to get better. Sleep on the side of the bed closest to the bathroom. You will be going more often because of the fluid changes after delivery. Don’t hesitate to take medications for pain—they are safe with breastfeeding. -Anna Burgansky, MD, Assistant Professor of Obstetrics and Gynecology at NewYork-Presbyterian/Columbia University Medical Center, Director of Obstetrics and Gynecology, NewYork-Presbyterian/Lawrence Hospital
Wear an abdominal binder around your waist (even in the hospital) to help support your abdominal muscles. Go on a date with your partner or treat yourself to a special evening for the one month birthday. You have earned a night out and making time for each other keeps the team in teamwork. -Geeta Sharma, MD, Attending Obstetrician and Gynecologist, NewYork-Presbyterian/Weill Cornell Medical Center
Don’t hesitate to ask for help from a lactation consultant if you are having breast feeding difficulties. Get as much sleep as possible when you get home with your newborn. Take a nap when the baby is sleeping as you will need your strength and preserve your patience at this time. Eat healthy meals, especially if you are breastfeeding and do not binge with fast foods, cakes, or chips.
–Michael Divon, MD, Chairman of the Obstetrics & Gynecology Department at Lenox Hill Hospital
Breastfeed! Unless you have a medical contraindication (and there are a few), breast is best for both mother and baby. Every woman is capable of breastfeeding. Like all new things, it sometimes takes time to get things started, but don’t give up! It is totally worth it and enormously satisfying. Watching a baby thrive on breastmilk is a powerful feeling for a mother and a wonderful way to bond. -Janet Stein, MD, Director of Obstetrics, Mount Sinai Beth Israel
As much as this is an exciting and wonderful time for all new parents, significant medical issues may arise that can be overlooked if the mother is unaware of them. Infections can occur during the early postpartum period where the busy new mother may ignore the symptoms while she is preoccupied with her newborn. A fever (greater than or equal to 100.4) with or without malaise, abdominal pain, increased bleeding or breast tenderness is not normal. This can be a sign of a uterine (endometritis), breast (mastitis) or a wound infection (abdominal incision post Cesarean section or vaginal laceration). Women must call their provider immediately when fever or other signs of infections are recognized, for the successful treatment of postpartum infection is time-dependent. The early recognition of signs and symptoms of infection can prevent sepsis—a life-threatening condition.
Another serious problem in the postpartum period is the early identification of psychosocial issues. These can present with great variation ranging from postpartum blues to psychosis. Postpartum blues are very common in the first few weeks after giving birth and new mothers must be aware of this. Over 70% of women may appreciate bouts of unsolicited crying, sudden mood swings, and negative feelings toward their newborn. Women with a history of depression or other psychological diagnoses prior to pregnancy are at high risk for postpartum psychological issues. However, all women are at risk due to hormonal changes and social stresses that arise during this time, such as guilt due to having to return to work, economic concerns, family conflicts, and unresolved issues due to an unplanned pregnancy. Persistence of extreme mood changes or inability to function must be recognized by the family, the patient, and the provider. The obstetrician should be contacted to assist in directing the patient to the appropriate medical referrals.
–Peter G. McGovern, MD, Chairman, Department of Obstetrics and Gynecology, Mount Sinai Roosevelt and Mount Sinai St. Luke’s
Sometimes women get swollen or have hemorrhoids appear after delivery. Putting ice packs on for the first 24-hours followed by warm soaks or sitz baths can help relieve the discomfort. -Joanne Stone, MD, Director, Maternal Fetal Medicine, The Mount Sinai Hospital
Rest at home leads to success in breastfeeding and helps the mother become a sane parent. When my patients leave the hospital I always warn them about well-meaning family members. Everyone wants to come by to visit the baby. Little children want to hold their newborn cousins, and all want to hear the story about the miracle birth. The mother needs to rest after her delivery. She needs to learn her baby’s routine. Family members should be told to keep their visits short. Tell them to bring food: pizza, quiche, stew. Children should not be handling the newborn. The mother should let the dirty laundry pile up or give it to her in-laws or parents to do. Most importantly the new mother should try to sleep when her baby sleeps. If her mother wants to take the baby outside, the new mother to take the opportunity to nap.–William Schweizer, MD, Clinical Associate Professor, Department of Obstetrics and Gynecology at NYU Langone Medical Center
