5 Month Pre-natal Visit - It's a Girl!

21 week OB visit summary
Overall weight gain 5 lb 9.6 oz
In the last month 2 lbs 9 oz
Fundal Height 21 cm
Fetal Heart rate 145
Blood pressure 122/70

This has been a very exciting four weeks since my last post.  Honestly too much excitement.
Let's start with the good stuff.

I'm having a girl! We decided to find out at our 20 week ultrasound the gender of the baby.  We didn't find out with our last child, and it just was not as exciting as I hoped.  Besides that it was way harder than I could have guessed to find gender neutral baby clothes - even the bottle brushes come in pink and blue!  Not that I'm going to run out and buy a bunch of pepto-bismol pink.  I would have been happy to have another boy - brothers is great, and plus all of our clothes are boy.  I have to admit though that I'm super excited to get to experience having a daughter.  And check this out -

Now the not so fun - I had the flu this last month.
And yes it was the flu - I tested laboratory positive
Yes I did get my flu shot - back in september
I wash my hands, I clean my stethoscope, and I wear a mask when patients complain of flu-like symptoms.
The silver lining is I got to the doctor right away and got Tamiflu within 36 hours of the onset of my symptoms.  I was only really, really sick for about 36 hours after that.  I did end up in the hospital emergency room because I couldn't stop vomiting and had a fever of 103.9.  Just Yuck!  Not recommended.  The only plus here is I think I have the flu to thank for my lack of weight gain.  I have been a little bad about diet - eating breads and pasta more than I should.  I also didn't use my treadmill for almost two weeks - even though I felt better I was still very fatigued and washed out for about 7-10 days after.
Would I get the flu shot again?  In a heart beat.  Saying you wouldn't get the flu shot because it didn't prevent the flu 100% of the time, is like saying you stopped wearing your seat belt because you still got in an accident.  Any ways from what I've seen in clinic people that didn't get the flu shot got way more sick, and if what I had was not as sick I really don't want to experience the alternative.

I am being pushed out of my pre-maternity clothes.  Mostly because my shirts are getting too short.  I still have some pants I can button up thanks to how much weight I gained with my last pregnancy I have some extra large regular people pants.  I use a thing called the belly belt with my other pants.

Link to buy

This lasted me in my last pregnancy for a long time.  I'm really trying to make it till spring because I don't want to buy sweaters and long sleeve shirts that I'll only wear for another four weeks and never again.  I also use belly bands to help make my shirts reach but it only takes you so far.  These come in a variety of colors.

And that's really it for this month.  Trying to persist with my protein shakes and preeclampsia tea.  I did not end up getting an exercise video because I realized two things 1. I would have to buy a yoga mat, and 2. I'm never going to exercise at home, I just can't.  So plan now is to shell out for pre-natal yoga classes.  Still going to the chiropractor and acupuncturist and having no more aches or pains.  It's exciting to be half way there, and to be showing - enter the rude and awkward comments from co-workers etc.
Hopefully next month is decidedly less exciting.

4 month Pre-natal Visit

Stats:
Total weight gain 3 lbs
Total in last month 1 lb
Fetal heart tones 150's
Fetal movement present during exam

The big news for me at this visit is I get my week back! Woot!
At the nuchal translucency they estimated the baby's age to be about a week less than I had thought by dates, which might not seem like a big deal but it really was to me.  Now my midwife says that likely my conception and period dates are far more accurate than the ultrasound and we should stick with that.  So I am officially 17 weeks.

The constipation of the first trimester has resolved - thank god.  I do still have some back aches but these are minor compared to what they were before.  I am under regular chiropractic and acupuncture care.

I have been waiting for my second trimester energy spurt - maybe that comes later the second time?  I find myself going to bed at 8:30 sometimes.  To be fair I am not as tired as I was last month.

Also I am starting to show which is nice.  I love a pregnant belly, can't wait for it to get even bigger.

Exercise has been somewhat dismal - maybe 2 hours a week at best.  I know I need to do better.

Excited to find out the baby's gender in three weeks.  We didn't find out last time but this time I want to know.

Otherwise everything is routine and run of the mill - just the way you want it to be.

The Constipated Pregnancy

Re: Constipation.
Wow! I do not remember being this constipated in my last pregnancy!
It finaly seems to be easing now that I am stepping firmly into my second trimester.
I do eat a lot of whole fruits, and a midling amount of steamed or baked veggies.  Also everything we eat is whole grain or whole wheat.  Of course one can always get more fiber - I could chew lettuce topped with grapenuts, but let's talk about what's realistic here.
Here are the things that I tried for treatment:
1. Fiber Powder: Metamucil mixed with 12 ounces of Water
-effect - overall increased feeling of bloatedness, and increased stool bulk, no relief of constipation
-tolerability - very tolerable - the orange taste is actually kind of nice, and it gets me to drink more water
- pregnancy safety - 4 stars - not absorbed
2. Walking - no less than 30 minutes per day
-effect - increased sensation of urge to defecate, no relief of constipation
-tolerability - moderate - it's hard to get on that treadmil when you're tired and you've had a long day and your back hurts, but in the end it actually increased my energy
- pregnancy safety - 5 stars - moderate to mild exercise always recommended in pregnancy
3. Switching to liquid Calcium Magnesium Supplement
- effect - decreased muscle cramps and back pain, no relief of constipation symptoms
-tolerability - moderate - the stuff I have tastes like vanilla but it's still a thing I have to take
-pregnancy safety - 5 stars - calcium and magnesium are recommended in pregnancy - see vitamins and supplements post
4. Aloe liquid
- effect - none discernable
- tolerability - low, this stuff tastes fairly awful although I have had worse
- pregnancy safety -2.5 stars - unknown
5. Senna 17.6 mg at bedtime
- effect - over relief of constipation or no effect - ie diarrhea
- tolerability - very good - just throw it on the pile with the other pills
- Pregnancy safety - 3.5 stars - Short-term use of senna is generally considered safe during pregnancy*
5. Colace - Docusate Sodium 100 mg Oral Three times daily
- effect - fair relief - easier bowel movements although not as soft as could be desired
- tolerability - fair/moderate- easy enough to swallow these but hard to remember to take something three times a day
- pregnancy safety - 3 stars- Short-term use of docusate is generally considered safe during pregnancy*

* Mahadevan U and Kane S, "American Gastroenterological Association Institute Medical Position Statement on the Use of Gastrointestinal Medications in Pregnancy," Gastroenterology, 2006, 131(1):278-82

Protein Shake

Let's take a minute to talk about our friend's protein shake.
I am referring to the woman who inspired me to write this blog, and my friend in my head Brittany Susan.
This shake is a direct steal from her blog.
Her recipe reads as follows
" 3 scoops soy protein powder from Trader Joe's, plus a splash of juice, greek yogurt & some fruit & spinach"
Like any good groupie I ran out and bought the protein powder and tried to make the smoothie.  Here is what I have come up with that works for me

1. 1 cup partially thawed frozen fruit (no sugar added)
2. 1 banana
3. 1 cup total greek yogurt 2-0%
4. 1 tbsp of steamed pureed kale
5. 2 scoops of trader joe's soy protein powder dissolved in 4 oz 1% milk

I could not get 3 scoops of that protein powder to liquify with a "splash" of anything, I wanted to stay away from juice since it's basically liquid sugar which is why I went with milk.  This is a good breakfast and holds me for about 4 hours.

This is when I have a handful of nuts to get me that last hour to lunch.

Cheers!

Second Pre-natal Visit

Stats Weight +2.5 lbs
Fetal Heart tones 155-161 bpm
Crown Rump Length Measured by Ultrasound 5.79 cm
Gestational age estimated to be 12 weeks today, so due date is now officially July 10th.

So far so good.  Although the holiday eating combined with a lack of exercise has contributed to a bump in my weight.
It is hard to exercise with back pain.  Lately however my pain has been much improved and I am back on the wagon doing my treadmill.  This weekend I am going to buy a pre-natal workout DVD and try it at home.  I can't find a way to rent one, and I guess I can risk the $15-20 it will cost to buy one.

My midwife's advice to me today - eat 6 small meals a day with protein and vegetable
Avoid caffeine and drink water

She also said that I need to do some processing to release some of the trauma surrounding my previous birth.  It was nice to hear her say that because sometimes I feel like such a winer complaining about my beautiful, vaginal, optimized birth experience.  It's nice to have someone empathize with you.
Such a good provider (cascading hearts).

nuchal translucency was all normal - my risk of a down syndrome baby is now 1 in 8041, and of trisomy 18/13 1 in >10,000
I'm not at all sure what we would have done with a negative result, and it is nice not to have to really figure that out.  And it was nice to see that little person swimming around.

Prenatal vitamins and supplements part 2

Now we get to the crazy stuff.
The stuff that may or may not have a lot of science behind it.  Things that probably can't hurt and might help, and I'm grasping at any straws I can when it comes to preventing preeclampsia.
There have been no conclusive research studies showing any concrete evidence that any thing prevents preeclampsia.
Be advised the craziness increases as you go down the page

1. Aspirin 81 mg per day - As my midwife will tell you this is not a vitamin or supplement it is a drug.  More specifically an anti-platelet drug which may increase your risk for bleeding.  So DO NOT take it without talking to your medical provider.  I began this only after I found out I was pregnant because I didn't want to bleed a ton during my periods.
There is mixed evidence - in my opinion - on aspirin for lowering the risk of pre-eclampsia, some small studies showed a good benefit, while other larger studies which included more lower risk women did not.  In the end it did not show any harm, and I feel the possibility of a benefit is worth it if the risk is low. *

2. Selenium 100 mcg per day - why am I taking this?  Because my mentor pregnancy blogger took it.  She posted about a tiny tiny itsy bitsy study that only contained 166 patients.  Three of the women who did not take the selenium developed preeclampsia, and none of the women taking selenium did. Is it a scientific conclusion that taking selenium will help - no.  Will it hurt, no.  Am I taking it - yes I am. *

3. Vitamin B12 - I actually found out from my doctor that my vitamin B12 level was about 200 ng/dL.  While this is not considered deficiency, I believe I was having symptoms of inadequate vitamin B12 (tingling in my fingers which has disappeared since I started on B12).  Most studies have not shown a correlation between B12 levels and preeclampsia.  There is some evidence that deficiency may relate to development of HELLP syndrome which is related to preeclampsia.*
Recommended daily intake during pregnancy is 2.6 mcg per day.*

4. Turmeric - More specifically I take Meriva which is made by Thorne.  I work with some naturopathic doctors who are renowned in the twin cities and I talked with them about ways to reduce the inflammatory response.  This is my own thinking that since preeclampsia is an inflammatory autoimmune condition that I can therefore lessen or prevent it by lowering my own inflammatory response.  Turmeric contains curcumin which is an antioxidant that lowers the presence of chemicals in the body that cause inflammation.  At the very least it has helped with my back pain. *

5. Raw cocoa powder - okay yuck, just yuck.  If it tastes bad it must be good for you right?  I disguise this by mixing it with my morning coffee.  And no this is not a caffeine free pregnancy - I work full time in family practice and I have a 2 year old okay.  Raw (non-dutched) cocoa powder is high in flavanoids which are a kind of anti-oxidant, anti-inflammatory.  There have not been many well done studies on the use of cocoa, however there does seem to be a great deal of evidence that it promotes cardiovascular health.  When your blood volume is increasing by 50% and you are at risk for a disease which is mediated by endothelial factors what could be better- and once again it certainly can't hurt. *

Besides this I also take Cranberry extract 400 mg per day because I had some trouble with urinary tract infections in my previous pregnancy.  I am also taking Zinc to reduce the frequency and severity of viral infections.  I work in primary care and sick people cough in my face at least twice a day.  I read a study in clinician reviews earlier this year that showed an effect of zinc on lowering frequency and severity of colds, and I can tell you from my n of one, that it works.

One of my co-workers asked me if all these pills and supplements make me feel full, and the answer is maybe?  I am a great taker of pills, I have no problems swallowing them although the omega 3's give me the fishy burps.  It's not forever it's just until July, and really I can do this for as long as that.

Prenatal Vitamins and Supplements part 1

What a mis-nomer, since you not only take it before you become pregnant but all through your pregnancy and breast feeding!

Before I became pregnant I only took 1 mg of Folic acid per day.

Folic acid is necessary to prevent neural tube defects, and the fetus' neural tube forms in the first four weeks after conception - which is before most people know they are pregnant, thus the reason to start before.

I have a beef with combination pre-natal vitamins, they have way to much of things you don't need like vitamin A (which can cause birth defects if taken in excess) and not enough of other things like calcium and vitamin D.

Since I found out I was pregnant I began to take the following

1. DHA-EPA 1 gram per day: These are the omega-3 essential fatty acids in fish oil—are crucial throughout life, but especially during pregnancy, when a woman's demand for DHA in particular increases substantially. DHA comprises approximately 20% of the fatty acid in the brain's cerebral cortex. That's why DHA is among the most important nutrients for pregnant and lactating women. The DHA consumed by expectant moms sets the foundation for her baby's developing brain, eyes, and nervous system.* 

2. Calcium 500 mg twice daily - Calcium is a nutrient needed in the body to build strong teeth and bones. Calcium also allows blood to clot normally, muscles and nerves to function properly, and the heart to beat normally. Most of the calcium in your body is found inside your bones.
A growing baby needs a considerable amount of calcium to develop. If you do not consume enough calcium to sustain the needs of your developing baby, your body will take calcium from your bones, decreasing your bone mass and putting you at risk for osteoporosis. Osteoporosis initiates dramatic thinning of the bone, resulting in weak, brittle bones that can easily be broken.

• 
  
• The U.S. Recommended Daily Allowance (USRDA) for calcium is 1200 milligrams (mg) per day for pregnant and lactating (breastfeeding) women over age 24. The USRDA for women under age 24 is 1200 to 1500 mg. of calcium per day.

Pregnancy is a critical time for a woman to consume more calcium. Even if no problems develop during pregnancy, an inadequate supply of calcium at this time can diminish bone strength and increase your risk for osteoporosis later in life.*

3. Magnesium 400 mg daily - This is a vitamin that works in conjunction with calcium.  It reduces the likelihood of preterm labor, and is important for baby's bone and teeth development.  There is also some indication that magnesium may reduce nausea in the first trimester.  I started taking magnesium years ago to reduce the frequency and severity of my tension headaches.  It also works to calm leg cramps and round ligament pains in pregnancy
Recommended daily allowance in Pregnant women, 19 to 30 years of age: 350 milligrams (mg) of magnesium per day *

4. Vitamin D 5000 Units daily - I live in Minnesota where six months out of the year you would have to stand outside naked for three hours at high noon to make enough vitamin D, so I was already taking this before pregnancy.  It is more important though during pregnancy and lactation.  Vitamin D supports immune function and is needed to absorb and store calcium for bone growth and nerve function.  The previous recommended daily allowance of vitamin d was 400 Units a day, but you should get your vitamin d level checked by a medical provider and discuss appropriate supplementation based on your blood level.*

I defy you to find a pre natal vitamin that contains all of these items at their recommended allowance and less than 4000 units of Vitamin A.

If you have an interest in taking your vitamins and supplements to the next level of craziness please see part 2 of this post.