Five steps to a healthy pregnancy
Article Date: Apr 12, 2011

Erin Talaska, M.D., OB/GYNSo, you're expecting, or hope to be soon. Congratulations! There are a few things you should know as you start on this remarkable journey. First, if you smoke, stop. Secondly, don't drink alcohol. Period. Now that that's out of the way, take a nice, deep, cleansing breath and sit back as Erin Talaska, M.D., OB/GYN, at Alegent Health Clinic, explains how to take it one step at a time.

1. Find the right doctor.
"The best overall strategy for a healthy pregnancy is to form a partnership with your OB/GYN or primary care physician, start getting prenatal care early and be consistent with your appointments," said Dr. Talaska.

Your family doctor can recommend an OB/GYN, and your friends and family will likely have some suggestions, too. Websites like www.alegent.com are a great source of information, offering physician information and videos.

"During your first visit, you get a feel for the physician and can have a long talk about philosophies on pregnancy and delivery," said Dr. Talaska. "It should be two-way communication. I appreciate it when my patients are not afraid to ask questions and give input as well as seek my advice."

2. Follow a healthy diet.
Contrary to popular belief, "you're really not eating for two," said Dr. Talaska, who talks to her patients about the Food Pyramid guidelines and eating proper portions. The average normal weight gain during pregnancy is 25 to 30 pounds.

"If a woman has is planning for pregnancy, with diet and exercise in mind, that is always helpful," she said. "It's ideal if she starts taking folic acid supplements or prenatal vitamins before, or as soon as she finds out, she is pregnant.

"Women with significant morning sickness worry about losing too much weight. "As long as you stay hydrated, most women don't lose much weight and it's not detrimental to the pregnancy," said Dr. Talaska.

If you are planning a pregnancy, Dr. Talaska says, talk with your doctor about your prescription medications; you may need to switch to a safer medication during pregnancy.

3. Get proper exercise.
"I encourage moderate exercise in pregnancy -- it's healthy for weight management, blood pressure and weight control," said Dr. Talaska. Weight-lifting and aerobics are fine in pregnancy, but usually need to be modified toward the end of pregnancy to lower weights and impact. All exercise should be modified in pregnancy so the maternal heart rate does not go above 140 for longer than 15 minutes, and does not go above 150 while exercising. Water aerobics is also a good exercise during pregnancy.

4. Know which sources to trust. When it comes to seeking out advice, be careful. It won't be long before you find too much information from websites, books and well-meaning friends. "If someone tells my patient something different than I told her, I want her to bring it up with me so we can be sure she has accurate information," said Dr. Talaska.

Dr. Talaska's favorite picks for reliable information are WebMD or any pregnancy publications by The American Congress of Obstetricians and Gynecologists. To supplement your craving for information, sign up for childbirth education classes and tour maternity suites at the hospital where you will give birth.

5. Manage stress in a healthy way.
"Pregnancy can be a very happy time in life, but also comes with stress, and it's not good to have a lot of stress no matter what," said Dr. Talaska. "One of the best stress relievers inside and outside of pregnancy is exercise."

Stress can also be relieved with good family support or taking yoga or meditation. If there are extreme issues, noted Dr. Talaska, Alegent Health mental health professionals have been called upon for help.

A good night's sleep is also important, but that can be elusive during the third trimester when you're uncomfortable and ready to give birth. At this time, it's especially important to practice good sleep hygiene: Turn off the TV and don't use the computer within two hours of bedtime; if you've had a normal pregnancy and there is good fetal movement, your doctor may allow the use of a mild medication to help you sleep.

To find a doctor who is right for you, visit Alegent.com/doctors or call 1-800-ALEGENT.


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Reader Comments
Posted: Apr 20 2011 8:49 AM CST by Rebecca

You may find that the resources you come across (even the ones listed in this article) are often biased. For example, it is important to tour the hospital where you plan to give birth in order to learn about routine cares and hospital policies. However, you should then consider a childbirth education class NOT affiliated to the hospital which might expose you to information you would otherwise never hear.
I would also like to note that not all prenatal care providers are physicians (yet another example of the biased information you may be recieving if you rely on only one source).




Posted: Apr 20 2011 9:02 AM CST by Joseph

When discussing which sources to trust, I agree that there is a great deal of information that may not be helpful. That being said, ACOG is not always the best source for accurate information, specifically around women's choices related to the birth process. AGOG's official position is that home births result in a twofold to threefold risk of infant mortality as compared to hospital births. The problem is that by ACOG's own admission gathering actual scientific data to support this claim has not been successful (Obstetrics and Gynocology; Volume 117, No 2, Part 1, Feb 2011, pg 425). ACOG's opinion on the safety of home birth is not directly based on scientific data. This should be taken into account when considering the wishes of the mother and family, especially when evaluating the information ACOG provides about the safety of alternatives to hospital births.




Posted: Apr 20 2011 2:55 PM CST by Katrina Moerles

Rebecca: Thank you for your response. I wrote this story and, yes, it's important to consult a number of credible sources to make informed health care decisions. Expectant parents, or those planning to become pregnant, have choices and should consider them carefully. What kind of birth experience do you want? Should you choose an OB/GYN, a family medicine physician who delivers babies, a certified nurse midwife (Alegent Health has one at Mercy Hospital in Council Bluffs) or even a doula (a labor coach who may be certified as a childbirth assistant). The key is to find people and resources that YOU trust to guide you through a healthy pregnancy and birth. -Katrina Moerles, Alegent Health




Posted: Apr 27 2011 12:11 PM CST by Erin Talaska, M.D.

Based on Joseph’s comments, I would like to add more consumer-friendly sources with reliable information: "What to Expect When You’re Expecting" or “What to Expect Before You’re Expecting” both by Heidi Murkoff and Sharon Mazel; and “The Mayo Clinic Guide to a Healthy Pregnancy” by Mayo Clinic, Roger W. Harms, et al.

Women who want a home birth should be aware of Nebraska and Iowa regulations. The state of Nebraska prohibits certified nurse midwives (CNMs) from attending home births (Neb. Rev. Stat. Sec. 38-613 (3) (b), and unlicensed people may perform the CNM functions in limited circumstances, like an emergency. (Neb. Rev. Stat. Sec. 38-612.) However, there are no regulations restricting a home birth if a physician is present.

Alegent Health does not have any physicians that attend home deliveries, and I’ve not heard of any other physicians in the area that do so, either. The state of Iowa has no legal prohibitions on CNMs or certified professional midwives (CPMs) assisting with home births.




Posted: Jul 18 2011 2:13 PM CST by Lindsey

Hi,

I'm just curious Dr. Talaska, do you know of any plans to involve midwives in the birthing process at Bergan in the future? Other hospitals in the area have midwives as options but I cannot seem to find any Alegent hospitals in Omaha that do. Oh, and also what is your take on your patients using doulas?




Posted: Aug 1 2011 6:41 AM CST by Erin Talaska, M.D.

Thank you for your questions. While the role of midwives has been discussed, as are many options regarding patient care, there are no current plans to involve midwives in patient care at Bergan Mercy.

As far as doulas go, I have no problems involving a doula with a patient's labor process, as long as both the patient and the doula have an open mind about possible interventions and necessary procedures throughout the labor and delivery process. I also ask that my patients discuss their birth plans with me, and we usually go over these around the 36 week visit.




Posted: Sep 26 2011 10:32 PM CST by Becky

I agree that the "Mayo Clinic Guide to a Healthy Pregnancy" provides a wealth of information. However, there are much better choices that expectant parents can read than "What to Expect When You're Expecting," which many find to be very fear-based or at least patronizing. As a former childbirth educator, I highly recommend Dr. Sears' Pregnancy, Birth and Breastfeeding books.




Posted: Jul 16 2012 10:21 PM CST by Ranie

I am curious about your thoughts on natural childbirth and the over use of medical intervention. Say your patient was striving to deliver naturally and did not want any pain medications, pitocin, and wanted to avoid a C-Section if at all possible. Would you allow a longer labor and be supportive?




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