FAQ

There is a bacteria that may be present in deli meats and unpasteurized, soft cheeses (brie, feta, blue cheese, queso blanco, etc.) that may infect pregnant women. Although it is very rare, it can be very serious. Therefore, it is recommended that pregnant women avoid deli meats (unless they are heated thoroughly) and unpasteurized cheeses. In addition, all meats and fish should be cooked all the way through. We recommend against any undercooked or rare steak, burgers, fish, or sushi. Fish is safe and recommended 2-3 times a week. Please avoid high mercury containing fish, such as shark, swordfish, tilefish, mackerel, or kingfish.

As long as you are having an uncomplicated pregnancy and if you have been active prior to pregnancy, we recommend that you continue moderate activity during pregnancy. This includes 30 minutes or more of exercise on most, if not all, days during the week. Activities to be avoided are any with a risk of falling or abdominal trauma, or where you are flat on your back. In addition, scuba diving is not recommended during pregnancy. There are no absolute heart rate parameters for exercise, although you should not exercise to the point of exhaustion. In addition, you should stop exercising if you have vaginal bleeding, extreme shortness of breath, headache, chest pain, muscle weakness, contractions, decreased fetal movement, or leakage of fluid from the vagina.

Pregnancy related physiologic changes may persist 4-6 weeks post-partum. Therefore, women should gradually resume pre-pregnancy exercise routines. Please refrain from vigorous exercise until you are cleared at your six week postpartum visit.

It has not been studied whether hair dye is absorbed into the bloodstream and may affect a developing fetus. Therefore, to err on the side of caution, we recommend that you wait until the 2^nd trimester (13 weeks or beyond) to dye or highlight your hair.

VACCINES

The influenza vaccine is recommended for all women who will be pregnant through the flu season (September-April annually). It is safe in any trimester of pregnancy. Pregnant women are more likely to contract the flu and/or develop a complication of the flu than non-pregnant adults. Furthermore, many babies are born during the flu season and cannot receive a flu vaccine until they are six months of age. They may receive some benefit from antibodies passed through the placenta and breast milk of mothers who have gotten the flu vaccine. We typically offer the flu vaccine between September and February. There are decades of safety data on flu vaccines in pregnant women.

Covid vaccination is recommended for pregnant women for the same rationale as above. Covid infection in pregnancy may cause more severe illness than in nonpregnant individuals. Other risk factors for severe illness include medical conditions such as obesity, diabetes, high blood pressure, and lung disease. Furthermore, it is a risk factor for poor placental function, preeclampsia, blood clots, preterm labor, and stillbirth. Overall, the risk for pregnant women to develop severe illness or death is rare, however ACOG recommends the Covid vaccine and/or current booster to all women who are pregnant, breastfeeding, or planning pregnancy. To date, there is no evidence of birth defects or complications to babies whose mothers receive the Covid vaccine. In fact, babies whose mothers received the Covid vaccine at least 3 weeks prior to birth are universally found to have circulating antibodies to protect them from infection.

RSV, or Respiratory syncytial virus, is the leading cause of hospitalization among US infants. In August 2023, the FDA approved Abrysvo for pregnant women who will be delivering during RSV season, between September and January. The vaccine is recommended between 32-36 weeks of pregnancy. It is not recommended prior to 32 weeks due to the risk of preterm labor, and not after 36 weeks as it likely will not result in sufficient antibody production in the mother. For those mothers who are not able to receive the vaccine prior to 36 weeks, their babies may receive Nirsevimab, an RSV antibody. It should be noted that the availability of the RSV antibodies for babies cannot be guaranteed and may be prioritized for more high risk infants.

It has also been discovered that there is an increasing number of babies who are being infected with whooping cough. Most of these cases are due to adults who are infected and transmit the bacteria to their baby. We now know that adult immunity to whooping cough wears off, so we recommend that all adults in close contact with infants under 12 months of age receive the Tdap (Tetanus, Diphtheria, and pertussis) booster shot. Pregnant mothers are advised by the CDC to get the TDAP vaccine in each pregnancy, anytime after 27 weeks regardless of their vaccination history. It is not harmful to have the vaccine within 5-10 years of the previous vaccine, and the baby will get some antibody transfer through the placenta prior to birth. We routinely administer this vaccine at the time of the 28 week visit.

If your pregnancy is healthy and uncomplicated, you may work until the onset of labor. If complications develop and we recommend that you stop working, please contact Jeanne (Bethesda office) or Tessa (Rockville office) to assist you in filling out paperwork.

Episiotomy is no longer considered a routine practice during delivery. However, there are certain circumstances in which episiotomy may be considered necessary. These may include situations in which delivery needs to be expedited or facilitating an operative (vacuum or forceps) delivery. We do our best to avoid making an episiotomy routinely.

We support and encourage VBAC in the appropriate candidate (one previous low transverse Cesarean section). Both Repeat Cesarean section and VBAC have risks. It is important to weigh the risks for each individual woman and make an informed decision. Please feel free to discuss this in more detail with your doctor.

We do our best to support natural and alternative birthing techniques, assuming that labor is progressing normally and without any complications. If you have specific concerns, please address them with your doctor.

Ultimately, our birth plan for you is a healthy outcome for you and your baby. If you have specific preferences or wishes for labor and delivery, please bring them to the attention of your doctor so we can discuss them.

As long as you are admitted in labor or undergoing induction of labor, you may get an epidural anytime. Studies do not show that getting an epidural slows down labor or increases the risk of Cesarean section.

Operative delivery, via vacuum or forceps, is performed occasionally, in the appropriate setting. These may include a prolonged second stage (the “pushing” stage), suspicion of potential compromise of the baby, or to shorten the second stage for the mother’s benefit. Each method has some inherent, minimal risk. Both methods are endorsed by the American College of Obstetrics and Gynecology. Please feel free to address specific concerns with your doctor.