Nausea Beyond the First Trimester

Nausea in the first trimester is pretty common. You may have even noticed that morning sickness is everyone’s favorite/not favorite topic during your early pregnancy. Strangers want to know how often you’re throwing up. Your mother may fuss over you and entertain you with her own long-ago stories of what she ate and what she couldn’t stomach looking at. Your partner might approach you with fear and anxiety at every meal time, hoping for a green light to discuss food selections. Accompanying every interaction is likely to be a reassuring “At least it’s almost over! A few more weeks and you’ll feel much better!”

Why isn’t this nausea going away??

For most of you with morning sickness, you will indeed find that it resolves as you enter the second trimester. But for an unlucky few, nausea may continue for the duration of the pregnancy, or in a more likely scenario will fade for months and return in the third trimester. Usually the reappearance of nausea is benign and does not signal a cause for concern, although discussing your symptoms with your healthcare provider is always recommended, especially as late nausea may be a sign of preeclampsia. Assuming that you’ve had a patient/provider conversation about your symptoms, let’s discuss some reasons for the late-term nausea and some coping techniques.

Third trimester nausea: Cameron’s story

Cameron is one of the unlucky ones. A mother of three, she had routine first trimester morning sickness with all three pregnancies, which faded away with the first two babies by 16 weeks. With the third pregnancy, however, she had some memorable bouts with nausea in the last 5 weeks before delivery.

“I was so tired all the time, with two young children at home and a traveling husband. I wasn’t taking time to eat well or to sit and put my feet up, so I shouldn’t have been surprised one morning when I had to bolt for the front door and throw up in the bushes.” Her next unexpected attack was the following week, at Christmas at her mother’s house. With so much going on and a crowded house full of relatives, she and her husband were sharing a bathroom. “He farted in there, and the whole house heard me throw up. Funny in hindsight, but it wasn’t pretty at the time!”

Cameron said she frequently felt queasy during those weeks, and struggled to find enough to eat to fuel her body and combat the fatigue that built every afternoon. In her 36th week she caught a stomach virus and ended up in the ER for IV fluids and anti-nausea medication, after 3 days of being unable to keep anything down. Her baby was born healthy at 38 weeks after an induction for hypertension, and the nausea disappeared.

So what can you do if you find yourself in Cameron’s shoes?

(Please note that what we are discussing here is typical morning sickness, and not the more serious hyperemesis gravidarum. If you suspect you have HG we recommend contacting your provider immediately to receive care for this severe form of nausea and weight loss.) 

Identifying causes may be helpful so that you can target your treatment, but if it’s the common issue of hormones and the growing baby, there’s not much you can do other than try coping techniques. Think about what you’re taking in:

  • Are there spicy or greasy foods causing heartburn?
  • Is your prenatal vitamin triggering stomach upset?
  • Are you staying well hydrated?
  • Do you eat small, frequent meals, or carry snacks with you?
  • Can you try ginger tea, or suck on a peppermint candy?
  • Above all, finding some time to rest is likely to help you cope with the nausea, and is also an essential component of preparing yourself for labor. Who can you call on to help you disconnect and focus on self-care for a while every day?

This Healthline article provides some more helpful suggestions, and discusses the link between nausea and labor: When Morning Sickness Doesn’t Go Away: Third Trimester Nausea (healthline.com) Your doula can also be an excellent source of information and support, so reach out! And hang in there, because relief is in sight!

3 Tips for a Healthy Third Trimester

The third trimester is between 28 and 42 weeks of pregnancy, and the final weeks before delivery. While your baby is growing and getting ready for their birth day, you might be experiencing more discomforts. With difficulty sleeping, feeling full after a few bites, heartburn, and frequent urination, how do you have a healthy third trimester? Here are some tips for keeping you and your baby healthy as delivery day approaches. 

Continue eating a healthy and balanced diet–and getting your vitamins and minerals.

During the third trimester, the Office of Disease Prevention and Health Promotion notes that pregnant people may need to consume 450 more calories than their normal diet. They recommend that this come in the form of vegetables, whole grains, and proteins–not sugars and fats. As your baby gets bigger, they may start to compress your stomach, and you can feel full after eating only a little bit. Consider high-protein snacks in between meals if you are having trouble eating what you normally might at a meal. 

You may have been taking a prenatal vitamin, and you can continue that into the third trimester. You want to keep getting proper amounts of folate, iron, and calcium. Check with your care provider about what your diet and calorie consumption should look like during a healthy third trimester. 

Stay physically active for a healthy third trimester. 

The National Institutes of Health recommend that people try to be as physically active during pregnancy as they were before. With the physical changes that your body is going through as you prepare for labor (link to blog), you may find the exercise harder or more uncomfortable. However, studies show that exercise can help reduce bloating, leg cramps, and backaches, and reduce other conditions like gestational diabetes, preeclampsia, and postpartum depression. Consider moderate exercise, like a walk around the neighborhood, a water aerobics class, or a prenatal yoga class. 

Listen to your body and your body’s signals.

By the end of your pregnancy, you may feel bloated, with pains in your belly and back, among other places, and tired from a lack of sleep. You might be uncomfortable, but your body is preparing for birth. While it might be hard to imagine getting comfortable before baby is born, you can try a number of things to relieve the aches. A warm bath or shower can help you relax, and relax your muscles. Pregnancy pillows or other support pillows can make sitting or sleeping more comfortable. Wear loose fitting clothes and don’t be afraid to fan yourself if you are hot! 

Learn more about what to expect during a healthy third trimester in our four week Complete Childbirth Education class or our intensive, one-day Birth Basics. 

Tips for Traveling While Pregnant or With Baby This Holiday Season

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Are you planning on traveling this holiday season? For many of us, this feels like the first, best opportunity to see loved ones after almost two years of the coronavirus pandemic and lockdowns. Here are some tips for flying or taking car rides while pregnant and with your newborn. 

No matter where you are traveling, consider getting vaccinated for COVID-19 if you are not already. USA Today recently reported that only 18% of pregnant people in the United States are vaccinated against COVID-19. The Centers for Disease Control, American College of Obstetricians and Gynecologists (ACOG), and World Health Organization all recommend the COVID vaccine even during pregnancy. The benefits of the vaccine far outweigh the risks. 

Flying During Pregnancy

The American College of Obstetricians and Gynecologists (ACOG) write that during healthy pregnancies, “occasional air travel is almost always safe.” Most domestic airlines allow pregnant people to fly until about 36 weeks of pregnancy, but international airlines may have different cut-offs. You should always consult with your healthcare provider and the airline before booking any travel. 

If you do choose to fly while pregnant this holiday season, you can do a number of things to make the flight more comfortable. First, book and aisle seat if possible. This way, you can get up and walk around more easily. Sitting for more than four hours increases your risk of deep vein thrombosis (DVT), a blood clot that forms in your leg and can cause pulmonary embolism (when the blood clot gets stuck in your lung). Even when you are sitting, you can move your feet, toes, and legs to keep up circulation. 

You should also wear the seatbelt low across your hips, below the belly and avoid carbonated drinks. All domestic flights currently require masks during travel, and you should consider wearing an N95 or surgical mask, which offer the most protection against airborne pathogens like coronavirus. To stay hydrated, drink water. 

Taking Long Car Rides During Pregnancy 

Like flying, taking long car rides during pregnancy might feel uncomfortable. Wear loose-fitting clothing and layers that can be taken off or put on. You should also be drinking water and eating regular meals. Usually when we drive we want to get there as soon as possible, but remember to stop to use the bathroom and stretch your legs. Sitting in the car for extended amounts of time increases the risk of DVT and can just be uncomfortable. 

Even though a few hours-long car ride might not seem as noteworthy as flying somewhere, remember to speak to your care providers about where and how you are traveling. They may want to offer additional advice to keep you and baby safe. 

Flying with Newborn Baby

You should speak with your baby’s care provider before deciding to go on a flight. As uncomfortable as flying can be for us, it can be especially bad for newborns. Because their immune systems are still developing and planes are by nature crowded spaces, babies might be more susceptible to picking up a virus during a flight. 

The cabin pressure changes may also hurt baby’s ears. If you are traveling, let baby suck on something during takeoff and landing. And while we don’t always notice how loud a plane is, the engines and air circulation can be very loud for a baby’s new ears. Consider noise-cancelling headphones to protect their hearing. 

The level of oxygen inside an aircraft is also lower, and while this might be fine for some babies, talk to your doctor about any of baby’s heart or lung issues. 

And, although baby is allowed to be in your lap during the flight, best practice would be to purchase a seat for baby and to properly install their infant car seat (double checking for FAA approval). This gives you the mobility to get up and move around as well as a familiar place for baby to sleep. It also is by far, the safest way for baby to fly. 

Finally, make sure that you have everything your baby might need during the flight in an easily-accessible carry-on bag. 

Car Rides With a Newborn 

First, make sure that your car seat is properly installed [link to blog]. Like flying, you should also have everything baby needs in an easily-accessible bag. You or your partner may want to sit in the back seat with baby.

Before you leave, consider when and where you’ll be making stops along the way. Think about when your baby usually eats and where the best place to stop might be. Because of COVID, you may want to stop at a rest stop or picnic area rather than a restaurant. 

Am I actually going into labor?

Although the conventional knowledge is that people are pregnant for nine months (which would be 36 weeks), most babies are actually born between 38 and 42 weeks. This means that you can think of a “due month” rather than a specific date. In fact, less than 5% of babies are born on their due date. But this date range can present a problem: how do you know if you are actually going into labor? Here are four ways to know if you are going into labor. 

You experience certain physical and emotional changes. 

There are specific physical and emotional changes we hear from clients that make your doula double check her birth bag and put her running shoes by the door! A change in emotions and becoming more sensitive, bursts of nesting energy, new or unusual cravings can signal your body is getting ready for labor. You may also have physical changes. These include feeling “crampy” or having backaches, increased vaginal discharge, loss of mucus plug (especially blood-tinged mucus), and softer, more frequent bowel movements. Be in tune with your body and emotions, and communicate those changes with your care providers as you get closer to your due month.  

You’re having uterine contractions. 

Uterine contractions are the first sign of going into labor for most people. But how do you know the difference between uterine contractions and Braxton Hicks or false labor contractions? Uterine contractions are regular and consistent; they get steadily closer, stronger, longer and do not lessen with rest, movement, eating or drinking. You may have contractions before you are in labor. But if they are not causing your cervix to change, you are not in labor. See our blog post on latent labor for more on those contractions.

Your water breaks. 

It always happens in movies: water spills on the floor and the character knows their baby is coming. In real life, only occasionally does your water break ahead of contractions. For the vast majority of people, contractions will follow within 12-24 hours. 

Your cervix is not a crystal ball and it can’t tell you if labor is imminent.

Pre-labor cervical exams are not necessarily an indication of when labor will begin. There are a number of cervical changes that have to take place ahead of dilation, the number measured in centimeters that we all associate with labor. Your cervix will shift forward to align with the birth canal, soften or ripen, thin (or efface) and THEN finally dilate. These changes may be evaluated by your care provider during a cervical exam once you head to the hospital in order to determine if you are in labor. 

To learn more about childbirth and the stages of labor, sign up for our Complete Childbirth Education class or Birth Basics. 

5 Things You Should Know About Pregnancy and the COVID Vaccines

If you are pregnant right now or trying to become pregnant, you might be asking yourself, “Should I get a COVID-19 vaccine?” or “Should I get a booster?” Pregnant women are often excluded from drug and clinical trials because the potential risk is often too high, and this was this case with the COVID vaccine trials. According to an article published last year in the New York Times, “Scientists have accumulated a small but steadily growing body of evidence that the vaccines are safe and effective during pregnancy.” Boosters  At Doulas of Baltimore, we encourage you to make decisions regarding your pregnancy and birth that make you feel comfortable and are grounded in the best information available. Here are 5 things you should know about pregnancy and the COVID vaccines (as of January 2022). 

Pregnant women have an increased risk of severe disease after a COVID-19 infection. 

In a study conducted in 2020, Centers for Disease Control (CDC) researchers analyzed data on 1.3 million women ages 15-44 who were diagnosed with SARS-CoV-2, the virus that causes COVID-19. They found that, “pregnant women were at increased risk for severe COVID-19–associated illness.” Pregnant women were more likely to be admitted to the ICU and receive invasive ventilation. Although they are not sure why this is, they speculate it could be because your body is working harder when you are pregnant– including “increased heart rate and oxygen consumption, decreased lung capacity, a shift away from cell-mediated immunity.” Another study found that pregnant women who contracted COVID were at an increased risk for preterm birth. 

A COVID vaccine booster is safe for pregnant people.

If you received your first two shots of the vaccine before you were pregnant, you may now be wondering if you should be get a booster shot. Doctors are now recommending that people who are pregnant get the booster or third shot of a vaccine if they are eligible. Because pregnant people have an increased risk of severe disease if they get COVID, it is important to keep yourself as protected as possible. Dr. Brian Brimmage of the University of North Carolina health system says that,“Obviously, a pregnant woman getting seriously ill with COVID is dangerous for her and her baby.”

A recent study shows the Pfizer and Moderna vaccines produce an immune response in pregnant and lactating women. 

Although pregnant women had this higher risk of severe disease, they were not included in any of the clinical trials for vaccines conducted last year. However, when the vaccine rollout started, some of the healthcare workers who received the vaccine were unknowingly pregnant at the time. Researchers could then track and monitor those women, and additional studies began specifically enrolling pregnant women. 

The CDC now writes that you can receive the COVID-19 vaccine if you are pregnant. In a study of 103 women, researchers found that the Pfizer and Moderna vaccines gave women an immune response (meaning the vaccine did what it was supposed to) and antibodies to COVID-19 were present in breast milk and cord blood. 

When administered during pregnancy, the Pfizer and Moderna vaccines do not damage the placenta. 

An early conspiracy theory regarding the COVID vaccines and pregnancy involved the idea that it might damage the placenta. A study just published in Obstetrics and Gynecology found that COVID “vaccination was not associated with placental histopathologic lesions,” meaning it did not damage the placenta. 

STAT news now reports that, “Three of the leading professional organizations focused on pregnancy and fertility — the American Society for Reproductive Medicine, the American College of Obstetricians and Gynecologists, and the Society for Maternal Fetal Medicine — all recommend that pregnant people get vaccinated, as well as those considering pregnancy.”

Protect yourself against COVID-19. 

If you don’t want to get the vaccine right now, the CDC recommends taking steps to reduce your risk of contracting COVID. This includes all the key recommendations from the last year: wearing a mask, avoiding crowds, not spending time indoors with poor ventilation, washing your hands, and keeping physical distance. 

At Doulas of Baltimore, we support the decisions that you make during pregnancy, without judgement. This blog post is not intended as medical advice, but provides some information about the latest research and commentary from the government and professional organizations regarding the efficacy and safety of COVID vaccines on pregnant women. As with all of your pregnancy and birth decisions, you should consult with your doctor before making any decisions about receiving a COVID-19 vaccine.