My Doctor Online The Permanente Medical Group

Exercise and Pregnancy

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We encourage you to exercise during your entire pregnancy, as long as you choose exercises that are safe for you and your baby. We can tell you more about which exercises to choose and which to avoid while you are pregnant. It's a good idea to have a conversation with us if you're planning on participating in any sports.

• If you haven't exercised before, start slowly. Some activities are safer for pregnant women than others: try bicycling, swimming, jogging, golf, racquet sports, low-impact aerobics, brisk walking, or yoga. Special exercises to prepare for birth can help you feel more comfortable during pregnancy and help your body prepare for labor.
• Exercise regularly and safely. If you exercise at least 30 minutes per day on most days, you'll feel more fit, control your weight gain, sleep better, and have less constipation and water retention.
• Wear loose-fitting clothing, the right shoes, and enough support for your breasts.
• Drink water before and after exercise.
• Avoid deep-bending motions and vigorous stretches.
• Warm up for 10 minutes before exercising and cool down for 5 minutes afterwards.
• Stop exercising if you experience vaginal bleeding, pain, cramps, dizziness, or headaches.
• Shorten your routine. If you're choosing any high-intensity exercises (where you're breathing hard and your heart rate is increased), be sure you do them for only about 10 to 15 minutes at most. Moderate activity (where your heart rate is slightly elevated, but you can still comfortably hold a conversation) should last for 20 to 30 minutes.
• Avoid low blood sugar levels by not exceeding 45 minutes of total exercise in a single session.
• Don't exercise too vigorously! Take your pulse by placing your index and middle fingers on the inside of your wrist. To find how many times your heart beats in a minute, count the number of beats for 10 seconds and multiply by 6. Your pulse should not go above 140 beats per minute. The baby's birth weight may be low if a woman exercises at a high intensity throughout her pregnancy.
• Avoid high-risk sports. Some sports, such as scuba diving, are dangerous, and we recommend not doing them during pregnancy. Other sports should be avoided because of the risk of falls. These include downhill skiing, horseback riding, gymnastics, water skiing, and ice-skating. Sports such as volleyball, softball, hockey, and soccer become more dangerous in the last trimester and should be discontinued.
• Use light weights (2 to 8 pounds) to tone your muscles. If you are careful to prevent joint and ligament injury, using light free weights is a good choice. Don't use heavy resistance on weight machines and avoid heavy free weights.
• After week 16, don't exercise on your back for longer than 3 minutes. The weight of the uterus can press on a large blood vessel (vena cava) and decrease blood flow to your brain and to the uterus.

Healthy Diet and Weight Gain

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Tips for a healthy diet:

• Eat well-balanced meals with a variety of foods. The daily food guide can help you choose the nutritious food you and you baby need while you're pregnant.
• Avoid fast foods with high fat and calories. Choose broiled chicken and salad instead of hamburgers and fries.
• Keep healthy snacks available to eat during the day.
• Read labels so that you know what you're eating.
• Drink water. We recommend 8 to 10 eight-ounce glasses of fluid every day, including water, milk, and soup.
• Limit or omit coffee, tea, sodas, and other caffeinated drinks (like colas).

Weight Gain

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The recommended amount of weight gain for a woman with a normal weight is about 25 to 35 pounds. However, the recommended amount of weight gain varies depending upon your weight and body mass index (BMI) before you became pregnant. BMI helps to determine if your weight is appropriate according to your height.

Try to follow these guidelines for weight gain:

• If you began your pregnancy at a normal weight, you should gain about 25 to 35 pounds.
• If you began your pregnancy underweight, you'll need to gain more weight (about 28 to 40 pounds).
• If you began your pregnancy overweight, you may not need to gain as much weight (about 15 to 25 pounds).
• If you're obese, you need to gain less weight throughout your whole pregnancy (11 to 20 pounds).
• If you are having twins, we may refer you to a dietitian who can advise you on your ideal weight gain.

Remember, these are general guidelines for weight gain that do not always apply to individuals. Medical studies show that weight gain anywhere from 20 pounds to 50 pounds for the pregnancy can be normal and not pose any risks to the baby.

Too much weight gain

Women who gain too much weight during pregnancy are at increased risk of having a premature baby or a larger than average baby. Babies who are larger than average at the time of birth are at higher risk for a variety of health problems, including being overweight. Women who gain too much may also have health problems such as diabetes and high blood pressure, which can cause complications. What to do:

• Cut down on fats like butter, margarine, oil, gravy, mayonnaise, salad dressing, sour cream, and sauces.
• Choose lean meats, chicken or turkey (without the skin), and fish.
• Drink nonfat or 1 percent milk. Eat nonfat or low-fat yogurt and low-fat cheeses.
• Avoid or limit fried foods and foods from fast-food restaurants.  
• Snack on fresh fruit, raw vegetables, or popcorn (without butter) instead of chips and candy.
• For dessert, try fresh fruits, sherbet, or fruit ices instead of ice cream, cakes, or pastries.
• Replace any juice or soda you're drinking with water.
• Walk every day unless your practitioner tells you to rest more.

Don't diet!

Your weight gain is very important to your baby's normal growth and development. If you don't eat enough of the right foods, your baby can be deprived of important nutrients.

• Don't try to lose weight while you're pregnant. Wait until after you finish breastfeeding your baby before trying to lose weight.
• Follow our daily food guide and check off what you eat every day.
• Eat the recommended servings of healthy foods each day. Don't skip meals; your baby needs regular meals at regular times to grow properly.
• Check with your doctor if you have any questions or worries about the amount of weight you're gaining.

Sexuality and Pregnancy

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Changes in desire

Your sexual desire may change during pregnancy. As your feelings change, talking with your partner is important. Your pregnancy can also affect your partner's feelings.

Pregnancy can be a time to find new ways to enjoy making love. You can explore new positions if intercourse becomes uncomfortable in late pregnancy. You may be more comfortable in a side-by-side position or with the woman on top. You may have a slight, bloody vaginal discharge or have mild contractions after making love. This is normal as long as the contractions or the discharge don't continue for more than 1 hour. Give us a call if you experience persistent contractions or discharge.

Is it safe?

Most couples can enjoy a sexual relationship throughout pregnancy. Talk with us if you have concerns about safety. Sexual activity may be risky if:

• You're at high risk for preterm labor.
• Your placenta is over your cervix (placenta previa).

If this is true for you, we can discuss your options.

Use protection if you need it

Though you do not have to worry about preventing pregnancy, you still should use condoms if you are at risk of contracting a sexually transmitted disease (STD). It is particularly important now, since some types of STDs can be passed to your baby.

Sex after giving birth

After you give birth, we recommend you wait before resuming sexual activity. As a general rule, we recommend waiting:

• 6 weeks if you gave birth vaginally.
• 8 to 10 weeks if you give birth by C-section.

Every woman's recovery after birth is a bit different. We can discuss how ready you are to resume having sex at your postpartum visits.

Work and Travel During Pregnancy

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The decision to work as your pregnancy progresses is an individual one. We can discuss any special concerns you might have. If you do continue working, here are some tips that may help:

• Take frequent breaks.
• Change positions often. If you've been sitting for a long time, stand up and walk around. If you've been standing a lot, sit down with your feet up.
• Keep one foot on a low stool with your knee bent to take the pressure off your lower back when standing for a long time.
• Cut down on other activities if your job is strenuous. Try to stop working when you're tired.
• Avoid dangerous fumes, chemicals, and extreme temperatures.
• Stay away from tobacco smoke.
• Empty your bladder at least every 2 hours.
• If possible, try to rest during your lunch hour.
• Bring your water bottles and healthy foods, so you can have good nutrition throughout the day.

Traveling During Pregnancy

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For most women without any medical complications, it is safe to travel during the first and second trimesters. During mid-pregnancy, you may feel the best, have the most energy, and may be able to enjoy a vacation with your partner that is free of strollers, diapers, and baby food.

Important things to know before you consider traveling:

• Most airlines don't let you fly after you are more than 36 weeks pregnant, or they require a letter giving medical clearance.
• Most cruise ships don't let you board after 24 weeks. Check with the cruise line before booking your ticket.
• Don't fly in a small, non-pressurized airplane because this can reduce the oxygen supply to your baby.
• Non-Kaiser Permanente hospitals won't have your medical history or medical records readily available. Take copies with you.

Stay safe when you travel

There are several things you can do that will ensure that your trip is safe:

• Tell us where and when you plan to travel.
• Plan to relax. Remember that the demands of the growing baby will cause you to fatigue more easily than usual. If you're sightseeing, rest frequently. Don't join any tour groups that make you adhere to a rigorous schedule.
• Avoid traveling to high altitudes. There's less oxygen at higher altitudes, and it might make you feel sick or tired.
• Stop frequently to urinate whenever you feel the urge. This will help you avoid bladder infections. Drinking enough liquids will also help.
• Stop at least every 2 hours to stretch when traveling by car. If you're traveling by plane or train, be sure to get up and move around frequently to improve your circulation.
• Eat small, frequent, healthy meals to avoid low blood sugar, indigestion, or constipation. Choose foods wisely to make sure that your baby is getting the nutrition it needs. Carry snacks in case you have a long wait between meals and don't forget to bring your vitamins.
• Make sure drinking water and eating fresh fruits and vegetables are safe. Our travel nurse can help determine which countries have safe water, fruits, and vegetables.
• Remember to wear your seat belt! Even as your belly expands, you need to wear a seat belt to protect you and your baby. Use both the lap belt and the shoulder harness. Position the lap belt low, below the baby (not across your stomach or uterus).

What to Avoid When You're Pregnant

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Don't smoke

If you smoke, it's very important to stop now – for your health and your baby's. Women who smoke during pregnancy are more likely to:

• Have problems in pregnancy and childbirth.
• Give birth to premature and underdeveloped babies who have health problems after birth and throughout life.
• Have babies who are born underweight, which puts them at greater risk for being overweight later in life.
• Increase the baby's risk of sudden infant death syndrome (SIDS or crib death).
• Expose their babies to second-hand smoke. Children in smoking households have 4 times as many respiratory infections (lung, sinus, and ear infections) as those from nonsmoking households.

If you've quit smoking, it's important to stay smoke-free during pregnancy and after your baby is born. Not smoking will help your health and the health of your family. You've worked hard to stop smoking. Use your new skills to remain smoke-free:

• Encourage your partner or other family members to quit smoking with you. It's easier not to smoke when you're surrounded by other nonsmokers. Support each other in staying smoke-free.
• Talk with us or visit your local Health Education Center for help with quitting smoking or staying quit. Some facilities offer smoking cessation programs specifically for pregnant women.

Don't use alcohol and drugs

Drinking alcohol or using drugs during pregnancy is harmful to your baby. These drugs can cause your newborn to cry a lot or have problems eating, sleeping, or breathing. Later, the baby may have trouble learning. Alcohol and other drugs can cause more serious problems, like birth defects or brain damage. They can even cause you to have a miscarriage.

It can be challenging to stop using alcohol or other drugs. If you or someone in your family has a problem with drugs or alcohol, please let us know. We can help.

Find help if your partner has ever hurt, hit, or threatened you or made you afraid

Abuse is when someone attacks you with words, objects, or fists. Abuse usually happens when one person tries to control another person. If someone has hurt you before, it may happen again. Sometimes abuse starts when you become pregnant.

Abuse during pregnancy can cause health problems for you and your baby. Women who are abused while they are pregnant aren't as healthy and often have more anemia, infections, and bleeding. Babies born to abused women have a higher risk of low birth weight, premature birth, and death. Please talk to your doctor or nurse practitioner if anyone is hurting, threatening, or verbally abusing you.

• Contact the National Domestic Violence Hotline or call 800-799-7233
• Contact the National Sexual Assault Hotline or call 800-656-4673.

Avoid caffeine

Avoid caffeine or consider switching to decaffeinated beverages. Caffeine crosses through the placenta to the fetus and can affect fetal development. It can also cause an increased risk of miscarriage. However, if you want caffeine, try keeping it to less than 200 mg per day. This means 1 cup of coffee or 3 cups of tea. If possible, try alternative methods to perk up such as walking briskly around the block, stretching for 5 minutes, or drinking a glass of cold water.

Stay away from kitty litter

Cat feces can sometimes cause an infection called toxoplasmosis. If you become infected during pregnancy, it could harm your baby. To prevent this:

• Have someone else change the litter box. If you must do it, wear rubber gloves and wash your hands in warm soapy water right afterwards.
• Wear gloves while gardening, especially if there are cats in the neighborhood. If any cats visit your garden or sandbox, be careful not to touch the feces they may leave behind.

Don't use hot baths, hot tubs, saunas, tanning beds

We recommend that you avoid hot baths or using a hot tub, sauna, steam room, or tanning bed while you're pregnant. High temperatures may harm your developing baby. If you enjoy baths, please remember to:

• Keep the water warm, not hot. A warm bath can be a helpful way to relax.
• Be sure to use a rubber mat. The bathtub is an easy place to slip and fall because your center of gravity and your balance are changing when you're pregnant.

Skip manicures

Some studies show that some chemicals in nail polish can harm your developing baby. To be safe, we recommend you avoid nail polish and manicures during pregnancy. If you enjoy manicures:

• Choose a well-ventilated salon so you can avoid any harmful fumes.
• Bring your own instruments to the salon to decrease the chance of infection.
• Paint your own nails by a window or in another area with good air circulation.

Limit or avoid hair coloring

Most hair dyes contain harsh chemicals. Because of this, some women choose not to color their hair during pregnancy. While we don't have evidence that hair dye has caused harm to pregnant women, it can't hurt to be extra careful if you do color your hair:

• Choose a well-ventilated area. Good air circulation will decrease your exposure to the chemicals in your hair coloring product.
• Wear latex gloves if you're dyeing your hair yourself.
• Don't leave the dye in your hair longer than the instructions recommend.

Your Care with Me

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Please call our Appointment and Advice line right away if you’re experiencing:

• Pain or dizziness
• Vaginal bleeding
• A bladder infection (pain or blood with urination)

If you think you might be pregnant:

• You can stop by our lab for a pregnancy test. You don't need to make an appointment or bring any paperwork.
• You can buy a home pregnancy test kit in our pharmacy or at your neighborhood drugstore.

When you know you're pregnant, please call our Appointment and Advice line to schedule your first prenatal visit. If you have had a tubal (ectopic) pregnancy in the past, call us as soon as you know that you’re pregnant.

During routine prenatal appointments, I'll evaluate your health and the health of your fetus. My staff or I will invite you to register for our pregnancy-related classes and encourage you to take advantage of our online resources.

• Subscribe to our Healthy Beginnings newsletter. The newsletter is delivered to your e-mail inbox every week of your pregnancy, and it has information and answers to common questions as your pregnancy progresses.
• Consider your options for pain relief during childbirth. You have many options if you choose to have pain relief during your labor and delivery.

The following online Emmi programs may help you as you approach your due date:

• Prepare for your Childbirth
• Pain Relief for Childbirth
• C-Section
• Vaginal Birth After C-Section (VBAC)

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Contacting Me

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

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Convenient Resources for You

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As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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