Michal Finkelstein is a certified nurse-midwife and a registered nurse with 20 years experience, who runs a prenatal clinic for pregnant women in Geula. If you want to ask Michal Finkelstein a question, please click here (internal link to bottom of the page with question form).

 

Q. I just found out that I am pregnant. What should I be eating during the next 9 months?

- Sara

 

A. Good nutritional planning starts well before a woman becomes pregnant. Whether it is your first pregnancy or you have given birth before, you have to "get yourself in shape". We are not necessarily talking about exercise, we want to talk about your diet and supplementation. Folic acid at 400mcg should be taken at least 2 months before conception and for the first trimester to reap its protective benefits against birth defects as well as placental strengthening values. Any iron or B12 anemias should be corrected before conception and in between pregnancies, and watched during the pregnancy for signs of worsening.

I like to recommend Nettle tea (úä ñéøôã ) for providing abundant vitamins, minerals, and iron for women, especially in the first trimester when you don't have much of an appetite.

     Eating a varied diet of all the basic food groups is the most simplistic way to insure you are eating right. You can check on the internet on http://www.MyPyramid.gov for the exact recommended diet formula for a pregnant woman of your height and weight. A pregnancy weight gain of anywhere between 8-18kg. is average.

     Fluid intake should also be included when we mention diet, as what we drink can be a hidden source of unwanted calories. My rule is the 2/3 - 1/3 proportional intake law! Two-thirds water and one-thirds any other beverage. Recommended fluid intake in the summer is 3 liters, in the winter 2-21/2 liters.

 

          Q. I am 39 weeks pregnant with my first baby. I think I lost my mucous plug last night. When will I go into labor?

- Daniella

 

            A. One of the biggest questions that expectant couples (and grandparents) ask is, "When will labor begin"? Eighty percent of the time, a woman can expect to go into labor between her 39 and 41 weeks. Therefore, 10% of all women will give birth before the 39th week, and 10% will carry beyond the 41st week. There are no generalizations for first births or ninth births. Of course a first trimester ultrasound will make the accuracy of the due date more exact.

     The increased amount of mucous discharge seen when the cervix begins to efface and dilate signifies that birth is approaching. However it is important to know if a you were vaginally examined directly beforehand as that may have caused the plug to loosen when it may not have done so on its own. Therefore, if a you have not been examined within the past 24 hours, the excess mucous (with some bloody strands) most likely signifies that you will go into labor within four days at the latest.

     You don’t need to go to the hospital for this minor amount of bloody discharge as long as fetal movements are felt, and your waters have not broken. We consider bleeding to be problematic when the amount reaches that of the first day of a normal period.

 

            Q. My doctor says that my baby is measuring 4100 grams. Can I still give birth vaginally?

- Tamara

 

          A. Estimating the baby's size before delivery is a tricky "science". Actually science is more often wrong and the hands of an experience practitioner, doctor or midwife, are much more accurate. In fact, only the ultrasounds performed before week 12 (the end of the 1st trimester) are accurate for the fetus' size and gestational age, and thereafter ultrasounds are up to 20% inaccurate for fetal weight and age! So why risk performing a cesarean section just on one ultrasound opinion? Thank G-d most places don't, but since some still do, it is important to know there are other important facts to consider:

•  Get a second opinion
•  Normal /abnormal 50gm sugar test: If you didn't take a GTT (Glucose Tolerance Test), it isn't too late. The medical staff is nervous to let a woman who has an over 4kg baby with suspected diabetes deliver because of potential complications with the shoulders. With a normal blood test you can prove that you don't have diabetes and that it's only a healthy big baby (especially if you've delivered a big baby in the past).
• Try and keep the birth as natural as possible - stay upright, out of bed - standing, sitting, use a birth ball, and hire a doula.
• If the chief medical doctor on staff does not think the baby is larger that 4500kg, you will be allowed to attempt to delivery vaginally.

 

B'Sha'ah Tovah

               Michal Finkelstein RN CNM

 

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