Frequently asked questions

Pregnancy causes various physical changes, the majority of which being quite normal and presenting no risks for the mother or her child. Some brief advice may be beneficial for you to be able to deal with the conditions. As many questions have repeated over and over, below you will find the most frequent ones.

Is it possible to determine the exact day of conception?

Knowing the exact day of conception is a difficult thing, as conception occurs when there are sperms in the Fallopian (uterine) tube at the time of ovulation. Sperms can live in a woman’s body several days after intercourse, most commonly three days, but also longer, as described in various studies. That is, conception may occur even one week after the intercourse. And it may be also mentioned that ovulation varies as a result of different factors, and a good quality sex may induce an earlier ovulation.

What to do in case of morning sickness?

Morning sickness is a common symptom of pregnancy, present in three quarters of pregnant women, half of which suffer from vomiting, typically in the morning. The reasons are the hormones. The morning sickness is even presumed to be caused by the substances produced by the fetus through placenta cells, because excessive food consumption, especially sugar, may be harmful to fetus. The pregnant woman need not be concerned about a reduced intake of nutrients interfering with the fetal development, as her body has is a sufficient reserve of nutrients during the first weeks of pregnancy. Some dietary guidelines may help: enough liquids in small amounts (gulps), eating small portions more frequently, and avoiding heavy, fatty and spicy food. When you crave for special combination of tastes (sour and sweet foods), there is no need to object their consumption. Sometimes a change of the setting will help, such as a light breakfast while walking in the park.

Some pregnant woman find mint tea very soothing and relaxing as it calms the stomach. Similarly beneficial is ginger tea or a ginger soft drink. Some pharmacies sell ginger candies. From among prescription medication, rectal suppositories against vomiting are often prescribed, but then you should be careful, because in case of overdosing, nasty neurological symptoms may appear. Recently also medications neutralizing stomach acid is recommended to reduce heartburn and nausea safely in pregnancy. Morning sickness usually ends after the first three months of pregnancy.

What is the purpose of pregnancy diary book/journal?

It has a special function. It is a medical documentation from which healthcare providers draw information on the development of pregnancy. It is kept by the pregnant woman, although it may often be studied also by persons close to the pregnant woman. Therefore some women are reluctant to include any sensitive information in the journal (such as previous venereal diseases, abortions, etc.). The journal should contain all significant medical information and results of screening tests (both diagnostic and also confirmatory). The expectant mother should always have the pregnancy journal, created at the beginning of pregnancy, with her together with the rest of medical documentation. It may be very useful for the medical staff in cases of sudden complications.

In the first trimester I had lip herpes twice, and I read herpes may cause fetal damage.

Herpes simplex virus (HSV) affects more than one third of the world population, bringing about a wide scale of clinical manifestations from mild symptoms, through discomfort, to death. There are two HSV types – HSV1, most commonly causing oral herpes (herpes simplex labialis), and HSV2, the primary cause of genital herpes (herpes simplex genitalis).

Most cases of primary HSV l infections emerge by the age of five, passing without any symptoms.  Rarely, some non-specific symptoms, such as increased temperature, fatigue, muscle and joint pains may also occur.

Primary infection may appear at any age and may be transmitted by direct contact or through respiratory droplets (by saliva transmission when kissing, by physical contact). The incubation period is 2 – 7 days. The virus enters the body through minor skin injuries, mouth mucosa, and eye conjunctiva lesions.

HSV2 primary infection occurs in adolescence and adult age. It is associated with sexual intercourse. In childhood occurrence, sexual abuse should be considered. Primary infection is typical also for neonatal herpes simplex, occurring through infection after the rupture of amniotic sac when the infant passes through the birth canal in case of active maternal genital HSV2 infection. The primary infection is manifested on the genitals and their surroundings (herpes simplex genitalis), but due to various sexual practices, it can be also found in the mouth mucosa, and in the facial, conjunctival and rectal area.

Repeated HSV1 outbreaks are typically found on the face/lips while HSV2 outbreaks are commonly found in the genital area. They are manifested first by a burning and itching feeling in the area, where small blisters appear in one or two days, turning into scabs, and gradually disappearing. Herpes leaves no scars on the skin.

Repeated herpes simplex labialis is no obstacle for vaginal delivery.  During childbirth herpes may be covered by gauze dressing.

In case of genital herpes, due to possible infection of the baby, cesarean section is recommended. If you suffer from genital herpes, inform your gynecologist about it. In such case you should start using antivirus medication in the 36th week as prevention against new outbreaks, so that you could have a natural, vaginal childbirth.

Incidentally, I had an X-ray at the beginning of my pregnancy. What are the risks ?

X rays penetrate the body tissues and may affect some cell processes.  Therefore it is considered potentially harmful for fetal development, and x-ray screening is not recommended during pregnancy. However, radiation really dangerous for the fetus must be very high, but such radiation is not used in contemporary devices. Harmful impact of radiation on pregnant women during common tests has not been confirmed by any studies. So incidental x-ray of a woman not aware of her pregnancy does not require any special precautions, and this is clearly not a reason for termination of pregnancy.

I have been bitten by a dog prescribed me anti rabies shots. Is it safe for the baby?, I am 12 weeks pregnant, and my doctor 

Rabies is a serious, fatal disease transmitted to humans from infected animals.
Vaccination prevents the virus from travelling from the bitten area alongside the nerve fibers to the brain, not allowing the development of the disease. Quite naturally, though, clinical trials of vaccines in pregnant women have not been made. With regard to the risk of fatal rabies, pregnancy is not a counter-indication for starting a post-exposure treatment. So, if vaccination was recommended by an infectologist, do not hesitate to be vaccinated.

What are the suitable conditions of work and employment? 

It has been ascertained that there is a high risk of preterm labor in pregnant women doing night work, standing throughout the working hours or carrying heavy objects. That is why the employer should be notified of a woman’s pregnancy to be able to change her working conditions that will be sufficiently safe. However, fully sedentary jobs are not ideal, either. Incorrect sitting posture has negative impact on the hip spine, making worse the pains in the back; by sitting the whole day, blood flow in calves is impaired which may cause blood clotting. So in sedentary jobs, regular breaks, taking short walks or tip toe exercises may be quite helpful.  Thrombosis may be prevented also by sufficient hydration and water drinking regime. For those working while standing up the whole shifts (e.g. waitresses or hairdressers) adequate rest breaks must be provided. High risk employment in pregnancy also includes the work in pre-school establishments, because various common childhood illnesses may be dangerous for the fetus. In such cases it is important to take extra hygienic precautions and avoid contact with the children’s saliva (when kissing). For women who have never had chicken pox (varicella), vaccination prior to pregnancy may be used. The same applies to nurses in pediatric departments. And there are some jobs which are absolutely improper for pregnant women, such as working in highly contagious settings (departments of pathology, departments of infectious diseases, veterinary clinics). Currently, smoking is prohibited almost in every workplace, except for hospitality establishments, where the pregnant woman is entitled to demand transfer to a different workplace. Working with electronic equipments, such as monitors, laptops, data printers or copiers, is not dangerous, despite electromagnetic radiation.

What is healthy lifestyle and diet of pregnant woman? Is vegetarian diet appropriate during pregnancy?

Healthy living of a pregnant woman is essentially not different from the non-pregnant population. Some foods may be potentially risky for pregnant women, but these are not a typical part of our list of dishes/bill of fare. Undercooked meat should be specifically emphasized. A pregnant woman should avoid raw and undercooked meat as it may contain toxoplasma parasites and listeria bacteria, potentially dangerous for the fetus. Vegetables from the garden (especially root vegetables) must be carefully washed, as they may be contaminated by cat feces, toxoplasma, or listeria. Unpasteurized milk and milk products may also cause listeriosis, therefore they should be avoided.

Currently the views on nutrition in pregnancy are changing because of the growing number of obese young women who represent a high risk group from gynecological point of view. It has been found that excessive increase of weight in pregnancy (over15 kg) increases the risks of continuing overweight and obesity after delivery. Similarly also excessive intake of nutrients in pregnancy may affect switching on of genetic information in infants and may lead to future risks of obesity and diabetes. Although, so far unexplored, the impact of excessive use of vitamins in pregnancy  is potentially significant, because unnatural vitamin levels may affect switching on of some fetal DNA regions. Therefore, a varied and well-balanced diet providing adequate caloric intake is ideal. Grandma’s advice to pregnant women to eat for two, i.e. to eat double amounts, has been overcome.

Insufficient amount of nutrients may burn the proteins, the necessary building material of fetal development.

It is advisable to eat fresh cooked meals, to store unfinished meals in a cool place, and to heat them properly before consumption.

Vegetarian diet may be good for pregnant women only when meat is substituted by milk and dairy products. Complete avoidance of animal proteins may result in anemia, preterm birth and low weight of the baby.

I am concerned about my stay in hospital because I have a dietary regimen, I do not eat some kinds of meat or food, I suffer from histamine intolerance, I may eat only gluten free food.

Please draw attention to your specific eating habits or dietary regimen immediately after admission to hospital. The dietitian nurse will help you with a list of special meals. Otherwise you may have problems in choosing the food from the meals offered. 

Are sports activities allowed in pregnancy?

Adequate aerobic activity is required during pregnancy. In active women, the risks of pregnancy diabetes, high blood pressure or having a big baby (weighing over 4 kilos) are reduced. However, sports activities in which direct stomach or pelvis injuries are possible should be avoided. In some cases sports are not safe in some medical conditions, such as heart and blood vessels disorders, restricted pulmonary disorders, risks of preterm birth delivery, conditions after cervix stitch due to persisting bleeding in the second and third trimesters, placenta previa after 26 weeks (when the baby’s placenta partially or fully covers the opening in the mother’s cervix), amniotic fluid leaking, preeclampsia, high blood pressure and large amount of protein in urine, serious anemia, insufficiently controlled diabetes, expected low weight of the fetus, orthopedic disorders, etc.  

Biking is considered safe, but dangerous downhill rides are not recommended for possible risks of falling off of the bike with likely abdominal trauma. Swimming is advisable with preventive application of vaginal probiotics for mycosis risks when bathing in chlorinated pools. Contact or collision ball games (basketball, volleyball, handball) should be avoided for possible hits to pregnant uterus, prior to 12th week, however, uterus is completely protected by pelvic bones and there is no risk for uterine or fetal injury. The scope of physical activities should be reasonable, not leading to total exhaustion.  The pregnant woman must feel well after enjoyable activities.

Should a pregnant woman avoid contact with domestic animals?

Humans have a long history of living in close company with the animals, so their presence in our surroundings does not affect the progress of pregnancy. The only exceptions are cats and wild cats whose excrements may contain a dangerous parasite toxoplasma gondii. However the infection is not transmitted through the contact with the cat, only through the contact with the excrements. So there is no need to get rid of the pet, it is enough to have the cat’s litter box cared for by another family member. Other pets, such as dogs, bunnies, and cavies present no risks. Sanitary precautions are important, though. 

Should travelling by car or by plane be restricted during pregnancy?

For travelling by car while pregnant there are no restrictions, but seat belt should be worn with the horizontal strap placed below the stomach, and the diagonal strap placed between the breasts and the top of stomach. Do not switch off the airbags. During longer drives some breaks for short walks are advisable for better blood flow in your legs. Proper hydration is also important.

Flying is not considered unsafe today, as no increased risks for pregnant women have been found. Flying is safe until 36th week. During landing safety belt must be worn under the belly. Leg exercises, sufficient hydration and walking every hour are advisable.

However, travelling brings two special risks as the pregnant woman gets away from her physician and maternity hospital, and any possible complications will have to be dealt with in a local hospital. The standard of healthcare in some exotic countries may be inferior to that provided here. Some preventive measures (vaccination, medication) are not safe during pregnancy, therefore travelling destination should be carefully considered. 

Is sauna safe?

As a result of increased levels of thyroid hormones, some pregnant women do not tolerate heat easily.  Due to changes in blood circulation a pregnant woman may have a tendency to faint. So you should never be alone in the sauna (and this applies to the general population, as well). 

A friend of mine had ultrasound scans made every time she came for an antenatal consultation but I had only three ultrasound scans during the whole pregnancy. Why?

In principle any patient should undergo only the examinations the results of which might influence the process of decision-making. It has been found that more then 3 ultrasound scans have no positive impact on the results of pregnancy. Some physicians who have ultrasound equipment in their offices show the pregnant woman her baby’s heartbeats and the baby’s size at every appointment. It may be psychologically beneficial; but it has no impact on healthy fetal development or successful pregnancy.

I have suffered from mycosis for the second time during my pregnancy. Should also my partner be treated?

I have suffered from mycosis for the second time during my pregnancy. 

Vaginal fungal infection is quite a common complication in pregnancy, and increased hormone levels may help the excessive growth of yeast in the vagina. This vaginal inflammation is caused by the yeast present in the vagina, so treatment of the partner who has no symptoms is unnecessary. As a preventive measure, probiotics may be used for vaginal immunity. 

My blood pressure was 145/90 at the last prenatal examination. The doctor sent me to an internal specialist. Is there anything to worry about?

When blood pressure is raised in pregnancy, the doctor always raises a warning finger. This may occur in the second half of pregnancy due to various causes. It may either be the case of a preexisting hypertension discovered during pregnancy or of a complication directly related to pregnancy development. It is necessary to diagnose the serious condition, the so called preeclampsia, a placental disease with risks of complications for the child and also for the mother, requiring an induced labor. In cases of hypertension (high blood pressure) without preeclampsia, pregnancy prognosis is good. Preeclampsia must be treated by the obstetrician, as it is a placental disorder and not a maternal disease. It is important to monitor the baby’s conditions and the mother’s blood pressure; and as placenta, cannot be treated, the only solution may often be an induced labor for high risks of serious complications. Mere hypertension may be treated by medication, but it must be watched, too, because also in such cases a risk of preeclampsia exists. The internal specialist may act as an advisor, but it is the gynecologist who is responsible for pregnancy, so such woman should be watched within a high risk pregnancy program.

During ultrasound scan in 30th week my doctor told me the baby will be big. I am now quite concerned, worrying about the delivery process. May I ask for a cesarean section?

Individual growth charts may vary, but an estimated weight in 30th week does not say very much about the baby’s weight at birth. The growth may slow down, so it is quite irresponsible to make the expectant mother uneasy by such “prognosis“. However, it should be emphasized that by means of ultrasound the baby’s weight at birth may only be guessed; such estimates are rough and imprecise. Some studies even show that mother’s feelings are more exact that ultrasound estimates. For example with estimated birth weight of more than4,000 g, nearly half of the babies actually weigh less, but  too much stress and too many useless cesarean sections may occur as a result of imprecise expectations. There is enough evidence showing that weight guessing before delivery does not bring better results, as it may lead to useless cesarean sections. Estimating fetal weight before delivery is important only in two cases, first if the mother has diabetes and the specific fetal growth is asymmetric. In such cases, with estimated weight of more than4 200 g, cesarean section should be offered. Secondly, in breech/bottom down deliveries, with estimated weight of more than3,500 g, cesarean section should be considered, too. Mothers often ask for unnecessary C-sections; then they are surprised to see their babies have normal weights, but they end up with useless uterus scars and all other related risks.

I am first time pregnant in week 36, and the baby is in the breech (bottom down) position. My doctor says I must have a C-section birth. Is there really no other option?

In 30th week, as many as 20 % of babies are in the bottom down position, but at the time of delivery, only 4 % remain in this position. Provided that some conditions are met, natural breech birth is safe and the children born in this position are as healthy as the children born head down. The basic condition is the estimated fetal weight does not exceed3 500 g, which is a safe limit also by imprecise ultrasound measurement.  A myth persisted in Slovakia in the last century about harmfulness of natural breech birth of boys for risks of harm to testicles and reduced fertility has been disproved by numerous observations.

Natural breech birth is safe with a skilled and experienced doctor. If the obstetrician considers himself/herself to be insufficiently trained or skilled, C-section may be safer for the mother, as cesarean section is the basic obstetrical surgery manageable also by an intern doctor who is not a certified specialist.

I am 37 weeks pregnant and after a visit to prenatal clinic, I found I was slightly bleeding. I got alarmed and went to an emergency, where I was told that it was common. 

Bleeding during pregnancy always requires attention, particularly in the last weeks. It could be a sign of placental problems that may indicate high risks of complications both for the mother and the child.  However, there are two exceptions in which it is common and without any serious risks. It may occur in case of discharge of mucus and blood, the blood plug. While the cervix is getting ready for labor, its canal is opening, and thick mucus, protecting fetus from bacteria, may leak into vagina and out. Such mucus contains a little blood. It is a common occurrence and does not necessarily mean an early beginning of labor, as the woman may give birth 14 days after the plug has been discharged. Secondly, bleeding may occur after examination, during which delicate cervix vessels may break and bleed. Similarly slight bleeding may also occur after intercourse at the end of pregnancy.

How do I recognize early water breaking? I heard amniotic fluid may leak for a longer period and need not be fully discharged.

When your water breaks early, the membrane of the amniotic sac ruptures before the woman goes into labor. This may happen at the due term of   labor or before the due term. When the membrane breaks, the risk of infection grows, and the woman must be immediately checked. There is about one liter of amniotic fluid, so if the water breaks before labor, the water may gush out, which is a clear sign. But in some cases only the so called front amniotic fluid around the baby’s head breaks, or the water from some parts of the amniotic sac leaks. In such cases the diagnosis may be tricky also for the medical staff.  Lab tests, distinguishing between amniotic fluid and urine are not exact, and also massive discharge may be falsely positive. At present we have precise tests measuring levels of certain proteins in the amniotic fluid.  When the water breaks in due time and there are no signs of infection, we may wait 24 hours for the spontaneous birth starting. Some authors describe beneficial effects of labor induced also six hours after water breaking.  80 % of women go into labor spontaneously and naturally. Problems arise when water breaks early. In such case it is necessary to consider the risks of immature fetus and the risks of infection. In principle, in some cases we may wait until the fetus is mature. 

I heard that in some hospitals forceps are still used in assisted birth. Is it safe for the baby ?

Forceps is a device used in cases where it is necessary to speed up childbirth in the second stage of labor. Certain conditions must be met before using the forceps. In the hands of experienced obstetrician it is a life saving and safe instrument helping to guide the baby’s head out of the birth canal.  In this sanatorium less than 2 % of births are assisted in this manner. Alternatively, vacuum extraction may be used, where a ventouse, a device consisting of a cup which is attached to the baby’s head to draw the baby by suction and traction at the second stage of labor. Both devices are safe and are only used in cases when prolongation of labor would not be good for the baby or the mother, and cesarean section is not possible, because the baby’s head has already moved to a low pelvic position. Moreover, to organize a cesarean section takes certain amount of time, and forceps and ventouse deliveries are much faster.

I gave birth by a cesarean section three years ago, because the baby was in the bottom down position. Now I am in 32nd week, and the baby is in normal position. Will I have a natural birth?

Natural birth after a previous cesarean section is possible and safe, provided that some conditions are satisfied. The basic conditions include the facts that prevision C-section was made in the lower uterus and that the woman became pregnant more than one year after previous surgery. The management of labor after a cesarean section does not differ from any other delivery management. After birth the obstetrician may check the scar by his fingers, but this procedure has been recently substituted by ultrasound scan of abdominal cavity before the mother leaves the operating room to exclude bleeding of the scar into the abdomen. The risks of scar complications are very low; only in1 % of women the scar breaks open during delivery, which is, however, mostly found by chance during a postnatal check up. The risks of serious rupture are very low, but it may happen as a result of incorrect management of labor (with high doses of medication to induce delivery, abdominal pressing, etc.).

When inducing labor past the due date should occur?

The past due date period means in reality two weeks following the due date set for labor. At that time the risk of cesarean section is very high because placenta cannot provide sufficient nutrition for the baby and the baby uses up the energy necessary for the delivery. Therefore we try to induce labor two weeks after the due date at the latest. The woman is admitted to hospital usually 7 to 10 days after her due date, and labor is induced for a better chance of a natural birth.

  • At present, induction involves prostaglandin medication. For an induction, cervix must me ripe. Its ripening can be induced by mechanical dilators by means of small sticks getting thicker by absorbing moisture by a fluid-filled balloon thus dilating the cervix. When the cervix is open, medication is directly inserted into its canal. This technique may be repeated in some cases. When cervix is ready, labor may be induced by rupturing the membrane of amniotic sac to break the water. Then, labor will begin spontaneously. 

Why patients leave hospital on the fourth or fifth day after birth or even later in Slovakia? Princess Kate left the hospital one day after birth. A friend fromSwitzerlandwas discharged so early, too. 

InSlovakiaand also in theCzechRepublic, there are different traditions compared to other countries, based on a different organization of pediatric care. Healthy women could be released from hospital after 24 hours after non-complicated childbirths. “Longer“ hospital stay is, however, limited by the time when blood can be taken from the newborns for some screening tests,  i.e. not earlier than 72 hours after birth. In addition, longer stays may also be required in case of neonatal jaundice, for which some newborn babies must be monitored or treated, mainly by phototherapy. On the other hand, especially the first time mothers may thus get some practical advice on postnatal care of the new born baby already in hospital. 

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