October 2012: 20 Questions to Ask During Pregnancy

By Heidi Smith Luedtke, PhD
Frequent doctor’s visits give moms-to-be many opportunities to talk with their healthcare providers. And an ongoing dialogue is the best way to ensure you get excellent care for yourself and your baby.
Unfortunately, after vital signs and basic measurements, there may be little time to talk. When your doctor asks, “Do you have any questions?” you may freeze up and forget what you wanted to know. No worries. We polled the experts to glean 20 great questions to ask your provider. Here are their answers.
1. Is my weight healthy? “Obesity increases your risk of miscarriage, preterm birth, diabetes and high blood pressure,” says Robert Atlas, MD, chair of obstetrics and gynecology at Mercy Medical Center in Baltimore, Md. Get personalized advice about how much weight you should gain (or lose).
2. How can I stop smoking? Use of cigarettes doubles the risk of miscarriage, says Atlas. Your provider can recommend behavior change strategies – and local support groups – to help you quit.
3. Do I need new meds? Some prescription drugs increase the risk of birth defects, says internist Marie Savard, MD, author of Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About. Alert your OB to any medications you’re taking. She may switch you to something safer.
4. Am I at risk for gestational diabetes (GD)? Moms who get GD are seven times more likely to develop type-2 diabetes post-pregnancy. If you have family risk factors, ask for a hemoglobin A1c blood test, says Savard. Hormonal changes in pregnancy can trigger hidden diabetes.
5. Should I get immunized?  Your physician may recommend shots for the flu, hepatitis B, and tetanus, especially if you’re at risk. Live-virus vaccines and those for measles, mumps, and varicella (chicken pox) may be harmful during pregnancy. Speak up to make sure you’re safe.
6. Should I continue to see my general practitioner and/or specialists? “Someone has to take the lead on medical care during pregnancy,” says Savard, “and it’s usually the OB/GYN.” But don’t ignore other providers. A team approach gives you more comprehensive care.
7. Am I drinking enough? “Fluids transport nutrition to your baby, prevent preterm labor, and minimize nausea, bloating and headaches,” says women’s health nurse practitioner Camilla Bicknell, RNC, MSN, co-author of The Pregnancy Power Workbook. Pale yellow urine is a sign you’re drinking plenty. Not sure? Ask.
8. Can I book a longer appointment? “Patients tend to minimize what they need instead of asking for extra time,” says Savard. The receptionist isn’t just a gatekeeper, she’s an ally. Let her know you have several concerns to discuss.
9. Should I change my workout routine? Kickboxing and ice skating are out, because of the risk of belly trauma or falling down. But common sense isn’t enough. “Certain pregnancy-related conditions may worsen with exercise,” says obstetrician James Betoni, DO, co-author of The Pregnancy Power Workbook. Looser tendons and ligaments make pregnant women more prone to sports injuries. Get a fitness prescription.
10. What are the signs of miscarriage? “Although miscarriages are common, they can be frightening, sad, and potentially dangerous,” says Bicknell.  Get smart and seek early medical care at your doctor’s office or the emergency room to avoid additional complications.
11. Would you (please) explain my test results? If your results don’t make sense, ask for an explanation or retest. Shalini Wittstruck, a national ambassador for the March of Dimes, was assured that she wouldn’t go into preterm labor based on the results of a fetal fibronectin test. “I wish that I would have followed my gut and pushed back on the test result,” says Wittestruck, whose son was born 10 weeks premature. “Had I sought a second opinion, the pre-term birth might have been avoided.”
12. What are the signs of early, false and real labor? Braxton Hicks contractions are common in the third trimester, when your uterus is training for the big event. Learn the difference between false labor and the real deal so you don’t stay up all night worrying about an early delivery.
13. When should I go to the hospital? Your caregiver may want you admitted right away if he’s concerned about preterm birth or labor and delivery complications. Otherwise, you may want to stay home during early labor, so you can eat, drink and do as you please.
14. What are my pain control options? A good pain control plan takes your medical situation and preferences into account.  New mom Cody Gredler found out placing an epidural can be challenging for patients with minor scoliosis, like herself. “My epidural had to be redone three times, which was not a barrel of laughs,” she says. “When it was finally put in correctly, it was bliss.”
15. When should I ask for anesthesia? Every hospital has its own guidelines, says Atlas, and some won’t administer an epidural before you’re dilated to 4 centimeters. If you wait too long, the anesthesiologist may be busy in the operating room when you need relief. Get intel from your labor nurse. She knows the system.
16. Who will attend my birth? Find out who is on call when your primary healthcare provider is off, says Atlas. Delivery-day surprises add unnecessary stress.
17. Could you recommend a lactation specialist? Seventeen percent of moms who wanted to breastfeed quit in the first four weeks, because of sore nipples, concerns about milk supply, or latching difficulties. Consult a pro for pointers.
18. Should I restrict my activities? The adrenalin rush of new motherhood may cause you to do too much too soon. Before you head home with your newborn, find out whether you should limit exercise and sex. Nurture healthy (and reasonable) expectations.
19. How do I care for my wounds? If you had tearing during delivery or have stitches from an episiotomy or c-section, infection prevention is top priority. Learn how to clean and soothe your wounds, and when you should get a checkup.
20. What are my contraception options? Ovulation is typically suspended for moms who breastfeed more than 6 times per day, but there are exceptions, says Atlas. Ask about birth control before you’re in the mood.
The Questions Game
Sometimes even the best questions don’t yield the answers you seek. If you don’t get a satisfying response:
          Ask again. It’s possible your provider was distracted or didn’t understand your query.
          Find a fill-in. Other office staff – including nurses and midwives – may have more time to address questions.
          See a specialist. Your provider may be uncomfortable giving advice outside her area of expertise.
          Say goodbye. A practitioner who consistently brushes your concerns aside isn’t in your corner. Find a new provider. Your well-being is worth the hassle.
TIP: Studies show 50% of patients forget what the doctor told them to do after their appointment, says Marie Savard, MD, author of Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About. The solution? Bring along a health buddy who can take notes and give moral support.
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