Pregnant expansion birth

How Does the ACA Expansion Affect Medicaid Coverage Before and During Pregnancy?

Medicaid is a major source of coverage for pregnant women, financing roughly four in ten births nationally and a majority in some states. A recent report on maternal health found that more than 80% of pregnancy-related deaths were preventable and recommended broader access to health insurance, which can improve prenatal care initiation and follow-up after pregnancy. A previous KFF analysis found that postpartum enrollees in Medicaid expansion states had greater continuity of Medicaid coverage in the year following childbirth, compared to enrollees in non-expansion states. However, the analysis did not examine coverage in the months leading up to childbirth. Coverage prior to and throughout pregnancy can promote pre-pregnancy health care and early prenatal care, including many of the services and tests provided during the first trimester, which can lead to healthier pregnancies and help reduce the risk of complications. In this brief, we examine whether the Medicaid expansion also helps women enroll earlier in the months leading up to pregnancy and childbirth using Medicaid claims data for women with a live birth in 2019.

Women in expansion states are more than twice as likely to be enrolled in Medicaid prior to becoming pregnant compared to women in non-expansion states (Figure 1). Most (59%) enrollees in expansion states with a live birth were enrolled prior to pregnancy (at least 11 months before delivery), while only 26% of enrollees in non-expansion states were enrolled prior to pregnancy. Four in ten (40%) enrollees with a live birth in non-expansion states enrolled once they became pregnant or soon after (7-10 months prior to delivery). Generally, the income limits for pregnant women to qualify for Medicaid coverage are higher than the limits for other adults, which allow many women to become newly eligible for Medicaid once they are pregnant. The difference in income levels between pregnant adults and other adults is especially large in non-expansion states (Appendix Table 1), which helps to explain why a smaller share of women in these states are enrolled in Medicaid prior to the start of pregnancy. Other research has found that most of the women newly enrolled in Medicaid during their pregnancy were uninsured before enrolling, and the rate of uninsured women who gain pregnancy-related Medicaid coverage is higher in non-expansion states.

Women in non-expansion states are more likely to enroll later in their pregnancy than women in expansion states. About one-third (34%) of pregnant women in non-expansion states enrolled in Medicaid within six months of delivery, roughly in the second trimester or later in their pregnancy, compared to 22% of women in expansion states. Smaller shares of women enrolling in Medicaid during the month of delivery could have been uninsured at the time of delivery but were found to be eligible during their hospital stay.

Our analysis of prenatal coverage in Medicaid builds on previous KFF research, which together find that the Medicaid expansion promotes continuity of coverage in the prenatal and postpartum periods. Other research also finds that expansion has contributed to improvements in a number of outcomes related to reproductive health. Looking ahead, the Medicaid expansion may be a key issue in several state elections. In the 12 states that have not adopted the Medicaid expansion as of 2022, all but two (North Carolina and Mississippi) have upcoming gubernatorial elections in November 2022. Additionally, South Dakotans will vote on a ballot measure to enact the Medicaid expansion through a constitutional amendment. If passed, the amendment would direct the state to implement the Medicaid expansion by July 1, 2023. In North Carolina, state legislators may renew discussions on the Medicaid expansion, which passed in separate bills in both state legislative bodies but was not included in the final FY 2023 budget bill. States that newly implement Medicaid expansion will receive a temporary fiscal incentive under the American Rescue Plan Act through an enhanced federal match on most Medicaid spending. The outcome of the recent court decision overturning Roe v. Wade has highlighted the importance of health coverage for women and children, especially those with low incomes.

Appendix

Methods

Data Source and Sample Selection

Our analysis uses the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Research Identifiable Files (RIF), 2018 – 2019, Release 1. We linked the 2019 Inpatient and Other Services header files with the 2018-2019 Demographic Eligibility (DE) Base File and DE Dates File. We used BENE_ID to link files when available and, when BENE_ID was missing, we used MSIS_ID to link files (see the TMSIS User Guide for information on linking variables).

To identify Medicaid enrollees with a live birth in 2019, we use the reference codes for live births provided by Calkins et al. in their technical specifications for “Maternal and Infant Health (MIH): Identifying Pregnant and Postpartum Beneficiaries in Administrative Data,” available on the CMS website. After flagging patients with a live birth in 2019 in the claims files we merged the claims file with the eligibility files and excluded individuals enrolled through a medically needy eligibility pathway or through a separate Children’s Health Insurance Program (SCHIP) during the month of delivery. Finally, we measured the length of time women were continuously enrolled leading up to childbirth. If enrollees had a gap in coverage that was 27 days or less (less than one month) then we considered that person to be continuously enrolled from before the gap in prenatal coverage. If an enrollee had a gap in coverage during the prenatal period that was 28 days or more, we only included the latest enrollment period following the gap and leading up to childbirth. However, we expect very few pregnant women to have gaps in coverage because the federal government requires that pregnant enrollees have continuous eligibility from the month of application for Medicaid through at least 60 days postpartum.

State Exclusion Criteria

We use data from 39 states in our analysis. We exclude 12 states (AL, DC, FL, KS, KY, NC, NE, NM, OK, RI, TN, and WY) due to missing or inconsistent data based on state-level information available from the DQ Atlas as well as our own analysis of the CDC Wonder Natality Files. We used several measures from the DQ Atlas to assess states’ data quality, shown in Appendix Table 2. We further excluded states whose final sample in this analysis had a difference of 20% or more from the number of Medicaid-covered births in the CDC Wonder Natality Files. In total, our final sample included 1,259,397 deduplicated enrollees with a live birth, while CDC Wonder reported 1,254,767 newborns covered by Medicaid (a difference of +0.4% from CDC Wonder).

Your growing pregnant belly: What can you expect?

If you’re newly pregnant, it’s natural to wonder when you’ll start to show and what the different pregnant belly stages will look like for you.

But every pregnancy belly will be different, and hopefully, you’ll be glad to know there’s no “normal” size or shape that your growing belly will follow. In fact, to determine how your pregnancy is developing, your health care provider won’t be looking at the shape of your belly. So rest assured that however your bump develops is completely right for you.

Of course, that’s not to say that the whole process has to be a mystery. To find out more about how your pregnancy belly might grow and the changes it can create in your body, we spoke to Dr. Charlsie Celestine, obstetrician and gynecologist, New Jersey, US.

When is a pregnant belly most likely to start showing?

As we know, everyone is different, but you may first start to notice some visible changes to the size of your belly around the 12th week of your pregnancy. “Most likely, the belly will start showing to the point where others would notice it if you wore tight clothing around the middle of the second trimester — around 16 to 20 weeks,” explains Dr. Celestine.

Differences in a growing pregnancy belly: Size and shape

It can be hard not to compare yourself to others when it comes to the shape and size of your pregnant belly, but remember that every baby bump is unique. “Just as bodies vary in shape and size, the pregnant belly is different for each individual,” explains Dr. Celestine.

While your baby will impact the size and shape of your growing uterus, she adds that “There’s no exact science as to why a belly is a certain size. I will say that usually, in early pregnancy, your belly is higher and then drops lower toward the end. But even the high and low levels differ with each person. It’s truly individual.”

Pregnancy is a time of real change for you mentally and physically. You’re adjusting to seeing your body work in new ways and looking different than the way it did before, so the one thing you don’t need to do is be harsh on yourself about how your pregnancy belly is shaping up. Remember Dr. Celestine’s advice that it happens for everyone individually, and try to embrace the changes as and when they come for you.

High pregnant belly and low pregnant belly

As Dr. Celestine explained, having a high pregnant belly is common in the earlier stages of your pregnancy. However, you may notice your pregnant belly ‘drop’ lower into your pelvis as you progress through your third trimester of pregnancy. This process is called engagement (or you might hear it called lightening), and it is your body’s clever way of preparing for labor by moving the baby closer to your pelvis. Wondering when you might go into labor? You can use Flo’s due date calculator to work out your predicted due date.

What changes might your pregnant belly cause for your body?

As your baby bump grows, you may notice a number of physical symptoms like stretch marks or back pain. Not everyone experiences these changes, however, so if you haven’t got these symptoms, then don’t worry; it doesn’t mean anything is wrong.

Stretch marks

Stretch marks are indented streaks on the skin that can appear on the belly during pregnancy. “Stretch marks can happen at any time, but it’s most common to see them late into the second trimester and into the third trimester as the skin really starts to stretch,” explains Dr. Celestine. “Stretch marks have two underlying causes. Firstly, they have a genetic link. If your mom or sister had them during pregnancy, then you are likely to as well. Secondly, they truly do come from skin stretching. So if your skin stretches quickly, they tend to appear.”

Dr. Celestine continues: “The best things you can do (which are not 100% guaranteed to work) are to not gain over the recommended amount of weight in pregnancy and also keep the skin hydrated with oils and lotions.” Of course, you can also rely on drinking good old-fashioned water for hydration.

Weight gain during pregnancy varies greatly for different women, and a healthy weight gain will depend on your own weight before pregnancy. As with everything pregnancy-related, weight gain is unique to everyone. Try not to get carried away with fixating on how much you’re gaining; some weight gain in pregnancy is absolutely normal. Remember to eat a healthy, varied diet, try to remain active if you can, and most importantly, don’t be hard on yourself about the way your body is changing.

Belly button

You may be surprised to hear that your pregnant belly expansion can also change the appearance of your belly button. “For some people, the pregnant belly button remains the same, whereas for others, it pops out,” says Dr. Celestine. “This means an ‘innie’ becomes an ‘outie’ temporarily.”

Experts say this is most likely to happen in the second or third trimester, and it most commonly occurs when you’re around 26 weeks pregnant. While the change might be alarming, rest assured that this is completely normal, and there’s no need to worry. “[The belly button] usually reverts back to normal in the few weeks after delivery,” adds Dr. Celestine.

A line on pregnant belly (linea nigra)

Around 80% of pregnant people will get a linea nigra — a dark vertical line through the center of your belly, sometimes extending all the way from the abdomen to the pubic bone. It usually appears during the second trimester.

“This line appears due to the hormone changes in pregnancy,” says Dr. Charlsie Celestine. “If you have darker skin, you tend to have a darker line. This will also disappear in the weeks after delivering your baby.” Ever wondered if there’s such a thing as a “baby girl belly” vs a “baby boy belly”? As you can imagine, there are plenty of unfounded old wives’ tales on it, and one of them links to the linea nigra. “There’s a myth that the length of the line indicates the gender of your baby, but that’s not true — it’s all just hormones.”

Experts aren’t entirely sure what the linea nigra is for or the exact hormone that causes it. However, some believe it’s due to the rising levels of the melanocyte-stimulating hormone created by the placenta. This causes a rise in melanin, the substance that gives your skin its color.

Back pain

There’s no getting around it: unfortunately, your growing belly can also cause back pain. Rest assured; this is common — in fact, studies show that between 50% and 80% of pregnant women experience back pain, so you’re certainly not alone in your pain. Thankfully, there are various things you can do to relieve it, from having a massage to taking a warm bath.

But why do so many pregnant people experience back pain? “Back pain in pregnancy has two causes,” explains Dr. Celestine. “The hormone changes in pregnancy cause the tendons and cartilage that hold your spine and joints in their proper position to soften. This can cause pain and can happen as early as the first trimester. Also, as your uterus grows, it shifts your center of gravity, meaning that your posture changes and can put stress on your lower back. This type of back pain usually happens at the end of the second to the third trimester.”

Difficulty breathing

It’s completely understandable that feeling breathless during pregnancy can be very worrying. While you shouldn’t ignore this symptom, it’s unlikely to be a sign that anything is wrong. Research suggests that around 60% to 70% of healthy pregnant women experience shortness of breath during pregnancy, so you’re certainly in good company.

“If you have difficulty breathing, you should always have this evaluated by your doctor first,” says Dr. Celestine. “But it’s also common in the third trimester. The uterus and baby are up so high that for some people, it limits their ability to take a normal deep breath.”

How to take care of your pregnant belly

During your pregnancy, it might feel soothing to moisturize your bump. Planning a self-care evening for yourself? You’ll find plenty of beauty products targeting these pregnancy symptoms, including pregnancy belly masks that work similarly to a traditional face mask.

How might a pregnant belly change during each trimester?

As we’ve seen, your belly will continue to grow through each trimester, often sitting higher up at the start and dropping lower to the pelvis by the end of your pregnancy.

If you’re carrying more than one baby, your baby bump might also appear to be growing faster. “It’s the same [as carrying one baby], just larger, and you’ll feel or see symptoms and signs such as back pain and belly button changes sooner,” explains Dr. Celestine.

First-trimester pregnant belly: Weeks 1 to 12

During your first trimester, you may not see any visible signs of a baby bump. Instead, you may experience other early signs of pregnancy, like nausea or constipation.

You may also feel and look bloated, which can be confusing when you’re looking for signs of an early pregnancy belly. However, bloating in early pregnancy is usually caused by rising levels of progesterone — not by the size of the baby. The hormone makes the muscles in your womb relax, preparing it to expand along with your growing baby.

Second-trimester pregnant belly: Weeks 12 to 27

Your baby will continue to grow rapidly throughout the second trimester. It’s perhaps no surprise then that this is the trimester when you will most likely start to show or see your belly expand — especially if you’re having more than one baby or carrying your second child.

Third-trimester pregnant belly: Weeks 28 to 40

Around week 31, in your third trimester, your baby will have finished most of their major development and will start to gain weight rapidly. Your bump will continue to grow, and your stomach might feel tight. This can feel uncomfortable, but hang in there; it won’t be long until you can meet your new baby.

Take a quiz

Find out what you can do with our Health Assistant

Post-pregnancy belly: What happens to your belly after delivery?

As you experience the changes happening to your body during the months of pregnancy, it’s completely natural to wonder what will happen after giving birth. Dr. Celestine explains what you can expect: “After delivery, the uterus slowly starts to shrink back to its normal size in your pelvis. As that happens, the skin and abdominal muscles also start to go back into position.”

How quickly this will happen varies hugely from person to person. “It can take weeks to months,” adds Dr. Celestine. Try not to set any expectations for yourself, and remember everything your body has just achieved!

Looking for some idea of what you might expect? As one Flo user said in our Secret Chats: “After delivery, our bodies, bellies, and boobs can seem huge compared to how we were. You are wonderful no matter whether you snap back right away or whether it takes 12 months!”

Another Flo user added: “It’s nearly three weeks since I gave birth. My stomach has horrendous stretch marks! Got lots of loose skin still, and my belly button is still nonexistent. The best thing of all, though, is I have a beautiful and healthy baby girl.”

Meanwhile, another user said: “It took a whole nine months for this belly to grow — it definitely won’t take a day to go back. It’s a process, and I’m ready to wait.”

Pregnant belly: The takeaway

Remember that the size, shape, and symptoms of your belly expansion vary hugely from person to person. Your second trimester is when you’ll most likely start to see physical changes to your belly, which will continue through to the end of your pregnancy. It’s also the trimester when you might first spot stretch marks, a linea nigra, and changes to your belly button.

But whether you feel like you have a huge pregnant belly or a barely visible bump, every pregnant belly is beautiful. So try to relax and embrace your unique bump however and whenever it grows.

Written by Kate Hollowood

Physiological changes in the body during pregnancy

From the very first days of pregnancy, a woman's body undergoes profound transformations. These transformations are the result of the coordinated work of almost all body systems, as well as the result of the interaction of the mother's body with the child's body. During pregnancy, many internal organs undergo significant restructuring. These changes are adaptive in nature, and, in most cases, are short-lived and completely disappear after childbirth. Consider the changes in the basic systems of the vital activity of a woman's body during pregnancy.

The respiratory system during pregnancy works hard. The respiratory rate increases. This is due to an increase in the need of the mother and fetus for oxygen, as well as in the limitation of the respiratory movements of the diaphragm due to an increase in the size of the uterus, which occupies a significant space of the abdominal cavity.

The mother's circulatory system during pregnancy has to pump more blood to ensure an adequate supply of nutrients and oxygen to the fetus. In this regard, during pregnancy, the thickness and strength of the heart muscles increase, the pulse and the amount of blood pumped by the heart in one minute increase. In addition, the volume of circulating blood increases. In some cases, blood pressure increases. The tone of blood vessels during pregnancy decreases, which creates favorable conditions for increased supply of tissues with nutrients and oxygen. During pregnancy, the network of vessels of the uterus, vagina, and mammary glands decreases sharply. On the external genitalia, in the vagina, lower extremities, there is often an expansion of the veins, sometimes the formation of varicose veins. Heart rate decreases in the second half of pregnancy. It is generally accepted that the rise in blood pressure over 120-130 and a decrease to 100 mm Hg. signal the occurrence of pregnancy complications. But it is important to have data on the initial level of blood pressure.

And changes in the blood system. During pregnancy, blood formation increases, the number of red blood cells, hemoglobin, plasma and bcc increases. BCC by the end of pregnancy increases by 30-40%, and erythrocytes by 15-20%. Many healthy pregnant women have a slight leukocytosis. ESR during pregnancy increases to 30-40. Changes occur in the coagulation system that contribute to hemostasis and prevent significant blood loss during childbirth or placental abruption and in the early postpartum period.

Kidneys work hard during pregnancy. They secrete decay products of substances from the body of the mother and fetus (the waste products of the fetus pass through the placenta into the mother's blood).

Changes in the digestive system are represented by increased appetite (in most cases), cravings for salty and sour foods. In some cases, there is an aversion to certain foods or dishes that were well tolerated before the onset of pregnancy. Due to the increased tone of the vagus nerve, constipation may occur.

The most significant changes, however, occur in the genitals of pregnant women. These changes prepare the woman's reproductive system for childbirth and breastfeeding.

The uterus of a pregnant woman increases significantly in size. Its mass increases from 50 g - at the beginning of pregnancy to 1200 g - at the end of pregnancy. The volume of the uterine cavity by the end of pregnancy increases by more than 500 times! The blood supply to the uterus is greatly increased. In the walls of the uterus, the number of muscle fibers increases. The cervix is filled with thick mucus that clogs the cavity of the cervical canal. The fallopian tubes and ovaries also increase in size. In one of the ovaries, there is a "corpus luteum of pregnancy" - a place for the synthesis of hormones that support pregnancy. Walls vaginas will loosen and become more elastic. External genitalia (labia minor and major), also increase in size and become more elastic. The tissues of the perineum are loosened. In addition, there is an increase in mobility in the joints of the pelvis and a divergence of the pubic bones. The changes in the genital tract described above are of extremely important physiological significance for childbirth. Loosening the walls, increasing the mobility and elasticity of the genital tract increases their throughput and facilitates the movement of the fetus through them during childbirth.

Skin in the genital area and in the midline of the abdomen usually becomes darker in color. Sometimes "stretch marks" form on the skin of the lateral parts of the abdomen, which turn into whitish stripes after childbirth.

Mammary glands increase in size, become more elastic, tense. When pressing on the nipple, colostrum (first milk) is released.

Changes in the bone skeleton and muscular system . An increase in the concentration of the hormones relaxin and progesterone in the blood contributes to the leaching of calcium from the skeletal system. This helps to reduce the rigidity of the joints between the bones of the pelvis and increase the elasticity of the pelvic ring. Increasing the elasticity of the pelvis is of great importance in increasing the diameter of the internal bone ring in the first stage of labor and further reducing the resistance of the birth tract to fetal movement in the second stage of labor. Also, calcium, washed out of the mother's skeletal system, is used to build the skeleton of the fetus.

It should be noted that calcium compounds are washed out of all bones of the maternal skeleton (including the bones of the foot and spine). As shown earlier, a woman's weight increases during pregnancy by 10 -12 kg. This additional load against the background of a decrease in bone stiffness can cause foot deformity and the development of flat feet. A shift in the center of gravity of the body of a pregnant woman due to an increase in the weight of the uterus can lead to a change in the curvature of the spine and the appearance of pain in the back and pelvic bones. Therefore, for the prevention of flat feet, pregnant women are advised to wear comfortable shoes with low heels. It is advisable to use insoles that support the arch of the foot. For the prevention of back pain, special physical exercises are recommended that can unload the spine and sacrum, as well as wearing a comfortable bandage. Despite an increase in calcium loss by the bones of the skeleton of a pregnant woman and an increase in their elasticity, structure and bone density (as is the case with osteoporosis in older women).

Changes in the nervous system . In the first months of pregnancy and at the end of it, there is a decrease in the excitability of the cerebral cortex, which reaches its greatest degree by the time of the onset of childbirth. By the same period, the excitability of the receptors of the pregnant uterus increases. At the beginning of pregnancy, there is an increase in the tone of the vagus nerve, in connection with which various phenomena often occur: changes in taste and smell, nausea, increased salivation, etc.

Active endocrine glands there are significant changes that contribute to the proper course of pregnancy and childbirth. Changes in body weight. By the end of pregnancy, a woman's weight increases by about 10-12 kg. This value is distributed as follows: fetus, placenta, membranes and amniotic fluid - approximately 4.0 - 4.5 kg, uterus and mammary glands -1.0 kg, blood - 1.5 kg, intercellular (tissue) fluid - 1 kg , an increase in the mass of adipose tissue of the mother's body - 4 kg.

Pregnancy Questions and Answers - Useful Articles

What to expect? How to eat? How to deal with difficulties? How to do everything right? These and many questions will be answered by Irina Alexandrovna Soleeva, an obstetrician-gynecologist at the Sadko clinic.

- How is due date calculated?

From the first day of the last menstruation. To determine the due date, 280 days are added to the first day of the last menstruation, i.e. 10 obstetric, or 9 calendar months.

Usually, the calculation of the due date is simpler: from the date of the first day of the last menstruation, 3 calendar months are counted back and 7 days are added. So, if the last menstruation began on October 2, then, counting back 3 months (September 2, August 2 and July 2) and adding 7 days, determine the expected date of birth - 9July; if the last menstruation began on May 20, then the expected due date is February 27, etc.

Expected due date can be calculated by ovulation: from the first day of the expected but not arrived menstruation, count back 14-16 days and add 273-274 days to the found date.

- And if you know the exact date of conception, how many days to add?

A large-scale study was conducted with a large number of pregnant women, according to various indicators, the gestational age and, accordingly, the date of birth were determined. It turned out that the woman most often remembers the date of the last menstruation. And from this fixed date, as the study showed, childbirth occurs at the 40th week ± a couple of weeks. Obstetrician-gynecologists are guided precisely by this system of calculations.

- Should I change my diet, if so, how?

4 meals a day are recommended in the first half of pregnancy, 5-6 meals a day in the second. It is better to eat often, but little by little. For healthy women, there are no forbidden foods (except alcoholic beverages), only more or less preferred ones.

So, the body absorbs easily digestible milk fats and vegetable oils better. The latter are not only a source of essential linoleic acid, but also vitamin E, which has a positive effect on the course of pregnancy.

To eliminate constipation, it is worth enriching the diet with sources of dietary fiber (fiber, pectins) - vegetables and fruits, buckwheat and oatmeal.

In the second half of pregnancy, sugar, confectionery and flour products, rice should be eaten in very small quantities. Do not get carried away with fried, spicy, salty foods, because. during this period, the liver and kidneys of a pregnant woman function with tension. It is better to prefer boiled and steamed dishes.

The main thing is to include a variety of foods in your diet: vegetables, fruits, juices - and you will provide yourself and your unborn child with everything necessary for normal development.

- I really want olives, but they are canned. Can?

It depends on the gestational age. After 20 weeks, I would not recommend eating too salty foods, including olives. And in general, any canned food is not the most suitable food for a pregnant woman. Although olives, in themselves, the product is very useful. Therefore, within reasonable limits, say, a jar can be eaten in two days.

- And the grapes?

Grapes are very well digestible. It's fructose. It is immediately absorbed and quickly raises blood sugar. But if you are overweight, it is either not recommended at all, or it is allowed in small quantities. It is allowed to eat a small brush, or you can treat yourself to something else.

For some reason, it is customary for us to believe that if you are pregnant, you have to eat for three or whatever you want. As a result, pregnant women buy grapes in boxes and eat them in kilograms. Such a diet does not lead to anything good: sugar appears in the urine, blood sugar rises, babies are born large. Moreover, a large load falls not only on the mother's pancreas, but also on the child's pancreas - the baby from birth will be predisposed to being overweight.

- Is it possible to reduce excess weight during pregnancy and cleanse your body with the help of special teas?

All cleansing teas are contraindicated during pregnancy. We have drugs that improve the functions of the liver and kidneys, which have a diuretic effect. We assign everything individually. There are no special cleansing procedures during pregnancy. However, we have fasting days - here is the best cleansing procedure for you.

- Which vitamins are best for pregnancy?

Now there is a huge selection of various vitamin complexes for pregnant women. Of course, they are all close to each other in composition. One or two components or the dosage of some vitamin differ. In order not to harm yourself and the baby, to achieve the maximum effect, each patient needs to select vitamins, based on the advice of her doctor, who controls the course of pregnancy.

- How long should I take them?

Do not take multivitamin preparations continuously. The necessary course can be selected only by a doctor, taking into account the state of your body. We have different periods when it is better to stop taking vitamins altogether. In certain weather seasons, when there is enough sun, fresh vegetables and fruits, there is no need to take vitamin complexes.

- Can I continue playing sports?

Not only possible, but necessary. From the first months of pregnancy. They will help to maintain good physical shape, and this will definitely help during childbirth, relieve excessive tension and improve mood. The main thing that you should not forget is that the training program should be specially adapted for pregnant women and should be carried out under the supervision of a doctor or an experienced instructor.

- Do I really have to push in prenatal classes? Will not diligence create the danger of premature birth?

No, there is no danger in this exercise. If there is anything to beware of, it is cycling, horseback riding, roller skating - all sports with an increased risk of injury.

- Can I take a contrast shower?

If a woman used this procedure before pregnancy. But during pregnancy, the water should not be too hot. By the way, hot baths and a bath should also be excluded.

- Can I continue to have sex while pregnant?

Each couple decides for themselves. If it gives pleasure to both, if the woman is comfortable, then you can keep your sex life almost until childbirth. Of course, too active sex will have to be excluded, and completely stopped 2-3 weeks before the birth: too vigorous sexual intercourse: it can provoke premature birth.

If earlier it was very strict: from 30-32 weeks, sexual life stops, now sex life is excluded by the doctor only if there are any deviations. After a while, he may allow you to resume intimacy. There are cases when sexual life is excluded for all 40 weeks.

- Do I need to use protection during pregnancy in order not to get pregnant again?

Very funny question. If one pregnancy has already occurred, re-conception during this period can no longer occur. The need for protection is therefore eliminated.

- Can I sleep on my stomach?

On short terms it is possible. The uterus comes out of the pelvic cavity after 12-13 weeks. Before that, it is protected by the pelvic bones, which means that we will not cause any harm to the fetus.

- So, the work of the expectant mother. Is it worth revising your working day, taking into account the new state?

Work during pregnancy is perfectly acceptable if there are no abnormalities. It is important to remember that pregnant women should not lift weights, work in heat and high humidity. Contact with harmful substances and prolonged standing should be avoided.

- Can motorists continue to drive?

You can drive a car if there are no contraindications from the doctor who monitors you during pregnancy. And it is not desirable in the later stages after 30 weeks, because there is a very strong load on the muscles of the pelvic floor, legs and arms work, concentration of attention is required - this is an additional stressful situation for your body. And of course, do not neglect the seat belt. He will not pull your stomach, but will pass under it and under your arm obliquely.

- How to deal with the symptoms of varicose veins?

It depends on the degree of varicose disease, its severity. Despite the rich selection of various drugs for internal and local action - tablets, drops, ointments - the most effective method of struggle is, nevertheless, wearing compression underwear. By the way, those who spend most of their working time sitting at a table, or vice versa, standing on their feet, should also think about the prevention of varicose veins.

It is better to stop your choice on tights: an elastic band or a stocking squeezes the leg too much, and when bandaging the legs, it is difficult to determine the necessary compression.

Tights should be selected by a doctor. A phlebologist works in our clinic. He will be able to choose the desired degree of compression.

Do not be afraid that underwear will be too tight on both legs and stomach: there are special tights for pregnant women. A special insert on the stomach fits him, supporting him, without squeezing at all.

- How to be smokers: won't quitting a bad habit cause stress for the body if the smoking experience before pregnancy was quite long?

Smoking during pregnancy is very bad. This applies equally to active and passive smokers. The fetus develops chronic hypoxia - a constant lack of oxygen. And it primarily affects the development of brain structures. The result is deviations from the norm in mental development. Even if the violations are minor at first, in infancy, most likely, they will manifest themselves in kindergarten or school, when the maximum load falls on the child's intellect. It will be difficult for the baby to learn, to perceive some information.

Moreover, there is a growing threat of premature births, miscarriages at different stages of pregnancy. Babies are often born small.

Stories that giving up habitual smoking will become a strong stress for the body are far from the truth. Our expectant patients break this bad habit without much difficulty. Even if you regularly inhaled tobacco smoke both before and after conception, you should not think that it is still too late to quit. The harm you will do to your baby if you continue to smoke is incomparable to the reluctance to part with a cigarette.