Yes, in most circumstances. Our practice is very supportive of TOLAC (trial of labor after cesarean section). Most women who have a prior cesarean section are candidates for a trial of labor. Approximately 60-80% of women are successful, and the overall risk for uterine rupture is low. You can discuss with your obstetrician the overall risks/benefits, and what factors may improve or decrease your chances of success.

• Avoid unpasteurized soft cheeses such as brie, feta, goat, blue, or camembert (may contain listeria).

• Avoid hot dogs and deli meats unless heated to steaming hot (may contain listeria).

• Avoid seafood with high levels of mercury (shark, swordfish, king mackerel, or tilefish). See EPA recommendations regarding guidelines for eating fish during pregnancy.

• Avoid raw or undercooked meats (may contain toxoplasmosis).

Toxoplasmosis is a disease that presents serious implications if contracted during pregnancy. It is associated with eye malformations, intellectual disability, and other brain malformations. In addition, some children develop hydrocephalus (water on the brain) and are subsequently intellectual disabled or have other related complications. Fortunately, toxoplasmosis is uncommon in the pacific northwest. To minimize the risk of maternal infection, avoid eating raw meat, raw eggs, or undercooked poultry. We recommend that all meats, seafood, poultry and eggs be thoroughly cooked before eating or tasting. Heating food to an internal temperature of 150 degrees or more kills toxoplasma organisms as well as other bacteria and parasites. Be careful not to touch your mouth, nose, or eyes after handling raw meat or poultry. Hands, utensils, and kitchen surfaces coming into contact with these raw foods should be thoroughly washed. These precautions will also help prevent you from getting Salmonella food poisoning that is relatively common in undercooked eggs and poultry. Pregnant women should refrain from handling soiled cat litter. Toxoplasma infection in domestic cats can be prevented by feeding them only dry or canned food and restricting them from hunting birds and rodents; however, remember that other people’s cats may not have undergone these precautions. When outdoors, avoid contact with or wear gloves and a facemask when handling materials that are potentially contaminated with cat feces (for example, garden soil, lawns, and sandboxes) and thoroughly wash your hands when finished.

Pregnant women are at high risk for getting sick from listeria, harmful bacteria found in many foods. Listeria can lead to a disease called listeriosis. Listeriosis can cause miscarriage, premature delivery, serious sickness, or death of a newborn baby. If you are pregnant, you need to know what foods are safe to eat.

How will I know If I have listeriosis?

Because the illness could take weeks to show up, you may not know you have it. Early signs may include fever, chills, muscle aches, diarrhea, and upset stomach. At first you may have flu-like symptoms such as fever, chills, muscle aches, diarrhea, and upset stomach. Later you could develop a stiff neck, headache, convulsions, or lose your balance.

What should I do If I think I have listeriosis?

Call our office if you have any signs. If you have listeriosis, there are treatments that can be given.

Fight Bacteria – Fight BAC!®

• Clean: Wash hands often with soap and warm water. Use clean dishes, spoons, knives, and forks. Wash countertops with hot soapy water and clean up spills right away.

• Separate: Keep raw meat, fish, and poultry away from other food that will not be cooked.

• Cook: Cook food to a safe minimum internal temperature. Check with a food thermometer. Ground beef 160 °F; Pork 160 °F; Poultry 165 °F.

• Chill: Refrigerate or freeze within 2 hours–refrigerate or freeze within 1 hour in hot weather (above 90 °F). Don’t leave meat, fish, poultry, or cooked food sitting out.

COLD/ALLERGY MEDICATIONS DURING PREGNANCY

The following are common medications that have been approved by all the physicians for use during pregnancy:

1st Trimester (12 weeks or less):

• Acetaminophen (such as Tylenol) – as directed on the label

• Vicks Vapo-Rub

• Cough drops

• Honey mixed with lemon/lemon juice for cough

• Saline nasal spray

• Chloraseptic throat spray for scratchy throat.

2nd and 3rd Trimesters (over 12 weeks), in addition to the above:

• Diphenhydramine (such as Benadryl)

• Loratadine (such as Claritin)

• Cetirizine (such as Zyrtec)

• Pseudoephedrine (such as Sudafed)

• Cough syrup with Dextromethorphan (such as Robitussin DM)

• Afrin nasal spray for no longer than 48 hours

If you have used these medications for more than 5 to 7 days or feel that these are not working, please give us a call before you try other medications not listed.

Avoid herbal remedies in pill or supplement form, such as Echinacea. These products have not been studied sufficiently in pregnancy to determine their safety during pregnancy.

If you have a fever, painful cough or worsening sore throat, see your primary care provider for evaluation.

Over-the-counter gastrointestinal medications can be helpful at times and are considered safe to use intermittently. These include:

• Antacids (such as Tums or a liquid antacid) for an upset stomach or heartburn; or Zantac if a trial of Tums or antacids has not helped

• Stool softener docusate sodium (DSS) or fiber products (such as Metamucil, Fibercon or Citracel) to help relieve constipation

• Simethicone (such as Gas X or Mylecon) for excessive bloating from gas

• Miralax for constipation

During the first half of your pregnancy it is safe to continue sleeping on your back. After 20 weeks it is best to avoid lying on your back for prolonged periods of time. Sleeping tilted to one side or another can help to maximize blood flow to you and your baby. Try using a pillow between your legs or behind your back to get more comfortable. Don’t be alarmed if you wake up on your back after going to sleep on your side. Spending moderate amounts of time on your back does not have an adverse effect on your baby’s health.

It is safe to have your teeth cleaned during pregnancy. Local anesthesia to numb the area is safe if repair work is needed. Avoid nitrous oxide “laughing gas,” x-rays, and teeth whitening.

Household painting (with latex-based paint) should be safe after your first trimester, although it is helpful to have someone else do the painting. Be cautious of dust and paint fumes, and keep the room well-ventilated during the project. If you are remodeling an older home, we recommend you avoid lead-based paint, paint chips, and paint dust. Low volatile organic compound paints are a good alternative.

The physicians at Northwest Women’s Healthcare deliver babies at Swedish Medical Center First Hill, Seattle.

We avoid episiotomies whenever possible, although in certain circumstances it may be necessary for a safe delivery.