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How is gestational diabetes treated?

If you have GDM, your prenatal care provider wants to see you more often at prenatal care checkups so she can monitor you and your baby closely to help prevent problems. At each checkup, you get tests to make sure you and your baby are doing well. Tests include a nonstress test and a biophysical profile. The nonstress test checks your baby’s heart rate. The biophysical profile is a nonstress test with an ultrasound. An ultrasound uses sound waves and a computer screen to show a picture of your baby in the womb.

Your provider also may ask you to do kick counts (also called fetal movement counts). This is way for you to keep track of how often your baby moves in the womb. Here are two ways to do kick counts:

1. Every day, time how long it takes for your baby to move ten times. If it takes longer than 2 hours, tell your provider.
2. See how many movements you feel in 1 hour. Do this three times each week. If the number changes, tell your provider.

If you have GDM, your provider tells you how often to check your blood sugar, what your levels should be and how to manage them during pregnancy. Blood sugar is affected by pregnancy, what you eat and drink, how much physical activity you get. You may need to eat differently and be more active. You also may need to take insulin shots or other medicines. 

Treatment for GDM can help reduce your risk for pregnancy complications. Your provider begins treatment with monitoring your blood sugar levels, healthy eating and physical activity. If this doesn’t do enough to control your blood sugar, you may need medicine. Insulin is the most common medicine for GDM. It’s safe to take during pregnancy.  

Here’s what you can do to help manage gestational diabetes:

• Go to all your prenatal care checkups, even if you’re feeling fine.
• Follow your provider’s directions about how often to check your blood sugar. Your provider shows you how to check your blood sugar on your own. She tells you how often to check it and what to do if it’s too high. Keep a log that includes your blood sugar level every time you check it. Share the log with your provider at each checkup. Most women can check their blood sugar four times each day: once after fasting (first thing in the morning before you’ve eaten) and again after each meal.
• Eat healthy foods. Eat three regular meals and two to three snacks each day. Have one of the snacks at night. Talk to your provider about the right kinds of foods to eat to help control your blood sugar.
• Do something active every day. Try to get 30 minutes of moderate-intensity activity at least 5 days each week. Talk to your provider about activities that are safe during pregnancy, like walking. Walk for 10 to 15 minutes after each meal to help control your blood sugar.
• If you take medicine for diabetes, take it exactly as your provider tells you to. If you take insulin, your provider teaches you how to give yourself insulin shots. Tell your provider about any medicine you take, even medicine that’s not related to GDM. Some medicines can be harmful during pregnancy, so your provider may need to change them to ones that are safer for you and your baby. Don’t start or stop taking any medicine during pregnancy without talking to your provider first.
• Check your weight gain during pregnancy. Gaining too much weight or gaining weight too fast can make it harder to manage your blood sugar. Talk to your provider about the right amount of weight to gain during pregnancy. 

If you have gestational diabetes, how can you help prevent getting diabetes later in life?

For most women, gestational diabetes goes away after giving birth. But having it makes you more likely to develop type 2 diabetes later in life. Type 2 diabetes is the most common kind of diabetes. If you have type 2 diabetes, your pancreas makes too little insulin or your body becomes resistant to it (can’t use it normally).  

Here’s what you can do to help reduce your risk of developing type 2 diabetes after pregnancy:

• Breastfeed. Breastfeeding can help you lose weight after pregnancy. Being overweight makes you more likely to develop type 2 diabetes.
• Get tested for diabetes 4 to 12 weeks after your baby is born. If the test is normal, get tested again every 1 to 3 years.
• Get to and stay at a healthy weight.
• Talk to your provider about medicine that may help prevent type 2 diabetes. 

Last reviewed: April, 2019

Method Options

1.  Abstinence/Outercourse–100% effective at preventing pregnancy

            Demands personal discipline and accountability, Hormone-Free

Long Acting and Permanent Methods

2.  Levonorgestrel/Hormonal IUD–99.8%

            Intra Uterine Device, inserted by health professional, lasts 3-6 years (depending on                       brand), can be removed at any time, contains Progestin-only

3.  Tubal Ligation „Tubes Tied“–99.5%

            surgical procedure, no maintenance, permanent contraception, Hormone-Free

4.  Copper/Non-hormonal IUD–99.2%

            Intra Uterine Device, insertion by health professional, lasts 10-12 years, can be                             removed at any time, Hormone-Free

Routine Methods

5.  DMPA Injection „The Shot“–94%

            Get repeat injection every 12-13 weeks, contains Progestin only

6.  Oral Contraceptives „The Pill“–91%

            Take a pill every day, contains Progestin and Estrogen (combined hormonal)

            Progestin Only Pills (POPs) or „Mini Pills“ must be taken within the same three hours                                every day and contain progestin-only

Short Term and Other Methods

7.  Male Condoms–82%

            Use correctly every time, protects against pregnancy and STIs,  Hormone-Free

8.  Withdrawal „Pull Out“–78%

            Penis must be removed from vagina before a man ejaculates, and no semen can touch the vagina, Hormone-Free

9.  Fertility Awareness Based Methods–76%

            Requires daily documentation and personal accountability/discipline, abstain or use                       condoms during fertile days, Hormone-Free

Condoms and Abstinence are the only forms of birth control that protect against STIs and HIV.  STIs can be spread through any genital contact, and can also be present in the upper thighs, buttocks, and mouth.  Anal sex receivers (bottoms) are at the highest risk for HIV contraction. 

STIs–Sexually Transmitted Infections can cause infertility if not treated, some STIs can be cured, some are incurable

HIV–Human Immunodeficiency Virus is incurable, but can be treated to make the virus non-contagious

per US CDC and WHO Department of Reproductive Health and Research 2011

What about breastfeeding as birth control?

Breastfeeding can be used as a natural form of birth control, but only for six months.  When a woman is breastfeeding (lactating), she commonly will not have a period (amenorrhea).  Thus, using breastfeeding as birth control is called „Lactation Amenorrhea Method,“ or LAM. 

LAM/Breastfeeding is a temporary form of birth control only available to women who meet the following three criteria:

            1.  Menstrual bleeding, including spotting, has not returned after two months post-partum

            2.  Mother exclusively/primarily breastfeeds on a consistent basis, and baby does not eat  any other food, water, or liquids

            3.  Gave birth less than six months ago      

–LAM is 98% effective only if a woman meets all three criteria. 

–Women must breastfeed their baby on demand, or at least every four hours during the day time, and every six hours during the night time, otherwise she is risking pregnancy.

–Pumping does not protect against pregnancy, only nursing.  Avoid pacifiers. 

–If your baby has a weak suckle, it can reduce LAM effectiveness.  Contacting a nurse, doula, or lactation consultant may help increase LAM effectiveness. 

–After six months, breastfeeding women may continue to not have a period, but will not be                      protected against pregnancy, even if they exclusively breastfeed with a strong suckle. 

(Criteria established by US Dept of Health and Human Services, last reviewed Aug 2017)

Emergency Contraception (EC) pills are an effective form of emergency contraception.  EC does not terminate a current pregnancy, but prevents pregnancy.  A fertilized egg must travel from the fallopian tubes to the uterus, and attach to the uterine wall in order to develop a healthy pregnancy.  It takes approximately 72 hours (3 days) for a fertilized egg to travel from the fallopian tubes to the uterus. Because of this, most EC pills are only effective if taken within 72 hours of unprotected sex, as it must be taken before the egg attaches to the uterus.  Some EC pills can be effective up to 120 hours (5 days).  Non-hormonal/copper IUDs can be used as emergency contraception if inserted within 120 hours of unprotected sex. EC should only be used as an emergency backup, and not taken routinely.  If a woman finds herself taking EC routinely, she should consult a doctor for a more reliable and consistent form of birth control. 

(If you are currently pregnant, taking EC will not abort your baby, as it is not an abortion pill).  

IUDs

An IUD is an Intra-Uterine-Device.  There are two types of IUDs:  Hormonal and Non-Hormonal. Hormonal IUDs are a form of progestin-only birth control.  Non-hormonal IUDs contain no hormones, but instead contain copper, which is naturally toxic to sperm.  IUDs are great option for women who want long term reversible pregnancy prevention.  It is recommended a woman wish to delay pregnancy for at least one year before getting an IUD.  IUDs are over 99% effective.  

How are IUDs inserted?

            IUDs are typically inserted via the vagina, through the cervix, and into the uterus.  The device itself stays inside the uterus, while two thin, flexible strings hang down into the top of the vagina.  Only trained medical professionals can insert and remove IUDs in a sterile, approved facility.  IUDs can also be inserted through the abdomen after a cesarean (c-section).  Insertions are typically quick.  A bi-manual exam is required before insertion, and can be performed immediately before your insertion.  You do not require two separate appointments.

Does it hurt?

            Insertion can be painful for some women, while others report little to no pain.  Women who have never given birth tend to report more pain than woman who have given birth.  It is recommended to take NSAIDs (like Ibuprofen) 1 hour before insertion.  After insertion, cramping and abdominal pain are the most common symptoms.  Women should continue taking NSAIDs every 4-6 hours to alleviate cramping.  It is recommended to have someone drive you home after insertion.

What are the side effects?

            The most common side effect is changes in menstruation.  Your menstrual cycle may be atypical following an IUD insertion.  Non-hormonal/Copper IUDs can increase a woman’s flow; while hormonal IUDs tend to decrease, lighten, or stop menstruation altogether.  This is common of Progestin-only contraceptives, however does not happen to all women.  Some women bleed after insertion, others do not. Other potential side effects are:  pelvic pain, vulvovaginitis, headache/migraine, and genital discharge.  Some women experience mood changes while on birth control.  Every woman is different.  It is recommended to give your body 3-6 months to adjust to the IUD, as side effects can minimize over time.  Some women using IUDs experience ovarian cysts.  Most cysts go away naturally.  Contact your doctor if you begin to experience severe pelvic pain. 

When do IUDs start becoming effective?

            Non-Hormonal IUDs are effective immediately, and can actually be used as an emergency contraceptive if unprotected sex occurred five days or less before insertion.  Non-hormonal IUDs can last 10-12 years.

            Hormonal IUDs take seven days before becoming effective.  Abstinence, or condoms should be used for one week after insertion to avoid pregnancy.  If a woman is currently taking another form of birth control (like the pill), it is safe to continue use until the IUD becomes effective. (So a week after the IUD is inserted, stop taking the pill.)  If a hormonal IUD inserted on Days 1-5 of the menstrual cycle (Day 1 is the first day of the period) it is effective immediately.   Hormonal IUDs can last anywhere from 3-6 years depending on brand. 

Do I need to do anything after my insertion?

          A follow up visit is recommended after insertion.  Doctors vary in when they require a follow up.  It is important to be compliant in your doctor’s recommendation/orders.  At this visit your provider will check your IUD position and ask how you are responding.  Many IUD users have their doctor check their IUD whenever they go for a Pap smear.  Depending on your past pap results, age, and lifestyle, you may need to receive a Pap smear every year, every three years, or every five years.  Keep whatever schedule is recommended by your doctor.  IUD users will eventually have to return to a doctor to have their IUD removed, either when they desire to become pregnant, discontinue, or if the IUD is soon to expire. 

How do I know my IUD is where it should be?

          While the actual device stays inside the uterus, two thin, flexible strings attached to the device hang into the top of the vagina.  It is recommended to check the strings by lightly touching them (do not push) once per month.  Many women combine their monthly string check, with their monthly self breast exam.  It’s best to check the strings at the same time each month to ensure consistency, as the cervix has different placement depending on the phase of the menstrual cycle.  If you can feel only the strings, your IUD is where it should be.  If you can feel any part of the device itself, contact your doctor, as your IUD has likely been partially expelled and you are not receiving pregnancy prevention. 

What if I cannot feel my strings?

          If you cannot feel your strings, contact your medical provider.  An ultrasound will be done to ensure your IUD has not expelled or migrated.  If your IUD is in place, you can continue having your IUD, just with the strings inside you. Contact your doctor immediately if you begin experiencing severe pelvic pain.  An ultrasound should be conducted every two years (or as directed by your doctor) for patients who have their strings inside their uterus.  If the IUD is not in the correct position, your doctor will most likely remove the device.  If you wish, a new one can replace the old one on the very same day.  If the IUD is not present, it means it was expelled and the patient is not receiving any contraceptive protection.  If the patient has had unprotected sex in the past five days, emergency contraception may be used, however depending on when the IUD was expelled, the patient may already be pregnant. 

Potential Complications?

          Expulsions, perforations, and ectopic pregnancies are among the more serious potential complications. IUD expulsions are not standard, but can happen.  A few variables can increase their likelihood:  users who are 19 or younger, less than 4 weeks postpartum, immediate post-abortion insertions, and women who are breastfeeding.  Perforation of the uterus is less common than expulsions, and typically occurs during insertion, or if the IUD migrates.  Women who are breastfeeding have an increased risk for perforation.  Women who contract infections easily (like urinary, or yeast infections) should avoid getting an IUD.  Pregnancy is rare with an IUD, but pregnancies occurring with an IUD are more likely to result in miscarriage, or be ectopic. Anyone with an IUD who begins to experience severe pelvic pain should contact their doctor immediately. 

How is it removed?

         IUD removals are typically faster and than insertions.  Many patients report no pain during removal.  When a patient wants to become pregnant, requires a new IUD, or simply wants to try a different method of birth control, a trained medical professional gently pulls the IUD strings until the device is out.  If the strings have gone inside the body, the device can still be removed via strings, it just will take a little more time and searching from the provider.  It is uncommon for an IUD removal to require surgery, and typically only happens if the IUD has become imbedded.  Only a trained professional should remove an IUD.  Some women bleed after removal, and some do not.  Most women resume a normal period shortly after removal, while others can take a little longer. 

Will I be able to get pregnant after an IUD?

     Fertility can return quickly after removal.  If a woman wishes to become pregnant, she should remove her IUD and begin tracking her periods.  It can take a few cycles for natural periods to resume, and women vary on how soon they become pregnant after removal.  Some women become pregnant before they even have their first post-removal period!  Almost all couples  become pregnant within one year of trying to conceive. 

(US MEC–United States Medical Eligibility Criteria for Contraceptive Use, revised 2017)

Planned Parenthood

Mirena and Paraguard Full Prescribing Information

Sterilization

There are two main types of female sterilization.  There are modern non-surgical implant systems, and the traditional tubal ligation procedure, otherwise known as „getting your tubes tied.“  Non-surgical implant systems are fairly new, and not currently available in Kosovo; because of this, we will focus on traditional tubal ligation.

What is sterilization?

            Sterilization is a surgery that results in permanent loss of fertility, thus causing sterility.  Tubal ligation is the most common form of female sterilization. During tubal ligation, the fallopian tubes are cut, tied, blocked, cauterized, or removed completely.  This permanently prevents sperm from being able to reach the egg, as sperm and egg are joined in the fallopian tubes.  Tubal ligation is not a hysterectomy.  During a hysterectomy, part or all of the uterus (and sometimes cervix, ovaries, fallopian tubes) is removed, and the operation changes a woman’s hormones.  Only the fallopian tubes are touched during tubal ligation, and the operation is non-hormonal. 

With my fallopian tubes blocked, won’t my eggs build up inside me?

            Women who undergo tubal ligation need not worry about their eggs „building/piling up“ inside of them.  Their ovaries will continue to release an egg(s) every month.  However, instead of traveling down the fallopian tubes into the uterus, the egg will simply stop where the surgery occurred, and naturally be absorbed by the body.  The woman will continue to menstruate as usual, despite there being no egg released into her uterus. 

How do I get a tubal ligation?

            Tubal ligation can be done for any woman, at any time. It is a routine procedure, but does require general anesthesia.  For this reason, it all standard risks of surgery and anesthesia apply.  Notify your doctor of all past surgeries and current medication.  Women will need to schedule pre and post operation appointments.  Some women schedule their tubal ligation ahead of time, such as after childbirth or a cesarean, as they will already be at the hospital and doing follow up appointments with their doctor after the birth. 

Who can get tubal ligation?

           Any woman who wishes for permanent sterility can get tubal ligation.  It is recommended women undergoing tubal ligation be in a committed, long term relationship, and be over 30, as these recommendations can decrease the likelihood of regret.  However, any woman who is absolutely sure she is done having children, and understands the permanency of the decision, is eligible for tubal ligation, regardless of age or marital status.  Some women choose tubal ligation if their past pregnancies were very difficult or dangerous, or if they have had multiple cesareans.  This decision is made to protect the health and life of the mother. 

What happens?  Will I have a scar?

            During the procedure, a very small incision is made to the abdomen, typically the navel. The abdomen is inflated with gas to allow more room for the surgeon to work, without having to make a larger cut.  This technique produces a very small, faint scar usually hidden in navel.  The entire procedure is approximately 30 minutes.  If a woman is having a tubal ligation directly after a cesarean, or other abdominal surgery, the doctors will use the same incision site as the main surgery, and she will have a scar typical of a cesarean section.

Will I have to stay at the hospital? Will it hurt?

            Many women are released once their anesthesia has worn off and have clear vitals.  Some women stay at the hospital for one day.  Fatigue, cramping, dizziness, and bloating from the gas are common post-op side effects.  Some women report feeling pain upon waking from the anesthesia, but it typically wears off after a couple hours.  Doctors will discuss pain management before being discharged from the hospital.   If you have a tubal ligation after a c-section, you will likely stay in the hospital for 3-4 days, as is standard for a cesarean birth.   

How do I recover after surgery?

            Follow all doctors orders, which may include, but are not limited to:  Avoid getting the incision site wet for 48 hours after surgery.  Carefully pat dry after bathing, and avoid rubbing/itching.  Avoid heavy lifting, and gradually resume normal activities as healing progresses, with extra care and rest the first week after surgery.  Notify a doctor if the wound bleeds through your bandage, persistent and intense abdominal pain occurs, temperature of 38 C or greater, fainting spells, or foul smelling discharge.  Women should return for a post-op appointment if instructed by their doctor. Recovery time is typically 1-3 weeks.  If a woman has a tubal ligation immediately after a cesarean, it does not increase her recovery time, and she will recover the same as someone who only had a cesarean, which is typically 6 weeks. 

When will it become effective?  When can I have sex?

            Most forms of tubal ligation are effective immediately, however discuss with a doctor when it is safe to resume sex.  Most women wait 1-2 weeks after post-op before resuming intimacy.  Only have sex if you feel ready in your recovery.  If there are no concerns from the doctor or woman, the woman is done worrying about birth control forever.  Yearly wellness exams and routine pap screenings (every 3-5 years) are recommended for all women.  Less than 1% of sterilized women become pregnant within one year after surgery. 

Will tubal ligation change my hormones or period?

            Tubal ligation only stops sperm from reaching the egg by blocking the fallopian tubes.  It does not change a woman’s hormones, and it is non-hormonal.  It will not change a woman’s menstrual cycle.  There are minimal to no side effects after a sterilization, and very few women notice a change in their period.  Tubal ligation will not cause a woman to enter menopause early. Tubal ligation is not a hysterectomy.  Since a hysterectomy is the removal of part/all of the uterus, it changes a woman’s hormones and causes a woman to enter menopause early; tubal ligation does not. 

Male sterilization is rarely offered in Kosovo, but is becoming a more popular option in surrounding countries.  Male sterilization has a fast recovery time, only requires local anesthesia, and is more effective than female sterilization, although both are more than 99% effective.

Below is more information on male sterilization for any participants who are interested. Do not need to go over in class if participants are not interested, or do not feel their male partner would be interested. 

Male sterilization is called a vasectomy.  Vasectomies are not offered in Kosovo, but are available in nearby countries.  A vasectomy is not the same as a neuter/castration.  A neuter/castration involves the complete removal of both testicles, and changes a male’s hormones.  This is not performed on humans unless there is a serious medical concern and no other options.  For male sterilization, the procedure requires only local anesthesia and is typically done directly in the exam room.  Vasectomies are non-hormonal; they do not alter a man’s hormones, and he will still become aroused and function the same sexually. Vasectomies do not remove anything, but rather cut, tie, clip, or cauterize the vans deferens.  The vans deferens are small tubes that connect the testicles to the urethra.  When the vans deferens are altered, it prevents sperm from entering the urethra.  After a vasectomy, a man will still ejaculate the same, there will simply be no sperm in his semen.  His body will naturally absorb the sperm that does not pass through his vans deferens; it will not build up.  Vasectomies require minimal recovery.  Patients are advised to rest, and avoid sex and heavy lifting for one week.  Vasectomies take 3 months/12 weeks to become effective.  Condoms or other forms of birth control should be used during this time.  Men must return to the doctor 12 weeks after surgery to test their semen.  Once they are cleared sterile by a doctor, they will have permanent contraception.  Vasectomies are highly effective, over 99%. The most common reason why vasectomies fail is couples have unprotected sex before the man is cleared sterile.  Vasectomies are a great way for the male partner to contribute to family planning, are inexpensive, have low recovery time, less risk, and allow for permanent worry free intimacy.  Only use sterilization if you are absolutely sure you are done having children/do not want children, or if pregnancy poses a serious health/life risk. 

Article written by

Ryann Qavdarbasha

Effectiveness, Correct Usage, and Duration

While it is true the majority of birth control has high effectiveness at preventing pregnancy, that is only true if the user takes the birth control correctly every time. No one is perfect, it is very difficult for many people to remember to take and use birth control correctly all the time. Because of this, birth control effectiveness must consider „Perfect Use“ and „Practical Use.“ For example, Male Condoms, if used correctly every time, are 98% effective at preventing pregnancy. However, because condoms require personal skill and accountability, their practical use effectiveness rate is only 82%. This is a common theme with all the different methods; the more required from the user, the less effective the method. This is why IUDs and Implants are the most effective forms of birth control, as these methods are very low maintenance–no daily pills to remember to take, no stopping before sex, no keeping track of cycles, and no trips to the pharmacy. IUDs and Implants are the only forms of reversible birth control that have the same rates of Perfect and Practical use. Sterilization also has the same rates of perfect/practical use, but is permanent.

World Health Organization pregnancy rates, USA 2011

Percentage of women experiencing unintended pregnancy after one year of method use

Method	Practical Use	Perfect Use	% Continuation Use at 1 yr
None	85	85	–
Spermicides	28	18	42
FABM	24	–	47
Standard Days	–	5	–
2 Day Method	–	4	–
Ovulation Method	–	3	–
Sympo-Thermal	–	0.4	–
Withdrawal	22	4	46
Sponge	–	–	36
Parous Women	24	20	–
Nulliparous Women	12	9	–
Condom-Male	18	2	43
Condom-Female	21	5	41
Diaphragm	12	6	57
Oral Contraceptives	9	0.3	67
Transdermal Patch	9	0.3	67
Vaginal Ring	9	0.3	67
Depo-Provera	6	0.2	56
IUD Copper/Non-hormonal	0.8	0.6	78
IUD Mirena/Hormonal	0.2	0.2	80
IUD Implant	0.05	0.05	84
Female Sterilization	0.5	0.5	100
Male Sterilization	0.15	0.1	100

Another variable that makes birth control more/less effective is its duration.  The longer the method lasts, the more effective it is at preventing pregnancy.  Sterilization and LARCs (Long Acting Reversible Contraceptives) and are the most effective forms of birth control, and they are both methods that last the longest, with sterilization lasting forever.  LARC users also have the highest rates of continuation.  That is, IUD and Implant users were more likely to stick with their method of birth control compared to other forms.

Permanent Methods

After a woman has recovered from her sterilization, there is zero maintenance required from her.  Yearly wellness exams and routine pap and breast screenings are recommended for all women.

After a male has been cleared sterile, there is zero maintenance required from him.  Yearly wellness physicals and routine testicular checks are recommended for all men. 

Less than 1% of sterilized couples become pregnant within a year after surgery. 

Remember, sterilization is permanent.  Only use sterilization if you are absolutely sure you are done having children/do not want children.  Sterilization reversal surgery is sometimes possible, but odds greatly vary.  It is highly advised to view and treat any sterilization decision as permanent.

Long Acting Reversible Contraceptive (LARC) Methods

IUDs last a long time.  Copper/Non-Hormonal IUDs last for 10-12 years, and Hormonal IUDs lasts for 3-6 years.  After a woman has been seen for her follow up appointment after insertion, there is little maintenance required.  Women should check their IUD strings once per month to assure proper placement.  Yearly annual physicals are recommended for preventative care for all people, especially those using medication.  IUD users should continue their routine pap schedule per recommendation of their doctor.  Women should return for removal if they wish to become pregnant, or if it is time for a replacement.  Less than 1% of IUD users will become pregnant within one year of use.  The most common reason why IUD users become pregnant is expulsions without the woman’s knowledge. 

Implants last 4 years.  A trained medical professional will numb the patient with local anesthesia and then insert the Implant into the upper arm.  The procedure is very quick.  Users should visit their doctor yearly, and return sooner if they have any undesired side effects or concerns. .05% of Implant users will become pregnant within one year of use.  The most common reason why Implant users become pregnant is incorrect placement/no placement at all. 

Routine Methods

Depo-Provera is a highly effective form of birth control that lasts for three months.  One injection results in three months of pregnancy prevention.  A repeat injection is given every 12-13 weeks, totaling four injections per year.  As long as a woman returns for her next scheduled injection, she will receive continuous protection against pregnancy.  If a woman returns later than 15 weeks from her last injection, she is not protected against pregnancy.  6% of Depo Provera users become pregnant within one year of use.  The most common reason why a woman becomes pregnant while using Depo-Provera is because she returned too late for her next injection, or did not return at all.

Oral Contraceptives

Oral Contraceptives require daily administration.  Oral contraceptives can be purchased over the counter in Kosovo.  Women considering oral contraceptives should decide which type is best to fit her needs.  Reading all of the instructions and fine print, and paying attention to hormonal doses (lower doses tend to have less side effects) is important when deciding what type to try.  9% of oral contraceptive users will become pregnant within one year of use.  Inconsistent or incorrect use, or discontinuation of use was the most common reason for pregnancy.  Leaving your pills in an area where they could be damaged by heat or dampness is not recommended.  Some antibiotics can interfere with the effectiveness of oral contraceptives.  If a doctor prescribes you antibiotics, inform them immediately you are taking oral contraceptives.  It may be recommended to use condoms or abstinence until your have finished your antibiotics.  If a patient takes their pill every day, as directed, the effectiveness is over 99%. There are two main types of oral contraceptives:  Combined Oral Contraceptive (COC) and Progestin Only Pill (POP). 

Combined Oral Contraceptive (COC)

Combined Oral Contraceptives are the most common form of oral contraceptive pills.  COC contain the combination of Progestin and Estrogen. COCs can come in either 21 day, 28 day, or 91 day packs. Most COCs come in 28 day packs:  three weeks of active pills (pills containing estrogen/progestin), and one week of inactive/placebo pills.  The inactive/placebo week is when the woman will have her period, as there is no active ingredient in the pills taken during that week.  Pill users are still protected against pregnancy during their inactive week, as long as they start a new pack once their inactive week is over.  Taking one pill every day will prevent pregnancy.  A woman may begin taking COCs at any time in her cycle.  If a woman starts her COC within five days of when her period starts, she will be protected against pregnancy immediately.  For example, if a woman starts her period on Monday, that is Day 1.  As long as she starts her COC on days 1-5 (Monday-Friday), she will be protected against pregnancy immediately.  If a woman starts her COC any other time, she will not be protected for another seven days.  Using another form of birth control, like condoms, is recommended during the very first week of starting COCs.

Progestin Only Pills (POPs)

Progestin Only Pills contain no estrogen, but only progestin.  POPs only come in 28 day packs.  Every pill in a POP pack is active, which means every pill contains the active ingredient of progestin.  Because women using POPs are receiving a continuous supply of progestin, their period commonly lightens or discontinues altogether (similar to other progestin-only contraceptives, like hormonal IUDs and Implants).  POPs must be taken every day, at the same time. Women taking POPs must take their pill within three hours of the same time every day, otherwise she is risking pregnancy.  If you take your pill later than three hours past your usual time, use a backup method of birth control for the next 48 hours.  It is not advised to take POPs if remembering to take a pill at the same time every day is difficult for you.  POPs can be initiated at any time.  Pregnancy protection will begin 48 hours (two days) after starting POPs.

How do I take the pill?  What if I miss a dose?

            It is essential to take the pill every day.  POPs must be taken at the same time every day in order to be effective, whereas COCs are effective as long as a pill is taken each day.     Setting an alarm or keeping your pill pack next to things you use every day can help remind you to take your pill.  Contact your pharmacist/doctor if you are unsure how to take your birth control.  If you miss a pill, continue your next dose as usual, and contact your pharmacist/doctor/nurse.  They may ask when your last period started, or when you last had unprotected sex.  Use a condom until you are able to talk to them.  Make sure you know the exact name of your birth control when you call, as different brands and types require different instructions.  If you find yourself frequently missing your birth control pill, a more convenient method (like an IUD) may be a better option.  Contact your doctor/pharmacist if you vomit less than two hours after taking the pill. 

Any side effects?

            It is important to remember pregnancy typically has more serious side effects and complications than birth control.  Some users have headaches, nausea, sore breasts, gastrointestinal issues (like diarrhea), spotting between periods after starting the pill, or changes in mood.  Like most medications, side effects should subside after 2-3 months.  If a woman does not like the way the pill makes her feel, she should consult her doctor/pharmacist to see if there is an alternative brand (or different method) that may work better for her. Contact a doctor/nurse immediately if you experience any of the following:  chest pain, trouble breathing, repeat/intense headaches, yellowing of skin/eyes, sudden back/jaw pain combined with nausea and sweating. 

(US MEC–United States Medical Eligibility Criteria for Contraceptive Use, revised 2017)

^{*Planned Parenthood}

(Not offered in Kosovo)Transdermal Patches and Vaginal Rings require a yearly prescription renewal in some countries, and weekly administration.  One patch/ring is used per week.  After the week is over, a new patch/ring replaces the old.  Similar to COCs, the Patch and Ring come in three active weeks, and one inactive week.  During the inactive week, the user will simply not wear a patch or ring, and will have a period.  It is important the patch/ring is changed weekly and consistently.  The ring should be placed comfortably in the vagina, and the patch should be firmly in place on the skin.  9% of Patch and Ring users will become pregnant within one year of use.  The most common reason for becoming pregnant while taking these methods is inconsistent use and late replacements (users replacing patch and ring later than one week.)

Short Term Methods

Diaphragms, Condoms, Sponges, and Spermicides are all short term methods that are only used before sex.  It is essential to use these methods before intercourse occurs.  Any semen on the vagina, or PIV (penis in vagina) sex for any amount of time can result in pregnancy.  Each method has different requirements and tips to be more effective.  All methods require consistent and correct use.  Since condoms are the only form found in KS, we will focus on them. 

Like all short term methods, condoms require a lot of responsibility from the user. 

–If you are relying on condoms as your form of birth control, be sure you have an ample supply of them at all times.  Often people forego condom use simply because they did not have  any or they ran out.

–Store condoms in a cool, dark place away from sunlight.  Storing condoms in places like wallets, cars, bathrooms, pockets, etc for more than one month should be avoided, as heat, moisture, and pressure damages them. 

–Use your fingers to open a condom wrapper, do not use your teeth or scissors. 

–Examine condoms for holes before using, and throw away/do not use any condoms that are                 expired, torn, sticky, or stiff. 

–Roll the condom all the way to the base of the erect penis, leaving a little room at the tip for                    semen to deposit. 

–Only use one condom at a time. 

–Use a new condom every time you have sex.  If the man loses his erection, he should remove the condom and replace it with a new one once he becomes erect again.  New erection, new condom. 

–If you are using latex condoms, it is ok to place a small amount of lubricant inside/on the                        condom.  Do not use vaseline, lotion, baby oil, butter, or cooking oils as lubrication, as these can cause breakage.  Only use lubricants that are approved for latex, such as KY Jelly.  Some condoms are pre-lubricated. 

–There are a variety of brands, types, and sizes of condoms.  No brand is more effective at                    preventing pregnancy and STDs than another; proper and consistent use determines effectiveness, not brand.  

–Lambskin condoms only protect against pregnancy, not STDs.

–Most people fit the standard size.  If the condom feels too tight, try a larger size.  If the condom slips around or falls off during sex, try a smaller size. 

–Condoms can delay ejaculation, resulting in longer sex.  This is helpful for men who                               experience pre-mature ejaculation and wish to have longer intercourse. 

–Using condoms and another form of birth control is dual protection against STDs and                             pregnancy.  Dual protection is recommended for all people in non-mutually monogamous  relationships. 

–18% of women who only use condoms will become pregnant within one year of use.  The most             common reason for pregnancy is inconsistent or incorrect use. 

Other Methods

Withdrawal is a method used by many people.  Withdrawal is also called coitus interruptus, or simply „The Pull Out“ method.  The Pull Out method is when the man removes his penis from the vagina before ejaculation.  This method requires a lot of personal restraint and self control.  It also requires trust between partners. This method is typically more difficult for young or sexually inexperienced males to execute correctly, as they are not as familiar with their sexual responses and boundaries compared to older and more experienced males.  Withdrawal is a great method to combine with other methods, but it not very effective on its own.  Some men pull out even when they wear condoms, or even if their female partner uses birth control, as it provides extra protection against pregnancy.  22% of women who only use this method will become pregnant within one year.  The most common reason for pregnancy with this use is the male being young or inexperienced, not withdrawing soon enough, or the man pre-ejaculating. 

Fertility Awareness Based Methods

Fertility Awareness Based Methods are a variety of methods used to prevent or achieve pregnancy by tracking when a woman is ovulating.  Women are only fertile for six days per menstrual cycle, the day she ovulates and the five days prior to ovulation.  During those fertile days, women using FABMs should abstain from sex.  This can sometimes be difficult, as many women report being more sexually aroused during their fertile time.  In the case a woman wishes to have sex during her fertile time, condoms should be used.  It is recommended to have 3-6 months of cycle information (to establish baselines and averages) before relying on these methods. Women using these methods should use an online app, a personal calendar, cycle beads, or a chart to track their individual cycle.

Standard Days Method

–Version of the „Rhythm Method“ that relies on tracking a woman’s monthly menstruation cycle.  –The first day of a woman’s period is Day 1. 

–Standard Days Method recommends abstaining from sex or using condoms on days 8-19, as those are typically a woman’s most fertile days. 

–Many woman ovulate on day 13, however every woman is different, and some ovulate sooner/later than Day 13. 

–Standard Days Method is based on women who menstruate every 26-32 days.  If a woman has shorter or longer cycles than that range, or inconsistent cycles, Standard Days Method may not be the most reliable method for her.

Ovulation Methods

–Relies on diligent daily tracking of a woman’s discharge and cervix placement throughout her cycle. 

–During and right before ovulation, there is typically more cervical mucus.  Stretchy, clear, and slick discharge (similar to how uncooked egg whites look and feel) is a symptom of ovulation. A woman typically has this discharge mid cycle when she is most fertile. 

–This type of discharge allows for enhanced sperm mobility, making it naturally easier for a woman to become pregnant.  If a woman desires pregnancy, having intercourse when she displays this type of discharge is highly recommended. 

–If a woman wishes to prevent pregnancy, she should abstain from sex or use condoms during this time until symptoms subside.

–Women using this method should also note the placement of their cervix.  Women can touch their cervix by inserting their fingers to the back of the vagina, and feeling for the smooth, rounded shape of the cervix. When a woman is fertile, her cervix opens up and becomes softer.  It is also much higher and sometimes difficult to reach.  When a woman is non-fertile, her cervix is lower, harder, and closed.

–It may take a woman a few months to become familiar with her body and be able to note differences in discharge and cervical placement.  Many women who use this method feel it has helped them recognize normal/abnormal vaginal secretions; and have a better knowledge of their personal cycle and body–however, it takes time to learn and make these assessments.

–Medical guidance is highly recommended for all types of birth control, especially FABMs.

Temperature Method

–Relies on daily temperature checking. Women who use this method should use a Basal Thermometer every morning as soon as she awakes, and before she gets out of bed. 

–Documentation of daily temperatures is necessary to notice differences.  Women’s body temperature changes very slightly throughout her cycle, staying around 96-98 F before ovulation, and raising to 97-99 F after ovulation. 

–There is typically a slow decrease before ovulation, and then a sharp increase after ovulation,

although changes can be subtle.

–Women should track their daily temperatures on a Fertility Awareness chart. 

–Temperature Method can be difficult, as sometimes the temperature changes are very minimal.  Consistent documentation is necessary to best assess temperature changes.

When the Ovulation Method and Temperature Method are used together, it is called the Sympto-Thermal method.  Many women naturally combine Standard Days and Ovulation method, and track their menstrual cycle and ovulation symptoms on the same chart.  Fertility Awareness methods work best when more than one is used.  Whatever method(s) a woman can routinely maintain is the best method for her. 

With diligence, education, and awareness, these methods can be very effective.  However, due to a variety of reasons (incorrect or discontinued charting, not abstaining/not using condoms, inconsistent menstrual cycles, general confusion, etc) 24% of women who use Fertility Awareness Based Methods will become pregnant after one year of use. 

*^{Planned Parenthood}

Emergency Methods

Mistakes and accidents can happen to anyone.  Emergency Contraception should be used in the event of an accident/mistake, such as if the first method of birth control fails (condom broke/fell off or was not worn, partner didn’t pull out in time, forgot to take routine birth control pills, etc.), or if a woman is sexually assaulted*. 

*Inform women sexual assault/rape is about to be briefly discussed.  If any women feel they may be triggered or uncomfortable with this discussion, they are encouraged to step out of the room for 1-2 minutes until the discussion is over. 

Sexual assault is any forced or coerced sex–rape.  If you are forced to have vaginal sex, or if semen is left on/near your vagina, there is risk of pregnancy.  If you are correctly taking birth control, there is little risk of pregnancy.  If not, you may want to consider emergency contraception before it is too late (3-5 days).  If you are forced to engage in any other forms of sex (anal, oral, manual, etc), and no semen is left on/near the vagina, there is no risk of pregnancy. 

All forms of sexual assault are a major offense, regardless of what type of assault occurred, or who the perpetrator is–this includes husbands/boyfriends/life partners/friends.  If you have been sexually assaulted, know you are not alone, and it is NOT you fault.  Assault is always the fault of the perpetrator, as there is never a reason to assault someone.  Victims may choose to press charges against their assaulter.  It is recommended for victims of sexual assault to be seen by a doctor to ensure a pregnancy does not occur, and also to test if any STIs have been transmitted.  Remember, STIs can be transferred through any type of genital contact; sex does not have to be vaginal for an STI to be passed.  Finding someone you trust, seeing a qualified therapist, or talking to other assault victims may help in the emotional recovery after an assault.  Remember, assault is NEVER the victim’s fault.  If you were a victim of war rape, please contact Center for Promotion of Women’s Rights in the Drenas municipality to receive reparations. 

[Welcome any women who may have stepped out to re-enter the classroom/discussion.  Continue material on EC]

Emergency contraception is not intended to be used as a first form of birth control; that is, emergency contraception should not be taken as a replacement to more routine methods of birth control.  Emergency contraception is not an abortion, and cannot terminate an existing pregnancy.  Emergency contraception can only prevent a pregnancy if administered within 3-5 days of unprotected sex.  Typically, „unprotected sex“ is defined as sex without a condom, however in regard to emergency contraception, „unprotected sex“ means any sex that did not involve a means to prevent pregnancy.  For example, if a woman has sex without a condom, but is correctly taking her birth control pills every day, she is protected against pregnancy, thus she is having „protected sex.“  If that same woman forgets to take her birth control pill, she is now unprotected against pregnancy, and thus having „unprotected sex.“  If a woman is unsure if she is protected against pregnancy, she should contact her doctor/nurse/pharmacist immediately. 

There are two types of emergency contraception, a non-hormonal IUD and pills.

            1.  IUD:  Non-hormonal/Copper IUD is the most effective form of emergency contraception.  If this type of IUD is inserted within 120 hours (5 days) after having unprotected sex, it will prevent a pregnancy from occurring.  This is a great method to choose if a woman needs emergency contraception and continued pregnancy prevention.  Non-hormonal IUDs can last 10-12 years and can be removed at any time. 

            2.  Pill:  Emergency contraceptive (EC) pills are most common type of emergency contraception.  There are different brands and types of EC pills.  Only take one dose of EC pills; more doses will not give you more protection, and do not mix brands, as they may interfere with each other and become less effective.  A second dose will be required if you throw up less than two hours after taking your EC pill.  Read all instructions on/in the packaging carefully, and contact your doctor/pharmacist with the name of EC pill you took if you have any questions.                 

Levonorgestrel EC pills:  The most common types of EC pills contain Levonorgestrel and work best when taken within 72 hours (3 days) after unprotected sex.  The sooner these types of EC pills are taken after unprotected sex, the better they work.  Some brands of EC pills can be taken up to 120 hours (5 days) after unprotected sex.  Most brands of this type of EC pill can be purchased over the counter at a pharmacy. 

Remember, emergency contraception is not intended to be a first form of birth control, but rather used for accidents.  If a woman wishes to prevent pregnancy, she should receive a more routine form of birth control, as routine forms are more effective at preventing pregnancy, are less expensive that routinely purchasing EC, and tend to have less side effects.  EC pills are safe, but can contain high amounts of hormones, which can result in a variety of unpleasant side effects, like unusual periods or nausea.  Emergency contraception should not be taken if pregnant, however, if a woman takes an EC pill while unknowingly pregnant, it will not harm the baby.  Emergency contraception is not an abortion and will not terminate an existing pregnancy.  If a woman needs/decides to terminate a pregnancy, she should see a qualified health professional. 

*Planned Parenthood

Article written by

Ryann Qavdarbasha

Dental health (also called oral health) is the health of your gums and teeth. It’s an important part of your overall health.

Some studies show a link between periodontitis (a gum disease) and premature birth (birth before 37 weeks of pregnancy) and low birthweight (less than 5 pounds, 8 ounces). Taking good care of your gums and teeth during pregnancy can help you and your baby be healthy.

How does pregnancy affect your dental health?

Pregnancy changes in your body can affect your gums and teeth. During pregnancy, you have more blood flowing through your body, more acid in your mouth and rising hormone levels. Hormones are chemicals made by the body.

These changes mean that you’re more likely to have some dental health problems during pregnancy than you did before you got pregnant. These problems include:

• Gingivitis. This is when you have red, swollen or sore gums. Your gums may bleed when you brush your teeth. High levels of the hormone progesterone can lead to gingivitis during pregnancy. Without treatment, gingivitis can become a serious gum disease called periodontitis.

• Loose teeth. High levels of the hormones progesterone and estrogen during pregnancy can affect the tissues and bones that keep your teeth in place. This can make your teeth loose.

• Periodontitis. This is a serious gum disease. It happens when there’s swelling and infection in the gums and bones that keep your teeth in place. This can make your teeth loose.

• Pregnancy tumors. These tumors are not cancer. They are lumps that form on swollen gums, usually in between teeth. This can cause bleeding. The tumors may be caused by having too much plaque (sticky bacteria that forms on teeth). Pregnancy tumors usually go away on their own. But you may need to have them removed by surgery sometime after you give birth.

• Tooth decay. This is when acids in your mouth break down a tooth’s enamel. Enamel is the hard, outer layer of a tooth. Because you have more acid in your mouth than usual during pregnancy, you’re more likely to have tooth decay. If you have morning sickness and throw up often, you have even more acid in your mouth.

• Tooth loss. If you have serious tooth decay or gum disease, your teeth may fall out Or your dentist may need to remove your teeth.

What are signs and symptoms of dental health problems during pregnancy?

Signs and symptoms include:

• Bad breath • Gums that hurt when they’re touched, or gums that bleed when you brush your teeth • Loose teeth • Mouth sores, lumps or other growths • Red or red-purple gums • Shiny, sore or swollen gums • Toothache or other pain

Call your dentist if you have any of these signs or symptoms.

How are dental health problems diagnosed during pregnancy?

You may notice a problem with your teeth or gums, or your dentist may find one during a regular dental checkup.

Get regular dental checkups before and during pregnancy. If you haven’t been to the dentist recently, see your dentist early in pregnancy. At your checkup, tell your dentist that you’re pregnant and about any prescription or over-the-counter medicines you take. If you’re not pregnant yet, tell your dentist you’re planning to get pregnant.

Dental checkups during pregnancy are important so that your dentist can find and treat dental problems. Regular teeth cleanings also help prevent tooth decay. If you have any problems, your dentist can recommend treatment during pregnancy or after you give birth.

If you have a dental problem, your dentist may take an X-ray. An X-ray is a medical test that uses radiation to make a picture of your body on film. Dental X-rays can show problems, like cavities, signs of plaque under your gums or bone loss in your mouth. Dental X-rays use very small amounts of radiation. But make sure your provider knows you’re pregnant and protects you with a lead apron and collar that wraps around your neck. This helps keep your body and your baby safe.

How are dental health problems treated during pregnancy?

The kind of dental treatment you get depends on the problem that you have, and how far along you are in your pregnancy.

You may just need a really good teeth cleaning from your dentist. Or you may need surgery in your mouth. Your dentist can safely treat many problems during pregnancy. But he may tell you it’s better to wait until after birth for some treatments.

Your dentist may avoid treating some problems in the first trimester of pregnancy because this is an important time in your baby’s growth and development. Your dentist also may suggest postponing some dental treatments during pregnancy if you’ve had a miscarriage in the past, or if you’re at higher risk of miscarriage than other women. Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy.

How can you help prevent dental health problems?

Here’s how you can help keep your teeth and gums healthy:

• Brush your teeth with fluoride toothpaste and floss every day. Brush using a toothbrush with soft bristles twice a day. Floss once a day to clean in between your teeth. Regular brushing and flossing around the gum line can remove plaque and prevent periodontitis and tooth decay.

• If morning sickness makes you feel too sick to brush your teeth, rinse your mouth with water or mouthwash. If you throw up, rinse your mouth with water to wash away the acid.

• Visit your dentist for a regular dental checkup every 6 months, even during pregnancy.

• Eat healthy foods. They give you and your growing baby important nutrients. Your baby’s teeth start developing between 3 and 6 months of pregnancy. Nutrients, like calcium, protein, and vitamins A, C, and D, help your baby’s teeth grow healthy.

• Limit sweets. Having too many sweet foods or drinks can lead to tooth decay. Instead of sweets, drink water and pick healthy foods like fruits, vegetables, and dairy products.

Source: www.marchofdimes.com

What is gestational diabetes? Gestational diabetes (also called gestational diabetes mellitus or GDM) is a kind of diabetes that some women get during pregnancy. It’s a condition in which your body has too much sugar (called glucose) in the blood.

When you eat, your body breaks down sugar and starches from food into glucose to use for energy. Your pancreas (an organ behind your stomach) makes a hormone called insulin that helps your body keep the right amount of glucose in your blood. When you have diabetes, your body doesn’t make enough insulin or can’t use insulin well, so you end up with too much sugar in your blood. This can cause serious health problems, like heart disease, kidney failure, and blindness.

Most pregnant women get tested for GDM at 24 to 28 weeks of pregnancy. Most of the time it can be controlled and treated during pregnancy. If it’s not treated, GDM can cause problems for you and your baby. It usually goes away after you have your baby. But if you have GDM, you’re at an increased risk of developing diabetes later in life.

In the United States, 7 out of every 100 pregnant women (7 percent) develop gestational diabetes. You’re more likely than other women to have GDM if you’re African-American, Native American, Asian, Hispanic, or Pacific Islander.

Can gestational diabetes cause problems during pregnancy? Yes. If not treated, GDM can cause pregnancy complications, including:

• Cesarean birth (also called c-section). This is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus (womb). You may need to have a c-section if you have complications during pregnancy, like your baby being very large (called macrosomia). Most women with GDM can have a vaginal birth. But they’re more likely to have a c-section than women without GDM.
• High blood pressure and preeclampsia. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy. Preeclampsia is when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Signs of preeclampsia include having protein in the urine, changes in vision, and severe headaches. High blood pressure and preeclampsia can increase your risk for premature birth.
• Macrosomia. This means your baby weighs more than 8 pounds, 13 ounces (4,000 grams) at birth. Weighing this much makes your baby more likely to get hurt during labor and birth. And you may need to have a c-section to keep you and your baby safe.
• Perinatal depression. This is depression that happens during pregnancy or in the first year after having a baby (also called postpartum depression). Depression is a medical condition that causes feelings of sadness and a loss of interest in things you like to do. It can affect how you feel, think, and act and can interfere with your daily life. It needs treatment to get better.
• Premature birth. This is birth before 37 weeks of pregnancy. Most women with GDM have a full-term pregnancy that lasts between 39 and 40 weeks. But if there are complications with your pregnancy, you may need to have your labor induced before your due date. Inducing labor means your provider gives you medicine or breaks your water (amniotic sac) to make your labor begin.
• Shoulder dystocia or other birth injuries (also called birth trauma). Shoulder dystocia happens when a baby’s shoulders get stuck inside the mother’s pelvis during labor and birth. It often happens when a baby is very large. It can cause serious injury to both mom and baby. Complications for moms caused by shoulder dystocia include postpartum hemorrhage (heavy bleeding). For babies, the most common injuries are fractures to the collarbone and arm and damage to the brachial plexus nerves. These nerves go from the spinal cord in the neck down the arm. They provide feeling and movement in the shoulder, arm, and hand.
• Stillbirth. This is the death of a baby in the womb after 20 weeks of pregnancy.

Gestational diabetes also can cause health complications for your baby after birth, including:

• Breathing problems, including respiratory distress syndrome (also called RDS). This is a breathing problem caused when babies don’t have enough surfactant in their lungs. Surfactant is a protein that keeps the small air sacs in the lungs from collapsing.
• Jaundice. This is a medical condition in which a baby’s eyes and skin look yellow. A baby has jaundice when his liver isn’t fully developed or isn’t working well.
• Low blood sugar (also called hypoglycemia)
• Obesity later in life
• Diabetes later in life

Are you at risk for gestational diabetes?

You may be more likely than other women to develop gestational diabetes if:

• You’re older than 25.
• You’re overweight or obese and not physically active.
• You had gestational diabetes or a baby with macrosomia in a past pregnancy.
• You have high blood pressure or you’ve had heart disease.
• You have polycystic ovarian syndrome (also called polycystic ovary syndrome or PCOS). This is a hormone imbalance that can affect a woman’s reproductive and overall health.
• You have prediabetes. This means your blood glucose levels are higher than normal but not high enough to be diabetes.
• You have a parent, brother, or sister who has diabetes.

Even women without any of these risk factors can develop gestational diabetes. This is why your health care provider tests you for GDM during pregnancy.

How do you know if you have gestational diabetes?

Your health care provider tests you for gestational diabetes with a prenatal test called a glucose tolerance test. You get the test at 24 to 28 weeks of pregnancy. If your provider thinks you’re at risk for GDM, you may get the test earlier.

If your glucose screening test comes back positive, you get another test called a glucose tolerance test to see for sure if you have gestational diabetes.

How is gestational diabetes treated?

If you have GDM, your prenatal care provider wants to see you more often at prenatal care checkups so she can monitor you and your baby closely to help prevent problems. At each checkup, you get tests to make sure you and your baby are doing well. Tests include a nonstress test and a biophysical profile. The nonstress test checks your baby’s heart rate. The biophysical profile is a nonstress test with an ultrasound. An ultrasound uses sound waves and a computer screen to show a picture of your baby in the womb.

Your provider also may ask you to do kick counts (also called fetal movement counts). This is a way for you to keep track of how often your baby moves in the womb. Here are two ways to do kick counts:

1. Every day, time how long it takes for your baby to move ten times. If it takes longer than 2 hours, tell your provider.
2. See how many movements you feel in 1 hour. Do this three times each week. If the number changes, tell your provider.

If you have GDM, your provider tells you how often to check your blood sugar, what your levels should be, and how to manage them during pregnancy. Blood sugar is affected by pregnancy, what you eat and drink, and how much physical activity you get. You may need to eat differently and be more active. You also may need to take insulin shots or other medicines.

Treatment for GDM can help reduce your risk for pregnancy complications. Your provider begins treatment with monitoring your blood sugar levels, healthy eating, and physical activity. If this doesn’t do enough to control your blood sugar, you may need medicine. Insulin is the most common medicine for GDM. It’s safe to take during pregnancy.

Here’s what you can do to help manage gestational diabetes:

• Go to all your prenatal care checkups, even if you’re feeling fine.
• Follow your provider’s directions about how often to check your blood sugar. Your provider shows you how to check your blood sugar on your own. She tells you how often to check it and what to do if it’s too high. Keep a log that includes your blood sugar level every time you check it. Share the log with your provider at each checkup. Most women can check their blood sugar four times each day: once after fasting (first thing in the morning before you’ve eaten) and again after each meal.
• Eat healthy foods. Eat three regular meals and two to three snacks each day. Have one of the snacks at night. Talk to your provider about the right kinds of foods to eat to help control your blood sugar.
• Do something active every day. Try to get 30 minutes of moderate-intensity activity at least 5 days each week. Talk to your provider about activities that are safe during pregnancy, like walking. Walk for 10 to 15 minutes after each meal to help control your blood sugar.
• If you take medicine for diabetes, take it exactly as your provider tells you to. If you take insulin, your provider teaches you how to give yourself insulin shots. Tell your provider about any medicine you take, even medicine that’s not related to GDM. Some medicines can be harmful during pregnancy, so your provider may need to change them to ones that are safer for you and your baby. Don’t start or stop taking any medicine during pregnancy without talking to your provider first.
• Check your weight gain during pregnancy. Gaining too much weight or gaining weight too fast can make it harder to manage your blood sugar. Talk to your provider about the right amount of weight to gain during pregnancy.

If you have gestational diabetes, how can you help prevent getting diabetes later in life?

For most women, gestational diabetes goes away after giving birth. But having it makes you more likely to develop type 2 diabetes later in life. Type 2 diabetes is the most common kind of diabetes. If you have type 2 diabetes, your pancreas makes too little insulin or your body becomes resistant to it (can’t use it normally).

Here’s what you can do to help reduce your risk of developing type 2 diabetes after pregnancy:

• Breastfeed. Breastfeeding can help you lose weight after pregnancy. Being overweight makes you more likely to develop type 2 diabetes.
• Get tested for diabetes 4 to 12 weeks after your baby is born. If the test is normal, get tested again every 1 to 3 years.
• Get to and stay at a healthy weight.
• Talk to your provider about medicine that may help prevent type 2 diabetes.

Family Planning is helpful in maintaining optimal reproductive and sexual health. When women and families are able to plan and prepare for a pregnancy, increased satisfaction and comfort occurs in overall health, relationships (romantic and otherwise), careers, finances, and happiness.

1. Prevent/Delay Pregnancy: Contraceptives are a great tool to help you be in control of your fertility and sexual health. The urge to have sex is incredibly normal, and the overwhelming majority of people have sex without intention to reproduce. Many people want children at some point in their lives, but not necessarily now. Since becoming a parent is a major decision, it is ideal for people to make that choice when they feel ready and prepared. Contraception allows couples the freedom to choose when they want to have children and enjoy sex without the worry of unintentionally making a baby.
2. Assure Health of Mother and Baby: Contraception is incredibly helpful in spacing pregnancies. After giving birth, a woman’s body requires time to heal properly and rebuild nutrients. Most doctors recommend at least 18-24 months between pregnancies. That is, a woman should avoid becoming pregnant again until her youngest child is at least 1.5 – 2 years old, regardless of how she gave birth. If a woman is less than 18-24 months postpartum, it is encouraged for her to use a reliable birth control method; as having pregnancies too close together can put a mother and baby at physical and emotional risk, both in the long and short term.

Pregnancies too close together (especially less than 6 months after giving birth) have the following increased risks: premature birth, low birth weight, congenital disorders, placental abruption, and schizophrenia. Recent studies suggest Autism risks can increase in pregnancies less than 24 months apart, with the highest risk associated with pregnancies less than 12 months apart.

(Information by Mayo Clinic Staff/Mayo Foundation for Medical Education and Research MFMER, 2011)

Some health conditions (like diabetes, hypertension, obesity, etc) can complicate pregnancy. Women with these and other health conditions can have perfectly healthy babies, but they increase their baby’s chances of good health if the pregnancy is planned and discussed with a doctor beforehand. When a mother plans a pregnancy, she can begin nurturing and caring for her body prior to conception (such as: quit smoking/drinking, eat healthy, exercise, visit the doctor, take supplements–like folic acid, etc.) All pregnancies benefit if a mother is healthy before she becomes pregnant.

3. Medical Reasons: Contraceptives can be used to alleviate many medical issues, such as: Endometriosis, Polycystic Ovarian Syndrome, Dysmenorrhea (menstrual cramps), menstrual regulation, Menorrhagia (heavy bleeding), hormonal balance, menstrual migraines, PMS, PMDD, Acne, Anemia, and even Menopause. Some women use birth control for these reasons, even when they are not sexually active, with some birth control users having no sexual experience whatsoever. Combined Hormonal Contraceptives (Pill/Ring/Patch) can also be used to decrease the risk of certain cancers, specifically Ovarian, Endometrial, and Colorectal.

Article written by Ryann Qavdarbasha

Što je ranije moguće! Ovde je raspored prenatalne posete i šta da očekujemo.

Posetite doktora što je ranije moguće u trudnoći jer će to pomoći da se utvrdi u kojoj nedelji trudnoće ste, i da se identifikuju eventualne komplikacije. Dovedite svog muža ili drugog člana porodice ili prijatelja na ove posete za njihovu podršku i tako da bi oni mogli postavljati pitanja koja bi mogli da imaju. Ispod je raspored prenatalnih poseta, šta da očekujete na svakom i neka pitanja koja biste mogli postavljati svom doktoru. SZO preporučuje najmanje četiri prenatalne posete oko nedelja 16, 24-28, 32, 36 za nekomplikovanu trudnoću. Međutim, u mnogim zemljama žene idu svakog meseca kod doktora.

Poseta	Nedelja Trudnoće	Šta da očekujete
1	6-13 nedelje	Zdravstveni pregled sa pitanjima o poslednjoj menstruaciji, brojem trudnoća, alergija, prethodnih problema uključujući pobačaj i hronične bolesti, medicinska istorija porodice, uključujući genetskih bolesti, navika koje će uticati ploda npr pušenje, piće, droga. Doktor će meriti vašu težinu i krvni pritisak. Savetovanje od strane doktora  o tome kako da se brinete za vaše zdravlje, koju  hranu da jedete ili izbegnete, prenatalne vitamine, moguče tegobe, bilo kakve znakove upozorenja o kojima treba da pazite, dodatne testove koje treba imati u obzir i normalnih promena koje možete da očekujete pre sledeće posete. Pregled grliča  da bi proverio strukturu i uzeti bris u potrazi za abnormalne ćelije . Laboratorijski testovi za proveru krvi (krvna grupa, kompletna krvna slika, polno prenosljive bolesti, fetalne genetske bolesti ^), i urina (nivo proteina and bakterija). Ultrazvuk da proveri razvoj fetusa (gestacija i rok, veličinu, otkucaji srca, krvni pritisak, strukturne anomalije), odreÄ‘ivanje višestruke trudnoće, kao i skrining za genetske bolesti ^.
2	18-20  nedelje	Zdravstveni pregled sa pitanjama o vašim problemima ili brige od zadnje posete, kako ste se osećali, dali ste osećali bebu da se dviži, dali vam je curila tečnost ili dali ste krvarili.  Doktor će meriti vašu težinu i krvni pritisak, a možda će proveriti urin ako je potrebno. Savetovanje od strane doktora o tome kako se brinete za vaše zdravlje, znaci upozorenja, dodatne testove koje treba imati u obzir (na primer. dodatne analize krvi i / ili amniocenteza ako ste pod većim rizikom za genetske bolesti), i promene koje možete da očekujete pre sledeće  posete. Ultrazvuk da proveri razvoj fetusa na pr. veličinu size,  krvni pritisak, strukturne anomalije , zdravlje placente.
3	25-28  Nedelje	Zdravstveni pregled  sa pitanjama o vašim problemima ili brige od zadnje posete , kako ste se osećali, dali se dviži vaša beba.  Doktor će slušati  otkucaji bebinog srca i izmeriti stomak (ako doktor ima ultrazvuk, on će proveravati razvoj deteta). Doktor će meriti vašu težinu i krvni pritisak . Savetovanje od strane doktora  o tome kako se brinete za vaše zdravlje, znaci upozorenja,  promene koje možete da očekujete pre sledeće  posete ,  praćenje dnevnih kretanja vaše bebe . Laboratorijsku testovi za proveru krvi (anemija, Rh antitela,  test gestacijskog dijabetesa), i urine (nivo proteina).
4	31-34 Nedelje	Zdravstveni pregled  sa pitanjama o vašim problemima ili brige od zadnje posete  kako ste se osećali na pr. dali ste imali kontrakcije, glavobolju ili otok?, kako se kreće vaša beba. Doktor će slušati  otkucaji bebinog srca i izmeriti stomak da bi procenio dimenzije i poziciju bebe (ultrazvuk takoÄ‘e može izvršiti ove proverke, pored ostalih fetalnih pregleda).  Doktor će meriti vašu težinu i krvni pritisak . Moguće kontrole/testovi mogu da ulkjučuju kontrolu grliča ako doktor je zabrinut o nećemu na pr. predvremeni poroÄ‘aj, ili da bi proverio poziciju bebe. Ako je potrebno doktor će takoÄ‘e proveriti i vaš urin. Savetovanje od  strane doktora  o tome kako se brinete za vaše zdravlje, znaci upozorenja,  promene koje možete da očekujete pre sledeće  posete ,  praćenje dnevnih kretanja vaše bebe .
5	36-38 Nedelje	Zdravstveni pregled sa pitanjama o vašim problemima ili brige od zadnje posete  kako ste se osećali, kako se kreče vaša beba.  Doktor će slušati  otkucaji bebinog srca i izmeriti stomak da bi procenio dimenzije i poziciju bebe (ultrazvuk takoÄ‘e može izvršiti ove proverke, pored ostalih fetalnih pregleda).  Doktor će meriti vašu težinu i krvni pritisak. Savetovanje od strane doktora  o tome kako se brinete za vaše zdravlje, znaci upozorenja,  znaci neposrednog i aktivnog poroÄ‘aja ( ulkjučujući i to kad da pozovite doktora ili da idete u bolnicu), promene koje možete da očekujete pre sledeće  posete ,  praćenje dnevnih kretanja vaše bebe. Laboratorijski testovi da bi proverio urin (nivo proteina), vaginalni bris (StrepB test).
6	40-41  Nedelje	Zdravstveni pregled sa pitanjama o vašim problemima ili brige od zadnje posete  kako ste se osećali, kako se kreče vaša beba.  Doktor će slušati  otkucaji bebinog srca. Pregled grliča da omekšavanje ili dilataciju vašeg grlića. Savetovanje od strane doktora o tome kada i kako da počne poroÄ‘aj.

• Koliko ćete da vidite vašeg doktora će zavisiti od vaše zdravstvene prošlosti i ako bude nekih komplikacija koje zahtevaju više pregleda. SZO preporučuje najmanje četiri prenatalne posete oko nedelja 16, 24-28, 32, 36 za nekomplikovanu trudnoću. Međutim, u mnogim zemljama, žene idu svakog meseca kod lekara, i svake nedelje tokom poslednjeg meseca trudnoće.

^ Zajedno, test krvi i ultrazvuk su poznati kao kombinovani skrining u prvo tromesecje, koji daje procenu rizika da fetus ima Daunov sindrom kao i druge hromozomske probleme i oštećenja kod rođenja. Ovi testovi su opcionalni; možete se složiti ili odbiti da ih obavite. Ovi testovi nisu konačni, već obezbeđuju relativnu verovatnoću dali fetus ima neki genetski defekt. Postoje dva dijagnostički testovi koji pružaju određeni rezultat: 1) biopsija horionskih ćupica (CVS), obavlja se na 11-12 nedelje; ili 2) Amniocenteza, obavlja se na 16-20 nedelje. Ovi testovi su invazivni i nose mali rizik od pobačaja, tako da se obično samo obavljaju kada žena pokazuje veći rizik za genetske i hromozomske probleme. Vaš lekar će vas posavetovati ako su potrebni invazivni testovi, ali opet ovi testovi su opcionalni i to je potpuno vaša odluka da ih obavite ili ne.

Kakva pitanja da postavite tokom prenatalnih pregleda

Pri svakom pregledu: Bez obzira da li vas je pitao, obavestite svog doktora o svim simptomima, čak i ako izgledaju normalno, kao zamor ili bolove. Ne dozvolite da vas doktor užurba tokom vašeg pregleda ili da mislite da da je previše zauzet. Da, on može biti zauzet, ali trudnoća je uvek najvažnija stvar na svetu za vas.

Na vaš prvi pregled: Neke ideje o tome kakva pitanja da postavite svom doktoru pri vašeg prvog pregleda uključuju:

1. Koliko težine treba da dobijem, s obzirom koliko ja sada težim?
2. Da li je potrebno da vežbam ostvari i ako jeste, koja vrsta vežbi i koliko?
3. Da li postoje ograničenja u pogledu seksa tokom trudnoće?
4. Da li imam povećan rizik od komplikacija ili drugim stanjima? Koji dodatni testovi mogu biti potrebni?
5. Šta treba da jedem i pijem i šta bi trebalo da izbegnem?
6. Da li su lekovi koji trenutno uzimam bezbedni? Ako ne, šta mogu uzeti umesto njih? Koji drugi generični lekovi su bezbedni?
7. Koji kozmetički tretmani su dozvoljeni tokom trudnoće na pr. farbanje kose, manikir?
8. Kakve simptome mogu da očekujem, i kako ću onda snositi se sa njima? Šta je normalno, a za šta bi trebalo da te zovem?
9. Šta da radim ako … Ne osećam se dobro? Grčeve? Krvarim malo? Imam groznicu? Kada treba da te zovem ili da idem u bolnicu?
10. Već sam imao porođaj sa Carskim rezom. Mogu li da dobijem vaginalni porođaj ovaj put?

Vaša beba zavisi od vas da je držite zdravim tako da pogledajte šta je bezbedno tokom trudnoće.

Ako imate neke od ovih znakove opasnosti, odmah se obratite svom doktoru ili idite u bolnicu jer može da ukaže na veliku opasnost za vas i / ili vašeg nerođenog deteta:

• Jak i / ili konstantni bol u stomaku.
• Vaginalno krvarenje, posebno svetlo crvena krv.
• Jako, nekontrolirano povraćanje koja izaziva dehidraciju.
• Glavobolju, vrtoglavicu, ili duple slike ili zamagljen vid za 2-3 sata.
• Groznicu i / ili visoku temperaturu (38 ° C ili više).
• Iznenadno i ozbiljno oticanje lica i šaka i stopala, i / ili neobjašnjeno gojenje.
• Neobično sporo ili nikakvo kretanje vaše bebe posle šestog meseca.

Isprobajte ove savete za ublažavanje uobičajenih tegoba tokom trudnoće:

Promene u dojkama

• Nosite dobro prikladan grudnjak, po mogućnosti bez žica i napravljen od pamuka (jer pamuk ‘diše’ bolje nego sintetički materijal). Ako planirate da dojite, grudnjak će verovatno biti oko jedne veličine šolje veći od onih koje ste upotrebili u kasnoj trudnoći, tako da kupite grudnjak u devetom mesecu.
• Ako vaše dojke cure, nosite maramice za jednokratnu upotrebu za dojke unutar vašeg grudnjaka i menjajte ih nekoliko puta dnevno. Isto tako, dozvolite grudi da se osuše na vazduhu nekoliko puta dnevno i posle tuširanja.

Konstipacija

• Pijte više tečnosti, naročito čistu vodu. Izbegavajte sokove, kao što su koka-kole i drugih kofein pića kao što su čaj ili kafa.
• Jedete vlakna bogata voća i povrća, naročito sušeno voće kao što su kajsije i šljive.
• Izvršiti lake vežbe, kao što su hodanje, svaki dan.
• Izbegavajte laksative osim prirodnih omekšivača stolice i uvek proverite kod svog lekara.

Vrtoglavica ili nesvestica

• Pomerite se polako kada sedite ili ustanete.
• Izbegavajte stajanje na noge za duži vremenski period.
• Odmarajte kada je to potrebno i moguće.
• Jedite male zdrave obroke svakih 2-3 sata.
• Pijte dosta tečnosti; ne zaboravite da ciljate da pijete dva litra vode dnevno.During your last trimester, lie on your left side versus your back, when resting or sleeping.
• Proverite sa doktorom da li vam treba dodatak gvožđa.

Zamor

• Odmarajte i dremkajte kad god je moguće.
• Obavite lake vežbe, kao što su hodanje, svaki dan. To će vas manje, ne više, umoriti.
• Hranite se zdravo (mali redovni obroci su bolji) i dovoljno gvožđa i folne kiseline (preko dodataka).
• Ograničite kofein, koji je u čaj/kafa, sokova i čokolade, jer dok to može obezbediti kratkoročni podsticaj energije, to može povećati opšti zamor.
• Prihvatite da vam je potreban dodatni odmor i prilagodite svoj život u skladu sa tim, npr. izbegavajte dodatne odgovornosti kada je to moguće.
• Nemojte uzimati lekove jer one koje mogu da ublaže umor nisu bezbedne tokom trudnoće.

Glavobolje

• Jedite manje zdrave obroke na svaka 2-3 sata.
• Pijte dosta tečnosti; zapamtite da treba da pijete najmanje 2 litra vode.
• Opustite se, kao na primer preko dubokog disanja, čitanja časopisa ili masaže.
• Izlazite na svež vazduh, npr. hodajte.
• Pokušajte spavati bar 8 sati svake noći i odmarajte kad god je to moguće.
• Upotrebite hladnu ili toplu oblogu na vaše čelo.
• Proverite da li postoji nešto što vas uzrokuje glavobolje, npr. kafa, naprezanje očiju, i izbegavajte ih ako je to moguće.
• Uzmite samo acetaminofen (paracetamol) i nikad ne prekoračite preporučenu dozu. Izbegavajte ibuprofen i nikad ne uzimajte aspirin jer to može povećati rizik od krvarenja.
• Pozovite doktora ili idite u bolnicu ako vaša glavobolja je ozbiljna, česta, dugotrajna ili uključuje zamagljen vid, pege, i otok.

Gorušica

• Jedite manje obroke tokom dana.
• Izbegavajte ležanje nakon jela i večerajte oko dva sata pre spavanja.
• Izbegavajte čokoladu i masnu, kiselu ili začinjenu hranu, primer paradajz, agrumi, sirće, biber, naročito pre odlaska u krevet.
• Pijte mleko i mlečne proizvode koji mogu privremeno da ublaže simptome.
• Uzmite generične lekove, kao što je Gaviskon, u umerenosti (u velikim količinama može biti štetno), ali proverite sa vašim doktorom prvo.

Hemoroidi

• Izbegavajte konstipaciju.
• Nemojte sedeti na WC duže vreme ili napregniti se dok imate stolicu.
• Primenite hladne jastučiće za hemoroide da privremeno ublažavanje simptoma. Izbegavajte lekove koji sadrže lokalnih anestetika jer oni mogu da oštete vašoj bebi.
• Uradite Kegelove vežbe redovno.
• Kupajte se u toplu kupku za 15-20 minuta da privremeno da ublažavate simptome.

Bolovi u nogama/ grčeve i tegobe donjeg dela leđa

• Unosite dovoljno kalcijuma jedući mlečnih proizvoda kao što su mleko, sir i jogurt.
• Obavite lake vežbe, kako što je hodanje 20-30 minuta.
• Kupajte se u toplu kupku.
• Nabavite blage masaže od svog muža ili prijatelja.
• Uradite karlice nagiba vežbe za donji deo leđa.
• Izbegavajte stajanje ili sedenje duže vreme.
• Dignite noge što je češće moguće.
• Nosite sa cipele niskim potpeticama.
• Primenite dobro držanje sa podvlačenjem vaše zadnjice ispod, stojenje ravno i ispuštanjem ramena dole.
• Budite oprezni prilikom podizanja predmeta; savijte kolena umesto savijanje preko u struku.

Promene u raspoloženje

• Razgovarajte o tome kako se osećate i šta vas zabrinjava sa vašim mužem i prijateljima.
• Napravite vreme za sebe i uživajte u nečemu ili razmazite sebe, na primer na manikir.
• Provedite vreme na aktivnosti na koje uživate, osobeno sa vašim mužem.
• Obavite lake vežbe, kako što je hodanje 20-30 minuta.
• Odmarajte i dremkajte kad god je to moguće da biste izbegli iscrpljenost.
• Hranite se zdravom hranom (male redovne obroke su najbolje) i unosite dovoljno gvožđa i proteine.
• Posetite časova porođaja ili pročitajte o trudnoći i porođaju; znajući šta da očekujete će olakšati napetost.

Mučnina i povraćanje (jutarnja mučnina)

• Jedete manje, česte obroke i užinu tokom dana. Držite sa sobom jednostavne grickalice, kao na primer krekere.
• Ne ležite posle jela.
• Pokušajte da izbegnete hranu i mirise koji pokreću mučninu i izbegavajte masnu, kiselu ili začinjenu hranu.
• Pijte tečnosti uglavnom između obroka. Trudite se da pijete dva litra vode na dan. Ako ste povraćali mnogo, pijte elektrolite (kupiti sportsko piće ili napravite sopstveni sa 1 litar vode, 1/2 kašičice soli i 6 kašičice šećera).
• Izlazite na svež vazduh; prošetajte ili otvorite prozore.
• Uzmite prenatalne vitamine sa hranom ili pre spavanja.
• Probajte đumbir za smirenje stomaka (narendajte svež đumbir u vruću vodu da napravite čaj).
• Uzmite ekstra Vitamin B6 jedući puno banana, oraha, boranija, šargarepa, karfiol, krompir, nemasno meso i ribe. Takođe možete uzeti dodatke.
• Proverite sa svojim lekarom ako može uzeti bilo koji generični lek ili lekova na recept kako mnogi nisu bezbedni tokom trudnoće.

Nemirne noge (osobeno kad probate da spavate)

• Izbegavajte kofein, kao čaj, kafu, gazirana pića npr Koka Kolu i čokoladu.
• Obavite lake vežbe, kao što je hodanje 20-30 minuta.
• Masirajte noge, naročito pre odlaska na spavanje.
• Ispružite noge, naročito pre odlaska na spavanje.

Promene u koži

• Zbog promena u boji kože, izbegnite sunčanje, jer to može da utiče na boje kože.
• Zbog akne, mijte lice kako uobičajeno.
• Zbog strije, nema ništa što može da ih izbegne, ali trudite da se ne gojite previše, jer to uzrokuje strije.
• Zbog svraba u koži, ne tuširajte se sa vrućom vodom, upotrebite losione na kožu, nemojte nositi usku odeću i ne stojite na toplom.
• Ne brinite! Većina ovih prođe kad rodite bebu.

Probleme sa spavanjem

• Obavite lake vežbe, kako što je hodanje 20-30 minuta.
• Kupajte se u toplu kupku pre spavanja.
• Pre spavanja, pijte toplu vodu sa limunom ili toplo mleko.
• Jedete večeru za dva sata pre odlaska u krevet i izbegavajte šećer.
• Izbegavajte kofein, koji je u čaj / kafe, gazirani napici i čokolade.
• Nemojte uzimati lekove jer one koje mogu da ublaže nesanicu nisu bezbedni tokom trudnoće.
• Opustite se sa tehnikama relaksiranja, kao što su duboko disanje, čitajući časopis ili napravite masažu.
• Smanjite buku ili osvetljenje koje će vas ostaviti budan.
• Isprobajte različite pozicije za spavanje, kao što je ležanje na levoj strani sa jastukom između kolena.
• Odmarajte i dremkajte u toku dana, ako je moguće
• Ne brinite! Hormonalne promene kasnije u trudnoći znače da je normalno da spavavate samo 2-3 sata u isto vreme. To je samo nacin da Vam telo pripremi za predstojeće promene u svom životu

Oticanje

• Izbegavajte stojenje ili sedenje na jednom mestu za duže vreme i izbegavajte sedenje sa ukrštenim nogama.
• Edite hranu bogatu proteinima, kako što su pasulj, sir, riba, crveno meso i piletina.
• Pijte toplu vodu sa limunom
• Lezite sa jastucima pod svojim listovima i nogama dva ili tri puta dnevno.
• Nemojte nositi usku odeću, kako što su pantalone, hulahopke i čarape visoke do kolena.
• Obavite lake vežbe, kako što je hodanje 20-30 minuta.
• Pokušajte da pijete dva litra vode dnevno.

Vaginalni sekret / gljivična infekcija

• Pokušajte da nosite suknje umesto pantalone.
• Nosite 100% pamučni donji veš i spavajte bez donjeg veša.
• Promenite veš, ako je moguće, u toku dana.
• Jedete jogurt ili probiotik dodatke.
• Ograničite proizvode od šećera i kofeina.
• Izbegavajte ispiranje osim ako vaš lekar je rekao.
• Pozovite svog lekara ako sekret gori, svrbi, mirise, ili uzrokuje oticanje.
• Nemojte uzimati lekove, čak ni one generične, pred da da proverite sa vašem doktorom.

Proširene vene

• Obavite lake vežbe, kako što je hodanje 20-30 minuta.
• Nemojte nositi usku odeću, kako što su pantalone, hulahopke i čarape visoke do kolena.
• Nosite hulahopke za podršku kada planirate da stojite ili hodate dugo vremena. Obucite ih pre nego što ustajete iz kreveta ujutru.
• Izbegavajte stojenje ili sedenje na jednom mestu za duže vreme i izbegavajte sedenje sa ukrštenim nogama. Ako treba da sedite duže vreme, svakih 30-60 minuta ustanete i istegnite se ili šetajte okolo.
• Lezite sa jastucima pod svojim listovima i nogama dva ili tri puta dnevno.
• Nosite cipele sa niskim potpeticama.