Question 10, Is it safe to have sex while pregnant?

It might be well to first discuss the physiology of the sexual response in women.  There would be no problems to mother or fetus related to sexual arousal. Blood flow to the pelvic organs is increased and some lubricating fluids are produced neither of which would be harmful.

During female orgasm, there is some vaginal muscle contractions but aside from an increased pelvic organ blood 'congestion' no significant changes occur to the uterus including blood flow to the placenta. Some women describe uterine contractions with intercourse but this is not a result of female orgasm but the effects of the semen.  Semen has a compound in it named a prostaglandin.  In fact that is where this chemical got its name.  It was found some time ago that fluid from the prostate gland would cause the smooth muscle of the uterus to contract.  It is true that a woman who is threatening pre-term labor or who has an advanced cervical dilatation may be 'pushed' into labor by the prostaglandin in semen but in normal situations it is not a problem.  In fact, sometimes, we might encourage a woman near term to have sexual intercourse as the semen may help soften, thin and dilate the cervix.

There may be an increased risk of infection as bacteria are introduced into the vagina by the mechanics of penile penetration but again, in normal circumstances this is not a concern.  If the male has a sexual transmissible infection this could certainly be a problem.

One last comment about the mechanics of intercourse.  Some have expressed a concern about the potential of the erect penis causing some mechanical harm to the fetal head.  This is impossible and not a concern at all.

There are some benefits of sexual intimacy during pregnancy.  Having an orgasm is almost always a stress relieving and relaxing event.  The anxiety of pregnancy can be benefited by this.  It often allows a better nights sleep as well. Since one of the difficulties during pregnancy for a woman is getting a good nights sleep this may be helpful.  A woman's sense of self image and beauty is often challenged with the physical changes that accompany pregnancy.  A husband who reassures his wife that he finds her beautiful and attractive can also be very important and what better way to express this then by letting her know he would like to be with her physically.

Finally, a woman's interest in physical intimacy is quite variable from one woman to the next and even from one pregnancy to another.  The hormonal changes so pronounced during gestation are hard to predict and are varied.  It behooves a caring partner to be aware of these complicated emotions and try and discern how his wife is responding to these hormonal changes.  Act accordingly men.  Women, you need to be aware that most men find the physical changes that are occurring to your body arousing, stimulating and attractive.  Enjoy these changes, enjoy your pregnancy and be assured it is healthy and beneficial in almost all circumstances to enjoy physical intimacy.

Answer question 9, How much weight should I gain while pregnant?

There are still many health care professionals who feel caloric intake should be increased during pregnancy.  This idea is based on the baby and the reproductive organs requiring more calories.  It has merit but by far and away the biggest problem we see in the U.S. is too much weight gain.

The healthy mom who stays active and eats a normal diet without trying to "eat for two" will gain about 20 lbs.. Anything above this is not necessary. The extra weight represents the fetus, the fluid around the fetus, the placenta and the extra blood volume the mother carries.  It also is representative of the extra fat stores mom needs to feed her baby if she breast feeds.  It takes about 500 calories per day to feed a growing newborn.  So if the baby, fluid and placenta weigh about 10lbs. total this leaves about 10lbs. of fat stores for feeding baby.

If mom is eating regularly, not over eating, after delivery she will easily get the extra 500 calories per day needed for the nursing baby.  The natural storage of the extra weight is an emergency storage in case the mom is put in a starvation situation.  That is so rare of a problem in the U.S. I have never seen it.

So,  a 20 lb, weight gain is ideal in pregnancy. This leaves a 10 lb. buffer which will probably not be needed anyway.  I should mention that gaining way more then this is the norm in the U.S.. Most mothers put on 40 lbs. and I have seen 90 lb, weight gains more then you would think.  I do not worry about a 40 or 50 lb. wt. gain as it doesn't really affect the baby and moms do fine.  It gets tough to lose pregnancy weight for most women so I encourage the lower weight gains but usually don't make a big deal of it.  It is not that big a deal. No pun intended. ;)

Question #8: Is it normal to have pelvic/uterine cramping while pregnant?

It is not uncommon at all to feel menstrual like cramps throughout pregnancy. The uterus is basically a muscle and designed to contract.  As with any muscle it resists stretching.  The slow but steady growth of the fetus subtly over time enlarges the uterus and during that process the smooth muscle will contract to one degree or another.

Early in pregnancy I get asked all of the time if it means there is an increased in miscarrying.  As long as there is no bleeding it feel it is nothing to worry about.  Later in pregnancy there is a concern as to whether the cramping represents labor.  It is very common to have a lot of uterine cramping at about 6-7 months and continuing through pregnancy.  A woman who has had a child already will experience this more.  These are called Braxton-Hicks contractions named after an English physician.  They are harmless.

I would say the best way to determine if these false labor contractions (Braxton-Hicks) are truly false labor is to trust your instincts.  Almost all women know for sure when real labor starts.  It is much more painful, more regular and over several hours will progress and become more painful and the contractions closer together while maintaining their regular frequent nature.

Question #7: Can I fly while pregnant?

The short answer is "only in an airplane." :) More elaboration is useful.  Aside from the inherent dangers associated with a potential plane crash, (which by the way are not as likely as getting killed in a car crash on a mile for mile basis) the only issue is changes in barometric pressure.

It is true that barometric pressure changes can and do effect the fetus but only minimally.  It is much more of a potential problem with the vastly higher pressures we see in scuba diving. The pressure changes in flying are related to decreasing barometric pressures which can lessen the oxygen saturation of the blood.  When we are talking of getting up around 10,000 feet or higher it could theoretically diminish the amount of oxygen the mother delivers to the baby and could be an issue so I would not recommend a woman spend much time above this 10,000 foot level.  NO Himalaya expeditions while pregnant but skiing at Snowbird is ok if you don't decide to live on Hidden Peak.

The average cabin pressure changes in an aircraft would never be much more then traveling up to 7 or 8 thousand feet and is not a problem.

The other two minor considerations have to do with access to medical care.  The airlines are not equipped to deliver a baby in mid flight and therefore are not going to ever say it is fine to fly if you ask them outright as they don't want to assume that liability.  They would ask for a doctors note to shift the liability to the doctor.  Unless you are within a week or two of your due date this is not really a problem. It is not true that normal barometric pressure changes as with flying, a storm or going into the mountains will induce labor. The other access to care issue has to do with flying away to some distant city where you are not aware of medical resources such as your doctor or hospital.  Flying to Boston when you are 38 weeks pregnant may increase your chances of having your baby in Boston delivered at an unknown hospital by an unknown physician., but it is only related to the fact you are approaching your due date.   I am sure you would get excellent care there but in unfamiliar surroundings.

I typically recommend not flying after 34 weeks for the reasons mentioned above and not asking the airlines permission.  If you do want to ask the airlines if it is ok to fly take a note from me to that effect because they will ask for a doctors release.