Q: I'm birthing in a hospital, but I don't want to have to be on my back in bed. What are my options?

A: It sounds like you already know the benefits of freedom of movement in labor and birth. Standing up, for example, allows gravity to help put the baby's head on your cervix. Research continues to show that restricting women's movement during labor may result in worse birth outcomes.

Because each facility has different rules, the hospital where you plan to deliver will have the best answers for you. Women often talk with their doctors or midwives about these concerns, but neglect to find out what's allowed once they're checked in. If the hospital supports it, your doula can teach you to reposition the hospital bed so you can squat and hold the top of the bed or be on all fours. You may also be able to bring along inflatable fitness balls for you and your partner to use for labor support.

But don't wait until labor begins to find out whether freedom of movement will be possible for you. It is one of the most medically valid questions you can discuss ahead of time. Although media images portray laboring women in bed, active birth positions make contractions more efficient and shorten labor, as well as provide greater comfort and less chance of intervention.

Q: Is it possible to feel yourself conceiving? I swear I know the exact moment I became pregnant, but my family thinks I'm a little nuts. Is there any medical evidence for this?

A: I can find no research to support a physical ability to recognize the moment of conception. But I can't argue against the possibility of some spiritual connection between a mother and a new life.

Q: Last night my husband and I were having sex, and I think the baby moved! It was such a strange sensation. Does that mean we shouldn't be intimate anymore? I'm in my third trimester.

A: The baby couldn't care less if you have sex, climb stairs, or do anything that jostles him. If you're having a low-risk pregnancy with no complications, you can have sex up until the day you deliver. However, there are some medical reasons to avoid sex during pregnancy including:

1. Your practitioner has advised against it.

2. You're currently experiencing bleeding. If so, avoid sex until your physician can determine the cause.

3. You have placenta previa, in which the placenta covers the cervix, and you're past 28 weeks when the cervix starts to thin.

4. You or your partner has a sexually transmitted disease. If your partner has herpes, you should stop having sex about eight weeks before your due date to avoid an infection at the time of delivery.

5. Your water has broken, or you think you might be leaking fluid.

Q: I've been to a few parties this winter where I can smell smoke from a fire in the fireplace. I've read that breathing smoke can be harmful for a fetus. How seriously should I take that warning?

A: Burning wood in the fireplace is generally safe during pregnancy, if the chimney is operating properly and carries away the majority of the smoke and carbon monoxide. But if there's visible smoke, or it's making you cough, I recommend that you leave the party, or at the very least crack open a window to allow fresh air in and make it easier for the fireplace to vent.

Carbon monoxide is a colorless, odorless gas formed by burning material. Excessive exposure is dangerous. In a study of pregnant women in Guatemala, those with daily exposure to wood smoke delivered babies whose birth weight was, on average, 2 ounces lower than the babies of pregnant women who weren't exposed. And the early symptoms of carbon monoxide poisoning-headaches, nausea, fatigue-can all be mistaken for the flu this time of year.

Q: My mother is against breastfeeding and my husband is very pro-breastfeeding. What can I do to deal with their different opinions?

A: You're not alone in experiencing this generational divide. Our mothers, and even their mothers before them, likely didn't breastfeed. Today, we know the health benefits of nursing, for both mom and baby, and are encouraged to do it for as long as possible. That's why I recommend my clients explain the decision to breastfeed not as a personal choice, but as one made as a result of new information. Giving the grandparents handouts about the advantages of breastfeeding can be a powerful communication tool.

But beyond the health implications, for many the deeper issue is finding one's own path in parenting. Remember, breastfeeding will not be the first or last conflict. It's normal and natural to want approval of your parenting styles, but what matters more is learning to hush external voices and finding your own confidence as a mother.

When a client shares this common concern with me, I know it will be crucial to nourish and protect the breastfeeding relationship from the doubts and insecurities of the first three weeks postpartum. Nursing is a learned skill that requires listening to baby's cues and using your own body wisdom. So, having resources like a postpartum doula or lactation consultant, or attending free La Leche League meetings, are that much more important.

If research and instincts support your desire to breastfeed, your partner's backing will be invaluable. Research shows that encouragment from the father, together with his positive attitude and knowledge of nursing's benefits, has a strong influence on how long a mom nurses successfully.

Q: My co-workers constantly tell me my desires and preferences for labor aren't going to happen - how can I handle that?

A: Your workplace may not be the right environment to share birth preferences or post-natal priorities. Birth is very personal. After all, it's part of our human sexuality and reproduction-and that demands privacy.

So, use this situation as your first step in defining clear boundaries and protecting your instincts. Your co-workers weren't privileged to hear how you made a baby-I hope!-so they needn't hear how you will meet that baby. Remember that while what resonates for you is important, your colleagues might not be coming from a neutral place. Some women won't be able to acknowledge your personal preferences and may take your choices as a rejection of theirs-or use your pregnancy to talk about what still hurts about their delivery experience.

Finding like-minded women outside of your professional network can be a valuable tool, so seeking a mother's support group-online or in person-might give you a more appropriate place to process your birth options and desires.

Q: I apply a generous amount of baby oil gel on my tummy and breasts one to two times a day to prevent stretch marks. Will the absorption of the product do any harm to me or to my baby? Will baby oil gel even prevent stretch marks?

A: Baby oil is safe to use externally as a moisturizer, and rubbing cream or oil on your belly daily can be excellent for the itchy, stretched skin in that area. However, stretch marks are hereditary and no product applied during pregnancy will prevent their appearance. Maintaining gradual weight gain can help minimize marks, as can promoting your skin's elasticity by eating right and drinking plenty of water.

Q: Is it OK if I occasionally skip my prenatal vitamin? In my first trimester, I would avoid it if I was feeling particularly nauseous that day. And, honestly, sometimes I just forget. I’ve never been a regular vitamin-taker. Can I get the nutrients in it by changing my diet, instead?

A: Of all the ingredients in prenatal vitamins, just two are essential for the average pregnant woman. The first is folic acid (at least 400 micrograms daily), a B vitamin that ideally should be taken months before conception and continued until the baby’s spinal nerves are encased by the spine, which happens around the ninth week.

The second is iron. The fetus takes a lot of the mother’s iron to make blood, and mom needs to make a lot more red blood cells herself to account for the increased blood circulating in her body.

Women who eat a healthy diet probably get the other necessary vitamins and minerals on their own. That means missing a pill here and there is not a huge problem.

But, if you frequently find yourself too busy to eat a balanced diet, you avoid dairy, or you don’t like vegetables and fruits, you should stick to taking the prenatal vitamin daily, without exception. Sometimes, switching to a children’s chewable vitamin at lunch and dinner can help lessen the nausea from full-dose prenatal vitamins.

Q: I’m a singer in two rock bands, surrounded by extremely loud music several times a week. I read that a mom’s noisy job can lead to retardation and hearing loss in her baby. Even though stars like Gwen Stefani tour while pregnant, I feel there’s no comparison—my speakers and the instruments are 10 times closer to me. Can you tell me anything about this?

A: Noise is actually very muted by all the layers between you and your baby, the amniotic fluid being the best insulator against sound. Still, it’s possible for the baby to be startled by noise after about 24 weeks. Some studies have reported a correlation between exposure to noise and preterm delivery, reduced birth weight, and high-frequency hearing loss in the fetus, but others have shown no relationship. My advice: If the sound is strong enough to feel in your bones, avoid the exposure. Any other loud noise is probably safe.

Q: My blood type is negative. I’ve heard this might complicate my pregnancy. What do I need to know?

A: What you’re referring to is your Rhesus type or Rh factor. Two things typically characterize blood type: the letters O, A, B, or AB and positive or negative Rh status. Because a baby’s blood type is a result of both its parent’s blood types, it’s possible for a fetus to have a different blood type from its mother. Differences in letter type rarely cause serious problems. But a difference in Rh factor can create antibodies that cross the placenta and destroy baby’s blood cells, causing severe anemia.
To make these antibodies, the mom must be Rh negative and carry a baby that is Rh positive. In the United States, only about 15 percent of blood types are Rh negative. That’s because Rh is a recessive gene, meaning that if you test negative you must have two copies of the negative gene. If you and your partner are both Rh negative, you cannot have an Rh-positive child. However, if you’re Rh negative and your partner is Rh positive, there’s a good chance your baby will be Rh positive, too.
When an Rh-negative mom carries an Rh-positive baby, there’s a 17 percent risk she’ll create these dangerous antibodies. If she receives a shot of a drug called RhoGAM around 28 weeks and again right after delivery, the risk is reduced to 1 in 1,000. For this reason, your doctor will type your blood early in your pregnancy. If you’re Rh negative and the father is Rh positive, you’ll be given RhoGAM and have a low risk of any related complications.


Itchy and Scratchy

Q: I’m in my 35th week and recently developed a really itchy rash on my belly. I go on daily walks in the woods so I thought it was just poison ivy, even after it spread to my legs, but now it’s so bad I can’t sleep. What’s happening to me?

A: Only a visit to your doctor can give you a diagnosis, but I suspect you have PUPPP (pruritic urticarial papules and plaques of pregnancy), what’s now more often called PEP (polymorphic eruption of pregnancy).
This is the most common itchy rash of pregnancy, affecting about 1 in 160 pregnancies. It develops late in the third trimester, tends to stabilize as the pregnancy progresses, and goes away with delivery. The cause is unknown and no increased risk of other conditions has been found in the mother or her baby as a result.
The rash often starts on the belly with red, itchy, and raised skin. Sometimes tiny blisters are present. In many women, the bumps merge into a larger red area. The face, hands, and feet are rarely involved, but spreading to the legs, buttocks, chest, arms, and back is common.
To treat it, your ob/gyn will likely prescribe a combo of pregnancy-safe antihistamines and steroids. But be sure to see a doctor now—in rare cases, an itchy rash can be a sign of something more serious.