8 rules you can (sometimes) break during your pregnancy
Sometimes pregnant women feel that all they hear from their doctors, friends, families, neighbors, and strangers are “You shouldn’t be doing ___” or “Didn’t you know you have to ___.” While rules and guidelines exist for a reason — including during pregnancy — there are some things that you can probably ignore every so often. Feel like you need to rebel and want to know what’s safe? We’ve got you covered.
1. Skip your prenatal vitamins. It’s true that prenatal vitamins are important, especially since many American diets fall short when it comes to the nutrients a pregnant woman needs to keep her and her baby healthy. However, skipping them occasionally is OK and will not cause any harm. Try not to do this when you are trying to conceive or are in your first trimester since the folate in your vitamins is super important during this time, but don’t stress if one day you feel too nauseated to swallow a big pill.
2. Have an occasional glass of wine. While the American College of Obstetricians and Gynecologists takes a hard stance on alcohol — that no level is known to be safe — it has yet to be proven that the occasional glass here and there can cause any major harm. We don’t suggest drinking nightly, but if you happen to be pregnant on New Year’s Eve and don’t want to skip the champagne toast, you can have a glass guilt-free.
Doctor’s note [8/17/15]: Comments on this article prompted me to rethink my wording of “occasional,” which I realize can be misleading, and so I wanted to clarify my meaning. Some women and doctors may take that to mean every week, while others interpret that as once or twice a pregnancy. My purpose here was to address the pregnant woman who literally is wondering if a glass of wine during her pregnancy is absolutely out of the question, such as in my example about New Year’s Eve. To that end, I stand with my recommendation that I would counsel her she can rest assured there is no data to say this is known to cause any harm, but of course our data is only good as our studies, which are incomplete at best. Of course, if she wishes to be as conservative as possible and follow the most conservative recommendations we have, then abstaining is certainly the way to go. Please see my full response below in the comments for more about this!
3. Eat for two. Yes, you need to increase your caloric intake during your pregnancy, but it’s never as much as eating for two. However, you are going to have those days where that is exactly what you want to do. Go for it! … Just not frequently, and don’t make a habit of it. But really, what other time can you get away with this excuse?
4. Take a break from your work out. Exercise has huge benefits for you and your developing baby. Unfortunately, most pregnant women don’t exercise at all or not enough. If you are active, though, and feel like you need a break because you are too fatigued, nauseated, or uncomfortable, go ahead and listen to what your body is telling you. Take time to rest and recuperate, so that when you are feeling better you can jump back into the game.
5. Drink coffee. No one should ever tell a pregnant woman that coffee (and caffeine) is off limits! You can certainly drink coffee in safe amounts. However, if you’ve sworn it off out of worry or concern, please let yourself break this “rule” when you desperately need a pick-me-up.
6. Sleep on your back. One thing we often tell pregnant women is to avoid sleeping on their backs because this can decrease blood flow to the placenta. However, your body is smart, and if lying on your back is causing any problems, you’ll start to feel uncomfortable (usually dizzy or lightheaded) and want to shift positions. But if sleeping on your back is the only way you can get comfortable and you feel fine, then do it.
7. Change the litter box. It’s true that you shouldn’t change the litterboxes of any outdoor cats to avoid exposure to toxoplasmosis. However, this rule doesn’t apply if your cat is indoor only (feel free to ignore this if you want to get out of this chore for 40 weeks …).
8. Skip the childbirth class. Most doctors and midwives recommend taking a childbirth class for first-time parents. However, if the idea of sitting in a room with a bunch of strangers practicing your deep breathing or watching a woman give birth on video freaks you out, go ahead and skip this one. Pick up a reputable book instead, or go online for information. Keep in mind not all sources are created equal however, so don’t believe everything Dr. Google tells you!
Dr. Lincoln: As a nurse, and currently 28 weeks pregnant, I’d like to thank you for this article. Now I have seen much hype on #2. As many people may not be aware, but in Europe it is common practice to have an occasional glass of wine. As in a every once in a while glass of red wine (every few weeks & or once in a very seldom while). Now the instructions over there is no alcohol during the first 12 weeks, and no more than one glass of wine occasionally. Nothing stronger. However, I personally just stay away all together. Not feeling the need to chance it. So keep in mind that pregnant women through the centuries drank wine frequently throughout their pregnancies, and babies survived. The big reason why it’s been made clear that no level has been proven safe is because there has been no studies performed on low/minimal use of alcohol during pregnancies. Like most drugs, no studies have actually been performed on human fetus and pregnancies to determine safety. Even Tylenol is only cat. B which means it’s only been studied by animal testing. Unfortunately though, FASD is a very real thing and should not be ignored yes. However, in majority of these instances the pregnant women drank more than just a glass of wine. And/or they drank unaware of their own tolerance level, and kept drinking. Big reason why CDC, Board of gynecology/obstetrics do not support any alcohol during pregnancy is because of the risk and liability they face if a pregnant women kept drinking. So basically, it is a think because rather than have the risk, it’s better no risk at all. And I’d like to thank you for the caffeine. I limit myself to the 200 mg caffeine limit set by the American pregnancy association. And I only partake occasionally. But I’d really like the fact that caffeine is ok in limited amounts to reach everyone. I hate feeling judged when I order a small coffee after not being able to sleep the night before due to this ever growing uterus. Anyways, that’s all I have to say!
Hi Sarah, Thanks for your thoughtful comments! I totally agree, especially that it drives me nuts when I see pregnant women shamed for having some coffee. Hope you have a great pregnancy!
Dr. Lincoln, I am very curious to know how you could deflect the possible harm #2 might do during pregnancy? Especially when you yourself chose not to drink during pregnancy. I’m under the impression that #2 is in violation of bundoo’s editorial policy which states “We rely on evidence-based information from the leading sources of pregnancy and pediatric research and guidelines.” You wrote yourself that according to the College of OB/GYN’s there is no known level to be safe. Correct me if I am wrong but that right there is NOT evidence-based information. Is #2 just a professional opinion of yours?
Hi Rita, I feel I’ve addressed this (and the idea of evidence/data and the limitations we have on both) in my update in the article above and in an additional comment I made below from 8/15). Thank you for your comment.
Thank you for #8!! I’m 28 weeks pregnant with my first and EVERYone is insisting I take a childbirth class even though I’ve done a ton of my own reading/research. A class seems very uncomfortable and I like to be able to skip things that cause me anxiety because what happens will happen, and there’s no use in stressing about it now! I’ve adopted a go-with-the-flow mentality since being pregnant since 0-5% of this experience has gone as ‘planned’ or expected and it’s helped my anxiety tremendously but people don’t understand that and it’s frustrating.
I’ve had 5 kids and currently baking my 6th. With my last pregnancy, I was unaware I was pregnant until 20 weeks. During that time, my husband and I had got married and we often drank all sorts of alcoholic beverages. …Sometimes alot! Once I found out I was pregnant, I stopped drinking and we did worry about the baby. But he was born with no complications and now he’s a very smart and healthy 18 month old.
The job I have now gets stressful at times and there are nights I will come home and have a glass of wine. It’s not every night, or every week, but on occasion. I’m not suggesting for anyone to consume alcohol, but I feel like an occasional drink is ok. I unserstand what she is saying in this article. If you don’t feel comfortable drinking any amount of alcohol, then don’t. It’s just a matter of choice and opinion. I am very aware of the consequences of consuming alcohol while pregnant. As I stated previously, I was worried because I, unknowingly, put my baby in danger. But thankfully, he had no issues or side effects. He even made it through a appendectomy I had to have when I was 28 weeks! He’s definately my little blessing!
And like I said, I’m not encouraging anyone to drink alcohol, I just wanted to share my story and my personal viewpoint on ejoying a occasional drink.
As a FASD Trainer and consultant, I could not agree more with the comments made regarding taking precautions regarding recommendation number 2! The research on this subject is that there is no low threshold of alcohol that has ever been deemed safe! Not that a small amount of alcohol has never been proven to cause harm. As a doctor, I understand there has not been extensive education provided to you on the subject. Most curriculum provide limited to no education on FASD for clinicians in training. However, you have a responsibility to understand the facts before making recommendations that could change people’s lives forever. There is an excellent training available in your community this January, that I strongly recommend you consider attending. The link to register for this is http://www.fascets.org/January%2016%20Registration.pdf . You must register by January 15. This training will clarify the facts for you and improve your work in private practice, moving forward. Please consider this opportunity.
First of all, I want to thank everyone who took time to respond to this blog post. I know it takes time out of your day to do so and obviously the majority have direct connections to this topic so of course it hit a nerve. Many posters here and on social media are foster parents to children with FASD and other spectrum disorders, and know that I think what you do is amazing — to take in a baby who you know had a less than stellar start in life, and to commit to parent them. That is wonderful stuff and not for the weak of heart. In the same vein that I took the time to read your responses, please do so with mine so you might better understand my intention (which was never to condone irresponsible, regular drinking — I promise!):
1. I do see that the picture of this article was perhaps not the most “feel good” photo out there. I’ve since asked my editors to change it to something else. Perhaps a pregnant woman drinking coffee? Because I think we can all agree the data on caffeine usage in pregnancy is pretty safe, yet so many pregnant women I see think the coffee they drink is in the same category as illicit drugs!
2. I promise you, I don’t walk around telling pregnant women to go have a glass of wine after every prenatal visit (and yet, I have had women tell me their doctors have said just that!) My point here was to address what I meant by occasional, which for me means on that special occasion such as an anniversary where a patient really wants to celebrate with a few sips of champagne (I also addressed this in the article itself, please see above). I do not mean weekly consumption, or daily, or anything of that regularity. Some of you still may take issue with that, and that is where we will have to agree to disagree. I fully support the ACOG statement that no amount of alcohol is known to be safe in pregnancy, but I also have to clarify that we have no data to show that two ounces of alcohol over 40 weeks of pregnancy causes FAS or FASD — but of course, abstinence from all alcohol is the only way I could ever guarantee you are doing no harm. I believe women are smart, and when presented with this information they will make the right decision for them. One woman may decide she can’t live with herself if she ever has a sip of wine in her pregnancy, while another will feel that is not something she is concerned about in light of lack of data and will opt for that glass of champagne.
3. I also want to point out that I’ve cared for many patients who have drank before knowing they were pregnant, since so many pregnancies are unplanned. Some have had episodes of binge drinking, and others have had a single beer. Women in both camps have asked me if they should pursue an abortion because of this alcohol exposure (you may think that is a ridiculous question to have, but I promise you it comes up). It is especially critical in these kinds of scenarios to respond with facts, not fear, and that is where I think data is especially important. I completely agree that as physicians we have an oath to “first do no harm.” This includes the less-obvious situations where me overstating the data we have about alcohol (for example, if I were to say, “Yes, the one beer you has been shown to lead to FASD and if you are worried about that you should terminate your pregnancy) would actually be doing the patient more harm than good. This is where I need to be honest, and in this case that means saying that while we can never be sure what effect something like a single beer may have had, the chances that it alone will lead to long-term problems for this child is slim at best and is not supported as yet by rigorous data that should lead a woman to terminate her pregnancy. The best course of action would be to avoid further alcohol consumption if she is concerned, and focus on what else she can do to have a healthy pregnancy.
I hope this has helped to clarify a bit of what I meant and to show that I never intended to offend anyone in the FAS/FASD community. For what it’s worth, I abstained from alcohol for all 40 weeks of my pregnancy out of personal choice. Just a few weeks ago when I finally tried to buy a bottle of wine (about a month after I delivered), I was refused because I forgot my ID at home. They honestly refused a mid-thirties woman with bags under her eyes, two kids in tow (one screaming), and covered in spit up. Thankfully, they couldn’t refuse my purchase of multiple baked goods which I consumed in its place…
Ok doctor or not, and as a mom of a teen who is FASD, no amount of alcohol is ever, ever, safe!!! Do not play Russian Roulette with your baby’s life, its not worth it, believe me. My son is 15, he has short term memory issues, cognitive disablities, low IQ, and many other issues. Do not believe this stuff its just not true. DO NOT DRINK WHILE PREGNANT!
I really agree with you even though there is a lot of people whom drink while pregnant everyday and nothing happens don’t be the one who do and everything goes wrong
Dr. Lincoln, I deal with FASD 24/7 because of my daughter’s birth mother’s prenatal alcohol use. Even small amounts of alcohol during pregnancy causes permanent, irreversible brain damage. PERMANENT. Among other things, it causes behavioural, cognitive and physiological impairments that have a profound impact on day to day functioning and quality of life. Simple tasks like remembering to bath, dress for the weather, and completing school work become difficult. The absence of physical characteristics of FASD is not an indicator of a lack of FASD. 90% of people with FASD do not have any facial attributes.
It is mindnumbingly irresponsible for a medical professional to advocate that any amount of alcohol is safe to consume during pregnancy. Spend some time talking to a person who lives with FASD and you will rapidly change your tune.
How sad in the interests of infotainment you have forgotten your medical oath to do no harm. Alcohol consumption in any amount during pregnancy causes harm.
And here lies the PROBLEM in ending an epidemic that has a way to be controlled. A DOCTOR -OB/GYN at that- giving advice that is truly harmful and feeding into the problem going against the Surgeon General’s advisories, CDC warnings, and admittedly the “American College of Obstetricians and Gynecologists hard stance on alcohol” (that no level of alcohol during pregnancy is known to be safe). It’s sad and angering when the uneducated put our children at risk with their opinions that “a little” alcohol is okay during pregnancy. Unfortunately, that little bit of alcohol doesn’t cause a “little bit of brain damage” and the brain damage doesn’t go away…..EVER. Our children don’t wear their brains on the outside so you can’t see the damage done. The gaps and damage broaden as years pass and our children SHOULD move past the concrete thinking into the abstract and don’t. The impulsiveness, dysmaturity, lack of cause/effect, inability to see ownership, communication difficulties (words are not communication), social skills, the list goes on. The children suffer a lifetime of a disability that truly there was no reason for. Alcohol is the ONLY drug that crosses the placenta. FASD is 100% preventable and THERE IS NO CURE!!!!!!!
Zero Tolerance from Day Zero!
If you are a doctor and you are telling women it’s ok to consume alcohol while they are pregnant you are violating your own oath to do no harm. You should have your licence revoked and now be allowed to practice medicine. I live with FASD myself I know what it’s like. It really hurts me to see professionals telling women they can do the same behavior that landed me where I am today and struggling as hard as I am. I am not just strong I am #fasdstrong #fasdlivesmatter
Please retract #2! A person witH your credentials and honors should not be telling vulnerable pregnant women or anyone else that it is safe to drink before or during pregnancy. By doing this egregious thing you are endangering the life of every baby you bring into this world! What an in insidious and irresponsible practice! For 25 years my husband and I and our son have been suffering intensely from our son’s bio mom’s drinking. There is no end in sight because his brain was permanently damaged by occasional bathing in alcohol. Do you know that fetal alcohol spectrum disorder doesn’t show up until later and that only 10% of children have the facial features and reduced cognition of fas? My son is bright, articulate, and has a neurotypical appearance but his extreme behaviors are symptoms of the brain damage caused by alcohol. You will make a difference for your patients and their children if you do your research and what could be considered malpractice with your irresponsible advice about drinking during pregnancy.
Edit above: “…and END what could be considered malpractice…” From Jill Stevens
Dr. Lincoln I am not sure where you came from and where you get gained your knowledge but one thing I can tell you for certain is that drinking even an occasional glass of wine is NOT safe. I have two boys that we adopted and their bio-mom drank “a little” while pregnant as she tells it and they live a daily nightmare! Please, please, please stop telling women it is okay to drink ANYTHING alcoholic while pregnant or even if they are thinking of becoming pregnant. I am sure after you as a caregiver of a mom and her precious cargo you will make the right decision. My babies and I would greatly appreciate it if you would not make these statements and tell your patients ZERO alcohol while pregnant is the only safe amount. Thank you
Please ignore #2……live in my world one day. My adopted daughter has FAS…the struggle is real ladies. Behavior….learning disabilities….sleep issues and the list goes on. No alcohol is safe….none! Trust me and others on this.
Sometimes people text while driving and nothing happens, sometimes a person drinks and drive and no one gets killed, sometimes a child stands near a high-rise windown and doesn’t fall out, or sometimes an airplane crashes and all passengers are safe, BUT we do NOT tell each other it is okay to take the risk and “moderately” do any of these. Same thing with drinking during pregnancy. Not safe! Check out the consequences before offering any advice…..or would you tell a pregnant woman to text whike driving only once a week? Why take the risk?
Re: #2 Dr. Lincoln–it’s obvious you have not lived the parenting experience of the end result of fetal alcohol exposure (which usually doesn’t show up at birth)
Why would any woman knowingly drink alcohol knowing that it is more damaging to neural tissue than heroine, cocaine and most other illicit drugs? As the adoptive parent of two children suffering (yes suffering) with FASD, I can tell you, that anyone willing to bring a life into this world, should be willing to abstain from alcohol when there are so many mocktails you can use to feel included in social events…If/when you click on the link cited above “no level is known to be safe” and read to the end you will see that a highly regarded pediatrician Dr. Kristie Rivers states “There is no safe amount of alcohol in pregnancy. In fact, the Institute of Medicine says that of all substances of abuse (including cocaine, heroin, and marijuana), alcohol produces, by far, the most serious neurobehavioral problems. The best way to prevent FASD is to completely avoid alcohol while pregnant and while planning a pregnancy.”
Might I add that not only are they the most serious, they are permanent and often invisible to the naked eye.
If you are a woman that has an alcohol use/abuse problem, I would encourage you to seek medical advise on how to reduce harm to yourself and your unborn child. If you are a woman of childbearing years, who drinks socially, USE BIRTH CONTROL as 40-50% of pregnancies are unplanned. Binge drinking (defined as 4 oz of alcohol at one time–surprised) has increased by 400% in women of child bearing age over the past 10 years. This is a serious problem causing unnecessary suffering AND costing society literally millions of dollars. Certainly, when you know this, you can avoid drinking until your child is born? No guilt intended here.. but consider this… There is no placental barrier for alcohol. Would you feed your newborn a martini? a glass of wine? a shooter? Of course not! That is what you are doing when you drink during pregnancy.
Just because alcohol is legal, does not make it safe. Dr. Lincoln, when you say the “occasional drink” to most women who are pregnant, they will maybe have that 1 oz of alcohol or small drink of wine. But others may not be so cautious. Even the picture of the woman in the blog, shows a glass that has at least 3-4 oz of wine.
We all want women to feel safe and supported during pregnancy but the mixed messages about prenatal alcohol use from the healthcare community have to be consistent.
Please, please stop telling pregnant women that a little wine is okay! I am a foster parent in southern Alberta, and I can tell you that if you had any training in FASD at all, you would not be saying that! Why take the risk when we know that alcohol causes permanent brain damage to babies, and no one knows for sure if any amount is safe? FASD is such a sad and heartbreaking thing when you see it up close. Please don’t give moms an excuse to indulge in such selfish behavior that could affect their child’s whole life!
#2 is just wrong. Google FASD… follow a few of the FaceBook FASD support groups… Talk with parents that are raising kiddos that have been prenatally exposed to alcohol and then come back and say that you are willing to take that risk. There is no safe limit. FASD = Brain damage..life long.
I wish I knew #6 wasn’t true when I was pregnant! I only slept on my side and was completely uncomfortable. I would have slept much better if I wasn’t paranoid about sleeping on my back.
Haha! I LOVE #7! I got out of this chore when I was pregnant with my first, and it never got thrown back to me…3+ years and counting! 😉