Top stories this week

• 1.  Sore nipples while breastfeeding
• 2.  Moving from crib to bed
• 3.  The new mom's survival guide
• 4.  Eating Organic During Pregnancy
• 5.  Your Baby's Development in the First Trimester

1. Expert: Daina Kalnins, MSc, RD August 25th, 2008
   	What foods should I avoid during pregnancy?
   	Eating a healthy, balanced diet is especially important during pregnancy, but there are a few foods pregnant women should know to avoid: 1. Soft, unpasteurized cheeses such as Brie, Camembert, Feta, Gorgonzola, and blue cheeses (if these types of cheese are labeled "pasteurized," then they are safe to eat). 2. Hot dogs and pre-packaged deli meats, unless reheated until they're steaming. 3. Cold pâté and smoked salmon, unless it's fully cooked (such as in a casserole). Why these foods are risky during pregnancy: Soft, unpasteurized cheeses, deli meats and smoked salmon may contain a bacteria called Listeria. Symptoms of listeriosis include flu-like nausea, vomiting, headache, fever and achy muscles and can occur two to 20 days after eating the contaminated food. This infection can cause miscarriage or be passed on to the fetus, leading to infection or blood poisoning. 4. Raw meats and fish (such as raw mussels, clams, oysters and sushi) and raw eggs (often found in homemade Caesar salad dressing, mayonnaise, custard, mousse or hollandaise sauce). Why these foods are risky during pregnancy: Raw meats, fish and eggs may be contaminated by salmonella, E. Coli or toxoplasmosis, which can put both mother and baby at risk. 5. Fish that contain high levels of mercury (such as shark, swordfish, king mackerel, tuna and tilefish). Canned light tuna is safe at about two cans per week while canned albacore tuna should be limited to 6 oz per week. Why these foods are risky during pregnancy: Methyl mercury can cause harm to the fetus and mercury consumed during pregnancy has been linked to developmental delays and brain damage. 6. Caffeine, found in coffee, tea, soft drinks and chocolate. Why it's risky during pregnancy: High levels of caffeine may cause low birth weight or premature delivery. Some studies have linked high caffeine intake to an increased risk of miscarriage, so you may want to avoid caffeine in the first trimester and then limit it to about two cups of coffee or two to three cups of tea per day (a maximum of 300 mg/day). 7. Herbal teas (especially chamomile). Why it's risky during pregnancy: Chamomile has been shown to have a harmful effect on the uterus and thus may pose a risk to the fetus. Safe herbal teas include citrus peel, ginger, lemon balm and rose hip. 8. Alcohol. Why it's risky during pregnancy: No level of alcohol has been proven safe during pregnancy. Drinking puts a baby at risk for developing fetal alcohol syndrome and even moderate drinking has been found to impact a baby's brain development.                                                                                                                                                       Daina Kalnins is a registered dietitian at the Hospital for Sick Children in Toronto. She has co-authored several books on healthy eating and nutrition in association with the Hospital for Sick Children, including Better Baby Food (the second edition was just released in summer, 2008) and Better Food for Pregnancy. Her latest book, YUM, is about nutrition and the importance of good food choices for children aged eight to 13.

2. Expert: Marjorie Greenfield, M.D. August 11th, 2008
   	Is it safe to travel during pregnancy?
   	For most women with a normal, healthy and low-risk pregnancy, travel is fine and is a fact of life. But there are a few things you should know before packing your bags: 1. The most stable part of pregnancy is from approximately 12 weeks to about 20 to 24 weeks and it's also when you're most likely to be feeling your best-so this is usually a good time to plan a trip. Just remember to check in with your doctor or midwife before going away, just so they're aware that you're leaving and can give you the all-clear. 2. On long trips when you're not moving, there's an increased risk of blood clots in your legs so it's important to get up and take a 10-minute walk every two or three hours. (And, if you're driving, that means getting out of the car for 10 minutes every two to three hours-usually your bladder requires that you do that anyway!) 3. People sometimes worry about radiation exposure when traveling by plane. If you're doing a tremendous amount of flying, there may be some amount of radiation exposure, but for most people it isn't an issue. 4. You may not want to be too far from home in your first trimester if you haven't seen your pregnancy on ultrasound or heard a heartbeat. (Early on, most women have a 15 to 30 percent chance of miscarriage, depending on their age and other risk factors, so they may not want to travel somewhere where there is less guarantee of finding quality medical care.) 5. You may also not want to be too far from home in your third trimester, especially if you're showing signs of preterm labor or have any risk factors for early delivery. If you end up going into labor early, you could be stuck in a foreign city with a newborn who needs to spend a few weeks in intensive care. It's important to talk to your doctor about whether it's advisable for you to go away and, if you do decide to travel, take a copy of your medical records with you. 6. If you need to travel later in your pregnancy, be sure to contact the airline regarding its cutoff policy. (For instance, all American Airlines and Air Canada flights allow pregnant women to fly up to and including 36 weeks, after which air travel is only allowed for short flights, under special circumstances and must be cleared by the airline's medical desk with a note from your doctor saying that you're fit to travel.) 7. If you're planning a visit to an exotic location, make sure your immunizations are up to date and be sure to check with your doctor and consult a travel medical specialist well in advance of your trip. Marjorie Greenfield, M.D. is a practicing board-certified obstetrician-gynecologist and fellow of the American College of Obstetrics and Gynecology (ACOG). She is currently associate professor on the  full-time faculty at Case Western Reserve University School of Medicine. Her new book, The Working Woman's Pregnancy Book, hit the bookshelves in May. marjoriegreenfield.com

3. Expert: Carri Warshak, M.D. July 28th, 2008
   	What are the risks of having a vaginal birth after a Cesarean?
   	The primary risk in attempting a VBAC (Vaginal Birth After a Cesarean) is the possibility of a uterine rupture or scar separation on the uterus. This is an uncommon complication occurring in approximately seven in 1,000 post-Cesarean labors. However, if it does happen, it requires a lengthy hospital stay for mom and can even cause fetal–and in rare cases, maternal–death. However, the benefits to vaginal delivery are many. It is well known that the recovery time after a vaginal delivery is much shorter for a new mom. There are also lower rates of postpartum pain, blood transfusion requirements and infection rates. In addition, babies born after a vaginal delivery have fewer respiratory problems in the nursery. Your decision to have a VBAC should involve a lengthy discussion with your ob/gyn. The timeline of your birth should play a crucial role in your decision to attempt a VBAC. There is an increased risk of uterine rupture when the interval between your pregnancies is less than six months (so if the child delivered by C-section will be 15 months old or less at delivery). In this case, the risk of rupture increases. There is also an increased risk of anemia and blood transfusions. Ideally, there should be at least two years between deliveries in order for the scar from the previous C-section to fully heal. Carri Warshak, M.D. is an OB-GYN specializing in high-risk pregnancies. She has done extensive research in placenta accreta, diabetes in pregnancy, ultrasound use during pregnancy and measures of fetal well being. An assistant clinical professor at the University of California, Warshak is also a mother of four and the creator, president and medical advisor of AskAnOB.com. For more details on this topic you can log on to: http://www.askanob.com

4. Expert: Dr. William Camann July 14th, 2008
   	Is it true that epidurals can lengthen labor or cause paralysis?
   	The current research shows that labor, particularly in first-time moms, is about one hour longer when an epidural is used. This is just an average, however, so some women will experience a longer extension of their labor, while for others it may be shorter. In some cases, the epidural can even decrease overall labor time. Regarding paralysis, it would be incorrect to say it is impossible or never happens. However, it is so exceedingly rare that most anesthesiologists will go through their entire careers without seeing a single case of paralysis caused by an epidural. Several million women receive a safe epidural each year in the U.S. There are a few specific risk factors, most notably certain blood clotting diseases or infections, which may increase the chance of neurologic side effects but epidurals are not typically used in women who have these conditions. William Camann is the director of obstetric anesthesia at the Brigham and Women's Hospital in Boston. He is also an associate professor of anesthesia at Harvard Medical School, and past-president of the Society for Obstetric Anesthesia and Perinatology. An internationally recognized authority on obstetric anesthesia and pain control during childbirth Dr. Camann is the co-author of Easy Labor, Every Woman's Guide to Choosing Less Pain and More Joy During Childbirth (Random House/Ballantine Books, 2006). You can find out more about his book at easylabor.net

5. Expert: Joanne Saab, RD May 18th, 2008
   	I am normally lactose intolerant, but when I got pregnant I could drink milk products with no side effects. Why did this happen?
   	This is actually a very common phenomenon during pregnancy. Many women find they experience an improvement in lactose tolerance when they get pregnant and, for some, this ability to digest lactose remains after they deliver, but for others their lactose intolerance returns or even becomes worse. Healthcare professionals often talk about a "rule of thirds" during pregnancy. The "rule of thirds" means that approximately one third of pregnant women will see an improvement in their symptoms, one third will remain the same, and one third will see their symptoms worsen. This rule of thirds can occur with many conditions, including: migraine headaches, eczema, asthma and lactose intolerance. Researchers still don't completely understand why this happens, although some attribute it to hormonal changes during pregnancy.   Joanne Saab, RD is a registered dietitian who practices in pediatrics at McMaster Children's Hospital in Hamilton, Ontario. Joanne is co-author of three books in conjunction with the Hospital for Sick Children: Better Food for Kids, Better Food for Pregnancy and the best-selling Better Baby Food. Joanne also enjoys being the mother to twin daughters who have taught her a lot of practical know-how on kids' nutrition.

6. Expert: Tracey Mallett April 7th, 2008
   	Is it safe to do downward dog in yoga during pregnancy?
   	Any exercise where your head is lower than your heart should be practiced in moderation after the first trimester because additional blood volume can lead to nausea and/or loss of breath. Downward dog can be done in moderation, but don't hold the position for extended periods of time. If you decide to do the pose throughout your pregnancy, listen to your body and stop if you feel uncomfortable in any way. Also, modify the pose by keeping your knees bent and your heels lifted off the floor to reduce stress on your lower spine. Your arms should also be positioned a little further apart than in your regular practice. The modification means your body weight will be supported predominantly by your upper body to reduce compression of your abdomen.   Safe alternates: Exercises that give similar benefits to downward dog are the cat-cow yoga pose and standing hamstring stretches with your foot resting on a chair. Tracey Mallett is a certified personal trainer and sports nutritionist. She is the author of Sexy in 6:  Sculpt Your Body with the 6-Minute Quick Blast Workout, as well as the creator and star of the 3-In-1 Pregnancy System for pre- and post-natal mothers. Her newest videos are Renew You and Super Body Boot Camp. A proud mother of two, Tracey lives in Los Angeles, California. (www.TraceyMallett.com)

7. Expert: Andrea Grace March 24th, 2008
   	What is the safest way to stay fit during pregnancy?
   	If you followed a regular exercise program prior to pregnancy, you should be able to maintain that program to some degree throughout. The key is to listen to your body, which undergoes many anatomical and physiological changes that can affect your level of physical activity. As your body shape changes, your centre of gravity moves forward and the curvature in your spine increases. These changes may add a little discomfort to your workouts (particularly in the last trimester). Your joints also loosen up to get ready for birth, creating an increased risk for injuries. Here are some things to keep in mind when exercising during pregnancy: Your body will naturally give you signals that it's time to reduce your level of exercise. Never exercise to the point of exhaustion or breathlessness–this is a sign that your body (and your baby) can't get the oxygen supply they need. Wear comfortable footwear with strong ankle and arch support. Take frequent breaks and drink plenty of fluids. Avoid exercise in extremely hot weather. Avoid rocky terrain or unstable ground when jogging. Contact sports and those with a potential for hard falls (such as horseback riding and skiing) should be avoided, while stationary cycling is recommend to reduce the risk of falls associated with regular cycling. Weight training should emphasize improving tone–so increase the repetitions and decrease the weight. Avoid lifting weights above your head and using weights that strain the lower back muscles. Due to the increase in your resting heart rate and decrease in maximal heart rate during pregnancy, don't use target heart rate to determine intensity of exercise. Great exercises for moms-to-be include: any form of swimming or water exercise, walking and yoga, which can help your body prepare for the birthing process. Precautions: See your health care provider if you experience any of these symptoms during or after intense exercise: nausea, dizziness, shortness of breath, vaginal bleeding, sudden swelling of hands, ankles or face, headache, high heart rate, amniotic fluid leaking, back or pelvic pain. Some information provided by the American College of Obstetricians and Gynecologists Meet our expert: Andrea Grace is the president and creator of Mommy and Baby Fitness, pre- and post-natal fitness programs with locations across North America. She is a CanFitPro and ACE certified fitness professional with 20 years of teaching experience and specialty certifications in pre-and post-natal and children's fitness. mommyandbabyfitness.com

8. Expert: Joanne Saab, RD February 25th, 2008
   	Is it safe to drink herbal teas during pregnancy?
   	The list of herbal teas that are safe to drink during pregnancy is short, simply because not enough studies have been done. Chamomile tea, however, is definitely not safe during pregnancy. Despite its soothing properties, chamomile may act as a uterine stimulant and was traditionally used to induce abortion and should be avoided. Safe herbal teas you can enjoy while pregnant include: citrus peel, ginger, lemon balm and rose hip–and you can have up to two to three cups a day of any of them. Other foods to avoid during pregnancy include: raw meat, pâté, raw fish (including oysters and sushi) and soft, unpasteurized cheeses, which contain the bacteria Listeria monocytogenes. Cheeses to avoid include: Brie, Camembert and blue-veined cheeses, such as Roquefort. Some pre-packaged soft cheeses, such as feta or chèvre, may be pasteurized, but just check the labels to make sure and avoid buying them fresh from a deli counter. If you're ever unsure about what is safe during pregnancy, a great resource is Motherisk (motherisk.org) at Toronto's Hospital for Sick Children. Joanne Saab is a registered dietitian who practices in pediatrics at McMaster Children's Hospital in Hamilton and has co-authored three books in conjunction with the Hospital for Sick Children: Better Food for Kids, Better Food for Pregnancy and the best-selling Better Baby Food.

9. Expert: Daina Kalnins, MSc, RD January 14th, 2008
   	I'm pregnant, but I haven't lost all the weight I gained from my previous pregnancy. How much should I be gaining now?
   	The amount of weight you gain during pregnancy depends on how much you weighed before you got pregnant. The same weight gain recommendations for a woman who is at her ideal weight before pregnancy don't apply to a woman who is over- or underweight. So, if you're overweight going into a second pregnancy, you don't need to gain as much this time around. Here are some things to consider: 1. How to tell if you're at your ideal weight. To determine whether you're at a healthy weight, it helps to know your BMI-a measurement of weight in relation to height. (To calculate your BMI, divide your weight in kilograms by the square of your height in meters-or check out Health Canada's online BMI calculator. Just go to www.hc-sc.gc.ca and enter "BMI" in the search box.) 2. How much weight you should gain. If you have a normal BMI (20 to 25), then you should gain more weight during pregnancy than if you are overweight, or have a higher BMI. So, if you have a BMI of 20 to 25, then a weight gain of 25 to 35 pounds (11 to 16 kg) is recommended. If your BMI is greater than 27, then you should only be gaining 15 to 25 pounds (7 to 11 kg). 3. With close pregnancies, you may need extra nutrients. In terms of micronutrients, you should make sure you get an adequate supply of folic acid, iron (which can be low during pregnancy and post-partum), calcium (and therefore vitamin D). It's best to check with your doctor to see how many extra nutrients you may need. 4. Keeping your weight down.  As always, some form of exercise routine is key-whether it's walking daily, cycling or doing prenatal yoga. And the "routine" part is probably the most important. Get in the habit of being active every day. And pay attention to your diet: decrease high fat and high salt foods, and focus on getting lots of fiber. Choose snacks like fruits and veggies and try to eat homemade foods as much as possible - that way you can control what you're getting. Remember to drink lots of water too. Daina Kalnins is a registered dietitian at the Hospital for Sick Children in Toronto. She has co-authored several books on healthy eating and nutrition in association with the Hospital, including Better Baby Food, Better Food for Pregnancy and Better Breastfeeding.