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Session 4: Week 22 - Keep Moving!

Main Education Topic: Pre-term Labor Precautions/Wellness & Nutrition

Additional Topics for Discussion:

  • Reviewing results from anatomy scans
  • Wellness & Nutrition
  • Anemia – iron rich foods
  • Physiologic Changes


Tour of Facility - Wellness Educator


Eating Right

Eating right during your pregnancy is one of the best choices you can make for yourself and for your baby.

Daily Food Choices/Food Groups

Grains: 6-9 servings. 1 serving = 1 slice of bread or ½ cup cooked rice or ½ cup cereal or ½ cup pasta

Vegetables: 3-5 servings. 1 serving = 1 cup raw or cooked vegetable or vegetable juice or 2 cups raw leafy greens. Red, yellow and green vegetables are a good choice. Fresh and frozen vegetables have less salt.

Fruits: 2-4 servings. 1 serving = ½ cup chopped or canned fruit or ¾ cup 100% fruit juice. Fruit juice has more sugar than fresh fruit–consider adding water to dilute. Fruits you can chew are best choice.

Milk: 3 cups. 1 serving = 1 cup milk or yogurt or 1.5 ounces of cheese or 2 ounces of processed cheese. If unable to drink milk, take 600 mg of a calcium supplement.

Meat & Bean Protein: 3-4 servings. 1 serving of lean meat = 2-3 ounces of cooked lean meat/poultry/fish or ½ cup cooked dry beans or ½ cup tofu. 1 ounce of protein = 1 egg or 2 tbsp of peanut butter or ½ cup nuts/ seeds. Bake or broil meat. Do not fry.

Fats & Oils/Sweets: Use sparingly. This includes butter, mayonnaise. NutraSweet, Equal and Splenda can be used.

Information from the U.S. Department of Agriculture Dietary Guidelines for Americans:

Caffeine: 300 mg daily. Coffee: 65-120 mg, Tea: 20-90 mg, Soda: 30-55 mg

Warning: Do not eat shark, swordfish, king mackerel and tile fish. Do not eat raw or undercooked seafood, eggs, or meat. You may eat up to 12 ounces (2 servings) of fish or shellfish each week. Choose canned light tuna – Albacore tuna has more mercury. Visit this website for more information:

Foods to Avoid

  • Soft cheeses, such as Brie Camembert, blue vein cheese, feta or Mexican-style cheese. Only eat cheeses that are labeled pasteurized.
  • Avoid unpasteurized milk or dairy products.
  • Do not eat unrefrigerated smoked seafood, such as salmon, trout, white cod or tuna unless it is an ingredient in a cooked dish.
  • Do not eat unrefrigerated patés or meat spreads (canned or shelf stable may be eaten).
  • Eat hot dogs and deli meats with caution.
  • Do not eat raw eggs.
  • Eat peanuts/nuts in small amounts during pregnancy. Recent studies suggest this may help prevent peanut allergy in your child.

Activity during Pregnancy – ACOG site CLICK HERE

Preterm Precautions – LH Booklet – pg 21 & top of 22

Premature Labor

Labor that begins before 37 weeks is considered premature. Babies born early can have problems with their lungs and other organs since they had not had enough time to fully develop. Premature births occur in about 1 out of 10 pregnancies. The healthiest babies are born close to full term. The earlier a baby is born, the more likely life-threatening health problems will occur.

Risk factors for premature labor include:

  • Use of tobacco, alcohol, street drugs and unprescribed medication during pregnancy.
  • Mothers younger than 18 or older than 40.
  • Not eating healthy food or consuming the right vitamins.
  • Having infections that go untreated.
  • Having already delivered a child prematurely.
  • Weighing less than 100 pounds before becoming pregnant.
  • Having had a surgical procedure to the cervix.
  • Twin (or other multiples) gestation.

Some woman without risk factors still deliver early. That is why all pregnant women need to be aware of warning signs for preterm labor. Many of the symptoms are similar to the normal discomforts of pregnancy. Being in tune with your body and noticing a problem early can help initiate medical treatment that may prevent your baby from being born prematurely.

Signs to look for include:

  • Menstrual cramping/irregular or regular uterine contractions that may not be painful.
  • Low back ache.
  • Increased vaginal discharge, spotting or fluid leaking from the vagina.
  • Increased pressure in the pelvis.

If you experience any of the above, stop what you are doing. Drink several glasses of water, empty your bladder and rest with your feet elevated.

When to call

If the above symptoms do not go away and you are experiencing six (6) or more uterine contractions in an hour, call your provider.


Labor begins with uterine contractions and the opening of the cervix. During a contraction, the uterus tightens and relaxes at regular intervals, causing the abdomen to feel hard, then soft. These contractions make the cervix thin out (efface) and open as wide as possible (dilate). The contractions move the fetus toward the vaginal opening. On average, labor lasts 12-18 hours. Second and subsequent labors are usually faster.

False Labor (Braxton-Hicks)

These contractions often are irregular and do not come closer together. They are considered “practice contractions.” They may occur prior to term (37 weeks) and are affected by walking, resting or changing position. Often felt low in the abdomen, these contractions are usually weak and do not become stronger in intensity. They also usually occur at night. If you can go to sleep, it is NOT the real thing. True labor will wake you up.

Preterm Precautions – Fetal Movement, What it is/isn’t

You will receive this information in your AVS (after-visit summary). Your AVS is available in MyChart, or you may request a printed version from your provider.

Preterm Precautions – March of Dimes Info below:

What you should know about preterm labor

Even if you do everything right, you can still have preterm labor. Preterm labor is labor that begins too soon, before 37 weeks of pregnancy. Babies born before 37 weeks are called premature. Premature babies may need to stay in the hospital longer or have more health problems than babies born later. Learning about preterm labor may help keep your baby from being born too early.

What causes preterm labor?

No one knows for sure what causes preterm labor, but there are some things that make you more likely than other women to give birth early. These are called risk factors. 

Risk factors for preterm labor

  • Having already had a premature baby
  • Being pregnant with twins, triplets, or more
  • Having problems with your uterus or cervix
  • Smoking, drinking alcohol, using street drugs or abusing prescription drugs
  • Being very overweight or not weighing enough
  • Having health conditions, like high blood pressure or diabetes
  • Having an infection during pregnancy like an STD or kidney infection
  • Getting pregnant again too soon after having a baby
  • Having a lot of stress in your life
  • Having premature birth run in your family

What can you do about your risk factors? Talk to your provider. You may be able to reduce your risk for preterm labor. Here’s how:

  • Smoking, drinking alcohol, using street drugs and abusing prescription drugs: Ask your provider about programs in your area that can help you quit.
  • Being very overweight or not weighing enough. Talk to your provider about your weight. Ask how much weight you should gain during pregnancy.
  • Find out about healthy foods to eat when you’re pregnant
  • Having chronic health conditions like diabetes or high blood pressure.
  • Ask your provider about treatments for your health conditions.
  • Having an infection during pregnancy:
    • Wash your hands well with soap and water after using the bathroom or blowing your nose
    • Call your provider if you feel burning when you go to the bathroom
    • Don’t eat raw meat of fish
    • Have safe sex
    • Having a lot of stress
    • Be active and eat healthy foods
    • Ask friends and family to help our around the house
    • Get help if your partner abuses you
    • Talk to your boss about how to lower your stress at work
    • See a counselor to find out about other ways you can reduce stress

Are there treatments for preterm labor?

Yes. Ask your provider if these treatments are right for you:


Progesterone is a hormone that helps your uterus grow and keeps it from having contractions. There are two kinds of progesterone treatment:

  1. Vaginal progesterone may help reduce your risk for premature birth if you have a short cervix (shorter than normal) and are pregnant with just one baby. The cervix is the opening to the uterus where your baby grows.
  2. Progesterone shots may help reduce your risk for premature birth if you've had a premature birth in the past and you're pregnant with just one baby now.

If you're pregnant with twins, triplets or more, progesterone treatment is not for you. It's only for women who are pregnant with just one baby. To learn more go to


A cerclage is a stitch that your provider puts in your cervix. The stitch may help keep your cervix closed so your baby isn't born early. Your provider removes the stitch at about 37 weeks. A cerclage is used only for certain women. For example, your provider may recommend a cerclage if you have a short cervix (shorter than normal).

Antenatal corticosteroids (also called ACS)

These medicines help speed up your baby's lung development. They also help reduce your baby's chances of having certain health problems after birth like breathing and stomach problems and bleeding in the brain.


These medicines kill certain infections that you and your baby have.


These medicines help slow or stop contractions. They may help delay labor, even for a few days. This delay may give you time to get treatment with ACS or to get to a hospital that can take care of you and your baby if you give birth early.

Bed Rest

Providers don't know for sure if bed rest can help you stay pregnant longer. But it may. Bed rest means that you take it easy and stay calm and still. Your provider may want you to rest just a few times each day or you may need to stay in bed all day.

How long should you wait before getting pregnant again?

It's best to wait at least 18 months between giving birth and getting pregnant again. This means your baby will be at least 1 1/2 years old before you get pregnant.

Too little time between pregnancies increases your risk of premature birth. The shorter the time between pregnancies, the higher your risk. Your body needs time to fully recover from one pregnancy before it's ready for the next one.

Here's what you can do:

  • Use birth control to make sure there's at least 18 months between giving birth and getting pregnant again. Talk to your provider about birth control options.
  • If you're older than 35 or if you've had a miscarriage or stillbirth, talk to your provider about how long to wait between pregnancies.

Anemia – Pregnancy & Anemia

You will receive this information in your AVS (after-visit summary). Your AVS is available in MyChart, or you may request a printed version from your provider.

Anemia – Iron Rich Diet

You will receive this information in your AVS (after-visit summary). Your AVS is available in MyChart, or you may request a printed version from your provider.

Physiologic Changes – Pregnancy at 23 to 26 Weeks

You will receive this information in your AVS (after-visit summary). Your AVS is available in MyChart, or you may request a printed version from your provider.

Learn the signs of preterm labor

Call your provider if you have even one of these signs:

  • Contractions that make your belly tighten up like a fist every 10 minutes or more often
  • Change in the color of your vaginal discharge or bleeding from your vagina
  • The feeling that your baby is pushing down. This is called pelvic pressure.
  • Low, dull backache
  • Cramps that feel like your period
  • Belly cramps with or without diarrhea

Your provider may tell you to:

  • Come into the office or go to the hospital
  • Stop what you’re doing
  • Rest on your left side for 1 hour
  • Drink two to three glasses or water or juice. Don’t drink coffee or soda.

If the signs get worse or don’t go away, call your provider again or go right to the hospital. Getting help quickly is the best thing you can do. If the signs do not go away, take it easy for the rest of the day.