Dr. Edward Lee (NorthShore)
In general, it is safe to pursue a natural birth after a c-section. It depends on a number of factors. If you had a c-section with a side-to-side incision, your risk of having complications during labor with your subsequent pregnancy is 1 in 200. However; sometimes, the complications can be severe - such as a ruptured uterus with risk to you and your baby. Your specific risk should be reviewed with your doctor but again, in general, I would say it is safe.

Dr. Edward Lee (NorthShore)
I don't know if I can say it is "too old" or not, but there are risks associated with having a baby at age 41. There is a higher risk of miscarriage and c-sections, as well as a higher risk of preeclampsia (a condition in pregnancy where someone has issues with high blood pressure and other changes). Also,d there is a higher risk that the baby can have some chromosome abnormality such as Down Syndrome. I believe the risk at age 41 is around 1/70. However; I have many patients who safely have healthy babies at age 41 and even older.

Dr. Edward Lee (NorthShore)
Actually, most exercises are okay during pregnancy. I would recommend that you try to keep your heart rate below 150 beats per minute and avoid exercises that involve abdominal collision or potential for abdominal collisions, as well as exercises that involve rapid changes in position - so avoid herky/jerky movements. Sit ups are okay as long as you are still able to do them. In general, you will not be able to exercise yourself into causing a miscarriage or triggering preterm labor. Patients who stay fit during pregnancy tend to do better with the physical stress of carrying the pregnancy, labor and postpartum.

Dr. Edward Lee (NorthShore)
You are suffering from a fairly common problem during pregnancy. The higher estrogen levels of pregnancy often trigger migraine type headaches. I have patients start with just tylenol at first. I recommend up 2,600-3000 mg maximum per day. If the headaches persist - adding caffeine is helpful. Maximum of 300 mg per day (about a grande size starbucks cup). Finally - if the headaches persist - we will provide our patients with prescription medications. You can also try acupuncture for your headaches without harming the pregnancy.

Dr. Edward Lee (NorthShore)
If Viagra helps you guys have intercourse - then yes, it can help you conceive. However; taking Viagra does not increase sperm counts or improve the sperm quality. Viagra, as far as I know, does not negatively impact sperm quality and does not increase the chance of birth defects.

Dr. Edward Lee (NorthShore)
The chance of conceiving per month depends on your age and it is somewhere between 10-25%. I tell my patients to think of this scenario. If I gave you a die to roll (like dice you see in a board game) and told you you have one roll per month and if you hit the number 1 - you will be pregnant. That is about the odds of getting pregnant each month. It seems that you got lucky with the first two and you got pregnant right away. Your chances going forward is about 20% per month. You could get pregnant right away again or it may take you couple of "rolls" (months) to get pregnant. The average couple takes about 4 months of trying before they conceive. If you have tried for a whole year and you are not pregnant (about a 15% risk) - then you should see the doctor for an evaluation.

Dr. Edward Lee (NorthShore)
Hi Tina, If you are being treated for your hypothyroidism and your thyroid levels are currently normal - then you should not have a harder time than anyone else in trying to get pregnant. Once you become pregnant - you should have your thyroid levels followed as often, you need to increase your thyroid supplements as the pregnancy progresses. Do not worry - your risk of your thyroid condition adversely affecting the baby is extremely low.

Dr. Edward Lee (NorthShore)
Hi Brittany, My general view is that sertraline is generally safe to use in pregnancy. I do not have my patients stop their sertraline while they are trying to conceive nor do I have them stop once they are pregnant. I also have started patients on this medication in the middle of pregnancy. The dose that you are using is relatively low as well. There are some studies that point towards a slightly higher risk of some cardiac defects with sertraline however; that is not considered a definitive fact, and it is a few more cases per 1000 pregnancies. Also, there is a growing body of evidence that when the pregnant mother is in better mental health during the pregnancy - it has long term benefits for the baby. So my recommendation is that you consider restarting your sertraline.

Dr. Edward Lee (NorthShore)
Hi Meredith. That's a big question and I will try to answer in a general sense. Avoid activities where you can cause collision on your stomach area (downhill skiing, sports where you have to dive on the floor, etc..). Avoid all medicines unless you need them. While most do not cause any birth defects, you should only take medicines when you need them. Avoid foods such as raw meats (sushi, rare meats), cheeses that come from unpasteurized milk and excessive amounts of sea food that can contain mercury. Avoid changing the cat's litterbox. Avoid sick people in general and avoid going to South america anytime soon if you can.

Dr. Edward Lee (NorthShore)
Hi Ria. Epidural: No evidence exists to say that epidurals make you forgetful. Preparing for labor: Taking a labor class that is provided at Northshore can help you know what to expect. Staying active with exercise and eating healthy is the best way to prepare. Exercise: I would recommend doing the exercises that you are familiar with. Swimming is a good exercise as you exercise the whole body. Treadmills and ellipticals are good as well. Food: A well balanced diet is recommended. Avoid junk foods and try to increase your vegetable / fruit intake. What is popularly known as the "Mediterranean" diet is a good diet to follow

Dr. Edward Lee (NorthShore)
Hi Terri. We typically employ a glucose challenge test to determine you risk for gestational diabetes. This test involves you drinking a measure load of glucose (50 grams) and then drawing your blood 1 hour later. If you have risk factors for diabetes (family history, previous gestational diabetes, previous large baby or obesity) then we will do a glucose test early in your pregnancy.

Dr. Edward Lee (NorthShore)
Hi Jessie. There are several things you can try before resorting to medications. Before you get out of bed, eat a few crackers or saltines so that your stomach has some food. As you may know, having an empty stomach often triggers nausea. Eating smaller meals helps as well, so instead of thinking of having 3 meals a day - break it down to 6 smaller half sized meals. Very sour things such as lemon drops may help. Ginger ale may help as well. Finally, if you need to resort to medication - a combination of Unisom (the sleeping pill) and Vitamin B6 is very very safe to use and helpful. Ask your physician about the specifics of that combination. These are medications you can obtain without a prescription.

Dr. Edward Lee (NorthShore)
Hi Kendra. Yes - it is very possible to gain too much weight. If you are an "average" sized woman - you should gain about 25-35 lbs with the pregnancy. If you are a larger than average woman - you should gain about 15-25 lbs. A pregnant mom needs only about 300 more calories a day during the pregnancy - which is what you get in a granola bar. So eat normally during the pregnancy, and the weight gain will happen naturally.

Dr. Edward Lee (NorthShore)
Hi Channa. Unfortunately - yes - a positive family history of breast cancer increases the risk of other family members (your baby being one of them). Fortunately, we have tests available to see if someone has the BRCA gene or not. In addition, other genetic tests for other breast cancer genes are available.

Dr. Edward Lee (NorthShore)
Channa, that is a very good question. The higher hormonal levels of pregnancy slightly increase the risk of breast cancer. But this is a slight increase. (I can't tell you the number off the top of my head) I would generally advise you not to hold off on having children because of your family history or your genetic history - even if you are a BRCA carrier. I would generally advise that you consider having your children sooner and once you are done - you have options for taking prophylactic measures to prevent breast (and ovarian) cancer.