Should I take multivitamin during the postpartum period? Should I ask for a biophysical ultrasound?

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Posted on Mon, 6 May 2013 in Women's Health
Question: This question is for Doctor XXXXXXX Raichle. Hi Dr. Raichle, it's me again. How are you? I am already 33 weeks, so not much left, so excited. I had two quick questions for you though.

I was wondering about post-natal vitamins. Do I need to take any if breastfeeding and if so, are there special ones or do I take the prenatal one? My vitamin has 600mg of calcium, 200mg of magnesium and 18 mg of iron and all the other multivitamins. Is it ok to keep taking this after birth?

My baby is barely moving - I know he has grown now and will not kick as hard, but I can barely feel him. Also, he does not move often, often 5-6 hours go without movement (that was the case before too, just now I barely feel him though). They did a non-stress test 2 weeks ago and he was ok. But now his moves are barely noticeable. Should I ask for a biophysical ultrasound? Or that is not needed and a regular ultrasound will do? Or should I even ask for another non-stress test and not an ultrasound? Thanks!
doctor
Answered by Dr. Timothy Raichle 1 hour later
Hello and thank you for the followup question!

During the postpartum period, it is important to stay on a prenatal vitamin. You need these 'building blocks' for breast milk production and to help replace blood lost at the time of delivery. I think that the current vitamin is adequate assuming a normal diet otherwise as well.

With regard to fetal movement, here is what I tell patients:
1. After 32 weeks, fetal movement should be very predictable
2. In any two hour period, if you are paying attention, you should be able to feel movement (and any movement counts as a movement)
3. You should be able to get to 10 movements in 2 hours
4. There are patterns of movement throughout the day - more after meals and in the evening.

At 33 weeks, I would be mildly concerned about the lack of movement that you are describing. In someone with your report I would do the following:
1. Check a followup growth to make sure the baby is growing normally
2. Have them confirm that the fluid volume is normal
3. Schedule you for weekly BPP's (mainly because your self-reporting of fetal movement is unreliable as far as a measure of fetal well-being in between visits)

By the way, the BPP checks for several measures of fetal well-being: movements, tone, breathing, fluid volume. It is well correlated with fetal well-being - i.e. the chance of a bad outcome in the week following a normal BPP is extremely low.

I hope that this helps and please ask for clarification if needed!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Timothy Raichle 1 hour later
Hi dr. Raichle, actually I just realized BPP is a bio-physical profile. It says online this could include a non-stress test and possibly and ultrasound. When you recommended to schedule a weekly BPP, do you mean a weekly ultrasound or only a weekly non-stress test or both?

Thanks
XXXXXX
doctor
Answered by Dr. Timothy Raichle 1 hour later
The options for antenatal testing (meaning testing of the fetus while you are still pregnant) in the setting of high risk pregnancies or in cases such as yours would be one of the following:

1. A weekly BPP (often done without an NST) - which is an ultrasound

OR

2. Twice weekly NST's and once weekly fluid volume (often called a modified BPP)

Either of these are acceptable. Please let me know if this helps or if you would like me to expound further!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Timothy Raichle 1 hour later
Thanks a lot Dr. Raichle, how is the fluid volume checked, if not through an ultrasound?

Also, is a weekly ultrasound in some way harmful to the baby or there is no such evidence? I definitely see how the benefits would outweigh the risks, so I hope my doctor would prescribe it to me, but just checking.

Thanks
XXXXXX
doctor
Answered by Dr. Timothy Raichle 4 hours later
The fluid volume is checked with an ultrasound as well. In either situation above, an ultrasound is done, but with a BPP it is a longer scan. There is not believed to be any harm in scanning as often as once per week.

If there is not normal report of fetal movement, then something needs to be done to evaluate the fetus and the fluid volume.

Good luck and please ask if you have more questions!!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Timothy Raichle

OBGYN

Practicing since :1999

Answered : 1686 Questions

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