Obstetrical Calendar

Please note that a brief and limited ultrasound may be done at each visit in place of the Doppler heart tones.  These ultrasound do not replace the Level II ultrasound that are performed at approximately 18-20 weeks.

Approved Prenatal Medicines

The medications listed can be taken safely for the minor discomfort of pregnancy.
In general, it is best to avoid any medications during the first twelve (12) weeks of pregnancy.

If you are taking a prescription, please notify the office as soon as possible.

Nutrition (what to eat / what to avoid)

Nutritional value of a woman’s diet during pregnancy is important for the health of the woman and the baby. The woman needs to eat a variety of food.  This includes:

• Plenty of fruit and vegetables (fresh, frozen, tinned, dried or a glass of juice).  Aim for at least five portions of a variety each day.
• Foods rich in protein such as lean meat and chicken, fish, eggs and pulses (such as beans and lentils).  These foods are also good sources of iron.
• Plenty of fibre.  This helps prevent constipation and is found in wholegrain bread, pasta, rice, pulses and fruit and vegetables.
• Dairy foods such as milk, cheese and yoghurt, which contain calcium.

Vitamins and nutritional supplements are sometimes needed, especially iron, calcium, folate, vitamin D (for some women), and protein.  Generally, sodium should be restricted to avoid developing high blood pressure (hypertension).

Iron
During pregnancy, a woman’s blood supply increases to supply nutrition to the growing fetus.  Iron is essential in making hemoglobin, a protein in red blood cells that carries oxygen throughout the body.  Iron cannot be made by the body and must be absorbed from foods you eat.  Although iron is found in many foods, it is hard to absorb.  This makes it difficult for your body to get enough iron to meet its needs during pregnancy especially with the higher blood supply demand during the second and third trimester.  When there is not enough iron, the body makes fewer red blood cells.  This is called anemia.

The risk of anemia is higher if you have morning sickness severe enough to cause frequent vomiting, if you’ve had two or more pregnancies close together, if you’re pregnant with more than one baby, if you have an iron-poor diet, or if your pre-pregnancy menstrual flow was heavy.
Iron deficiency anemia is common and is easy to correct.  Pregnant women should eat iron-rich foods to prevent iron deficiency.  Iron-rich foods include leafy greens such as spinach and broccoli, strawberries, meats, whole grains, prune juice, dried fruit, legumes, and blackstrap molasses.

Warning: Pregnant women should not eat liver because of its very high Vitamin A content.  Large amounts of Vitamin A can be harmful to the baby.

Routine prenatal care will help determine if a woman should take an iron supplement during pregnancy.  Some women require a 30 mg supplement per day or, if diagnosed with iron-deficiency anemia, as much as 60 to 120 mg of iron per day.   To make sure you absorb as much of the iron as possible, take your iron pills on an empty stomach.  Wash them down with water or orange juice (the vitamin C helps with absorption) but not with milk (calcium hinders absorption).

If you do develop anemia, you might not have any symptoms at all, especially if your condition is mild.  Or you might feel tired, weak, and dizzy. (Of course, these are symptoms that many women have during pregnancy, anemic or not.)  You might also notice that you’re paler (especially in your fingernails, the underside of your eyelids, and your lips) and have a rapid heartbeat, heart palpitations, shortness of breath, or trouble concentrating.  Finally, some studies have found a link between severe iron-deficiency anemia and cravings for non-food substances such as ice, paper, or clay (a condition known as pica). If you do have these cravings, don’t give in to them, and be sure to tell your healthcare provider.

Iron deficiency is the most common cause of anemia, but it’s not the only cause. You could also develop anemia by not getting enough folic acid or vitamin B12, by losing a lot of blood, or from certain diseases or inherited blood disorders such as sickle cell disease. The treatment for anemia depends on the cause. Iron supplements are not always the answer.

High levels of iron in supplements can upset your gastrointestinal tract. Most often, they lead to constipation, which is already a problem for many pregnant women. If you suffer from constipation, try drinking prune juice. It can help you stay regular (and is a good source of iron, to boot). You may also have nausea or, more rarely, diarrhea. If you think your supplement is making you feel queasy, try taking it at bedtime.

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Weight Gain

Pregnancy is no time to diet.  Every woman is different, depending on body type and weight before conception, but most women who deliver healthy babies gain about 25 to 35 pounds or more during pregnancy. Women who are underweight prior to pregnancy should gain a little more, and overweight women, a little less.

Women who do not gain enough weight have an increased risk for delivering babies with low birth weight (less than 2500 gm, or 5.52 pounds).  The National Institutes of Health considers low birth weight (LBW) a major public health problem in the United States.  LBW is a major cause of infant mortality, as well as many childhood developmental, physical, and psychological problems.

Although infant mortality in the United States has declined over the past several decades, it is still a significant public health problem.  Among African Americans, approximately 13% of newborns are underweight; among Hispanics, 6% to 9%; among Asian Americans, 5% to 8%; and among Caucasians, approximately 6% of newborns are underweight.  Racial variations in birth weight may reflect socioeconomic differences and this is an important focus of research funded by the National Institutes of Health.

Babies who are underweight are at risk for physical and psychological childhood disorders:

• They are more likely to experience asthma, respiratory tract infections, and ear infections.
• Babies who are born weighing less than 1000 gm (2.2 lbs), are at greater risk for cerebral palsy (a neurological abnormality).
• They are more likely to score low on intelligence tests and are more likely to have delayed development.

Gaining too much weight can also be a problem. It can make pregnancy an unpleasant experience, causing backache, leg pain, varicose veins, and fatigue.  It may lead to hypertension and diabetes.  Excess weight may also be difficult to lose after delivery.

Excessive weight gain may also cause problems for the baby.  Technically, an overweight baby is one who weighs more than 4500 gm, or 9.9 lbs.  Large babies make vaginal deliveries difficult, increasing the the risk for cesarean section.  Overweight babies may have an increased risk for health problems later in life (e.g., obesity, adult rheumatoid arthritis, diabetes).

Women who are gaining too much weight during pregnancy should follow the guidelines for healthy eating; avoid foods that do not have nutritional value; and consult a doctor, midwife, or dietician.
Every woman’s body is different, and determining how much weight a woman should gain is an estimate.  The following table provides recommended weight gain based on a woman’s body mass index (BMI) at the beginning of the pregnancy.  Body mass index measures the weight-to-height ratio and is calculated by dividing weight (measured in kilograms) by the square of height (in meters). A normal BMI ranges from 19.8 to 26.

For women whose BMI is normal, the recommended weight gain over the course of the pregnancy is 25 to 35 pounds. Women who are underweight, or have a low BMI, should gain more weight, and women who are overweight, or have a high BMI, should gain less.

Pregnant women should consult a physician or midwife if they have questions about how much weight they can expect to gain on a week-to-week basis during pregnancy. Generally, little weight is gained during the first trimester (3 or 4 lbs.). The most weight (about 12 to 14 lbs.) is gained during the second trimester. In the third trimester, a woman should expect to gain about 8 to 10 lbs.

Healthy eating helps ensure that the baby will have a healthy birth weight and will not be born with infections or other problems, reduces the risk for premature birth, builds up fats and fluids for use during breastfeeding, and reduces the risk for complications during pregnancy.  It is also important that women continue to eat well after the birth, especially if the baby is breastfeeding.

Pregnancy by Trimester (what is happening to you and your baby each trimester)

The First Trimester

What’s Happening with You
Physical Changes – Congratulations! While in the first three months of pregnancy you may or may not even know that you’re pregnant, there are some signs and symptoms that may indicate that you are, indeed, pregnant:

• Absence of menstruation – Keep in mind, though, that you may stain slightly at the time when you expected your period or when the fertilized egg implants in the uterus.
• Fatigue and sleepiness – If you can, try to get into the habit of getting an extra hour of sleep each night or taking afternoon naps. Don’t be surprised, though, if you still feel tired, no matter how much sleep you get! Another great way to combat fatigue is exercise, which not only helps you feel better throughout pregnancy, but may also help you sleep better at night.
• Frequent urination – For most women, this is something that will continue throughout the first trimester, subside in the second trimester, and return in the third.
• Mild to extreme nausea, with or without vomiting – Although this is commonly called “morning sickness,” it can actually strike any time of day or night. Morning sickness and food cravings may intensify toward the end of the first trimester.
• Heartburn, indigestion, flatulence and/or bloating
• Constipation – To avoid constipation, be sure to eat foods high in fiber, increase your fluid intake (especially water and fruit/vegetable juices, which can help to soften stools), and continue exercising.
• Food aversions and/or cravings
• Increase or decrease in appetite – For those women who do suffer from decreased appetite or nausea, it is especially important to remember to eat a balanced, healthy diet. Always try to maintain a healthy, well-balanced diet. Keep in mind that though many people say that you are “eating for two,” pregnant women only need an additional 300 calories each day – that’s about what you’ll need just to keep your calcium intake up!
• Tingling, tender and/or swollen breasts – Women who experience breast changes prior to menstruation are most likely to feel these changes in pregnancy, as well.
• Occasional slight headaches, faintness or dizziness – Many health care providers will say that it is okay to take Tylenol for headaches, even in the first trimester. Before taking anything, however, check with your own health care provider.
• Skin problems, such as acne or rashes – Many products that are commonly used for acne or rashes are NOT safe for use during pregnancy – check with your health care provider before using any products, even if they are over-the-counter.

Emotional Changes – Pregnancy can be an emotional rollercoaster for some women. Following are some changes that you may notice, even early on. For many women, these changes continue throughout pregnancy, while for others, the emotional changes are barely noticeable.

• Irritability, mood swings, irrational behavior, weepiness, comparable to premenstrual syndrome
• Apprehension, fear, joy and/or elation about your pregnancy
• Anxiety about motherhood and how it may affect your relationships, career and lifestyle

 What’s Happening with my Baby
In the first month (1-4 weeks), the embryo is really just a tiny speck the size of a pencil point. By the fourth week of gestation, the pregnancy may be visible by vaginal ultrasound. By the end of the second month (5-8 weeks) of pregnancy, the tiny tadpole-like embryo is about the size of a grain of rice. By the end of the third month (9-12 weeks), the embryo will resemble a very tiny human being, weighing an ounce and measuring approximately 1/4 inch long from head to buttocks, the size of a small strawberry. By now, the heart is beating and the arms and legs are formed, with finger and toe buds appearing. Bone is now beginning to replace cartilage.

Throughout the first trimester, the following will develop:

• placenta
• major organs and nervous system
• heart starts beating
• lungs begin to develop
• bones appear
• head, face, eyes, ears, arms, fingers, legs and toes form
• genitals develop
• hair starts to grow
• 20 buds appear for future teeth

Special Concerns
The primary risk for most women in the first trimester of pregnancy is early miscarriage. Following are possible signs of miscarriage:

• Bleeding with cramps or pain in the center of your lower abdomen. However, pain on either side alone may be caused by ectopic pregnancy and also warrants a call to your health care provider.
• Severe pain or pain that continues for more than one day, even if it is not accompanied by spotting or bleeding
• Bleeding that may be as heavy as a menstrual period
• Light spotting that continues for more than three days

Call Your Health Care Provider – Pregnancy is not a time to ignore warning signs from your body. On the contrary, throughout your pregnancy you will learn to pay careful attention to what your body is telling you. If you are experiencing something out of the ordinary, it may warrant a call to your health care provider. If you experience any of the following, be sure to call your health care provider immediately:

• Any of the above signs of a miscarriage
• Severe abdominal pain, especially if it is accompanied by bleeding, nausea, vomiting or swelling of the hands and face
• Slight vaginal spotting
• Heavy vaginal bleeding, especially if it is accompanied by abdominal or back pain
• Bleeding from the nipples, rectum or bladder
• Coughing up blood
• A gush or steady leaking of fluid from the vagina
• A sudden increase in thirst if it is accompanied by a decrease in the need to urinate or lack of urination for an entire day
• Swelling or puffiness of the hands, face or eyes, especially if accompanied by headache or vision difficulties
• Painful or burning urination, especially if accompanied by chills and a fever over 102 degrees and/or backache
• Vision disturbances that continue for two hours, including blurry vision, dimming or double vision
• Severe nausea and vomiting or vomiting more than two to three times a day in the first trimester

The Second Trimester

What’s Happening with You

Physical Changes

• A decrease or end to nausea and vomiting – In a few women, this “morning sickness” may continue and in even fewer it is just beginning.
• Nasal congestion and occasional nosebleeds, often accompanied by ear stuffiness
• “Pink toothbrush” from gums that may bleed
• Mild swelling of ankles and feet, as well as hands and face
• Hemorrhoids
• Slight, whitish vaginal discharge, called leukorrhea
• Fetal movement – Between weeks 16 and 20, you will begin to feel the fetus moving. In the beginning, it will feel like “fluttering” and you will soon feel regular rolls, kicks and jumps. Call your health care provider if you do not feel the baby move in a 12-hour period.
• Fatigue – You may experience disrupted sleep due to frequent need to urinate at night. Try to go to bed earlier at night and/or take an afternoon nap to minimize your exhaustion.
• Increased appetite – As your nausea subsides, your appetite will return. Keep in mind a healthy, balanced diet for you and your growing baby.
• Expanding abdomen – By the end of the second trimester, the top of your uterus will be near your rib cage.
• Itchiness and stretching – Many women experience itchiness as their abdomen and breasts stretch and grow. Use a good skin cream to help alleviate the itchy symptoms.
• Abdominal aches – As the ligaments that support your uterus are stretched, you may feel aching on one side or the other.
• Linea nigra – Many women experience a dark line, called the linea nigra, that appears down the middle of the stomach from your navel to your pubic line. This will disappear after delivery.
• “Mask of pregnancy” – You may get brown patches, also called the “mask of pregnancy,” on your face. This, too, will disappear after delivery.
• Darkened areolas – The areolas, or the darker skin around your nipples, may darken even further.
• Leg cramps – Many women say that these are particularly problematic first thing in the morning, when you stretch before getting out of bed. To help avoid leg cramps, stretch with your ankles flexed, not with toes pointed.
• Feet and ankle swelling
• Shinier, fuller hair

Emotional Changes

• Frustration at not really looking or feeling pregnant, but are too big for your normal wardrobe and too small for maternity clothes. This feeling tends to turn to excitement as the as the second trimester progresses and you begin to “show” the world that you are pregnant.
• A feeling of being “scatterbrained” – You may feel forgetful, drop things, and even have trouble concentrating.
• Many women experience dreams about baby animals, such as kittens or puppies with their mothers.
• Occasional irritability, absentmindedness, crankiness or “fuzzy” thinking due to sleep loss.
• Fewer mood swings.

What’s Happening with your Baby
Your baby is growing and developing rapidly. By the end of the fourth month (13-16 weeks), he/she will weigh ½ ounce and measure 2 ½ to 3 inches, or the size of a large goldfish. At this point, the fetus’ head is typically disproportionately large. At 13 weeks, the eyes are developed, although the lids will remain closed for several months still. At 15 weeks, the ears are fully developed. Most major organs, the circulatory system and urinary tract are operating. Although genitalia are developing, it may not be possible yet to determine the gender with ultrasound.

By the end of the fifth month (17-20 weeks), your fetus is approximately 4 inches long, the size of a small avocado. By now, the body is beginning to catch up with the head in size. Fingers and toes are well-defined and tooth buds are now appearing. You are probably experiencing the first joyful feelings of fetal movement. During the second trimester, the fetus kicks, moves, sleeps and wakes. He/she can swallow, hear, pass urine and even suck his/her own thumb!

By the end of the sixth month (21-24 weeks), your fetus is about 8 to 10 inches long. At this point, the fetus is covered by a protective, soft down called “lanugo.” Hair will now begin to grow on the head and white eyelashes will appear. Your baby is now beginning to develop fat, which helps to keep it warm. The fetus’ chances of surviving outside the womb are still risky, but it is possible at 23 to 34 weeks in a hospital with a good neonatal intensive care unit (NICU).

Your baby is nearly 13 inches long and weighs approximately 1 3/4 pounds by the end of the seventh month (25-28 weeks). Finger and toe prints have formed and eyelids are now parted. Eyebrows, eyelashes and fingernails are now formed. The baby continues to move consistently, with more pronounced periods of activity and rest.

Special Concerns
Sleeping positions – All pregnant women want a good night’s sleep, especially since they know that sleep will be elusive once the baby arrives! However, the two most common sleeping positions are on the belly and on the back, neither of which are recommended during pregnancy. The belly position may feel like sleeping on a watermelon! The back position may rest the entire weight of your pregnant uterus on your back, your intestines and the inferior vena cava, the vein responsible for returning blood from the lower body to the heart. The most recommended position is on your left side (although sleeping on the right side is fine, too), with one leg crossed over the other with a pillow between them.

Sexual Relations – Sex is a common concern for many pregnant women and their partners. Unless your health care provider has told you otherwise, it is perfectly safe to make love throughout your pregnancy without any risk to you or your developing baby. Many women experience a heightened sexual desire, while others would prefer not to be touched at all – it really does vary from woman to woman. As your body changes and your abdomen expands, you may want to experiment with different positions to find one that is comfortable for you and your partner.

Intercourse may be restricted under some of the following circumstances:

• Any time unexplained bleeding occurs
• During the first trimester, if you have a history of miscarriage or threatened miscarriage, of if you are showing signs of a threatened miscarriage
• During the last 8 to 12 weeks of pregnancy if you have a history of premature or threatened premature labor, or if you are experiencing signs of early labor
• If your membranes (amniotic sac of water) have ruptured
• If you have been diagnosed with placenta previa, when the placenta is located near or over the cervix
• In the last trimester if you are carrying more than one fetus

Feeling the baby move – Fetal movement is one of the biggest joys – and one of the biggest sources of stress – during pregnancy. From the moment that you feel that first flutter, you begin to truly understand that there is a living, human being growing inside of you. But just like you, the fetus will have moments of quiet relaxation and other times of restlessness and kicking.

More often than not, the fetus’ activity is related to your level of activity. For instance, if you have had a busy day, running errands or busy at work, you may actually “lull” the baby to sleep. The result? You may not feel much movement. In addition, because you are so busy, you may not be paying real attention to the level of activity. Once you slow down, you will most likely begin to feel more movement. That is why many women feel the most movement when they are laying down in bed at night.

Babies are actually the most active between weeks 24 and 28, with more clearly defined periods of rest and activity between 28 and 32 weeks.

If you are concerned that you have not felt much movement on any given day, you can try to do “kick counts.” In order to do this, sit or lie down in a quiet place. Check the clock when you start counting and count movements of any kind – kicks, flutters, swishes or rolls – until you reach 10. Note the time. Many times, you will feel 10 movements within 10 minutes or so, but sometimes it may take longer.

If you have not counted 10 movements by the end of an hour, have some ice water, milk, juice or a small snack (okay, you can indulge in some sugary candy), then lie down, relax and start counting again. If another hour goes by without movement, call your health care provider immediately. Although limited or no fetal activity is generally not a problem, it may indicate fetal distress.

Premature Labor – Premature labor is not something to be taken lightly. Although your baby has a good chance of survival outside the womb in a neonatal intensive care unit (NICU), there still exists a high chance for complications. If you even suspect that labor may be beginning, call your health care provider immediately. Following are some signs and symptoms of premature labor.

• Menstrual-like cramps, with or without diarrhea, nausea or indigestion
• Lower back pain or pressure, or a change in the nature of any lower back pain that you have been experiencing throughout your pregnancy
• An aching or feeling of pressure in the pelvic floor, thighs or groin
• A change in your vaginal discharge, particularly if it is watery or tinged/streaked pinish or brownish with blood. The passage of a thick, gelatenous “mucous plug” may or may not precede this “bloody show.”
• Rupture of membranes, with either a trickle or rush of fluid from your vagina

Sometimes, it is difficult to tell the difference between “real” labor and the Braxton Hick contractions that many women experience after the 20th week of pregnancy. Braxton Hicks contractions are a strange sensation for most women, a tightening of the uterus that typically lasts 30 seconds to two minutes. If this is your second pregnancy, you are more likely to experience Braxton Hicks contractions. Following are some ways to determine whether less frequent contractions may be a warning sign of premature labor:

• In general, contractions coming at regular intervals are a sign of real labor, although some women never have regular contractions.
• Go for a short walk – false labor contractions usually decrease with movement. If labor strengthens, call your practitioner.
• In general, true labor contractions become more intense. With false labor, intensity may waver or decrease.
• If you have not had a leakage of fluids, drink a cup of hot tea while taking a warm, relaxing bath (not hot!). This can often stop or slow down false contractions.
• You may want to call your health care provider, who can likely tell from your voice whether or not you are in labor. How? If you need to stop talking during a contraction, it could be the real thing!

Call Your Health Care Provider – If you experience any of the following symptoms, call your health care provider immediately:

• Fever over 100.4 degrees in absence of cold or flu symptoms
• Severe headache
• Blurred, dim or double vision
• Fainting or dizziness
• Sudden, unexplained large weight gain
• Sudden increase in thirst with infrequent and/or painful urination, bleeding or cramping
• No fetal movement in 12 hours
• Severe cramping
• Bleeding or spotting
• Change in vaginal discharge, especially if it is watery or tinged or streaked pinkish or brownish with blood
• Rupture of membranes (a trickle or rush of fluid from your vagina)

The Third Trimester

What’s Happening with You

Physical Changes

• Braxton Hicks contractions – These “practice” contractions may intensify or increase in frequency.
• Leaky breasts – By now, your breasts are nearly ready for the job of breastfeeding. You may experience some leakage of a yellowy liquid called colostrum.
• Itchiness and stretching – Many women experience itchiness as their abdomen and breasts stretch and grow. Use a good skin cream to help alleviate the itchy symptoms.
• Fetal movement – You should continue to feel strong, regular fetal movement. As your delivery nears, you may notice a significant decrease in fetal kicking, but an increase in rolling, stretching and quiet periods. Call your health care provider if you do not feel the baby move in a 12-hour period.
• Back and leg pain – These pains may increase due to the increasing weight of your baby.
• Varicose veins – Varicose veins may begin to appear on your legs – support pantyhose may help to ease the discomfort and aching.
• Shortness of breath – You may experience shortness of breath as your uterus pushes up against your diaphragm, a muscle that aids in breathing. This breathlessness goes away once the baby “drops” into the birth canal.
• Increasingly heavy vaginal discharge – Be sure to call your health care provider if you experience vaginal bleeding.
• Cervical changes – Upon internal examination, your health care provider may find that your cervix is beginning to efface and dilate in preparation for delivery.

Emotional Changes

• Apprehension and excitement may increase as the “big day” begins to approach
• Joy and wonder at this growing baby inside of you
• Anxiety over your safety and the safety of your baby during delivery
• “Nesting Instinct” may increase as you spend more and more time shopping for baby items, cleaning the house, etc.
• Will this pregnancy never end??
• Fears if misinterpreting or not recognizing signs of labor

What’s Happening with your Baby
By the eighth month (29-32 weeks), your baby weighs nearly three pounds and has fat stores under his or her skin. He/she may suck a thumb, hiccup, cry, respond to pain, light and sound. Bones will harden, but the skull remains soft and flexible for delivery. Because your baby has probably surpassed the two-pound mark, chances of survival in a Neonatal Intensive Care Unit are very good, but still with the possibility of complications.

Your baby weighs approximately five pounds and is about 18 inches long by the end of the ninth month (33-36 weeks). Brain growth will now accelerate, and your fetus should now be able to see and hear. Most other systems of the body are well-developed, although the lungs still may be immature, especially with boys. If you delivered now, your baby has an excellent chance of survival outside the womb with minimal serious complications.

And by the tenth month (37-40 weeks), your baby is approximately 20 inches long and weighs seven to eight pounds. With fully mature lungs, your baby has an excellent chance of survival outside the womb.

Special Concerns
Breech Position – Some time between weeks 32 and 36, most babies will turn themselves into a head down position to prepare for delivery. However, approximately three to four percent of full-term babies will remain in a breech position. If your baby is found to be in the breech position, your health care provider may discuss several options with you.

Some practitioners recommend exercises, such as walking, in the last eight weeks of pregnancy to help encourage a breech baby to turn. While there is no medical proof that these exercises work, there is also no harm in trying.

Your practitioner may also recommend trying an external cephalic version (ECV), where he/she applies his/her hands to your abdomen and, with ultrasound guidance, gently tries to shift the fetus to the head-down position. This procedure is done while monitoring the baby to be sure that the umbilical cord is not accidentally compressed or the placenta is disturbed in any way. Once turned, most fetuses do remain in the head-down position; however, there is still the possibility that the fetus will turn back to a breech position.

Some health care providers will attempt to deliver a baby that is in the breech position, while others will opt for a cesarean delivery. This is something that you should discuss with your provider.

Call Your Health Care Provider – If you experience any of the following, be sure to call your health care provider immediately:

• No fetal movement in 12 hours
• Sudden decrease in fetal movement compared to what has been “normal” for you
• Severe cramping
• Bleeding or spotting
• Diarrhea or nausea
• Severe lower back pain
• Pressure in the pelvic or groin area
• Change in vaginal discharge, especially if it is watery or tinged or streaked pinkish or brownish with blood
• Rupture of membranes (a trickle or rush of fluid from your vagina)
• Severe contractions
• Vaginal bleeding
• Visual changes, especially if your blood pressure has been a problem
• If you can’t differentiate between false and real labor – often, he or she can tell from your voice if it is the real thing or not.
• If you are experiencing the signs on the real labor.
• Talk with your health care provider about how regular your contractions should be when you call – typically, five, eight or 10 minutes apart.

Common Discomforts During Pregnancy

During pregnancy your body is going through many changes. These changes are triggered by hormones that prepare your body for pregnancy. These hormones can also cause many physical discomforts. Luckily, there are easy ways to relieve your pains.

Backache – Backache is one of the most common problems women face during pregnancy. The extra weight you are carrying causes a strain on your lower back muscles causing them to become stiff and sore. If you have a backache that refuses to go away or continues to get worse, call you doctor to be sure that this pain isn’t caused by another health concern.
Some ways to lessen and relieve back pain:

• When picking up objects below waist level, use your legs instead of your back by bending your knees and keeping your back straight. Avoid heavy strain on your back by letting someone else pick up heavy objects. Also, keep objects within your reach so you don’t have to strain yourself to grab them.
• Wear low heeled shoes. High heeled shoes tilt your body and put more strain on your back.
• Stay off your feet! If you have to sit for a long time, sit in a comfortable chair with good support on your back or put a pillow behind the small of your back. If you have to stand for long periods of time rest one foot on a stool while you lean your weight on the other to relieve pressure on your back.
• Sleep on your side with a pillow between your legs to support your back. Also, sleeping on a firm mattress will give your back more support than sleeping on a soft mattress. To firm up a soft mattress just have someone put a piece of plywood between the box spring and the mattress.
• Exercise to keep your back muscles stretched. Strengthen your back muscles by doing exercises and using good posture.
• Use an abdominal support garment to help take the weight of your belly off your back. Some maternity bottoms have built-in, thick elastics that ride below your belly to do the same thing.
• Use a heating pad, warm water bottle, or cold compress on your back to ease pain.

Breast Tenderness – As you body prepares itself for breastfeeding your breasts become larger and heavier. They most likely feel full and tender.
To help relieve breast discomforts:

• Wear a bra that fits well and has good support. A maternity bra, a bra built with extra wide shoulder straps, more coverage in the cups, and an extra row of hooks, is a good choice.
• Wear a supportive sleep bra to give you support while you sleep.

Constipation and Gas – During pregnancy you may get “backed up” from hormonal changes or from vitamin supplements. This can cause painful bloating and gas which may be exaggerated late in the pregnancy when the weight of your uterus begins to push on your rectum.
To reduce bloating and gas:

• Drink plenty of fluids to help flush out your digestive tract.
• Eat high fiber foods, including vegetables, whole grain bread, and bran cereal.
• Exercise to help your digestive system stay on track.

Frequent Urination – Frequent urination during pregnancy is caused by many influences. Your body is working hard to remove waste from your body. As your uterus grows it begins to press against your bladder and cause you to feel like you have to use the bathroom even if your bladder is almost empty. This may lessen in mid-pregnancy, as the uterus no longer rests on the bladder, but may begin again late in the pregnancy when the uterus drops into the pelvis. You may leak urine when you sneeze or cough due to pressure on your bladder. If this happens you can protect yourself by wearing panty shields or sanitary napkins.

To relieve frequent urination:

• Eliminate colas, coffee, and tea from your diet because caffeine makes you urinate more. Don’t reduce the amount of fluids you drink, as this will rob you and your baby of vital fluids.

Headache – Headaches during pregnancy can be caused by hormonal changes, stress, increased hunger, fatigue, or even caffeine withdrawal. It is best to speak with your doctor before taking any drugs to relieve the pain.
Here are some drug-free tips to reduce headache pain:

• Rest in a dark quiet room.
• Place a cold face cloth on your forehead.
• Gently massage your temples, or have someone gently massage them for you.
• Get plenty of rest.
• Drink plenty of fluids.
• Eat small meals throughout the day to keep your blood sugar constant.

Heartburn and Indigestion – Heartburn, a feeling of burning in the throat and chest, and indigestion, a bloated and gassy feeling that happens when a stomach is slow to digest, may happen during pregnancy. There are many drug-free ways to help relieve symptoms and prevent heartburn and indigestion. Before taking antacids you should speak with your doctor.
To reduce your heartburn:

• Eat smaller meals, more frequently, rather than three large meals a day.
• Relax and eat slowly, chewing your food thoroughly.
• Stay away from foods that bother your stomach, including fried, greasy, and fatty foods. If heartburn is a problem, avoid fizzy drinks, citrus fruit, and fruit drinks.
• Don’t lie down after eating and eat a few hours before bedtime. If heartburn is still a problem at night, try propping your head up against a pillow or elevate your head using a couple of books under the legs of your bed by your head.

Hemorrhoids – Hemorrhoids are painful, itchy varicose veins in the rectum. These can be caused by extra blood in your pelvic area and the pressure of your growing uterus on veins in the lower body. They may appear when you are constipated because straining bowel movements trap more blood in your veins. They may disappear only to return again during labor due to the strain of delivery.
Try these tips to help prevent hemorrhoids:

• Ward off constipation by drinking plenty of fluids and eating plenty of fiber.
• Keep your weight gain under control. Extra weight makes hemorrhoids more painful.
• Don’t sit for long periods of time. Sitting puts pressure on the veins in your pelvic area.

To reduce the painful swelling of hemorrhoids:

• Soak them in water.
• Apply ice packs.
• Apply witch hazel pads.

Insomnia – Your growing belly may make it hard for you to find a comfortable position while sleeping. Also, the impact emotionally and physically of having a new baby may make it hard for you to fall asleep.

To help you relax and get a good night’s sleep:

• Relax your mind and body in a warm bath or shower before bed.
• Learn relaxation exercises and breathing techniques.
• Limit your daytime sleeping.
• Sleep on your side with a pillow under your abdomen and another between your legs.

Leg Cramps – Leg cramps, especially at night, are a common discomfort during pregnancy, although the cause of them is uncertain.

To reduce cramping:

• Stretch your legs before going to bed
• Avoid pointing your toes when stretching or exercising

Lower Abdominal Pains – As your uterus grows, the ligaments that support it are pulled and stretched. This can cause dull or sharp pains on either side of your belly. These pains are most common between weeks 18 and 24. If these pains worsen or don’t go away, call your health care provider.

To prevent or relieve pains:

• Avoid moving quickly, especially at the waist.
• Bend toward the pain to help relieve it.
• Rest or change your position.

Nausea and Vomiting – In the beginning of your pregnancy you may feel queasy by the smell of certain foods and have trouble keeping food down. This feeling, known as “morning sickness,” can happen at any time during the day or night and may lessen by the middle of your pregnancy. This nausea and vomiting does not harm you or your baby if mild, but if it gets severe, you can’t keep any foods or fluids down, and you begin to lose weight, you should see your health care provider.
To help relieve nausea and vomiting:

• Drink plenty of fluids to keep from dehydrating. Sweet, bubbly drinks may help you feel better.
• Eat more often to keep your stomach full.
• If you are nauseated when you wake up, keep crackers next to your bed to nibble on before getting up. Get out of bed slowly, sit and rest before standing up.
• Eat foods that are low-fat and easy to digest.
• Getting fresh air may help. Try taking a short walk outside or sleeping with a window open.

Shortness of Breath – The increase of progesterone early in pregnancy may leave you short of breath. Later in the pregnancy, your uterus grows larger and may press against your diaphragm, making it difficult to breath. You may feel short of breath but you are still getting adequate oxygen.
To help you breathe easier:

• Give your heart and lungs a break by moving slowly and taking it easy.
• Give your lungs more room to expand by sitting or standing up straight.

Swelling – Due to the increase in water in your body you may experience some swelling, known as edema, in your hands, feet, face and other body parts especially later in the pregnancy and during the summer. If you notice a sudden swelling of any body part you should contact your health care provider.

To relieve swelling:

• Sit with your feet up often.
• Sleep with your legs propped up on a pillow.

Varicose Veins – Varicose veins, blue bulges on your legs or in the lower body during pregnancy are caused by the weight and pressure of your growing uterus. There are no ways to prevent this, but you can reduce the swelling, soreness, and itching.

Following are suggestions to help reduce your risk of developing varicose veins:

• When sitting or standing for a long period of time be sure to move around and change you position once in awhile.
• Sit with your legs straight not crossed.
• Relieve pressure by putting your feet up on something such a chair, desk, or stool.
• Exercise.

Wear support hose. Avoid wearing stockings that are tight around your legs.

Management and Care In The Delivery Room

After you arrive in delivery room, a labor and delivery nurse will escort you to your labor room where you will change into a delivery gown. You will be placed on an external fetal monitor to determine the quality and frequency of your contractions and to determine the well being of your baby by its heart rate. This fetal monitor is similar to the fetal monitor that you were on in the office during your last several visits. Your support person can be with you at all times. A pelvic examination will then be performed either by the labor and delivery nurse or by your physician. Once it has been determined that you are in active labor, our practice is to have two tubes of blood drawn from your forearm. This allows us to determine a recent blood count and to type and screen your blood. We usually request the nurse to start an intravenous line (I.V.) when you are in active labor. There are several reasons we like to have an intravenous line in place:

1. During labor, your body loses a great deal of fluids. The I.V. line contains salt water. We will be able to replenish your fluids so that you do not get dehydrated and therefore the baby will not get dehydrated.
2. The intravenous line allows us to give pain medication without having to give you another separate injection.
3. This intravenous line enables us to give you medicine after the baby is born to quickly contract your uterus so that you will have the least amount of blood loss and get back on your feet as quickly as possible.

We realize that many of you have attended prenatal classes and have some concept concerning anesthesia during you labor. If you desire a totally natural childbirth, we will
give you every bit of support to help you reach your goal.

Analgesia and Anesthesia

If you desire analgesia anesthesia during the course of labor, we have several options to give you.

1. 1. Intravenous or Intramuscular narcotics. This will be given to you at your request, assuming there are no contraindications. Narcotics are used in labor because they are time tested and well tolerated. In addition, narcotics can be easily reversed if you deliver rapidly.
2. Once you get into the active phase of labor or once your contraction pain become intolerable and you desire medication, we have the choice of giving you more analgesia or we can then offer you an epidural anesthetic. The staff anesthesiologist in the hospital would perform this epidural.  In order to have epidural anesthesia, you must have an intravenous line in place.  Each patient needs at least 1 liter of fluids before an epidural can be placed.

As with any procedure there are risks involved.  Risks of an epidural include but are not limited to bleeding, infection, spinal headaches, and paralysis.  These risks are definitely small.  One additional concern is that issue of back pain with epidural.  After an epidural, you may experience some pain at the site of injection.  However, long term back pain usually is a not an issue.  Many other factors contribute to long term back pain.  These may be the length of time you were in bed, the length of time you were pushing, or simply general back pain as you ages.

Concern regarding labor and delivery include an increase risk in occiput posterior position, inability to push effectively due to numbness, and an increase in assisted delivery.

As with any procedure there are advantages and disadvantages.  The advantage of an epidural is a more comfortable labor without contraction pain which may provide you with the rest needed to push.  Sometimes it will relax you enough making your cervix dilate faster.

Discuss with your physician and weigh the advantages and disadvantages prior to going into labor.

Episiotomy

At the time of the delivery of your baby, the doctor will decide whether an episiotomy is necessary. We do not do episiotomies routinely.  However, we feel that if there is chance of a tear in the vagina during the delivery, it is more appropriate to do an episiotomy. An episiotomy can heal quickly. For those patients who do not have an epidural anesthesia, a local anesthetic will be given. This local anesthetic is given during the cut and repair of the episiotomy so you do not have pain.

What You Should Know If You Are Having A Scheduled Cesarean Section

A scheduled Cesarean Section may be preformed for any one of several reasons. Some parents may have had a prior Cesarean Section and are electing to have a repeat Cesarean Section. Other patients may have a medical problem that makes a Cesarean Section delivery safer for them. Once a C-Section at a chosen time is decided upon, the doctor will discuss a suitable date with you. Most often because of scheduling rules in the hospital, scheduled C-Sections are performed between 7:30 am and 9:30 am. Generally, only one person is allowed to be with you in the delivery room where the Cesarean Section is taking place. You may choose whomever you wish to have with you. Ask the support person you have selected to be with you to arrive at the hospital at about seven o’clock in the morning.

In order to prepare for the procedure you will be asked not to eat or drink anything, not even a glass of water or cup of coffee, from midnight of the night before the C-Section. Eating or drinking will generally cause the Anesthesiologist to delay your procedure until the following day if not longer. Please remember not to eat or drink anything from midnight the night before your C-Section.

Most patients are admitted to the hospital the morning of the C-Section. Generally, you will be sent for pre-admission urine and blood work several days before your C-Section. When you arrive at the hospital, around six o’clock in the morning the day of you C-Section, your IV will be started and you will be shaved over the area of the pubic bone where the incision will be made. A catheter is placed in the bladder to allow drainage of urine during the C-Section and until the morning after the C-Section, so you can rest in bed and don’t have to get out of bed to go to the bathroom. Depending upon when your pre-admission blood work is done, one more tube of blood may need to be drawn. An Anesthesiologist will speak with you before the C-Section.

Once your C-Section is performed you will spend several hours in the recovery area on the Labor & Delivery Suite before going to your room. The hospital stay for a C-Section is generally 4 days starting the day after the procedure. Some patients will feel well enough to go home in three days. Usually the day after the C-Section the catheter is removed from your bladder and the intravenous is stopped if your temperature is normal and you can drink fluids well. Regular food is usually started the first day or two following the procedure.

(Please be aware that this is general information and that there may be slight changes from one patient to the next. If you have any questions that have not been answered, please feel free to ask us).