Birth to Conception

The information contained within this section should not be considered a substitute for medical care.

General OB Information | 1st Trimester | 2nd and 3rd Trimesters

General Obstetrical Information

Your Due Date
Travel
General Activity
Danger Signals
Fees
Diet and Weight Control
Hygiene and Clothing
Medication in Labor and Delivery
Work
Additional Information
Goals
Prepared Childbirth
Nutrition
Exercise
Cigarettes
Alcohol and Drugs
Episiotomy
Electronic Fetal Monitoring
Maternity Leave
Previous Cesarean Section
Medicines
Ultrasound
Father's/Partner's Participation
Immunizations

Your Due Date

The duration of the average pregnancy is 280 days or ten lunar months. The emphasis is on the word "average." Only about 4% of all women will actually deliver on their "due date". However, over 90% will deliver within two weeks of that date. If you should go beyond that time, that is, 41 weeks from your last menstrual period, then some special tests must be done to insure that your baby is all right. If this situation arises, we will discuss it further at that time.
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Travel

Travel by air in commercial aircraft can be unrestricted until you are close to delivery. After 36-38 weeks, it is more prudent to stay close to home unless there are extenuating circumstances. Most airlines will refuse you passage in your last month unless you have a note from your doctor. If traveling after 32 weeks, you may want to have a cervical check done during the week before you go.

Long trips by car are less desirable, but can be taken if common sense is used. You should stop every two to three hours, move around, exercise your legs, etc. A long trip into the backwoods country at 38 weeks may afford your husband an unexpected opportunity to act as midwife; common sense is the byword.
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General Activity

You may continue with most sports and most activities as in your nonpregnant state. You will probably notice that you tire more easily than before. This is normal, but you should listen to your body and rest when those feelings come. Avoid undue fatigue or extreme exercise. Don't use pregnancy as an opportunity to learn to skydive, scuba dive, horseback ride, mountain climb, etc. If your hobbies include any of these activities, be sure to discuss these with us, as we will probably want you to curtail or stop completely, depending on individual circumstances. Apart from unusually hazardous activity, you should be able to enjoy those things which brought you pleasure in the nonpregnant state.
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Danger Signals

To insure that your pregnancy is a happy and healthy event in your life, you must be able to recognize when something is going wrong. If any of the following occur, report them to us immediately:

Vaginal bleeding, no matter how slight, after 12 weeks.
Swelling of the face or fingers, after 28 weeks.
Severe, continuous headache.
Dimness or blurring of vision.
Pain in the abdomen.
Persistent vomiting.
Chills and fever.
Sudden escape of water from the vagina.

Fees

The fee schedule for obstetrical care will be discussed with you early in your pregnancy. There is an all-inclusive charge that includes prenatal care, delivery, and the postpartum check-up six weeks after your baby is born.

Laboratory work is extra and usually includes prenatal labs (a complete blood count, a blood type with Rh determination, a serologic test for syphilis, a Rubella titer, and a toxoplasmosis titer), a maternal serum "triple screen" test for birth defects and testing at seven months for diabetes. Many patients also receive an ultrasound, which is an extra cost. You may request an H IV test.

If additional lab data is necessary, there will be an additional lab charge, but the physician's fee remains the same.

There is an additional charge for circumcision-usually performed by the baby's physician.

If a Cesarean section becomes necessary, there will be additional charges for your total OB care by your doctor, the assistant surgeon, and the anesthesiologist.

The hospital has a separate set of fees, which depends mostly on the length of your stay. Your hospital bill is entirely separate from our office fees. They tend to be very fussy about financial arrangements and expect them to be made well in advance of admission.

Your maternity records will be sent to the hospital prior to your admission and the Labor and Delivery ward will be aware of your anticipated admission.
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Diet and Weight Control

The average weight gain in pregnancy is about 30- 35 pounds. Most of the weight will be gained in the last half of the pregnancy. At term, your baby accounts for 7-1/2 lbs., the placenta I lb., amniotic fluid 2 lbs., the uterus 2-1/2 lbs., and there is about 10 lbs. distributed throughout your body. A high protein, low fat diet is ideal for pregnancy. Protein does not have to be expensive. Good sources of protein can be found in fish and soybean products. Some additional dietary instruction is included with this packet.

You should also have a liberal intake of vitamin-rich foods such as raw vegetables. Pre-natal vitamin supplements are a good idea. Iron supplements are frequently necessary, as dietary sources cannot keep up with iron needs later in pregnancy. It is essential that your body have enough iron to make the red blood cells necessary to carry oxygen for both you and the baby. So, most women take a prenatal vitamin with Iron throughout pregnancy.

You may season your foods to taste; and unless specifically instructed otherwise, you may use salt if you wish. Although "water pills" were once used with great frequency, they are no longer felt to be necessary and, indeed, may cause problems.
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Hygiene and Clothing

Douching is not recommended, especially in the last trimester. Unless told to do so by the doctor, don't do it.

Tub baths are fine throughout pregnancy. Caution must be used however, because equilibrium is sometimes difficult to maintain in your protuberant state and it is much easier to slip and fall getting in and out of the tub. Caution and common sense is again the byword. Hot tubs are generally not recommended because your body heat rises and we don't think that is good for the baby. If you use a hot tub, it should be for only 5 to 10 minutes at a time (reduce the temperature).

A bra is necessary for proper support of enlarging breasts, but should not be too tight. Nursing bras (if you plan to breast-feed) should be purchased one size larger than your usual size and with a wide and deep enough cup.

Girdles are not advised. Sometimes though, specially designed maternity support devices can help back and abdomen pain. Ask your doctor.

Support hose are very helpful, especially if you're on your feet for long periods of time. With varicose veins, they are of great benefit. They should be put on first thing in the morning and they should fit snugly. The waistband should allow for plenty of expansion.

Outer clothing should be loose fitting. Avoid constricting rings as they impede the flow of blood and can even lead to formation of blood clots if tight bands are placed on upper legs.

Breast care is very important if you are planning to breast-feed. From about the fourth month, you may notice a thin, sticky discharge from your breasts. This is normal and is known as colostrum. Nipples should be gently cleansed with soap and a washcloth as often as necessary to remove the crustations. A non-allergenic mild cream, such as Masse cream, may be applied during the last month.

Dental hygiene - Pregnancy is a good time for a thorough dental checkup, as some women seem to suffer more cavities at this time (although it is not a proven fact). Special care should be given to the care of your gums. Dental x-rays and novocaine are safe in pregnancy.

Sexual intercourse - Unless otherwise instructed, intercourse is permitted until the onset of labor. If the bag of water breaks, or if there has been any vaginal bleeding, sexual intercourse is absolutely forbidden. Again, common sense is the byword.

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Medication in Labor and Delivery

The first step to pain relief during labor is education. The more prepared you are for the birth experience the less fear you have and the more relaxed you are. For even the most prepared mothers-to-be, labor can become an exhausting experience and you may lose your ability and interest in handling labor. There are three major choices for either analgesia or anesthesia.

Analgesia provides relief of pain between contractions allowing the mother to rest before the onset of the next contraction. It will not alleviate the discomfort of the contractions. The most common analgesics are Demerol, Fentanyl, Stadol, and Nubain. They work best when given directly into your vein, as through an "IV".

Regional anesthesia provides total or almost total relief of pain. An epidural block or intrathecal may be administered during labor and maintained for delivery. A spinal anesthetic (less common) is given directly into your spinal canal when we need faster or better pain relief for a cesarean section. It is not used for a labor anesthetic.

General anesthesia (where patient is temporarily put to sleep) is reserved for obstetrical emergencies.

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Work

You may continue your employment as long as you wish. Most women feel too tired and uncomfortable by the 38th week to carry on full-time employment. Some jobs and occupations should be stopped sooner, but most can be performed until term or until the patient wishes to quit. If you think yours is an unusual occupation that could adversely affect your pregnancy, bring it to our attention early. For example, it would be unwise for you to work with intense chemical fumes (you might get dizzy, but it won't hurt the baby), for example.
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Additional Information

We will also provide you with timely handouts through the rest of your pregnancy. You cannot read too much! There are many good books available.
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Goals

Pregnancy and childbirth are experiences of health. They are natural, normal physiologic processes. The goal is to have a healthy mom and a healthy baby. Our goal is to provide you with quality care and to assist you in the "normal" pregnancy and childbirth process, and to advise and assist when there are any problems.
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Prepared Childbirth

We encourage you and your husband to enroll in a Lamaze or similar class. Information is available in your 1st OB packet about locations and time of classes. It is completely acceptable to use the Lamaze method as an adjunct to other analgesia. That is, it is no failing on your part to ask for pain medicine. As situations arise in labor, we will discuss them and offer appropriate types of analgesia. You are free to accept or refuse them as you wish. Fathers are encouraged to be with you during delivery.
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Nutrition

Eat wisely during your pregnancy. When you are hungry, eat good food. Don't let people talk you into "eating for two". Eat approximately the same amount of food as before your pregnancy, but concentrate on a low fat, low refined-sugar diet. Eat plenty of fresh fruits and vegetables. Calcium may be obtained by eating 3 or 4 low fat dairy servings daily, or by using 4 or 5 "TUMS" daily.

A weight gain of 30-35 pounds for most pregnant women is a good weight gain. Eat 3 balanced meals a day plus 2 snacks, or 5 small meals a day. You are less likely to feel nauseous if you have something in your stomach. Try not to eat a full meal within 2 to 3 hours before going to bed. Watch out for "hidden sugar". Fruit jucies have more sugar than soft drinks. We recommend limiting both to no more than one glass daily.

Nausea is improved by frequent small snacks, Vitamin B6 50 mg every 12 hours, ginger (in food or in a capsule) every 6 hours, or by wearing "Sea Bands" obtained at a sporting goods store.
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Exercise

During pregnancy, exercise is especially important. Exercise will help keep you healthy and feeling the best you can in your rapidly changing body. The normal uterus begins roughly 2" by 4", at the end it can be as large as 12" by 15"! Just like the athlete who builds, tones, conditions and cares for her/his body before the Olympic event, you are building a body (the baby's) and you need to tone, condition and care for your body to be ready for labor and giving birth.

see also: What You Should Know About Exercise During Pregnancy

Everyday Exercises for the Pregnant Woman:

Good posture. Sit, stand, and lie down so your body can rest in these positions. Adjust your body posture as your center of gravity changes with your growing body.
Range of motion exercises are a good beginning and closing to your day. Range of motion means that you move every part of your body in every direction that you can. Start with your head and go to your toes. Take your time. Do not strain.
Exercise when watching TV or visiting. Sit in a Taylor position (sifting cross-legged "indian style" on the floor). This stretches the thighs and pelvic floor muscles. Rotate your ankles. Twiddle your thumbs. Wave your hands. Bend your elbows. Shake a leg. In late pregnancy, be careful of shaking your tail feathers as your pelvic girdle (hips) are looser and this may cause discomfort.
Walking is a great pregnancy exercise, also swimming, if available is a wonderful non-stress non-shock exercise. Remember, exercise for your good health. It improves circulation, respiration, elimination and disposition. It will help you during labor and in giving birth.

We are frequently asked about exercise in pregnancy In general, in a low risk pregnancy, exercise will not cause harm to the fetus. For the mother, exercise has physical and emotional benefits. Women at high risk of premature labor, growth retardation (decreased blood supply to the placenta), or other high-risk conditions should not exercise. Consult your physician to determine if you are at increased risk.

Women who were in good aerobic condition prior to pregnancy may continue to workout at their previous levels. For women beginning their exercising program in pregnancy or, restarting after a break of one month or more, a safe 'rule of thumb' is to workout up to a target heart rate of 140 beats per minute. Vigorous exercise should be limited to no more than 15-20 minutes. Do not exhaust yourself. A good rule of thumb for aerobic exercize: no more than four times per week; no more than 30 minutes per day.

Exercises Generally Considered Safe in Pregnancy:

Low Impact Aerobics
Pregnancy Fitness
Classes Bicycling
Stationary Bicycle
Golf
Cross Country Skiing
Jogging
Racquet sports (non-competitive)
Walking/hiking Swimming/ Water Aerobics
Weight Training (avoid 'straining' and abdominal 'pushing')

Exercises to be Approached with Caution and Common Sense:

Baseball/ Basketball
Gymnastics
Downhill Skiing
Mountain Climbing
Horseback Riding
Ice Skating/Roller-skating

Exercises to be Avoided During Pregnancy:

Activities that require sudden forceful contact--boxing, football, hockey, soccer.
Bungee Jumping
Scuba Diving
Sky Diving
Water Skiing

Cigarettes

Smoking increases your risks of a miscarriage, a small baby (which raises the baby's chances of problems at delivery), and the likelihood of your baby's health problems during infancy. The chemicals in tobacco (nicotine and carbon monoxide) pass through the placenta to the baby. If you are smoking now, quit smoking for you and the baby. By quitting, you will help give your baby a healthy start and decrease your own chances of getting heart disease and cancer. Smoking may change the taste of your breast milk. Also, your infant may suffer increased throat and ear infections, asthma, and bronchitis from "re-breathing" your cigarette smoke.
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Alcohol and Drugs

All alcohol and drugs pass from your blood, through the placenta to the baby. Alcohol, narcotics, marijuana and cocaine have long term effects on your developing baby. These may include problems at delivery, learning disabilities and mental problems. To be safe, stop drinking or taking drugs - why take the risk? Even a small amount is harmful.
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Episiotomy

An episiotomy is a cut made in the perineum from the vagina toward the anus. It enlarges the vaginal opening. An episiotomy is made only if necessary to prevent tearing of the vaginal opening. Kegel exercises (practiced tightening of pelvic floor muscles, as in stopping urination), warm compresses and a controlled birth can help prevent the need for an episiotomy.
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Electronic Fetal Monitoring

External fetal monitoring is done with a machine that records the baby's heartbeat and the mother's contraction. Two straps are placed around your abdomen (belly) in order to hold the round monitors in place. Two wires attach the monitors to a machine that records the information. The recordings give the nurses and doctors information of how the baby is doing during and in between contractions.

The internal electronic fetal monitor gives the same information as the external electronic fetal monitor but instead of straps around you, a wire is placed inside your vagina and a wire attaches to the baby's head. The bag of waters must be broken to have an internal electronic fetal monitor. An internal monitor is only used under certain circumstances and is not routinely done. If your physician feels it is needed, the reasons will be explained.
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Maternity Leave

Most employers are comfortable with two weeks prenatal and six weeks postpartum. This is extremely variable and depends upon the personal desires, medical conditions, financial needs and type of birth. You will not be routinely excused from work two weeks prior to delivery. In fact, most of our patients work until they deliver.
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Previous Cesarean Section

Women who have given birth by cesarean section without a contra-indication to vaginal birth are encouraged to attempt a trial of labor. Many women with a prior cesarean section can deliver vaginally without significant risk. Cesarean section is a major surgical procedure. Your doctor or nurse will talk to you about having a Trial of Labor. If you succeed in a vaginal delivery after a cesarean section, it is termed a VBAC (vaginal birth after cesarean).
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Medicines

Almost everything you take has some subtle impact on a developing fetus. Some drugs are absolutely toxic to the unborn child. Medical science knows too little about most drugs to be sure what their effects are. Most importantly, we sometimes only learn of their impact 15 or 20 years later. Even though you don't think of things like over-the-counter headache and cold remedies, aspirin, and so forth as medicine, they all fall into this category. Be sure to mention anything you're taking or have taken earlier in the pregnancy. See the list of medications approved for pregnancy:

Headache/Sinus headache
Tylenol
Sudafed (pseudoephedrine)

Cough
chlorpheniramine
dextromethorphan
hydrocodone
guaifenesin

Heartburn
Tums
Maalox
Mylanta
Rolaids
Riopan

Allergies/ Sinus
Claratin
Benadryl
diphenhydramine

Constipation
Fibercon
Colace
Citrucel
Metamucil

Antibiotics
penicillin
ampicillin
amoricillin
erythromycin
azithromycin
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Ultrasound

Ultrasound is a method of obtaining a picture of your baby to provide information about dating the pregnancy, some possible birth defects and fetal well being and growth. Ultrasounds are done based on the medical needs of each patient. The American College of Obstetrics and Gynecology recommends that one complete ultrasound is considered on each patient during pregnancy. This is usually performed between 18 and 22 weeks.
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Father's/Partner's Participation

This is a great opportunity for men and women to share in one of the most miraculous and heart-warming experiences of their lives. Please invite the father (or someone who is close to you) to participate with you in prenatal care, childbirth preparation classes and the labor and birth of your baby. This is the only time in all of history that this child will be born. Bonding and attachment between the child and their mother and their father begins during pregnancy.

Early bonding promotes family strength that is needed to deal with the stresses of parenting, which occur as your infant grows into childhood and adolescence.

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Immunizations

We recommend pregnant women who will deliver at any time from November through June recieve the flu vaccine in October or November while they are pregnant. Pregant women have reduced immunity and frequently wil be sicker than non-pregnant women for any illness.

If needed you may be vaccinated while pregnant to prevent:

Flu
Hepatitis B
Tetanus