Obstetrics
-
-
- Pre conception counseling
- Midwifery services
- Routine pregnancy care
- High risk pregnancy care
- Vaginal birth after cesarean (VBAC)
- Gentle cesarean section
- Ultrasound
- Postpartum care
-
Frequently Asked Questions
Nausea and vomiting are common during pregnancy, especially in the first trimester. You can try the following for treatment:
- Vitamin B6 25mg 3 times per day
- Unisom at bedtime
- Tums
- Acupressure wrist bands
If you cannot hold any liquids down or need additional relief from your symptoms call the office or talk to your provider about prescription medications that can help.
Travel in pregnancy is generally safe until about 35 weeks of pregnancy as long as you do not have any high-risk conditions. Check with your provider if you are not sure. It is also a good idea to check with the airline to see if they have their own regulations; you can usually find this information on their website or by calling the airline company. With any long-distance travel make sure to stay hydrated and make frequent stops to stretch your legs. Compression stockings can also be helpful to help with swelling and to prevent blood clots if you will be sitting for a long period of time.
If you have a low risk pregnancy you will have an early ultrasound around 8 weeks to assign your due date. We will see you again around 12 weeks for a complete physical exam (if needed) and lab work. After this, scheduled visits will be every 4 weeks until 28 weeks, then every 2 weeks until 36 weeks, then weekly until delivery. At each visit we will check your weight, blood pressure, urine, listen to the baby’s heartbeat and assess the baby’s growth. Some appointments will include specific events such as labs tests, glucose and GBS status.
Here is a sample schedule of what to expect during the pregnancy. Your provider may change your schedule based on you and your baby’s individual needs.
A routine OB visit consists of
- Weight check
- Blood pressure monitoring
- Urine sample
- Baby’s heartbeat check
- Measure fundal height (uterine size)
6 – 10 weeks
- Ultrasound to establish your due date
- Start taking prenatal vitamins daily
- Discuss genetic testing (optional)
12 weeks
- New OB visit
- Complete physical exam and update pap smear (if needed)
- Prenatal lab work
- Non-invasive prenatal testing, NIPT (optional)
16 weeks
- Routine OB visit
- Tetra screen (optional)
20 weeks
- Ultrasound for complete anatomy screen
24 weeks
- Labs for 1 hour glucose challenge test, CBC, antibody screen
28 weeks
- Labs for 1 hour glucose challenge test, CBC, antibody screen (if not done at 24 week visit)
- Rhogam injection if needed
- TDaP vaccine is recommended
- Hospital registration information given
30 weeks, 32 weeks, 34 weeks
- Routine OB visit
36 weeks
- Group B strep (GBS) culture
- Cervical exam
- Check baby’s position
37 weeks, 38 weeks, 39 weeks, 40 weeks
- Routine OB visit
- Cervical exam (if needed)
- Check baby’s position
- Discuss individualized delivery plan
Initial prenatal labs: This is usually done at your new OB visit around 12 weeks. Standard labs include: blood count (CBC), blood type, immunity to rubella and varicella, HIV, hepatitis B, syphilis, urine culture, chlamydia, gonorrhea. Additional labs may be ordered by your provider on an individualized basis.
Glucose test: This test is done between 24 – 28 weeks to screen for gestational diabetes. We ask that you not eat or drink anything (except water) for 2 hours before your appointment. You will be given a sweet drink and your blood will be drawn 1 hour later. If this initial screen is high you will be asked to do a second test that takes 3 hours to confirm whether you have gestational diabetes. If you were already diagnosed with pre-diabetes or diabetes, then you are not required to do this test. Usually a blood count (CBC) and antibody screen are also done with this test.
Group B Strep (GBS): This test is done around 35-36 weeks with a vaginal/anal swab. Group B Strep (GBS) is typically a harmless bacteria that many people carry without symptoms. However, for babies it can lead to a serious neonatal infection. But don’t worry, if you test positive we will recommend antibiotics when you are in labor to protect the baby against this bacteria.
Genetic screening tests were developed to detect women who may be at higher risk of having a baby with chromosomal abnormalities such as Trisomy 21 (Downs Syndrome), Trisomy 13, and Trisomy 18. These tests are only used to identify an increased risk of fetal genetic abnormalities or certain birth defects. They do not diagnose a specific condition. We offer NIPT (non-invasive prenatal testing), tetra, and AFP tests. If you are interested in any of these optional tests, please discuss this with your provider and check with your insurance plan to see if these tests are covered.
The Centers for Disease Control (CDC) recommends that women who are pregnant during the flu season receive the yearly flu shot.
https://www.cdc.gov/flu/highrisk/pregnant.htm
https://www.acog.org/patient-resources/faqs/pregnancy/the-flu-vaccine-and-pregnancy
The American College of Obstetrics and Gynecology (ACOG) recommends that pregnant patients receive the TDaP vaccine with each pregnancy during the 3rd trimester. Typically, this will be recommended by your provider at 28 – 30 weeks. This vaccine gives your baby protection against whooping cough, which can be dangerous for newborns, until they are able to get the vaccine with their pediatrician.
Prenatal vitamins are important during your pregnancy. We are more concerned that you actually take the vitamin than what name brand you choose to use. It is not necessary to take extra vitamins because certain ones can be harmful to both you and your baby. Ensure the vitamin you are taking has at least 400 mcg (micrograms) of folic acid daily. If you need an iron supplement, your provider will notify you.
Recommendations for total pregnancy weight gain are based on your pre-pregnancy BMI.
BMI less than 18.5 28-40 lbs
BMI 18.5-25 25-35 lbs
BMI 25-30 15-25 lbs
BMI greater than 30 11-20 lbs
You only need to increase your calorie intake by 300 calories per day during the 3rd trimester. Please do not “eat for two” as this will result in excessive weight gain.
Physical activity is good for you and your baby. If you are healthy and your pregnancy is normal, it is safe to continue or start regular physical activity. Pregnant women should get at least 150 minutes of moderate-intensity aerobic activity every week. You can divide the time into 30 minute workouts five days a week. Walking, swimming, stationary bicycling, and yoga are good options. Avoid exercise that puts you at risk of falling or getting hit in the abdomen (contact sports, skiing, snowboarding, horseback riding, etc).
There are no restrictions on sexual activity unless directed by your provider. Having sex during pregnancy won’t provoke a miscarriage and most sexual positions are safe as long as you are comfortable. Your provider may recommend avoiding sex if you have unexplained vaginal bleeding, leaking of amniotic fluid, your cervix begins to open prematurely, your placenta partly or completely covers your cervical opening, or you have a history of preterm labor.
Routine dental work is safe during pregnancy and we encourage you to keep up with your normal dental health routine. Some dentists will require a note from us saying that the visit is safe. We can give you a standardized letter to take to your visit.
We recommend starting to count fetal movements beginning at 28 weeks. This is done once a day and you should get 10 movements within 2 hours. If you are concerned about fetal movement, eat or drink something with sugar or caffeine, lie on your side, and place your hands on your belly. You should feel movement. If you notice a decrease in movements, please contact the clinic.
If you would like to make a birth plan, we are happy to review this with you in your third trimester. Please remember an important part of creating a birth plan is understanding it may change. Our goal is a safe delivery for you and your baby with as little intervention as possible. We will do our best to adhere to your plan within the boundaries of safety. The labor process is very dynamic, unpredictable, and unplanned events can happen. Birth Plan
Each provider makes an effort to deliver their own patients. However, you may be delivered by any of the providers in our group. We share a call schedule for nights and weekends. All of our providers share similar styles and philosophies; you will receive the same excellent care if your provider is not available. If you would like to be sure that your own provider delivers you, they may offer an induction of labor on a day when they are available.
We feel skin-to-skin contact and delayed cord clamping are an important part of the birth and bonding process. As long as your baby transitions without difficulty, this is a normal standard of care.
After an uncomplicated vaginal delivery you can stay 24-48 hours. After an uncomplicated C-section you may be ready to leave as soon as 48 hours, but you may stay as long as 96 hours. We see most of our patients 2 weeks after a C-section and 6 weeks after a vaginal delivery.
Obstetric ultrasound has been extensively studied and found to be safe for the baby. Current recommendations are to limit the use of ultrasound to those that are medically indicated.
Contractions: If you are less than 37 weeks and you are having contractions every 10 minutes for more than 1-2 hours. If you are full term (37 weeks or greater) and having consistent, regular, painful contractions every 5 minutes for at least 1-2 hours.
Vaginal bleeding: A small amount of vaginal bleeding can be normal after intercourse or after a cervical examination. It is better to call our office with any amount of vaginal bleeding to be safe.
Leakage of fluid: A large gush of watery fluid or consistent small trickling of fluid from the vagina could be a sign that your water has broken. This requires evaluation at the hospital.
Decreased fetal movement: We recommend starting to count fetal movements beginning at 28 weeks. This is done once a day and you should get 10 movements within 2 hours. If you are concerned about fetal movement, eat or drink something with sugar or caffeine, lie on your side, and place your hands on your belly. You should feel movement. If you notice a decrease in movements, please contact the clinic.