Partners in Obstetrics & Women’s Health

Obstetrical Services

Having a baby is one of life’s most exciting experiences. Pregnancy can also be very stressful for you and your family. The information on our women’s health web site is designed to give you some guidelines you will need to ensure a smooth pregnancy and delivery of your baby.

The birth of each baby has a long lasting impact on the physical and mental health of mother, baby, and family. We are able to offer you information on the role of a birth assistant, a DOULA, which is a positive contribution to the care of women in labor. Your first prenatal visit may take up to two hours to complete. A full history and physical will be performed. Diagnostic laboratory studies you can expect to have done will include:

• Pap smear
• Blood type and Rh
• Complete blood count
• Antibody testing
• HIV testing
• Hepatitis B testing
• Syphilis screening
• Rubella screening
• Diabetic Screening if you are over the age of 25 or have a family history of diabetes…or if at your first visit, you are approaching your 26th week.
• Screening of genetic disorders such as Sickle Cell Anemia, Trisomy 21 and 18, Cystic Fibrosis, Tay Sachs or Canavan’s Disease is offered if appropriate.
• Vaginal or Pelvic Ultrasound may be completed at your first visit depending on a variety of factors, to confirm your due date.

Genetic Counseling will be offered at this time if you are over the age of 35, have had more than 2 subsequent miscarriages, a stillborn infant, or a child who died in infancy. Genetic counseling is also offered if you are concerned you may have an inherited disorder or birth defect, or you are concerning that your job, lifestyle, or medical history may pose a risk to your pregnancy ( for example…exposure to radiation, medications, chemicals, infection, or drugs.)

Genetic Counseling is also helpful if you desire additional information regarding genetic defects within your ethnic group. Couples that are first cousins or close relatives would also benefit from counseling. Genetic Counseling will be offered to you if your Maternal Serum Alpha Feto Protein screen (MSAFP) is abnormal so you can review your options related to this screening procedure. The choice for this service is truly your decision based on the recommendations form the medical staff.

Please be advised that while good prenatal care can significantly decrease harmful risks to you and your baby, there are no guarantees that a pregnancy will proceed without any complications.

Miscarriage occurs in approximately 20% of all pregnancies, due to no fault of the parents. Concerns related to pregnancy loss or miscarriage are normal. Mild bleeding or spotting, heaviness or fullness, cramping in the lower abdomen can be normal the first trimester. Tylenol, bedrest, and increased fluid intake can help alleviate these symptoms. However, severe menstrual cramps and heavy vaginal bleeding can indicate an imminent miscarriage and should be evaluated.

Follow up prenatal visits will be much shorter in duration. Your weight, blood pressure, urine, fundal height ( uterine size ), and infant heart tones will be checked at each visit. During the first 28 weeks, your visits will normally be every 4 weeks. From 29 to 36 weeks, you will visit every 2 weeks. In your final month, you will visit us every week. Certain conditions may require more frequent visits. A pelvic exam is performed at 37 weeks to ensure your baby is head first and check cervical dilation.

Last Trimester of Pregnancy

The following information is very important in your last 12 weeks of pregnancy. Your baby is enclosed in a bag of water called the amniotic sac. This fluid protects your infant while in the uterus. Sometimes the bag of water will break or rupture before you go into labor. If you experience a sudden gush of fluid or a slow leaking of fluid you will neeed to be examined. If it occurs after office hours, go directly to the Labor and Delivery Unit of the hospital. The hospital will contact us.

If you feel you are having contractions, begin to time them. This can be done by noting the time the contraction starts and ends. When the contraction begins, note them. Contractions are timed from start time to start time. If your contractions have established a regular pattern of 5-7 minutes for one or two hours time, you could be in labor. During working office hours, call us to let us know that you are coming in to be examined. If this occurs after office hours, go directly to the Labor and delivery Unit of the hospital.

Is This Normal?

Women experience many different feelings during pregnancy. As you have heard many times, no two pregnancies are alike, so avoid comparing yourself to others. During a normal pregnancy, you may experience unusual events that may concern you. The following list may help with some of these concerns.

Some normal things you may feel…

In early pregnancy

• Tender, fuller breasts
• Increased and frequent urination
• Heavy or bloated feeling
• Tiredness or fatigue
• Nausea or morning sickness

Mid pregnancy

• Increased vaginal discharge
• Brief, sharp pain on one side
• Backache
• Spotting after intercourse or exams
• Heartburn
• Shortness of breath
• Painless, random tightening of the abdomen

Late Pregnancy

• Stretching feeling in the pelvic area
• Feeling unsteady when walking
• Insomnia
• Leaking of milk from the breast
• Stretch marks on the breast, abdomen, and legs
• Increased frequency of urination
• Increased mucous discharge, spotting
• Hemorrhoids
• Swollen feet at the end of the day

Symptoms of Concern

The following is a list of symptoms that can be cause for concern. It is important if you have any of these symptoms to notify the doctor. You will know if there is a need to notify the doctor immediately or to wait and call during office hours.

If you feel you have “broken your water” or are in labor, you may go to the hospital without calling the doctor. During working hours you can come into the office for evaluation. The following symptoms often require immediate notification of the doctor, although your gut feeling about the situation is usually right.

• Vaginal bleeding, more than an occasional spotting or loss of mucous plug
• Leaking or gush of fluid from vagina
• Irritating vaginal discharge with or without odor, sores or itching
• Pain or burning upon urination
• Persistent nausea, vomiting or diarrhea
• Sudden, persistent abdominal pain
• Fever over 100.4
• Sudden puffiness of face, hands or feet
• Severe persistent headaches not relieved by rest or Tylenol
• Visual disturbances, blurred vision, spots before your eyes, blind spots or double vision
• A decrease or drastic change in the usual movement of your baby
• Constant abdominal pain or contractions, more than 2-3 times in an hour, especially if they do not lessen after change in activity or fluids (especially if more than 5 weeks before your due date).

If you have been involved in a fall, motor vehicle accident, or experience trauma to the abdomen, please go directly to the emergency room. There is no need to notify the doctor. The hospital will notify us of your admission.

Medication During Pregnancy

During the firsttrimester it is extremely important to avoid all medications, including suppositories and vaginal creams. During this time there is rapid development of the fetus and it is felt that certain medications could produce harmful effects, especially during this period.

If you are already on medication prescribed by another doctor, please let us know on your first visit. We will work with your primary care physician and/or specialist to ensure that the medication is appropriate, before taking it.

We would hope to have you avoid medications during pregnancy, but it is understood there are times when the benefits far outweigh the risks posed by the condition requiring medication. Please remember you are asked to avoid all medications in the first trimester unless prescribed for you. Please call during office hours if you have any questions regarding medications.

Disability Information

The great majority of expectant mothers can continue to work until late in their pregnancy without any problems. Sometimes however, the physical changes entailed in pregnancy or the demands of a women’s job can create workplace difficulties.

Please let us know if you have any concerns in this regard. We usually are able to suggest simple steps to deal with fatigue, “morning sickness”, or aches and pains that can be particularly challenging. If you have more serious symptoms or concerns about potential workplace hazards to you or your baby, we will evaluate the situation and respond accordingly.

When medically appropriate, we will recommend that a pregnant patient be placed on disability leave from her job. Such a leave is rarely required however, and in the absence of a serious condition that would endanger the health of the mother or baby, medical ethics prevent us from making such a recommendation. We will however, do everything we can to reduce or eliminate pregnancy related difficulties you may be having at work. This includes contacting your employer, when appropriate, to recommend helpful adjustments or alterations in your duties.

Please feel free to tell us of any work related concerns you may have. At the time of your medical leave, please allow us one week to fill out any disability papers your employer requires.

New Information

A report issued in January 2003 by the American College of Obstetricians and Gynecologists and co-authored by the American Academy of Pediatricians concluded that the majority of newborns brain injury cases do NOT occur during labor and delivery. Most instances of neurologic abnormalities occur prior to labor and birth. A task force formed in 1999 and comprised of experts from multiple specialties, issued a 94-page report confirming that most brain injury cases are not due to events that occur during labor, delivery, resuscitation, or treatment immediately following birth. For example, cerebral palsy and encephalopathy (a swelling of the brain) are due to events occurring before labor begins. The condition could originate from developmental or metabolic abnormalities, autoimmune or coagulation defects, infection, trauma, or a combination of these factors.

This report was endorsed not only by the National Institute of Child Health and Human Development of the National Institutes of Health, the Centers for Disease Control and Prevention—world renown government health institutions but also by distinguished non-government health organizations such as the March of Dimes Birth Defects Foundation, the Society for Maternal and Fetal Medicine, the Child Neurology Society, as well as international endorsements from the Australian and New Zealand Obstetricians and Gynecologists and the Society of Obstetricians and Gynecologists of Canada.

For more information on this study, please refer to the ACOG Web site.