Emetrol
*These medicines have been shown to
be safe, and are approved for pregnancy by the FDA. If you take
these for more than 2-3 days please notify your Doctor.
If you take routine medicine routinely, please notify your Doctor.
Your Doctor will review it on an individual basis.
Vitamins are prescribed to supplement a balanced diet. Iron supplements
are prescribed to be taken twice a day. You may usually use any over the
counter Iron that is 50-65 meq. of Iron. Slow Fe has a stool softener
in it. Surfac, Colace, or Metamucil will help mild constipation.
Notify your Doctor if constipation persists for more than 2 days. Additional
fluids and exercise will also help. If your prenatal vitamin makes
you nauseated, stop taking them until you are finished with your
first trimester. The nausea typically goes away at that time.
Go to top of page
Nausea and Vomiting in Pregnancy
Mild symptoms do not have a negative
effect on the fetus.
Diet:
- small frequent meals
- complex carbohydrates before rising such as crackers, toast,
or cereal
- have high protein snacks such as yogurt or nuts
- take fluids between meals rather than with meals
- sip carbonated beverages such as ginger ale or sprite in small
amounts
- sip clear liquids such as: clear soups or broth, diluted Gatorade,
jello water, ginger or any
- herbal tea with sugar, and popsicles.
Helpful medications:
- Vitamin B6 50mg - one by mouth three or four times a day.
- Emetrol 15 ml - on arising, can repeat every three hours.
Avoid:
Coffee, alcohol, iron and vitamins, fried foods, high fat foods,
spicy foods, dairy products.
Additional rest periods during the day are encouraged.
*Call your Doctor's office if you are unable
to retain small amounts of liquids for 12 hours.
Eat moderately! An additional apple a day - only. For a healthy
pregnancy it is recommended that you gain no more than 35 pounds
total. 3-4 pounds the first 12 weeks and 3-4 pounds the second 12
weeks, and 1/2 pound per week the last 12 weeks. pregnancy. You
are encouraged to take the Calcium every day. Tums or Calcium supplements
have been shown to lower and prevent BP problems in 5 to 10 regular
Tums or 4 Tums 500.
Please tell your Doctor if you have a house cat with a litter box.
If you do it is recommended that you not change the litter box while
you are pregnant. Do not dig in the garden during your pregnancy.
When pregnant :
- Do not douche
- Do not drink alcohol
- Do not smoke
- Do not use drugs
Go to top of page
Bodily Changes
What are the normal body changes that I feel
while pregnant
Your breasts will get larger and firmer. The areolae or dark areas
around your nipples will get darker and may develop bumps in them.
Veins in the breast may become more noticeable. At the 4th or 5th
month your nipples may start giving off a clear or cloudy liquid.
You may have to urinate (empty your bladder or pass water) more
often. However, this may lessen during the middle months of pregnancy
and then become more frequent toward the end of pregnancy.
You may feel sick to your stomach during the first half of your
pregnancy. Sometimes this is worse in the morning. Also, you may
feel heartburn (a burning sensation in your chest). These discomforts
can be helped by eating smaller meals and eating more often. For
example, rather than eating three regular meals a day, try six small
meals each day. Also try to snack on plain crackers (without butter)
especially early in the morning before getting out of bed. Try getting
more rest and drinking very hot or very cold liquids. For heartburn,
try not to lie down for at least one hour after eating.
Your moods may change. It is not unusual for a pregnant woman to
feel happy one minute then sad soon after without an apparent reason.
You may get tired more easily.
You may notice pulling pains in your lower belly and hip areas.
These are usually caused by the growth of your uterus.
Your belly will get larger as your baby grows inside.
You may notice skin changes such as stretch marks or striae (pinkish
lines on your breasts or belly) later in the pregnancy and some
brown blotches on your face. Creams, lotions or oils do not prevent
these changes. However, after pregnancy the marks tend to fade and
are less noticeable.
We recommend TriReduction Basic Cream and Emu Oil for Stretch Marks
You may get constipated and have to strain to have a bowel movement.
Hemorrhoids (large blood vessels near the opening in your rectum)
may develop. Constipation is best prevented or relieved by including
more fiber in your diet. Foods such as fresh fruits, fresh vegetables
and bran cereal are often helpful. Do not take laxatives unless
this is first discussed with your physician. Surface is stool softener
that is fine to take during pregnancy.
You may experience changes in your legs such as cramps and possibly
develop enlarged blood vessels (varicose veins).
You may get acne and body hair increase. These are usually normal
results of changes in the body's hormones during pregnancy.
For acne, we recommend Pineapple Enzyme Scrub.
What should I do if any of these changes
happen?
If they are bothering or worrying you, don't hesitate to let your Doctor
know at your next visit. If you need it taken care of sooner, call
your Doctor.
Go to top of page
Relationships with fathers
Recently, there has been an increased interest on the part of
fathers in the birth experience. There has also been a change in
our society's attitude and now men are encouraged in their efforts
to experience the pregnancy and childbirth.
The pregnant woman experiences the physical changes taking place
and is constantly reminded of impending parenthood. Often the man
feels like an outsider and has difficulty relating to his changing
role.
The father needs to understand what is happening to the mother
of his child, what effect this pregnancy will have on his relationship
with her, and what the new baby will mean to both of them.
Many men begin to worry about finances. There are the costs for
the prenatal care and delivery at the hospital. He wonders if his
salary is sufficient or will they also need hers.
Sexual concerns often surface. The father may fear that sexual
intercourse will somehow harm the developing child. Conflicting
feelings regarding the pregnancy, physical difficulties, and a constant
concern over how all this will effect their relationship contributes
to much frustration. With others, there is a "fear of abandonment",
that the child's birth will change his relationship with the mother
and that perhaps she will no longer love him.
It is very important that both parents openly discuss their feelings.
They must come face to face with what is happening and how it is
affecting them so they may make changes accordingly.
Men who are well informed and attend childbirth classes to help
with the birth of their child, often express their pride in their
being there to "give birth". They often have tremendous
feelings of importance. These men seem to be able to more readily
accept the role of fathering and quickly become actively involved
in all aspects of their child's care.
When the father views pregnancy as a "growing" experience,
he has the opportunity to gain a deep understanding of himself and
the mother of his child. This can help make this period in their
lives quite satisfying which may help smoothly pave the road into
parenthood.
Go to top of page
A new baby and other children
The arrival of a new baby is often the first real "crisis"
in the life of a young child. There is no "right" time to tell the
other children about another child coming. It all depends upon their
ages, how long they may need to adjust to the news, and how comfortable
you are discussing it with them at that time. It is important to
tell them before you go to the hospital and before the baby is born.
Each child will react in his own way depending upon how he views
this "new addition" to the family. Children may feel threatened
and react with behavior unlearned. They return to soiling their
clothes, acting helpless, speaking baby talk, or acting hostile.
It is best to help them view the situation positively. Encourage
them to talk about some of the changes that may occur in the household
with the arrival of the new baby. Encourage conversation from your
children about their feelings. Allowing your children to help prepare
for the new baby is often helpful. Perhaps taking them along on
a shopping trip for baby items will help with their understanding
and good feelings about the situation. Allow them to help around
the house in new and different ways. They will usually appreciate
the independence and enjoy their new feeling of importance.
After the baby comes, be sure to set aside time especially for
your older children, so they won't feel neglected. Young children
need constant reassurance that they are loved.
Several hospitals now allow young children to visit the new baby
soon after birth. The existence of "sibling visitation" programs
may be a consideration in deciding which medical facility you might
like to utilize when your baby is born. Many parents feel that involving
the other children early with a new baby promotes family closeness
and helps to avoid other possible problems with insecurity, jealousy
and rivalry.
You may want to think about "what is right" for your family and
what is available in your community for providing you with the type
of birth experience you desire. Please feel free to discuss with
your Doctor any questions or concerns you may have regarding the
adjustments of your other children to your new baby.
Go to top of page
Warning signs & hazards in early pregnancy
For what problems should I call your Doctor right away, even at
night or weekends?
- Bleeding from the vagina.
- Bad pains that do not quickly go away.
- Chills and fever.
- Vomiting that doesn't get better and if you are unable to hold
down fluids.
- Burning or any trouble passing urine.
Go to top of page
What are the dangers of cigarettes, alcohol,
caffeine and drugs?
These things can damage your unborn baby. If you already smoke
cigarettes or drink any alcohol, you will be given more information.
It is best not to smoke or drink alcoholic beverages while you are
pregnant.
Some new information suggests caffeine in coffee, tea, many cola's
and other soft drinks may be a cause of miscarriage (loss of babies
early in pregnancy) or harm the growth of the baby. It is best to
try to avoid or limit caffeine-containing drinks while you are pregnant.
Discuss the amount with your Doctor.
It is wise to check with your Doctor about the safety of any medication
before taking it. But, if you are taking a medication necessary
to your health, do not stop the medication without discussing it
with your Doctor. As for drug store medicines you can buy without
a prescription, please discuss these with us before taking them.
Go to top of page
Is it true that cats may carry a disease
that could affect my baby while I am pregnant?
Cats may carry a disease that is called Toxoplasmosis. This problem
is rare but important, as it is rather easy to prevent. Even though
it is rare, it has been known to cause very serious problems in
newborn babies including mental retardation, growth failure, blindness
and deafness.
To prevent it, avoid changing or cleaning the cats litter box
as the disease is usually spread to humans by cat droppings. Ask
someone else to do this for you.
Raw or poorly cooked meat (especially beef) is another cause of
this disease. Cook all meat until it is well done and avoid eating
raw beef in any form, including raw hamburger meat while you are
pregnant. It is also important to wash your hands after handling
raw meat.
Other ways of preventing this problem are to wash fruits and vegetables
before eating them and wearing gloves while gardening. Let your
doctor know if you have eaten raw meat or handled cat droppings
(litter box). Your Doctor will decide whether or not this is important.
Go to top of page
Seat belt in pregnancy
Should I use seat belts during pregnancy?
Yes! Your Doctor strongly recommends you use them for your baby's
safety, as well as your own.
Why are seat belts so strongly recommended
during pregnancy? I have heard that they can be dangerous?
Studies of pregnant women in car accidents have shown that you
and your baby are much less likely to have injuries if you are wearing
a seat belt.
What kind of seat belts are recommended?
The best is the combination of a lap plus a shoulder belt. If
no shoulder belt is available, a lap belt, worn correctly, is better
than no belt at all.
What is the correct way to wear a seat
belt while I am pregnant?
The lap belt should be worn low around the hip bones and be kept
as tight as is comfortable. The shoulder belt should be kept above
the high point of the abdomen (belly), but low enough to avoid having
it cross over your neck. Be sure to use the head rest to support
your neck. It is important to keep good posture while traveling.
If I am in an accident, what should I do?
In anything more than a simple fender-bender, you should get checked
by your Doctor as soon as possible. This is true even if you are
not hurting as your baby could be affected. Your Doctor may decide
to do some simple tests to be sure your baby is doing well. If any
vaginal bleeding or contractions occur, call your Doctor immediately.
Are you saying I should buckle up whenever
I get into a car?
Yes. Most accidents happen close to home so please don't save
your best safety measures for long trips. Buckle yourself and your
baby up every time you travel, even on the way home from the hospital.
By not using your seat belt, you are taking the risk of hurting
yourself or your baby. By buckling up you are doing the very best
you can to avoid injury.
Go to top of page
Exercise in pregnancy
Why is my doctor concerned about the kind
of exercise I do during my pregnancy?
Exercise makes you feel good and look good. Your physician wants
to be sure you set up a safe exercise program. It is important that
you know of any risks that could affect both you and your growing
baby. If you provide your Doctor with accurate information about
the kind of exercise, frequency, and intensity you are used to or
would like, a satisfactory exercise program can be set up to carry
you through pregnancy.
What actually happens to my body during
pregnancy that changes the way exercise affects both the baby and
me?
Your ligaments become easier to stretch. That is why you may feel
a little wobbly just walking. It is easier to sprain something,
like an ankle, or to pull a muscle. As your baby grows, your weight
distribution is different, your center of gravity changes which
may make it easier for you to lose your balance. Your ability to
catch your breath (get enough oxygen), is decreased during exercise.
Because of these changes in your breathing and circulation systems
you may occasionally experience dizziness or weakness. Now, when
you exercise, you will notice you don't have the aerobic capacity
you did before. With some adjustments you can continue to enjoy
exercising and return slowly, to your desired program after your
baby is born and your body is ready.
Are there times when I should not
exercise all?
Yes! Your Doctor may tell you to avoid exercise if you :
1. Have problems with early labor
2. Are excessively overweight or underweight.
3. Have blood pressure, heart, lung, or thyroid problems.
4. Have experienced vaginal bleeding during the pregnancy.
5. Are having problems with your baby's growth.
6. Are severely anemic.
7. Have leaking from your bag of water.
8. Have experienced #1, 3, 5, or 7 on the above list during a different
pregnancy.
How about some guidelines for safe exercising
that I can use during my pregnancy?
1. Drink enough before exercising, even in the winter.
2. Warm up slowly, at least 5 minutes before starting.
3. Stretch, but not to your limit so as not to injure your ligaments.
Remember, they are looser now.
4. Avoid exercises with jerky or bouncing motions.
5. Use a stable floor. Avoid loose rugs that may slide.
6. Exercise regularly (every other day), not just once in a while.
7. No competitive exercises.
8. Do not exercise during hot humid weather or if you have a fever.
9. Your body temperature should not go above 38 degree C. (101 degrees
F.). Avoid the use of hot tubs and saunas.
10. After the 4th month, do not exercise lying down on your back.
11. No weight lifting or anything where you hold your breath and
strain.
12. During pregnancy caloric intake is to be over and above your
usual need. Adjust it to your level of activity.
13. Avoid strenuous exercise at altitude.
How about things other pregnant women have
found helpful?
Choose exercise shoes that feel secure and help your balance.
Support hose can help your legs feel better during and after exercise.
Watch how you put your feet down, especially if you are planning
to walk and there is ice outside. If you need to increase your bra
size you might go right into a nursing bra if you plan to nurse,
or you may need an athletic bra for more support during your workouts.
Put your feet up with pride, this allows any swelling of your ankles
to go down. Your body is working hard helping your baby grow, 24
hours a day!
I've always wanted to take up a new sport,
like tennis, I don't even look pregnant yet, is this a good idea?
It is NOT a good idea to take up a new sport while pregnant. But
you can begin something that is on the "good for pregnancy" list,
that will give you a head start in beginning tennis after your baby
is born. Some good sports are, Yoga (without breath holding), swimming,
pregnancy classes, stationary bicycling (gently), easy stretching
(but not to your limit), and don't forget about daily walking in
fresh air!
Truthfully, I am worried about gaining
weight during this pregnancy, I like to exercise,can overdoing it
cause any problems?
There are several things to remember. Being pregnant is not being
fat. Exercise does release a chemical into the body called "endorphins"
which gives you that feeling of well being. Even with adjustments,
your body will have that feeling of "well being". Lastly, gaining
20 to 30 lbs. is healthy. Your baby's size and health depends on
this increased nutrition (but we don't mean candy, cola, and chips).
You must normally INCREASE calories during exercise for your pregnancy
and INCREASE calories and fluid over and above that for exercise.
If you do not have enough calories, your body can go into a chemical
state called ketosis which can cause developmental problems for
your baby. If you don't get enough calories regularly during pregnancy
your baby may not grow as well.
If I stopped exercising regularly a few
months ago, and want to start back up, what should I do?
Begin very slowly with low intensity. Remember, even if you are
in great shape, you will not be able to do what you did. Pregnancy
is a special time and requires not lower goals, but special ones
to help you and your growing child feel happy and stay well.
What are the rewards of a sensible program?
Your baby will be growing safely. You will feel and look good.
After the birth of the baby it will make it easier to return to
the exercise program of your choice.
When should I stop exercising immediately
and call my doctor?
If any of the following happen to you, stop what you are doing
and call your Doctor immediately:
1. Regular contractions.
2. Vaginal bleeding or leaking of fluid.
3. Blacking out of fainting.
4. Shortness of breath.
5. Pain.
6. Unusually fast heart beating that doesn't seem to pass.
7. Anything else that concerns you.
Is it safe for me to use a sauna, spa,
or hot tub?
During the first 12 weeks of pregnancy, the high heat to the body
from these activities may have as harmful effect on your baby. There
is a very small possibility that the brain and spine areas of your
baby may not form the right way.
Avoid these activities until after the first 12 weeks of pregnancy.
If you have already been in a hot area such as a sauna or hot tub
during these first 12 weeks of pregnancy, let your Doctor and staff
know now. You will be offered a blood test for alpha-fetoprotein
around the fourth month of pregnancy that can help find out if your
baby might have the type of problem mentioned above. More information
on this test will be given to you.
Go to top of page
Weight and diet
How much weight should I gain during pregnancy?
The best amount to gain depends on how much you weighed right
before you became pregnant. The doctor or staff will let you know
if this weight is considered overweight, normal or underweight.
If you are overweight the best amount to gain is 15 or so pounds.
If you are normal the best amount to gain is between 25 and 40 pounds.
If you were underweight the best amount to gain is between 28 and
40 pounds.
Important: do not try to lose weight while you're pregnant.
what problems can be caused by not gaining enough weight?
There is a slightly higher chance of your baby being smaller than
normal. This might lead to being delivered early. Small babies,
whether born premature or at the due date, can still have serious
problems after birth. To help lower the chances of having a small
baby, try to gain the amount of weight recommended by your Doctor
or nurse.
What problems can be caused by gaining
too much weight?
The extra pounds will put more strain on your back and legs. Also
being overweight can lead to serious medical problems for you such
as high blood pressure and diabetes. The extra weight may stay with
you after you deliver your baby. Breast feeding may help you lose
the extra pounds, but this is not true for everyone. Even if you
are overweight, do not try to lose weight while you are pregnant.
What is a good diet to follow during my
pregnancy?
Your body needs a good balance of foods to keep you healthy and
build a healthy baby. Try to eat regularly and not skip meals.
Important parts of your daily diet should include :
- Protein at each meal from meat, chicken, fish, eggs, beans,
milk, or cheese.
- Calcium, Vitamins A and D from a few glasses of milk each day
(low fat is best).
- B Vitamins from whole wheat cereals, breads or noodles.
- Vitamin C from the fruit or juice of oranges or grapefruits.
Other healthy additions to your diet are fresh fruits and vegetables.
Butter, margarine or vegetable oils should only be used in moderation
(these are empty calories). It is best to avoid "junk food" (candy,
sodas, desserts) as they are very high in calories and filling but
have few nutrients or vitamins.
To keep from becoming constipated, it might be helpful to have
high fiber foods like bran, bran cereals, breads, as well as fresh
fruits and vegetables including salads.
What about taking vitamins and iron
pills?
If you eat a balanced diet, the only extra things you may need
are some iron and multi-vitamins with folic acid. Later in your
pregnancy we may suggest you take an iron pill up to 3 times each
day. Taking additional vitamins and supplements available over the
counter may be harmful to your developing baby. Please check with
us before taking other vitamins or medications.
How far along is my baby?
By the end of the third month your baby has formed all of it's vital
organs such as the heart, lungs, and kidneys. Also formed are the
arms, legs, and the head. The baby weighs about one ounce and is
three inches long.
In addition the placenta has formed. This is attached to the inside
wall of the uterus (womb) on one side and to the umbilical cord
on the other. The umbilical cord then goes on to attach to what
will be the baby's belly button. Food or nutrition from your blood
stream travels through the placenta into the blood stream in the
umbilical cord and feeds your baby.
Go to top of page
The Second Trimester
(13-28 Weeks)
You will begin to feel more like yourself now. The morning sickness
should have passed and you will begin to feel good.
Your prenatal blood work will be drawn around the 16th week. Please
ask a nurse when you will be 16 weeks, if you do not know. These
laboratory tests must be performed at this time. A Trisomy profile
will be included in this laboratory work and will identify if you
are at increased risk for certain conditions. This is only a screening
test and is not diagnostic if it comes back abnormal additional
tests will be ordered.
Patients may be asked to have a Level 2 Ultrasound. This is a more sophisticated Ultrasound, which
shows more details of the baby. Your bladder should be comfortably
full for the Ultrasound. If you bring a VCR tape you may be able
to have the procedure taped for you. If you will be 33 years old
or older at your expected time of delivery you may be referred
for an amniocentesis.
This is the time to choose your baby's pediatrician. If you already
have a family doctor or pediatrician that you wish to use then let
us know this physician's name so he or she can be notified when
your baby is born.
You can then ask any questions about that doctor's management of
breast feeding, bottle feeding, well child care, insurance, office
hours, etc. This will give you a chance to see if you feel comfortable
with the medical management that this doctor offers.
Fetal kick counts
At 28 weeks you have become accustomed to your baby movements. Be
aware of fetal movement through the day. Sick babies do not move.
Count and keep track of your baby's movements. You will begin to
see a pattern.
You will need to count the baby's movement on the daily basis after
28 weeks. If the baby does not kick 10 times before 12 noon please
call your Doctor immediately.
A full day should never go by without feeling the baby move!
Go to top of page
General health care
If I have a job, when should I stop working?
Generally, you can work right up until the end of your pregnancy
if you feel up to it. The only types of jobs that might be a problem
are those where you work around certain chemicals or x-rays. If
you have any questions ask your Doctor.
What about exercise?
Avoid sports where you might get hit in the belly. Otherwise you
can continue the same activities as before pregnancy. Try not to
push yourself to the point of becoming overtired. You may find that
you have less strength and energy than before you became pregnant,
but exercise is still good for you.
Skiing is generally not a problem unless your pregnancy is considered
High Risk, and then the general recommendation would be to avoid
skiing.
What about high altitude stays - above
8-9,000 ft?
In non High Risk Pregnancies short stays (several days) at high
altitude are generally not felt to be a significant problem.
In High Risk Pregnancies high altitude exposes the mother and developing
fetus to less oxygen and should be avoided whenever possible.
Your physician will be happy to discuss your special problem with
you.
Go to top of page
Can I continue regular sexual relations?
Yes, as long as it is not causing you to have pain or bleeding.
For certain problems, you may be told to avoid sex. Some women find
that sex is more comfortable during pregnancy if they are on top
or lying side to side. Feel free to ask your Doctor any questions about sexual
relations during any of your prenatal visits.
Can I travel during pregnancy?
Yes. There are generally no problems with riding in a plane or
taking auto trips. In case you will be away for more than a week
or way from home near your due date, it is a good idea to get the
name of a doctor or hospital in the area where you will be.
Go to top of page
What about dental care?
Keep getting your regular dental check ups. Take good care of
your teeth. Let your dentist know that you are pregnant before any
x-rays are taken or any medicines are given to you.
How should I take care of colds or small
aches and pains?
You can take acetaminophen (Tylenol or Daatril) for mild aches
and pains. This is safer than aspirin. Don't take any other medicines
without checking with us first. Please take your temperature and
notify our office of any fever 1004 or greater.
Go to top of page
What about clothing?
Wear comfortable clothes that are not tight on your belly.
Flat heeled or broad heeled shoes are recommended.
Use a bra that gives good support to your breasts.
How far along is my baby?
Your baby, by the 4th month, weighs about four ounces and is close
to seven inches long. The head is the longest part of the body which
now has completely formed eyes, ears, nose, and mouth.
Sometime over the next month you should begin to feel the baby
moving. At first this may feel like a faint, gentle fluttering in
your belly. This movement is called "quickening".
By the fifth month of pregnancy your baby is 12 inches long and
weighs about one pound. Hair may be starting to grow on the head.
Even though many important inside parts of the baby such as the
heart and kidneys are well developed, the baby cannot survive outside
the mother at this time.
Go to top of page
Trisomy or alpha-fetoprotein test (AFP)
Why should I consider having this test
done?
This test is used to identify babies with a spine defect. Spine
defects occur when the baby is growing inside the womb and doesn't
form a complete covering around the major parts of the nervous system
(Brain and Spinal Cord). The defect is usually called spina bifida.
It may lead to various physical problems ranging from needing braces
to walk, to severe handicaps including the inability to walk, as
well as mental problems and even death. The AFP test is used to
screen for this.
AFP testing is routinely offered to all women who are pregnant.
The decision to have the test done is the patients. In this country,
the overall chance of having a child born with this defect is about
one in one thousand (1:1000). However, if you, the baby's father,
or any relatives have had a child with spina bifida, the chance
goes up to 10 to 20 out of 1000 babies. If you or the baby's father
actually have spina bifida, then the chances go up to 50 out of
1000. You should notify your physician if anyone in your family,
including yourself, the baby's father, or other children have had
spine defects. Remember, if you have had a child with anencephaly
(where the brain and scalp do not develop normally), this is considered
a type of spinal defect and should be reported to your physician.
Even though there is an increased risk of having a child with a
spine defect because of a family history, most of the children with
spine defects are born to couples without a family history of this.
how is the test done?
The test involves a simple blood test, with blood taken from an
arm vein at 16-18 weeks of pregnancy. If there is a history (either
in the family, a previous pregnancy, or the parents) of a spine
defect, genetic amniocentesis is a more appropriate test than the
blood test. More testing is needed when high levels of AFP are found
in the blood or amniotic fluid. Low levels of AFP can also be a
sign that the baby has a problem and should be tested further.
Why is the test done so early in pregnancy?
The test is most accurate early in pregnancy. Early testing also
lets us give you counseling about the choices open to you if a problem
is found. These may include planning which hospital and medical
staff will be needed for the pregnancy and delivery, or giving you
appropriate counseling and offering termination (an abortion) of
the pregnancy, but it cannot predict if your child will have a spine
defect once you are past 22 weeks. This is why the test is not done
after 22 weeks.
Does an abnormal test always mean that
the baby has a spine defect?
No, there are other conditions that can cause an abnormal test.
There are some normal conditions which cause an abnormal test including
twins, not being as far pregnant as you thought you were, or nothing
actually wrong with the baby. There are other things which can cause
an abnormal test (high or low). These include some birth defects
that have a high value, of Down syndrome (which was called a Mongoloid
child in the past) which can have a low value. In any case, an abnormal
test will require further testing to see if your baby has a spine
defect or any of these problems. If you need to have these extra
tests done, you will have a lot of worry and extra expense. This
is the main reason why the decision to have this test done is left
up to the patient instead of just doing it on everyone. After you
have read this material, you should discuss any questions with your
doctor or medical staff.
What will be done if the test is abnormal?
Your Doctor will explain the possible meanings of the abnormal
test and order some further tests which may include a repeat AFP,
ultrasonography and/or an amniocentesis to help discover the cause
of the abnormal alpha-fetoprotein test. The decision of having these
other tests done will be left up to you. Your physician will do
the further testing or refer you to a specialist.
Does the test always detect babies with
these abnormalities?
No test is absolutely foolproof. Rarely, this test can be normal
even though you may be carrying a baby with a spine defect. Fortunately,
this test is very good. Just by itself, it will detect 80% of all
spine defects. With the test and a complete ultrasound, it can detect
90-95% of all spine defects. But remember, a normal result on this
test does not guarantee a normal baby or a baby free of this or
other birth defects.
When will the results of the test be ready?
Usually the results of the test are back by 1 week.
Go to top of page
Breast or bottle feeding
Even though your delivery is months away, this is a good time
to think about how you're going to feed your baby during the early
months. Will you use breast milk or formula?
What are the advantages of breast feeding?
Breast feeding or nursing is unquestionably an excellent way to
feed your baby. It can give you much pleasure to have your child
in close contact with you during feedings, and of course, this contact
gives much pleasure to your little one.
Breast milk is the most easily digestible food that a baby can
consume. In other words, it is very agreeable and is unlikely to
cause spitting-up or any stomach problems.
No special preparation is needed such as measuring and sterilizing
and it's definitely cheaper than formulas.
If asthma or allergies run in the family, it seems that breast feeding
can cut down the chances of these happening in the baby.
Breast milk contains antibodies that protect young babies against
infections. They are made in your body and passed to your child
in the breast milk.
Breast feeding helps your body get back to it's normal size and
shape. The baby's sucking stimulates the muscles of your uterus
(which got stretched out during pregnancy) to return to normal.
Breast feeding can help prevent overfeeding. Breast fed infants
usually get just what they need during each feeding. There is sometimes
a problem of bottle fed babies getting too many calories and gaining
too much weight. Overweight babies often grow up to have weight
problems.
What are the problems with breast feeding?
Almost any mother can breast feed her baby. Women with certain
diseases or those taking certain medicines, may be told that they
should not nurse. Your Doctor will discuss this with you.
One of the greatest problems of breast feeding is a mother's fear
that she can't do it. This is common, but with a little help and
instruction these fears can be removed. If you think you want to
breast feed, your Doctor will help you and give you
information on how to prepare for it and how to handle problems
that can come up during nursing.
Some mothers think their breast size is too small. The part of
the breast that makes milk has little to do with the breast size.
Women with any size breasts or nipples should be able to nurse their
children.
Some mothers fear that breast feeding limits their freedom. Many
women have gone back to full time jobs after having a baby and continued
to nurse when at home. There are ways to save breast milk so it
can be put into a bottle for use when the mother is not home.
La Leche League is available 24 hours a day for support and questions. You can find their phone number in your local directory.
What about bottle feeding?
Some women may choose not to nurse their baby and, instead, desire
to give them formula. Formula is safe and healthy.
It is easy to buy. Most supermarkets and drugstores sell it.
Formulas are easy to prepare. In fact some are already premixed
so no preparation is needed.
If you choose to bottle feed, it is important to remember a few
things:
1. Keep bottles and nipples clean so germs don't get into the
baby's milk.
2. Try to hold the baby close to you while giving the formula. This
can help you and the baby build a closer relationship. Propping
a bottle on a blanket, so the baby lies alone and drinks, is not
a good habit and can be dangerous. Babies need and like close contact.
3. Always use formula for the entire first year of your baby's life.
Using regular or low fat homogenized milk before your baby is a
year old is not recommended and can lead to anemia or a low blood
count in the baby.
4. Later during your pregnancy, more information will be given to
you regarding the feeding of your baby.
Go to top of page
Involving your family in the pregnancy
How might the baby's father be affected
by my being pregnant?
Often when a woman becomes pregnant, she begins experiencing different
moods and concentrates on these feelings and on how her body is
changing. These changes can make the father feel neglected. He most
likely wants to be an important part of your life. He is probably
having many concerns about the new baby. All these things can put
some strain on your relationship. It is often helpful to talk about
the feelings both of you are having about the new baby. Several
other helpful things you can do are :
Bring him with you for some of your prenatal visits. Let him feel
the baby as it kicks and moves. Have him take childbirth classes
with you.
If you have more questions, ask one of the staff here.
Sometimes the father does not seem interested in the upcoming
baby or even worse, may seem angry. If this is a problem for you,
please let your Doctor know so that he or she can help you better deal with it.
How might my other children react to my
pregnancy?
Children, except for very young infants, usually notice that their
mom and dad are going through something new. It is important to
tell them that a new baby will be coming and explain how they can
help take care of the new child. Let little ones practice diaper
changing on a doll and let the older ones know how they'll be able
to help take care of their new brother or sister. Let them feel
the baby moving and kicking. Hospitals offer classes and tours of
your Doctorry for siblings.
They may get jealous because they think your new baby will be more
important than they are. It doesn't hurt to remind them how much
you love them and that they are just as important as the new baby.
Preparing for the hospital
If you have not yet discussed at which hospital you will deliver
your baby, you should do this today. The phone numbers are located
in the front of this book.
It is a good idea to make a practice trip to the hospital at some
time before actually going into labor. This way you can make sure
you know the correct roads and how long the drive takes. Many hospitals
will give you a tour of their labor and delivery area and tell you
where in the hospital you should go, when you arrive for your child's
birth. Even if they don't give a tour, check with them about all
their general policies for labor, delivery, and postpartum care.
If you have other children, you might want to make arrangements
ahead of time for someone to watch them when you go to the hospital
for the delivery.
Go to top of page
What will I need to bring with me to the
hospital?
Sometime during the month before your due date you might want to
pack a suitcase of things, to take with you to the hospital.
Some of the things you might want to bring are:
- bathrobe, slippers
- cosmetics
- 2 or 3 nightgowns
- nursing bras (if you plan to breast feed or otherwise just 2
good support bras)
- toothbrush, toothpaste
- hairbrush
- loose fitting outfit to wear home
About all you'll need for the baby is a baby blanket, a sleeper
or nightshirt and two diapers. If you are expecting cold weather,
then make sure these items are heavy enough to keep the baby warm
on the way home.
Go to top of page
Prepared childbirth
What is prepared childbirth?
A satisfying childbirth experience requires a lot of work from
both your mind and your body. The best way to make each birth experience
the best possible is to be prepared. You can become prepared by
learning what to expect during labor and delivery, including the
medications and anesthesia used. Also, it is important to know about
caring for the new baby. By knowing what to expect and how to respond,
the prepared woman can overcome fear and frustration. The woman
and her partner, usually the baby's father, can then take an active
part in the birth process. Fear is thought to be a factor in causing
significant pain during childbirth. Reducing fear makes labor and
delivery easier and the whole experience more enjoyable.
Are there special classes?
We feel the best way to prepare for childbirth is to take a series
of classes. Unfortunately, there are many classes with different
names that make for some confusion. Besides the term "prepared
childbirth" you may come across the terms "natural childbirth",
"childbirth without fear", "childbirth without pain",
"conditioning for childbirth", "the Lamaze method",
"childbirth and family life", and many more. All of these
classes are directed toward education about and overcoming fear
of childbirth.
Almost always, hospitals that permit the father or "coaches"
in the delivery room, require that the couple attend that hospital's
parent classes. These may be given along with other prepared childbirth
classes such as "Lamaze", or you may have to find classes
through another organization. The phone numbers for these classes
are located in the front of this book.
Fetal monitoring
What is fetal monitoring?
This is a technique used to watch the pattern of your uterine
contractions and the pattern of the baby's heartbeat. It is usually
done during labor. Fetal monitoring allows us to detect certain
problems. If such problems develop, the baby can usually be delivered
by Cesarean Section to prevent birth complications.
Will I be monitored?
This depends on whether or not you have certain problems during
your pregnancy (such as high blood pressure) or other problems during
labor. Your Doctor will decide if it is needed. If you have an epidural
your blood pressure will be monitored regularly until delivery of
the baby.
If you are monitored, don't get scared. It doesn't mean anything
is going wrong. It's usually just a precaution to make sure you
have a healthy baby.
What is a nonstress test and an oxytocin
challenge test?
Sometime before you go into labor, you may be asked to have fetal
monitoring done just to see if the baby is doing well. This special
monitoring, called a nonstress test, is done while you are resting.
An oxytocin challenge test is done with the administration of a
medication called oxytocin which is given to you through an IV needle
into a blood vessel in your arm. This medicine causes your uterus
to contract. If these tests are normal, it usually means your unborn
baby will do well for at least a week. Once you have a test done,
it is usually repeated weekly until the baby is born.
What if the monitoring is not normal?
Your Doctor will probably want to get your baby delivered quickly.
This may sometimes mean having a cesarean section.
How is the monitoring done?
It is done in the hospital. It can be done with external or internal
monitors. The external ones are on two belts fastened around your
waist. The internal monitors are the ones placed gently into the
vagina and into the uterus next to the baby and onto the skin of
the baby's scalp. Generally, monitoring is very safe.
Go to top of page
Signs of labor
When should I expect to go to labor?
Labor normally starts when your baby is full grown or as it is called
"term". This can be as early as two weeks before your
due date to as late as two weeks after your due date. If labor begins
before the two weeks ahead of your due date, your baby can be born
too early or premature. If it doesn't happen until after the two
weeks following your due date, your baby can be born overdue or
postmaturely.
How will I know that I am in labor?
Labor occurs when your uterus begins to tighten over and over
again in an effort to push the baby out. This tightness or contractions
are felt from the back which spread over the whole belly area. They
last from about 45 to 60 seconds and occur about every 10 to 20
minutes. After an hour or two, these contractions usually become
stronger and closer together.
Sometimes a small amount of thick blood streaked mucous may come
from the cervix, through the vagina during labor. This mucous plug
is normal. Some women experience a sudden gush or slow leaking of
clear fluid (amniotic fluid) from their vagina. This is the liquid
that has surrounded and cushioned the baby so far. Usually this
fluid is forced out toward the end of labor, but sometimes it occurs
earlier. You should call your Doctor if this happens to you.
What is false labor?
These are pains, that are often felt in the low belly which don't
follow a regular time pattern. They usually go away in a few hours.
What should I do if i'm really in labor?
First, use a clock to check how far apart the contractions are
and how long they last. When they are strong and occurring about
10 minutes apart, call us and we will tell you the best time to
go to the hospital.
If you think you are in labor, don't eat or drink anything since
it is possible that you may get sick to your stomach during labor.
What if I'm supposed to have a cesarean
section?
Let your Doctor know as soon as your labor begins, since you will need
to get to the hospital very soon and the Doctor will want to be ready for
surgery when you arrive.
What are the warning signs in labor that
tell me I need to call the doctor or go to the hospital as soon
as possible?
Decreased fetal movement
Vaginal bleeding
Rupture of membranes (bag of water)
Pain is not associated with uterine contractions
Labor and delivery
What happens when I get to the hospital?
If you have visited and toured the hospital already, you will
know where to go and you may have already pre-registered. If you
do not already know the hospital's procedures, go directly to the
labor and delivery section of the hospital.
You will be admitted to the hospital and then taken to the room
where you will spend the rest of your labor. This room may be a
labor room or a birthing room. If it is a labor room, you will be
moved to a delivery room shortly before the baby is born. If it
is a birthing room, you will stay in this room when you deliver
the baby.
After you get to your room you will be asked to put on a hospital
gown. Your temperature and blood pressure will probably be taken
and your Doctor will listen to your baby's heartbeat. An internal
exam may be done at this time to check the progress of your labor.
This will be done several times while you are in labor. If needed,
an IV may be started in order to give you fluids and medicine through
a needle in the veins in your arm. If your Doctor has requested
that your labor be monitored electronically, a monitoring device
will be set up that checks the baby's heartbeat and your contractions.
You can then rest while your contractions get stronger and your
cervix begins to open up, or dilate. If the bag of water that surrounds
the baby has not broken and the fluid has not leaked out, your Doctor
may painlessly break the bag and allow the fluid to leak out so
your labor can move faster.
When your cervix has dilated all the way and the baby's head is
beginning to push at the vaginal opening, you will be taken to the
delivery room if you are not in a birthing room. You may be placed
on a special table or bed almost like the one used for a pelvic
exam at our office. Prior to the delivery your Doctor will usually
prepare you for delivery by washing your pubic area. If an episiotomy
is needed (a surgical cut to make the vaginal opening larger), it
will be done at this time. Now you will help push the baby out.
When the baby is out, the cord is cut and the baby is wiped off
and wrapped in a blanket. The baby may then be placed on your belly,
placed next to you, or may be put into a warmer.
Finally the placenta comes out. Often a little pushing by you
will help get it out. If an episiotomy was made, it will be sewn
at this time.
If your baby is delivered in a delivery room, you will be taken
to a recovery room to rest and be watched for several hours. If
your baby is delivered in a birthing room, you will remain in that
room and be closely watched. At the same time, your baby will be
taken to your Doctorry for observation.
How long should labor last?
It can take as long as a total of 20 hours. Most of the time is
spent waiting for the gradual opening and enlargement of the cervix.
Your first baby usually takes the longest, and the total time often
gets shorter with each later pregnancy.
Go to top of page
The Third Trimester (28
Weeks - Delivery)
During this time your baby will be gaining weight very fast.
Car Seats
The Hospitals will require you to take your baby home in a car
seat. If you do not have one, you may rent one from the hospital
.
How to know when you are in labor
1. If you bleed more than a tsp. of blood.
2. When your contractions are five minutes apart for at lest one
hour.
3. If your membranes rupture; you feel a gush of fluid.
The vast majority of pregnancies are uncomplicated and end with
the birth of a normal, healthy baby. Even when complications do
occur, early diagnosis and treatment will often prevent serious
problems.
Go to top of page
It is important that you notify your Doctor immediately of these early warning
signs :
- Bleeding from the vagina, rectum, nipple, or from coughing
- Swelling or puffiness of the face or hands
- A sudden large weight gain
- Persistent severe swelling of the legs
- Severe or repeated headaches
- Dimness, blurred vision, flashes of light, or spots before you
eyes
- Sharp or prolonged pain in your abdomen
- Severe or continued vomiting
- Chills and/or fever
- Sudden escape of fluid from the vagina
- A significant decrease in fetal movement
Go to top of page
How far along is my baby?
By the eighth month your baby probably weighs between two to four
pounds and is somewhere between 15 to 17 inches long. Most important,
is that your baby is now able to survive outside of you, if you
were to deliver. He or she would be very premature but could be
helped to develop normally.
Fetal development at term
At the end of nine months (or at term) the average sized baby
weighs about seven or seven and a half pounds. Your baby's length
is approximately 20 inches. The skin is coated with a creamy coating
and hair and fingernails are developed. By this time your baby should
do well living outside the uterus, whenever that specific day comes.
Go to top of page
Patient instructions for induction of labor
If Your Doctor has scheduled an induction of labor for you.
The following is a list of directions that you should follow. As
always any questions may be addressed to the Nursing Staff
in Your Doctor's office.
1. Nothing to eat or drink after midnight the night before your
induction day.
You may brush your teeth in the a.m. but do not swallow any water.
2. Call the hospital Labor and Delivery Unit by 6:00 a.m. to see
if you can come on in.
