Obstetrics

 

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While pregnancy can be a blessed event, at times it can also be bewildering. Our physicians take pride in guiding you through your pregnancy every step of the way. For the nine months you’re expecting, you’ll know what to expect. For easy reference, some basic FAQs are provided below to acquaint you with basic pregnancy and postpartum information.

  • Pregnancy FAQs
  • Postpartum FAQs

HAVING A HEALTHY PREGNANCY

Q: What can I take if I have a cold?

A: If you are out of the first trimester, you may take Tylenol, Robitussin, Mucinex, Sudafed, and any lozenges or throat sprays over the counter. Please avoid aspirin and ibuprofen products. Please consult your physician regarding any other medications.

Q: Are Dental X-Rays Okay?

A: We discourage “routine” screening x-rays while pregnant. However, they are safe if needed to diagnose a potential problem. If this is the case, please make sure that they shield your abdomen with a lead apron while taking the x-ray.

Q: Can I take medications for headaches?

A: Most headache medications, such as aspirin and ibuprofen, along with most prescription migraine drugs, are not recommended. Consult your doctor if you are prone to migraines.

Q: What are the guidelines for exercise during pregnancy?

A: Women should not exceed the activity level they maintained before pregnancy. Being active and exercising for at least 30 minutes a day can be very beneficial and help to avoid some unwanted pregnancy side effects. Activity during pregnancy helps reduce backache, constipation, bloating and swelling; helps with sleep and mood; helps prepare for labor by strengthening your muscles and your endurance. Swimming, walking, yoga, and stationary cycling are all excellent ways to exercise in pregnancy. Remember to always hydrate yourself before, during and after exercise.

Q: Can I travel while I am pregnant?

A: Generally you should not travel on a cruise after 24 weeks or in an airplane after 32 weeks of pregnancy. After that, please consult your doctor.

Q: What foods should I stay away from during pregnancy?

A: Pregnant women should limit their intake of tuna, albacore tuna, tuna steak, swordfish, shark, king mackerel and tilefish. These fish can have high levels of contaminants that can cross the placenta and be harmful to your baby if consumed in large amounts. The Center for Disease Control recommends that you only consume soft cheese and dairy products that have been pasteurized. Hard cheese is generally pasteurized and safe during pregnancy. It is also recommended that pregnant women do not eat hot dogs, luncheon meats or deli meats unless they are properly reheated.

Q: Are there any beverage guidelines I should follow while pregnant?

A: Women are strongly urged to avoid alcohol during pregnancy, and to limit caffeine to no more than 200mg per day. For perspective, an 8-ounce cup of brewed coffee contains about 95 milligrams of caffeine, an 8-ounce cup of brewed tea contains about 47 milligrams and a 12-ounce caffeinated cola soft drink contains about 29 milligrams.

Q: What helps with nausea early in pregnancy?

A: Small, frequent meals, low-fiber foods and hot ginger tea may help ease nausea.

Q: Who should receive the Tdap(tetanus-pertussis) vaccination?

A: All adults should receive the Tdap booster at least once during adulthood. It is recommended that every pregnant woman obtain the vaccine during the second or third trimester of pregnancy, even if they have received the vaccine previously. Any adults that will be around a newborn baby should have the vaccine as well. This vaccine is available through offices of family practice and internal medicine (primary care) providers.

Q: If I develop diabetes during pregnancy, will I have diabetes forever?

A: Studies show a 50% chance of developing diabetes permanently within 10 years of developing diabetes during pregnancy. Be sure to have your blood checked once each year with your primary care physician.

Q: Can I color my hair?

A: No known studies have been done on this topic; however, your physician may recommend that you wait until your second trimester (at least 12 weeks) before coloring your hair.

Q: Can I get my nails done?

A: No known studies have been done on this topic.

Q: Can I go to a tanning bed?

A: No known studies have been done on this topic; however, doctors recommend that all women (pregnant or not) refrain from intense ultraviolet rays, which can result in long-term skin damage.

WHAT TO EXPECT WHEN YOU ARE PREGANT

Q: What should I do when my water breaks?

A: If your water breaks before 36 weeks, you should see your physician immediately. If your water breaks after 37 weeks, you should see your physician within the same day.

Q: If my water broke with previous pregnancies, is that an indicator that it will always break?

A: Every pregnancy is different. What you experience with one pregnancy may not occur with subsequent pregnancies.

Q: If something seems wrong during my pregnancy, when should I call the office?

A: Most pregnancies are normal and uncomplicated. However, it’s important to report certain problems to your physician. Call our office if you experience any of the following:

  • Medium to heavy vaginal bleeding
  • Severe, continuous headache that is not relieved by Tylenol, eating, or resting
  • Swelling of the face and hands
  • Dizziness or blurred vision
  • Severe pain in the abdomen
  • Persistent vomiting for more than 24 hours
  • Fluid trickling or gushing from the vagina
  • Decreased fetal movement

Q: What is a high risk pregnancy?

A: High risk pregnancies are complicated by a maternal, fetal or obstetric complication. Examples of fetal conditions include multiple gestation like twins and triplets, fetal growth problems or any medical complication the fetus may have that is detected during the pregnancy. Maternal high risk conditions include advanced age, high blood pressure, diabetes, and autoimmune diseases such as lupus. Obstetric complications include conditions such as placenta previa (where the placenta implants over the cervix) and preterm labor.

Q: Are you able to determine if I will need a c-section ahead of time?

A: Your doctor may be able to determine in advance that you need a c-section if you previously had a c-section or certain uterine surgeries.

Q: What if I experience bleeding during my pregnancy?

A: Many women experience some form of spotting or bleeding early in their pregnancy, which can be normal. If you experience bleeding similar to that of your periods, along with cramping or back pain, schedule an appointment with your physician.

Q: When will I start to feel my baby move?

A: Women can usually feel their baby move around 22 weeks, although some feel the baby earlier and some later.

Q: Why do some women wait three months to announce their pregnancy?

A: A woman’s chance of miscarrying is greater during the first three months of pregnancy.

OFFICE VISITS AND ULTRASOUNDS

Q: When should I schedule an appointment for my first OB visit after learning that I am pregnant?

A: Ideally you should schedule your first OB visit at around 6-7 weeks from your last menstrual period. If you are bleeding or in pain before then, you should schedule an appointment immediately.

Q: What will happen at my first prenatal visit?

A: The first visit will usually include a general exam and pelvic exam, blood work, assessment for any high-risk pregnancy factors, and any other testing or referrals deemed necessary based on your medical history. We will discuss any questions or concerns that you may have. We also give you lots of helpful information so that you can have an enjoyable pregnancy.

Q: How often are my visits?

A: In a normal low risk pregnancy, the first several visits are usually every 4-6 weeks; by 28-32  weeks you will be seen every 2 weeks and by 36 weeks patients are seen weekly. In high risk pregnancies these intervals may change depending on fetal and or maternal conditions.

Q: How many ultrasounds will I have during my pregnancy?

A: You may have an ultrasound in the first trimester to assess how far along you are, and whether there may be more than one fetus. We offer an ultrasound for genetic testing around week 12. There is another ultrasound scheduled at 18-20 weeks to assess fetal anatomy. In most cases, the physician can determine the gender of your baby from this ultrasound. Some patients may require additional ultrasounds depending on fetal and or maternal conditions.

Q: What is a 4-D ultrasound?

A: 4-D ultrasound  allows a 3-dimensional picture in real time. We offer these ultrasounds at our office purely for fun pictures of your baby. It is best to do this ultrasound between 28-32 weeks.

We know your baby is your main priority, but we certainly want you to take care of yourself as well. As part of our continuing care, you will have an appointment 6 weeks postpartum. If you had a c-section, you will need a 2 week postpartum visit as well.

POSTPARTUM BLUES AND DEPRESSION

Q: What are the postpartum blues?

A: About 2–3 days after childbirth, some women begin to feel depressed, anxious, and upset. They may feel angry with the new baby, their partners, or their other children. They also may cry for no clear reason; have trouble sleeping, eating, and making choices; and perhaps question whether they can handle caring for their baby. These feelings, often called the postpartum blues, may come and go in the first few days after childbirth. Generally, the postpartum blues will improve within a few days or 1–2 weeks without any treatment.

Q: What is postpartum depression?

A: Women with postpartum depression have intense feelings of sadness, anxiety, or despair that prevent them from being able to do their daily tasks. Postpartum depression can occur up to 1 year after having a baby, but it most commonly starts about 1–3 weeks after childbirth.

Q: What causes postpartum depression?

A: Women who have struggled with depression before pregnancy may be at higher risk for postpartum depression. Postpartum depression is thought to be caused by a combination of factors including:

  • Physical changes. After childbirth, a dramatic drop in hormones (estrogen and progesterone) in your body may contribute to postpartum depression. Other hormones produced by your thyroid gland also may drop sharply — which can leave you feeling tired, sluggish and depressed. These changes may trigger depression in the same way that smaller changes in hormone levels trigger mood swings and tension before menstrual periods.
  • Emotional issues. When you’re sleep deprived and overwhelmed, you may have trouble handling the stress of caring for a newborn. You may feel less attractive, struggle with your sense of identity or feel that you’ve lost control over your life. Any of these issues can contribute to postpartum depression.

Q: What should I do if I think I may have postpartum depression?

A: If you feel you may be experiencing postpartum depression, or if your loved ones are concerned about you having this condition, you should contact your ObGyn specialist or your primary care doctor as soon as possible.

Q: How is postpartum depression treated?

A: This condition is generally treated with antidepressants and/or counseling. Antidepressants are medications that work to balance the chemicals in the brain that control moods. If you are breastfeeding, discuss with your physician the risk of transferring this medication to your baby through your breast milk.

MEDICATIONS AND LACERATION CARE

Q: What medication can I take for pain control?

A: You may take Ibuprofen which is also known as Motrin or Advil. You may take 600 mg every 6 hours (or 800 mg every 8 hours) as needed for discomfort. Ibuprofen is preferable to other medications because it does not cause sleepiness or constipation and it is non-addictive. Do not take Ibuprofen on an empty stomach. If you need additional pain relief, narcotic medication (Percocet or Vicodin) may be prescribed. Note that narcotic medications may cause sedation and constipation.

Q: What about taking prenatal vitamins, supplements, and birth control medications?

A: If you are not breastfeeding, continue taking your prenatal vitamin for 6 weeks. If you are breastfeeding, keep taking your prenatal vitamin for as long as you are breastfeeding. If you were taking Iron supplements during your pregnancy, continue until your 6 week postpartum visit. If you have postpartum anemia, your doctor will recommend starting Iron supplements. You may take Iron Sulfate (also known as Ferrous Sulfate) 325 mg 1- 2 times per day for 6 weeks. Alternatively, you may take Elemental Iron 60 mg once daily for 6 weeks. Both are available over the counter. Birth control options will be discussed at your postpartum visit.

Q: What about caring for lacerations (Episiotomy)?

A: “Sitz Baths” (simply sitting in a tub of warm water for 15 minutes, 2-3 times per day) can help to relieve discomfort resulting from lacerations.  Additionally, Tucks pads, Witch Hazel and Lanacaine, may be applied to the external vaginal area as needed. You may also use oral pain medications as described above. Stitches will dissolve in 1-3 weeks. You will be more comfortable if you are not constipated; please follow directions above to prevent/treat constipation.

CONSTIPATION

Q: What should I do to relieve constipation?

A: You are advised to actively prevent constipation from occurring in the first place. Drink at least 64 ounces of fluids per day and eat a diet rich in fiber (whole grains, fruits and vegetables). Colace, Metamucil, and Milk of Magnesia can also be used to prevent or treat constipation; they are over the counter, safe to use while breastfeeding, safe to use together, and can be taken as directed on their bottles. To relieve hemorrhoid pain, use Sitz baths and topical agents such as Tuck pads, Witch Hazel pads, or Preparation H or Preparation HC.

BREASTFEEDING

Q: What advice can you give me for breastfeeding?

A: Wash your breasts with water daily for cleanliness: soap can be very drying and is not necessary. Air-dry nipples after each feeding. If nipples are sore, apply a few drops of lanolin after feeding and let air dry. Cooled, wet tea bags over your nipples can also be soothing. If your breasts are engorged, apply warm packs and express milk.

If you are not breastfeeding, wear a well-fitting bra for support. Use ice packs to relieve discomfort from engorgement (a bag of frozen peas for each breast works well). Avoid nipple stimulation and do not express milk, as this encourages the production of more milk. Non-breastfeeding engorgement will subside in 24-72 hours. You may use pain medication as directed above.

RESUMING ACTIVITIES

Q: How much activity can I safely do after giving birth?

A: Do not do heavy housework or strenuous exercise for two weeks. Walking is the exercise of choice during this time period. If you had a vaginal delivery, and are not taking narcotics, then it is fine to drive. If you had a C-section, do not drive for 1-2 weeks (or longer if you are still taking narcotics). If you had a C-Section, then you should avoid heavy lifting for 6 weeks. You may carry your baby in a car seat, but nothing heavier. It is fine to go up and down stairs.

Q: When can I have intercourse and use tampons?

A: Avoid tampons until your postpartum visit. Do not douche. Generally, we recommend abstaining from intercourse until you are 6 weeks postpartum. However, if you are between 4 and 6 weeks postpartum, you have completely stopped bleeding and your episiotomy is well-healed and non-tender, then it is okay to have intercourse.

UNDERSTANDING YOUR BODY

Q: What is uterine cramping?

A: Uterine cramping is normal, especially while breastfeeding. This cramping is how the uterus stops bleeding and returns to its pre-pregnant size. The uterus takes 4-8 weeks to return to its pre-pregnant size.

Q: What about vaginal bleeding and discharge?

A: Postpartum vaginal discharge, also called lochia, usually lasts about 2 to 6 weeks, yet even up to 8 weeks is normal. The color will change from bright red to brownish to tan and will decrease each week. It is normal to occasionally have a heavier gush of blood, especially after breastfeeding or with increased activity. Your bleeding should then return to the amount of flow you had prior to the gush of blood. Normal bleeding is less than a pad per half hour. If you are soaking a large maxi pad (soaked front to back, side to side, through and through) more than every ½ hour, more than once, please call your doctor. Do not use tampons until after your six week postpartum visit. Your period will resume in approximately 6-8 weeks if you are not breastfeeding. If you are breastfeeding, it is common not to have your period.

Q: When should I call my physician?

  • Fever greater than 101
  • Cesarean incision that is red, draining or increasingly painful
  • Signs of a breast infection: red and painful area on your breast, especially if associated with fevers greater than 101 and/or flu-like symptoms
  • Foul-smelling vaginal discharge
  • Excessive vaginal bleeding (see above section on vaginal bleeding)
  • Swollen, red, painful area on your leg
  • Chest pain
  • Persistently painful urination or inability to urinate
  • Worsening vaginal or rectal pain
  • Crying and periods of sadness lasting longer than two weeks

If you have questions about your infant, please contact your pediatrician.