Pregnancy Care

Quick look at pregnancy care

Pregnancy care is the health care a pregnant woman receives prior to childbirth (prenatal care) and directly after delivery (postpartum). It is important that every woman have prenatal care to make sure that she and her baby are as healthy as possible.

Services include physician consultation, pregnancy tests, ultrasound and lab tests. Nutritional and health education are also provided.

The benefit of regular care is that it helps doctors identify any health problems or issues with the pregnancy. In addition, these appointments can help women and their families feel more prepared for the birth of their baby.

What is prenatal care?

Prenatal (meaning before birth) care is the focus of a mother’s health care while she is pregnant. Women who are thinking about becoming pregnant or currently are pregnant should learn about prenatal care. Getting early and regular prenatal care promotes a successful pregnancy.

At a woman’s first prenatal appointment, our doctors will give her a schedule of all the visits that are necessary during pregnancy. Following is the typical schedule for checkups during a pregnancy:

• Weeks 0 to 28, every four weeks
• Weeks 28 to 36, every two to three weeks
• Weeks 36 to birth, once a week.

During these visits doctors will check on the mother’s health, as well as see if the baby is developing and growing normally. There are also a number of prenatal exams and tests that a doctor will recommend throughout the pregnancy. Women with high-risk pregnancies may have to receive additional care and see their doctor more frequently.

What to expect with a prenatal care checkup

During a patient’s first visit the doctor will do a full physical exam, pelvic exam, Pap smear, blood tests, urine tests and calculate the baby’s due date. The doctor will also ask questions about a patient’s medical history, lifestyle, diet, general health and more.

In later prenatal visits a doctor will examine the baby’s heart rate. The doctor will also check the mother’s blood pressure and weight, as well as her abdomen to assess the baby’s growth.

Prenatal exams and testing

Prenatal tests check on a mother’s health and baby’s development during a pregnancy. The type of exam given will often depend on how far along a woman is in her pregnancy, or if the doctor detects possible health problems. Depending on the parents’ family histories, patients and their doctors may also make the decision to screen or test for genetic problems. The following list includes some common prenatal tests.

• Amniocentesis: Evaluation of amniotic fluid containing fetal cells to diagnose certain birth defects such as Down syndrome, cystic fibrosis or spina bifida.
• Biophysical profile (BPP): Monitors the overall health of the baby and placenta via fetal heart rate monitoring and ultrasound.
• Chorionic villus sampling: A sample of tissue from the placenta can diagnose certain birth defects including chromosomal and genetic disorders.
• First trimester screening: Detects pregnancies at high risk for chromosomal disorders and other issues such as heart defects.
• Glucose tolerance test: Diagnosis of gestational diabetes.
• Group B streptococcus culture: Tests for bacteria that can cause newborn health problems.
• Maternal serum screening: Detects pregnancies at high risk for chromosomal disorders or neural tube defects.
• Nonstress test (NST): Fetal heart rate monitoring that can assess fetal and placental wellbeing.
• Ultrasound exam: Utilizing high-frequency soundwaves, this imaging test can be performed during a pregnancy to look at the baby’s growth and development. It also may be able to determine the gender of the baby.
• Urine test: Looks for urinary tract infections, diabetes and preeclampsia in a pregnant woman.

Pregnancy complications

Health problems that occur during pregnancy can involve the health of the mother, the baby or both. Some prenatal tests can help prevent these problems or spot them early. However, women should be aware of their body and if they notice any unusual symptoms, they should notify their doctor. Pregnancy complications include:

• Infections
• Gestational diabetes
• High blood pressure during pregnancy (preeclampsia)
• Problems with placenta, including placenta previa or placental abruption
• Vaginal bleeding
• Anemia
• Ectopic pregnancy
• Preterm labor
• Miscarriage.

High-risk pregnancy care

High-risk prenatal care is necessary if a woman has particular medical issues prior to conceiving, or if the pregnancy becomes complicated. Women who have been identified with a high-risk pregnancy usually need to see a doctor more frequently. The following medical conditions can affect a pregnancy and define it as high risk:

• A mother older than 35
• Risks identified in medical history
• Chronic health conditions, such as high blood pressure or diabetes
• Multiple gestation (twins or more)
• Overweight or underweight
• Problems with a previous pregnancy, such as preterm delivery
• Harmful lifestyle choices.

Twin pregnancy care

A pregnancy with twins or higher multiples (triplets, etc.) requires special prenatal care. A mother with twins should expect more frequent checkups, ultrasounds and other tests. Doctors will put more emphasis on a healthy diet and prenatal vitamins & nutrients for women with twins. Mothers with twins also might be cautioned to limit their physical exercise more than other pregnant mothers.

Preconception Counseling

Before a woman starts trying to conceive, it is a good idea for her to speak to her health care provider about how to best facilitate a healthy pregnancy. Preconception care and counseling revolve around evaluating a woman’s overall health and wellness while addressing lifestyle changes that will promote conception and fetal development.

Preconception care may occur during a scheduled annual exam, but some patients prefer to make a separate appointment dedicated to addressing their questions and concerns. Additionally, women who are having difficulty trying to conceive, or suspect that they may be experiencing infertility, may wish to speak with their OB-GYN about underlying factors that may be contributing to their struggle.

Health and wellness evaluation before trying to conceive

The early stages of pregnancy are critical for a baby’s development. In many ways, these initial weeks lay the groundwork for the entire pregnancy. The baby’s organs and major systems will start to form during the first two months following conception. Because of this timeline, a woman should ensure that any chronic health issues and risk factors are treated, controlled and addressed before trying to conceive.

During a preconception care appointment, an OB-GYN will talk to the patient about her health history, including vaccination records, previous pregnancies and any pressing concerns the patient may have. Additionally, the provider will identify any chronic health issues and talk about strategies for treating and managing them before and during pregnancy.

Depending on the issues identified, a woman may need to see a primary care provider or, less commonly, a specialist. Underlying issues that may affect healthy conception and pregnancy include:

• Irregular menstrual cycles and periods
• High blood pressure
• Thyroid conditions
• Asthma
• Depression
• Obesity
• Diabetes
• Seizure disorders
• Substance abuse.

The presence of one or more of these conditions does not necessarily mean that a woman will have an unhealthy or complicated pregnancy. Rather, they are indicators that extra care and attention should be paid to managing these issues before and during her pregnancy to keep her and the baby safe, healthy and thriving.

Finally, some women may be identified as being at a higher risk for passing on certain birth defects or congenital disorders. If this is the case, an OB-GYN may discuss options for genetic testing of the mother and father.

Preconception care and lifestyle adjustments

Equally important to evaluating a woman’s overall health is addressing lifestyle factors that will contribute to her success when trying to conceive. Leading a healthy lifestyle can alleviate some of the chronic health issues listed in the previous section and lower the risk of complications such as miscarriage and birth defects. Before trying to get pregnant, a woman will be advised to:

• Stop using tobacco products
• Stop using all recreational drugs, including marijuana
• Moderate alcohol consumption while trying to conceive
• Stop drinking alcohol as soon as pregnancy is suspected
• Lose weight if necessary
• Limit or eliminate exposure to environmental toxins at home or in the workplace.

Toxoplasmosis, a parasite infection that is often spread by cat feces, poses a risk to an unborn fetus if the mother is infected. For this reason, pregnant women and women trying to conceive may be advised not to change cat litter. But if a woman has had toxoplasmosis in the past, she will be immune to the infection and will be at a very low risk of developing it during pregnancy and passing it on to the fetus.

Because toxoplasmosis often does not cause symptoms in adults, a blood test may be ordered to determine if a woman is immune. When in doubt, it is best for all pregnant women to err on the side of safety and avoid changing cat litter until after the baby is born.

Medications and prenatal vitamins

A woman should start taking a prenatal vitamin containing at least 400 micrograms (mcg) of folic acid around three months in advance of trying to get pregnant. Folic acid is a vitamin found naturally in certain foods.

It is added to common grocery items like cereals, pastas and breads due to federal regulations. Folic acid plays a key role in fetal development, and supplementation helps to prevent miscarriage and major birth defects such as spina bifida.

Certain prenatal vitamins cause unpleasant side effects in certain women. These may include nausea, loss of appetite and digestive issues. It can therefore be a process of trial and error to determine which prenatal supplement is the best fit.

Some prenatal supplements are only available via prescription and others are sold over the counter (OTC). Prescription supplements are not necessarily better than OTC options. A woman’s OB-GYN can help her determine which prenatal supplement(s) are best suited for her individual needs.

Lastly, women who are trying to conceive should follow the same advice that is given to pregnant women regarding all OTC medications. They should limit or eliminate their use of certain medications taken for common ailments such as allergies, colds and headaches. This includes commonly-used drugs such as aspirin and ibuprofen.

Assisted Hatching

This involves the use of mechanical or chemical thinning of the zona pellucida (outer shell) of the embryo. It is believed this outer shell becomes thicker and hardened with the aging of the oocyte. Assisted hatching is performed before transfer and may be beneficial for women older than 38, for women with thicker zona pellucidas, or for a couple with poor quality embryos. Assisted hatching may also be utilized for couples that have failed to achieve pregnancy after multiple IVF attempts.

 

Pregnancy Tips

Being pregnant often raises questions and concerns about unknowns, particularly if it is a woman’s first pregnancy. We’ve provided care for pregnant women for over 30 years, and we fully understand these concerns. Below you’ll find some helpful pregnancy tips and guidelines that we’ve compiled based on common concerns and frequently asked questions.

With that said, it’s important to remember that every pregnancy is different. We encourage patients to schedule an appointment or call your provider with questions and concerns.

Pregnancy tips on lifestyle

Diet

A normal and healthy weight gain during pregnancy is 25-35 pounds. We advise that women pursue a healthy, balanced diet while avoiding processed “junk” foods. It’s also best to minimize use of sweeteners, such as NutraSweet and Splenda. A few other pregnancy tips related to diet follow.

• Caffeine: Limit use to 1-2 cups of caffeinated beverages per day.
• Alcohol: We advise that women do not drink alcohol during pregnancy. No research is available indicating how much alcohol may or may not jeopardize the fetus. Many women have inadvertently had alcohol early in pregnancy without subsequent problems for the baby. But the best policy is to not drink while attempting pregnancy and certainly to stop drinking once pregnancy is known.
• Fish: Up to 12 ounces (2 average meals) per week of fish that is low in mercury, such as salmon and shrimp, is okay. Canned light tuna has less mercury than albacore. Avoid shark, swordfish, king mackerel and tilefish.
• Cheese and meats: Avoid foods that are at a higher risk for listeria infection including hot dogs, deli meats (okay if reheated to steaming), soft cheeses, pates or meat spreads, unpasteurized milk or milk products, and raw or undercooked meats.
• Water: Stay hydrated, drinking 2-3 quarts of water daily (8-12 glasses or 64-96 ounces).

Exercise

Regular exercise (at least 3 times a week) helps prevent gestational diabetes and decreases the risk of postpartum depression. Recommended activities include swimming, elliptical or stair machines and yoga. It is best to avoid high impact and abdominal exercises, as well as any activities that can cause falling or heavy contact. Scuba diving should not be attempted, but snorkeling is okay. Walking, jogging and cycling are fine, although they may become increasingly uncomfortable later in pregnancy.

After 12 weeks, women should avoid any form of exercise that requires them to lie on their back. Exercising to the point of exhaustion is not recommended. And staying hydrated and nourished is very important.

Travel

Traveling by plane is okay until around 34-36 weeks into pregnancy. Some airlines require that pregnant women provide a doctor’s note, which we are happy to provide for patients who are not in the final stages of pregnancy.

Pregnant women may travel to the mountains, but are advised to stay below 10,000 feet due to decreased oxygen at higher elevations. It is always advised to stay hydrated and use plenty of sunscreen during hikes and other outdoor activities.

Smoking

Pregnant women should not smoke. The harmful effects of smoking during pregnancy are well documented. It may lead to a small baby, premature birth, bleeding and other complications.

Other pregnancy tips on lifestyle

• Hot tubs & heat: Avoid saunas, steam baths, hot tubs and electric heating blankets.
• Cats: Avoid changing cat litter.
• Painting: Latex painting in a well-ventilated room is generally safe during pregnancy. Avoid using a sprayer and any oil- or lead-based paints.
• Hair dye: There is no evidence to suggest that hair dye causes fetal effects.

 

Common pregnancy side effects

Constipation

Constipation is common throughout pregnancy. It can be a result of hormonal effects and/or the pressure that the fetus exerts on the digestive system. Increasing fiber intake (fresh fruit, vegetables, whole grain breads, high fiber cereals) and drinking plenty of water often prove helpful. Pregnant women can use stool softeners (see safe OTC medications during pregnancy) but should avoid laxatives.

Additionally, it’s important to note that calcium carbonate supplements (Tums) for acid reflux can make constipation worse. Blood in the stool may be a sign of straining or hemorrhoids. If serious symptoms arise, women are advised to notify us at the next visit or give us a call.

Morning sickness

Nausea and vomiting during pregnancy are common and usually subside with time. To reduce nausea, pregnant patients should get plenty of rest and avoid bothersome smells. Eating several small meals instead of three large meals may also be beneficial. It may also help to avoid fatty or spicy foods.

Ginger may naturally reduce nausea, and patients sometimes find it helpful to incorporate ginger-containing foods or ginger capsules (200mg three times a day). Vitamin B6 supplements may also help (25mg 3 times a day). Women who are unable to keep any food or liquids down should call the office.

Fetal movement

Women can expect fetal movement around 20-24 weeks. After 28 weeks, it’s best to make a mental note of daily fetal movement. At least 12 movements should be felt every day. Patients often find that it is easy to monitor for movement at bedtime (lying on the left side) or just after a meal. If fewer than 12 movements are felt during the day, we advise our patients to call the office.

Vaginal discharge

It is normal for a woman to have thicker vaginal discharge during pregnancy. But women should not douche while pregnant. Patients are encouraged to call the office if they leak clear, watery fluid.

Side pain

Many women experience side pain during pregnancy, especially when exercising, stretching or lifting. This is usually ligament pain caused by a growing uterus pulling on the ligaments. For relief, women are advised to use heat, rest, Tylenol or massage.

Heartburn

Indigestion and heartburn are very common in pregnancy, and can be treated using approved over-the-counter medications such as Tums.