Normal and High-Risk Pregnancy

Having the proper care and knowledge is essential to a successful term and delivery of your baby. I provide full pregnancy care, from conception through delivery and beyond. I offer specialized care in family planning, prenatal care and delivery. Prenatal care is crucial to your baby’s healthy development. Regular doctor’s visits are recommended and will allow for professional monitoring of your baby’s health. A regular appointment should include checking the baby’s heart rate and checking your blood pressure, urine and weight gain. Ultrasounds can be performed to visually check on the baby’s development.

In addition to my general obstetrical services, I also provide care for high risk pregnancies, including women with pre-existing medical conditions, multiple births or abnormal pregnancies that carry an increased risk of complications. I strive to develop strong, trusting relationships with my patients to help them experience a smooth pregnancy.

Some conditions that may increase the risk of complication during pregnancy or delivery include diabetes, high blood pressure, thyroid disorders, heart disease, cancer and more. Complications during pregnancy, such as gestational diabetes, premature birth and recurrent miscarriages can also be treated. For these women, close follow-up, personalized care and special delivery techniques are provided to ensure a healthy pregnancy. You and I can work together to ensure a safe and successful delivery.

FIRST TRIMESTER

WEEKS 6-13

Common Symptoms

You may be experiencing some of the following signs and symptoms of pregnancy.

• Missed period
• Fatigue
• Heartburn
• Food aversions and/or cravings
• Headaches
• Nausea and/or vomiting
• Breast tenderness and enlargement
• Frequent urination

Warning Signs

Please call my office immediately if you experience any of the following:

• Bleeding
• Severe cramping or pain
• Trauma or injury to the abdomen

INITIAL OB APPOINTMENT

• ULTRASOUND
• Measurements
• Estimate your delivery date
• Confirm the heartbeat

LAB

• Blood Type
• Antibody Screen
• Complete Blood Count
• Rubella
• RPR
• Hepatitis B
• Hepatitis C
• HIV
• Urine culture

Others as deemed necessary

Second Trimester

WEEKS 14-27

You may experience some of the following signs and symptoms of pregnancy.

• Mild swelling of hands and feet
• Lower abdominal aches/backaches
• Bleeding gums
• Increased appetite
• Constipation
• Leg cramps
• Increased vaginal discharge
• Nasal congestion/nosebleeds
• Baby movement or “quickening” first felt between 18-23 weeks

WARNING SIGNS

Please call my office immediately if you experience any of the following:

• Vaginal bleeding or spotting
• Leaking of a watery fluid
• Severe or persistent abdominal pain or tenderness
• Trauma to the abdomen
• Visual changes
• Severe headache unrelieved by Tylenol
• Severe or sudden swelling of the face
• Pain in the leg associated with tenderness behind the knee and swelling of that leg
• Chest pain and/or persistent difficulty breathing (normal to be short of breath after stairs while pregnant)

SECOND TRIMESTER TESTS

ANATOMY ULTRASOUND
Your anatomy scan ultrasound will be performed at the perinatologist office around the 20th week of pregnancy.

DIABETES SCREEN
Diabetes screen instructions are found here

ANEMIA SCREEN 
In addition to the diabetes screen, we will also screen for anemia with a blood count. If anemia is detected, your iron intake will be supplemented.

Third Trimester

WEEKS 28-42 WEEKS

You may be experiencing some of the following signs and symptoms of pregnancy.

• Occasional abdominal pain and tightening (Braxton-Hicks contractions)
• Difficulty sleeping
• Swelling of hands and feet
• Itchy abdomen
• Frequent urination
• Colostrum (leaking from nipples)
• Increasing back and leg aches
• Hemorrhoids
• Increased vaginal discharge

WARNING SIGNS 

Please call my office if you experience any of the following:

• Vaginal bleeding or spotting
• Leaking of watery fluid
• Decreased fetal movement
• Severe or persistent abdominal pain
• Trauma to the abdomen
• Pelvic pressure, low back pain, menstrual-like cramping or abdominal pain before 37 weeks in pregnancy
• Visual disturbance resulting in a sudden loss of part of your vision
• Persistent or severe headache unrelieved by Tylenol or a headache accompanied by blurred vision, slurred speech or numbness
• Severe or sudden swelling of the face.
• Persistent leg cramp or swelling of just one leg much greater than the other
• Difficulty breathing or chest pain

ADDITIONAL TESTING

GROUP B STREP SCREENING
Group B Streptococcus (GBS) is a bacteria that may be present in up to 40% of women. The most common sites affected are the rectum, vagina, and urinary tract. While GBS is not harmful to the pregnant woman, it may cause infections in newborn infants. The Center for Disease Control (CDC) recommends screening all pregnant women for detection of GBS at 35-36 weeks gestation.  If you are positive for GBS or have a history of GBS sepsis or GBS bladder infection, you will receive IV antibiotics during labor to decrease the rate of transmission of GBS to the baby. If your testing is negative, no further intervention is needed.

NON-STRESS TEST (NST) 
NSTs are external non-invasive electronic monitoring of the fetal heart rate.  Two discs rest on the abdomen, one picks up the fetal heart rate, the other notes contractions.  This test determines normal and abnormal variations in heart rate and is conducted at the hospital in the last 8 weeks of pregnancy.

BIOPHYSICAL PROFILE (BPP) 
A BPP is an ultrasound to evaluate fetal movement, fetal tone, fetal breathing and the amount of amniotic fluid.  It can be combined with an NST.  This may be used to obtain fetal reassurance in a high-risk pregnancy or in the case of decreased fetal movement.

 Additional testing may be recommended if you are experiencing complications, have preexisting medical problems, or have multiple gestations.

Post Partum

FROM DELIVERY TO 6 WEEKS AFTER
Most people spend their pregnancy worrying about delivery with little thought to the postpartum period.  This time period deserves some thought ahead of time.  Much like the birth preferences, it is nice to think about how you might need help and who you could call for reinforcements and support.

BLEEDING
Postpartum bleeding is called lochia.  Lochia often follows a progression of bright red bleeding for the first week or so, followed by watery pink or brown for several more weeks and, lastly, a yellowish white that may last for several more weeks.

Lochia may only last for 2-3 weeks but may last as long as 8 weeks.  It often starts and stops with no apparent reason.

Sometimes old blood sitting in the uterus passes as dark clots. As the uterus contracts, it will expel the old clots.  Call the office if the clot is greater than a tennis ball in size

ABDOMINAL CRAMPS
Cramping after birth is normal. These cramps are the uterus contracting and returning to normal size.  When you breastfeed, you release oxytocin which increases these contractions.  Often you will only notice these pains for a few days after delivery but some women may notice for a few weeks.  Ways to increase your comfort include emptying your bladder more frequently, using hot compresses and taking ibuprofen.  Pain often worsens with each subsequent pregnancy.

SWOLLEN BREASTS
Most women will have engorgement when their milk comes in.  You may notice a low-grade fever, aching and painful, swollen breasts.  If you are breastfeeding, continue to feed as often as your baby needs.  If you are not breastfeeding, place ice packs in a tight-fitting bra (sports bras are great!) 24 hours/day until engorgement has resolved. Also, avoid any extra stimulation of the breast by pumping, massaging or allowing warm water to run on them in the shower.  Those activities will slow the resolution.

SWELLING
Swelling in the hands, feet, and legs is common after delivery.  It will gradually go away as your body gets rid of excess fluid.  As this happens, you may be urinating and sweating more than usual. Please call the office if the swelling is in the face, associated with persistent headaches unrelieved by Tylenol or ibuprofen or if the swelling in the legs is associated with pain particularly behind the knee.

CONSTIPATION
The use of stool softeners is recommended until regular bowel movements are reestablished.  You can use colace or Miralax.  Once your bowel movements are normal, wean yourself off.  If you have constipation that requires more than a stool softener, try milk of magnesia. If you have not had a bowel movement within two days of going home, call the office for guidance.

VAGINAL TEARS OR EPISIOTOMY
Many women tear naturally when delivering, and occasionally, we have to make a small incision to help the baby delivery.  These are repaired with dissolvable stitches.  They will dissolve over 3-6 weeks time. To care for these:

• Try using cold packs immediately then dry heat, sitz baths or a spray bottle
• Sitz bath-a clear comfortably hot bath over your waist. This can be done 2-3 times a day for 15 minutes at a time.  Afterward, dry completely by blotting with a towel or blow drying.
• Periwash- a spray bottle used to rinse after using the restroom for the first week.  Pat or blow dry after

HEMMORRHOIDS
Try Preparation H, Tucks pads, dry heat and sitz baths for comfort.

HAIR LOSS
Thinning hair is normal postpartum often occurring months after delivery. It usually takes a year for hair growth patterns to correct themselves.

INTIMACY
The recommendation is to wait to have intercourse until seen  back in the office.  Most women are physically healed enough for sex after 6 weeks.  Many women who breastfeed struggle with vaginal dryness so we recommend having a lubricant available.

CHANGES IN BLADDER FUNCTION
Due to pressure to the bladder and nerves during labor, many women will have trouble controlling their urine after delivery.  Doing Kegel exercises (link) and emptying your bladder before it becomes overfull helps.

POSTPARTUM BLUES

• Sadness, tearfulness, irritability, and anxiety
• Insomnia
• Decreased concentration
• Brief beginning 2-3 days after delivery and resolved within 2 weeks

POSTPARTUM DEPRESSION

• Can occur anytime within 12 months of delivery
• Irritability, anger, feeling inadequate, overwhelmed, or unable to care for your baby
• Lack of energy (unable to get out of bed, to care for baby or self)
• Insomnia
• Decreased appetite, weight loss and inability to enjoy the taste of food
• Feeling shame, guilt or having failed as a mother
• SUBThoughts about hurting yourself, your baby or your other children

Please call the office if you have symptoms of postpartum depression. 

Prenatal Genetic Screening

We are happy to offer prenatal genetic screening. The Comprehensive Carrier Screen checks your DNA for over 300 genetic conditions including cystic fibrosis, Tay-Sachs disease, fragile X syndrome, and spinal muscular atrophy.