Prenatal Guide

Congratulations!

In order to promote healthy pregnancies for our patients, the physicians and staff of Camelback Women’s Health are dedicated to maintaining the highest quality and the most up to date prenatal care available today. We are excited and honored you’ve chosen our practice to provide you your very important maternity care.

Our philosophy of prenatal care centers on an individualized one-on-one relationship with your doctor and the care and support of our nurse practitioners.

Your physician will oversee the special considerations of your pregnancy personally at each visit. We make a special point to have the doctor you’ve chosen, whenever possible, available for your delivery. Continuity of care throughout the pregnancy and with each subsequent pregnancy is as important to us as it is to you. Because of this, you should choose to see the physician you feel most comfortable with.

Our goal is to promote a healthy pregnancy through education, early prenatal counseling, appropriate laboratory testing, proper diet and exercise. Since your unborn baby is entirely dependent on you, your health should be your most important consideration for the duration of the pregnancy. We encourage you to take advantage of this exciting time in your life to ask questions, read, and make any necessary changes to improve
your lifestyle wherever possible.

This guide is intended to serve as a reference for expectant parents at Camelback Women’s Health and is not meant to be a substitute for prenatal care visits.

It is important to read prenatal education materials and literature throughout your pregnancy and keep a list of questions you would like to discuss with your doctor during your prenatal visits!

Topics


 

Emergencies

For all questions and concerns, please don’t hesitate to call the office any time during normal business hours, Monday through Friday, 8am to 5pm. Our phones are answered by our reception staff continuously throughout the day, including over the lunch hours.

For routine and non-urgent questions, we encourage you to take advantage of your Patient Portal account. Through this safe/secure account, you can leave direct routine messages for a staff member or provider without spending time on hold, especially useful during peak/high volume call hours, which are typically Monday mornings and daily from 12n – 1:30pm and after 4pm.

The portal is available for you to use 24/7, however, it is only monitored during normal business hours and is NOT intended to be used for urgent or emergent medical issues.

All portal and phone messages will be returned, according to medical priority, throughout the day and after the last patients are seen. Routine messages received after 3pm will typically be returned the next business day.

If you are experiencing an urgent or emergent situation after normal business hours and feel you need to speak to someone right away, our phones are forwarded to an answering service who will alert the Camelback Women’s Health physician on-call.

You will be asked to identify yourself to the operator, explain the nature of your phone call, and provide a phone number where you can be reached. Please remain by the phone until we contact you (usually within 10-15 minutes). The response time may be longer if the on-call physician is delivering a baby or attending to another patient’s emergency, but your call will be returned as soon as possible.

Please restrict very late or early morning hour’s calls to urgent or emergent concerns only.

Please call our office IMMEDIATELY for:

Bleeding: If you experience heavy or bright red bleeding or any bleeding associated with pain. Dark red or brown discharges generally do not imply active bleeding, but should be reported when the office opens the next morning.

Contractions: If your contractions begin to develop a consistent pattern or involve severe pain. Contractions can occur irregularly throughout the pregnancy and generally do not present a problem, but regular, consistently patterned contractions can suggest preterm labor.

Leaking: Report any large gushes of fluid or continuous leaking of clear liquid immediately. Most other vaginal discharges can be discussed during office hours.

Fever: Temperatures over 101°F/38°C should be reported right away. If you think you have a fever, please check your temperature with a thermometer before calling.

Decreased/Absence of Fetal Movement: For women past 24 weeks, please report any absence or decrease of fetal movement lasting more than 4 hours. If you are concerned about your baby’s level of activity, it is best to monitor movements immediately after a meal while lying down. Movements during the last month of the pregnancy will involve more rolling and turning and therefore will require more concentration to notice. The frequency of movement is more important than the type of movement.

If you believe you are experiencing a medical emergency which requires a visit to the emergency room, please call us immediately. We may be able to evaluate and treat you in the office or, if necessary, contact the emergency room with instructions before your arrival.

For life threatening emergencies, please call 911.


 

Important Phone Numbers

Camelback Women’s Health

Paradise Valley (Tatum/Shea) – 602-494-5050
Biltmore (32nd St/Camelback) – 602-468-3912

Hospitals

University Banner Medical Center

Labor and Delivery: 602-839-2054
OB triage: 602-839-6700
Emergency Room: 602-839-2222
Hospital Information: 602-8839-2000
Tour and Prenatal Class Information: 602-839-CARE

HonorHealth Scottsdale-Shea

Labor and Delivery: 480-323-3420
Emergency Room: 480-323-3810
Hospital Information: 480-323-3000
Tour and Prenatal Class Information: 480-882-4636


 

Appointments

Appointment times are available Monday thru Friday from 8:30am to 4:40pm at both office locations.

Schedules vary from provider to provider. Our reception staff will do their best to accommodate your needs based on appointment availability.

Because of the nature of obstetric practices, it is very possible one (or more) of your appointments will be rescheduled or delayed due to another patient being in labor or other medical or hospital emergency. Please understand physicians must tend to these cases when they occur, just as they will be there for you when your special moment arrives! Our staff will review available openings and transition your appointment to a nurse practitioner’s schedule whenever possible.

It is very important we have your current contact information in case we need to reach you prior to your visit. We try our best to contact you in advance whenever possible, but very often a physician will need to leave spontaneously with little to no notice from the hospital.

We thank you in advance for your patience and understanding.


 

Maternity Benefits

Having a clear understanding of your health insurance benefits, coverage, and the limitations of your specific policy early on in your pregnancy is very important to help you plan and budget for upcoming expenses.

Each insurance company has many different plan and policy options. Deductible requirements, co-pay/co-insurance responsibilities, and benefit coverages will vary from policy to policy, so it’s important for you to be aware of your specific health insurance coverage.

If you are not familiar with the specific details of your plan, please refer to the documents you received when you enrolled with the insurance, whether from an employer, the state, or on-line. You can also obtain this information by calling the number listed on your insurance card or refer to the insurance company’s website.

Camelback Women’s Health staff will contact your health insurance company to verify your benefits and determine the amount you will owe Camelback Women’s Health for the routine global maternity package services.

We will assist you with monthly payment arrangements to help you meet this obligation in full prior to delivery due to the fact that you will receive additional bills from the hospital, surgical assistant (for Cesarean sections), anesthesiologist, and the pediatrician after delivery.

Before moving forward with advanced laboratory services, such as genetic or chromosomal testing, we strongly recommend you verify whether or not these services are a covered benefit under your insurance plan since not all insurance companies pay for these services, even if you have maternity coverage.

If you do not have insurance coverage, Camelback Women’s Health has an all-inclusive self-pay prenatal package for routine pregnancies. We can assist you with arranging a payment plan, if necessary.

For questions about your account or help with understanding your benefits, please contact the Camelback Women’s Health’s billing department at 602.494.5050.


 

Determining Due Dates

Pregnancy due dates are calculated from the FIRST DAY of your last period + 280 days. Pregnancies are then represented by weeks from that point in time.

A full term pregnancy is considered to be 40 weeks long.

Your health team uses your due date to determine how far along you are in your pregnancy, when you need to be seen, when to order certain time sensitive blood tests, the appropriate timing of ultrasound exams, and any other services needed throughout the pregnancy.

Pregnancy is broken down into trimesters: Trimester-By-Trimester


 

Routine Prenatal Testing

Prenatal tests are one of the many ways we determine the well-being of you and your growing baby.

At your first prenatal visit, your practitioner will give you a thorough physical, including a pelvic exam. You’ll have a Pap smear (unless you’ve had one recently) to check for abnormal cervical cells. At this time, a sample of your vaginal fluids will also be taken to screen for chlamydia and gonorrhea.

We will also collect samples to test for:

  • Blood type and Rh status
  • Complete blood count (CBC)
  • Syphilis
  • Hepatitis B & C
  • Immunity to German measles (Rubella)
  • HIV Screening
  • Urinalysis and culture

A urine sample will be collected at every visit to be tested for potential urinary tract infections and the amount of sugar and protein in your urine. Increases of sugar or protein in your urine could be a sign of potential problems.

Another vaginal culture, to screen for Group B Strep bacteria, will be collected at your 36th week visit. If you test positive for GBS, you will require antibiotics when you go into labor.

HIV Screening

HIV testing is considered part of the normal and routine prenatal screening process. If you chose to decline HIV testing, you will need to sign a consent form requesting to opt out. The decision to refuse testing can theoretically put a new baby at risk, so it is important to understand the possible consequences of not receiving the test.

The American Medical Association (AMA), the American College of Obstetrics and Gynecology (ACOG), the American Academy of Pediatrics (AAP), and the National Institute of Health (NIH) have passed resolutions to advise all pregnant women to have HIV testing during their pregnancy.

Medical treatments are now able to significantly reduce transmission and subsequent infection rates to babies from infected mothers if the treatment is started before delivery. So, even though HIV occurrence rates are relatively low in Arizona, it is important to identify positive HIV results as soon as possible.

Gestational Diabetes Screen

At 28 weeks, another set of routine labs will be drawn to screen for anemia, as well as, a glucose tolerance test to screen for gestational diabetes.

For the glucose screening, you will need to arrive to the office approximately 8:00am completely fasting. Fasting means nothing to eat or drink from midnight on. You can take a sip of water to quench your thirst, but nothing beyond a sip.

When you arrive to the office, please let the receptionist know you are there for your glucose test. The lab technician will give you a bottle of a sweet, syrupy liquid which you will need to drink rather quickly. A blood sample will be collected exactly one hour later.

Because the timing of the blood draw is important, we ask that you remain in the waiting area until the lab technician calls for you. It is important you not miss your draw time to avoid the risk of needing to start the process again. Accurate results are very important.

Because you will be fasting, we recommended you bring a healthy, low-sugar snack to eat immediately after your blood is drawn. Generally, a protein or granola bar are good choices.

If your glucose test result is abnormal, it does not necessarily mean you have gestational diabetes. Further testing will be needed to determine how your body is processing sugars over a longer period of time.

Gestational diabetes usually lasts for the duration of your pregnancy and resolves after delivery. It does not mean you have Type II or chronic diabetes. It does predispose you to diabetes in the future, though.


 

Genetic Screening & Testing

During your first visit, your doctor will review your family’s medical history to determine if you are a candidate for early prenatal diagnostic testing or genetic counseling. If you’re aware of a family history of serious birth defects or if you, the baby’s father, or any close relatives on either side have been diagnosed with a hereditary disease, it will be important to review this information during this visit. It will be helpful to ask older relatives to see if they are aware of any past hereditary issues, too. If you have had a previous pregnancy which has resulted in a diagnosis of a genetic disorder, we will also need to discuss this with you in detail.

Great strides are being made in science for early prenatal diagnosis of genetic and hereditary disorders every day and this testing could be applied to your pregnancy. The more you know and understand in advance, the better prepared you will be to address any special needs your child may require in the future. Although this testing is optional, we feel it is important you are aware of what your options are to make an informed decision.

Type of Test What is it for? When is it done? How is it done?
Carrier Testing Shows if mother or father is carrying a gene for an inherited disorder Can be done before, during, or after pregnancy Blood or saliva sampling of mother and/or father
Genetic Screening Shows if the fetus has a potential for having a disorder. It is NOT a definite ‘yes or no’ test. Usually performed during 1st or 2nd trimester of pregnancy Blood sampling of mother and/or by ultrasound
Free Fetal DNA Screening The baby’s DNA, crossing into the mother’s blood stream via the placenta, can show chromosomal disorders w/ 98% accuracy. Can be performed during the first trimester of pregnancy Blood sampling of mother
Diagnostic Testing It shows if the fetus has a genetic condition. Is performed during the 1st or 2nd trimester of pregnancy Amniotic fluid or samples from the placenta are collected.

Carrier Testing

If you would like to be tested, we recommend the mother be tested first. If the results are positive, the father of the baby should then be tested. If both parents are carriers, genetic counseling will be recommended.

Since the test detects approximately 85% of the known gene defects for cystic fibrosis, for example, a negative test is not a guarantee that you do not carry the cystic fibrosis gene. It would, however, be exceedingly unlikely that a child would be affected if one parent’s test was negative, but there could be a very small chance the baby will have the disease.

Cystic Fibrosis

The American College of Obstetrics and Gynecology and the American Academy of Pediatrics recommend cystic fibrosis (a serious and debilitating lung condition) testing to all pregnant and prospective pregnant women. Testing can detect approximately 85% of cystic fibrosis carriers. The gene is present in approximately 1:40 men and women and requires both parents to carry the gene in order for a child to be affected. Therefore, approximately 1:1600 children are affected by cystic fibrosis.

Additional Carrier Testing

Carrier testing is also available for SMA, Fragile X, Tay-Sachs, Sickle Cell Anemia, and others.

Genetic Screening

Alpha-fetoprotein Protein

AFP screening is a blood test offered to all pregnant women and is drawn between 15-20 weeks gestation. This test screens for a group of disorders called neural tube defects. These defects include spina bifida, myelomeningoceles, and anencephaly. These are serious conditions that affect the brain and nervous system of the fetus. The test, called the ‘triple screen’ or AFP+, can also serve as a screening for Down’s Syndrome (Trisomy-21) and Trisomy 18.

It is very important to understand that the AFP triple screen is exactly that, a screening test which has both the risk of being falsely positive or falsely negative. An abnormal test does not necessarily mean there is something wrong with the pregnancy, but gives you and your doctor the chance to carefully evaluate your situation and discuss the best possible options for you. The screen for neural tube defects is based on elevated AFP levels, but positive screen results detect only 3% of affected fetuses.

The screen for chromosomal problems is based on low AFP levels, two additional test markers, and these are then compared with your age group. The limitation of this particular test is that it could miss up to 30% of pregnancies affected with Down’s Syndrome for patients over 35 years of age and an up to 60% error rate in younger patients. This test is considered a guide for a course to further evaluation, taking into account your age and the calculated risk for the pregnancy being affected with a chromosomal problem.

Nuchal translucency screening

Nuchal translucency is an exciting advance in prenatal diagnosis. This screening involves a careful ultrasound which measures the thickness of the back of the fetus’ neck, usually takes place between 11 and 13 weeks. Increased thickening of the neck, or the absence of a nasal bone, is features which could place the pregnancy at an increased risk for chromosomal abnormalities such as Down’s Syndrome.

Nuchal translucency testing is non-invasive and therefore considered very safe as compared to an amniocentesis. Nuchal translucency testing can be done without the risks of a needle puncture to remove amniotic fluid and performed weeks earlier than an amniocentesis (16-17 weeks), so many fears associated with prenatal genetic testing can be alleviated sooner than later. With these testing advancements we rely much less on amniocentesis for the diagnosis of chromosomal abnormalities.

Genetic testing has been traditionally offered to patients over the age of 35, to patients with abnormal AFP (alpha fetal protein) results, or to patients with a significant personal or family history of chromosomal abnormalities. Nuchal translucency testing, however, is offered to all patients, regardless of age or family history.

When combined with an additional blood test, the nuchal translucency ultrasound is able to detect 85-91% of affected Downs Syndrome babies in mothers below age 35. AFP triple screening which normally performed at 15 weeks only detects 65-80% of affected babies, so the nuchal translucency testing is considered safe and highly accurate.

Based on the results of the nuchal translucency testing, if statistical risks of having an affected child are considered high, parents are then able to make a more informed decision on whether to pursue amniocentesis or not.

It’s important to understand that amniocentesis is still the preferred tests for parents who want certainty of the chromosomes and is always recommended to confirm the diagnosis with abnormal nuchal translucency results.

Free Fetal DNA Testing

Non-Invasive Prenatal Testing

Non-Invasive prenatal testing (NIPT) tests for what is known as “cell free fetal DNA”. After 10-12 weeks, a simple blood draw from the patient is needed and fetal cells are separated from the maternal blood sample. These tests check for chromosomal abnormalities such as Trisomy 13, 18 and 21; as well as sex chromosomes.

Diagnostic Genetic Screening

Amniocentesis

An amniocentesis is a procedure usually done between 14½ and 16 weeks gestation in patients who are at a higher risk for chromosomal abnormalities. The test involves taking a small amount of fluid from around the amniotic sac of the baby, under ultrasound guidance, and sending the fluid for cell culture. The results for this test take about 7-10 days to report since it involves a culture. Cultures require cells to grow under controlled conditions and reviewed under a microscope. Amniocentesis has a risk of about 1 in 250 of resulting in a miscarriage or rupture of membranes. This test is typically performed in our office and is very accurate in evaluating pregnancies at risk for chromosomal problems; however, you may be referred to a perinatology office, when necessary.

Chorionic villus sampling

CVS is another option in the event the nuchal translucency screen is abnormal. This test also diagnoses chromosomal abnormalities such as Down syndrome, as well as a host of other genetic disorders. Samples of cells from tiny fingerlike projections on the placenta, called the chorionic villi, are collected and sent to the lab for genetic analysis. This test allows a result by 13 weeks gestation vs a 17 week gestation result with an amniocentesis, but is at a higher risk of miscarriage and a referral to a specialist trained in this procedure is necessary. There is a Down Syndrome detection rate of 90-95% accuracy. It may be a useful option for some, but not all women.

We can discuss these options with you in more detail to determine the most appropriate test in your particular situation and family history.

Most, but not all, insurance companies cover these screening tests, so we strongly advise you to call your insurance company to verify your benefits and coverage. You may be financially responsible for some or all of the associated costs.


 

Weight Gain In Pregnancy

Weight gain in pregnancy is an important topic due to concerns of gaining either too much weight or not enough.

Recommendations vary regarding what is considered the ‘appropriate’ amount of weight gain. The general rule is a gain of 20-30 pounds. Women who are slightly overweight at the beginning of the pregnancy will need to gain less weight than women who are at their ideal weight. Women who are underweight at the start of their pregnancy, should focus on gaining a little more than normal.

The amount of weight gain reflects many factors other than just the weight of the baby. It also considers the weight of the placenta, the amount of amniotic fluid around the baby (which is quite dense), additional blood created to compensate for your body’s increased circulation needs, as well as excess fluid retained in the tissues. The combined weight of these factors represents the total weight gain of a pregnancy. Within 4-8 weeks after delivery, the vast majority of pregnancy weight will be lost with little to no effort on the mother’s part with appropriate weight gain.

It is important not to become overly concerned about weight changes from visit to visit since the time of day, type of clothing worn, recent meals, and other factors can affect the result seen on the scale.

Weight gain in pregnancy is not always a smoothly progressive event. A mother may gain a lot of weight in one month and gain much less the next. It is important to look at the overall trend and not focus on the weight gain at any one particular visit.

Thirty to forty years ago, weight gain restrictions were emphasized by obstetricians and many patients were compelled to limit weight gain to about 10-15 pounds during the course of the pregnancy. We now know this limitation is not healthy and does not improve the overall outcome of the pregnancy.

The truth is excessive weight gain is cosmetic. It does not necessarily have an effect on how much the fetus grows, whereas gestational diabetes or heredity have more of a role in how much the baby will weigh at birth. However, excessive weight gain may contribute to an increase in the necessity for a Cesarean section.

Ultimately, excessive weight gain simply means that the patient will have an excess of fat after birth, which can be lost by maintaining a healthy lifestyle after the pregnancy has ended. Here is a reasonable amount of weight gain a woman should target:

BMI Target Weight Gain
<20 28-40
20-26 25-35
27-29 15-25
30> 15

There is a BMI calculator located under the health and wellness tab of your Patient Portal account.

It is very important not to attempt to lose weight during pregnancy or to severely restrict your calorie intake. Your growing baby needs continual nourishment for its growth and development. These growth processes occur twenty-four hours a day.

The baby is dependent on sugar for energy which your body naturally provides. It will, however, struggle to maintain adequate sugar levels if you are not eating regularly. So, frequent small meals are recommended. Additionally, pregnancy hormones tend to slow down the digestive process, so there may be an uncomfortable sensation of fullness after eating a large meal, so smaller meals more often are also helpful for this reason.

The most important advice regarding weight gain is to eat wisely. Experience has shown that patients who gain excessive body fat during pregnancy are generally using little restraint and have poor eating habits during the pregnancy. Consuming a pint of ice cream or a bag of potato chips every evening is very unhealthy – under any circumstance!

Try to eat rich, fatty foods in moderation and concentrate on eating fresh fruits and vegetables, lean proteins, salads, simple pasta dishes and cereals instead. This will most often lead to an ideal amount of weight gain during pregnancy and increase the likelihood of easily losing the additional weight after delivery. We have frequently seen patients who have gained as much as 40 pounds in a pregnancy despite having excellent eating habits and regular exercise. Almost invariably, these patients will lose the weight very rapidly after the baby delivers.

Again, don’t become overly concerned about excessive weight gain, especially on the basis of single visit weigh-ins. Concentrate on keeping your activity levels up and focusing on eating healthy foods. This will ensure that your weight will not be a problem after you have your baby.


 

Exercise

In recent years, there has been more and more information available about the beneficial effects of aerobic exercise during pregnancy- for both the mother and for the baby.

Babies of mothers who exercise regularly during pregnancy are generally leaner and more vigorous at birth. Exercise promotes a sense of well-being in expectant mothers and labors tend to be better tolerated and faster in stronger, well-conditioned mothers. The post-partum recovery is also generally easier.

Aerobic exercise involves stimulating your heart to a higher heart rate, which results in improved blood flow to organs and muscles. The placenta, which serves as the filter and nutritional bridge between you and your baby, also receives the benefits of the improved blood flow during moderate exercise. Essentially, your baby gets a healthy workout with you!

Make it a special point to discuss with your doctor which exercises you normally do and whether these are safe and appropriate for your particular pregnancy. Brisk walks, light jogging, swimming, bicycling, or low impact aerobics are all good forms of aerobic exercise. Slow walks and working around the house all day do not qualify as aerobic exercise, since your heart rate remains relatively low during these activities.

At the gym, stair climbing machines, exercise bikes, or elliptical machines will give you a good workout. Be careful with maintaining your balance during these exercises. Avoid vertical impact movements such as high impact aerobics or horseback riding during your pregnancy.

You should exercise at least 3 times a week for 30 minutes at a time throughout your pregnancy. Start out slowly if you haven’t been on an exercise program recently.

Particularly in Arizona, it’s important to stay hydrated both during and after outdoor activities, so be sure to bring and drink plenty of fluid on walks or hikes.

If you normally work out by lifting weights, you may continue using weights in your exercises, but work on increased repetitions with lighter weight rather than adding heavier weight to avoid the possibility of straining. Avoid lifting weight over your head. Sit-ups are fine, but you’ll obviously notice that they will become harder and less beneficial as the pregnancy progresses.

Sex is considered healthy and safe during pregnancy. You and your partner should avoid positions that involve direct impact to the abdominal area. If you experience bright red bleeding after intercourse, please contact the office. Mild contractions frequently occur for the first hour or so after intercourse and are not usually a problem.

If you are at a high risk for pre-term labor, have had problems with bleeding, early contractions, or have any medical problems with this pregnancy or previous pregnancies, please be sure to discuss whether intercourse and exercise are advisable during your particular pregnancy.


Healthy Eating

A nutritious diet during your pregnancy is perhaps the most important element of having a healthy pregnancy and newborn. You are solely responsible for providing the nutrients for your growing baby. This is the perfect time to evaluate your eating habits and commit to making changes necessary for a healthy lifestyle you can maintain through your lifetime.

During early pregnancy, calorie content is not nearly as important as the quality of your diet. This guide gives very basic information on healthy eating during pregnancy, so please take a few extra minutes to read about nutrition in pregnancy from one of your more detailed prenatal books.

Many women, particularly in early pregnancy can feel lightheaded due to low blood sugars, so it’s important to eat small portioned frequent meals, rather than only eating 2-3 times a day. In general, however, pregnancy tends to be a time when a woman’s blood sugar levels run higher than normal, sometimes to the point where gestational diabetes can be a problem. This form of diabetes usually resolves after delivery. One of the the most important goals during your pregnancy should be to reduce or eliminate sugar from your diet whenever possible.

Read labels of prepackaged foods for sugar content and serving sizes. Fruit juices have high fructose concentrations (translation => sugar) and although there are beneficial nutrients in fruit juices, you should limit your daily intake to one serving of juice a day. The sugar substitute NutraSweet is a very simple protein and is a safe substitute for sugar, despite what some prenatal books suggest. We would recommend you avoiding saccharin as a sugar substitute, though. One or two servings of soft drinks or coffee with caffeine should be safe; however it would be best to try decaffeinated products whenever possible.

Calorie requirements go up modestly during pregnancy and weight gain should occur naturally without making
special efforts to eat more. One of the easiest ways to gain unhealthy weight is by thinking you should ‘eat for
two’.

At each meal, emphasize on lean proteins such as skinless chicken breast or fish; and be sure to include at least one green vegetable, which is an excellent source of vitamins, iron and calcium.

Avoid fried foods or foods with a high fat content whenever possible.

Foods high in fiber will help with digestion and constipation. Metamucil, Citrucel and Colace, an over the counter stool softener, can be used along with healthy diet to assist when issues of constipation arise.

Iron is important to help increase the blood supply during your pregnancy, but in general, iron supplements beyond what is in your prenatal vitamin are not needed if you eat iron-rich foods. Lean red meats and green vegetables are good sources of iron. If your doctor suggests an iron supplement, be sure to increase the fiber in your diet as well, since iron supplements can be constipating.

Healthy Foods In Pregnancy

Protein

Pregnant women need about 70 grams of protein per day, which is 25 more grams than usual. This is equal to adding one portion of meat or one glass of milk to your normal diet.

Healthy sources of protein are:

  • Eggs
  • Lentils/beans
  • Fish: salmon, canned tuna, shrimp, Pollock, catfish (2-3 servings per week)
  • Poultry: white meat; skinless
  • Beef: sirloin, 90%+ lean ground beef; tenderloin
  • Pork loin
  • Dairy: cottage cheese, yogurt, milk
  • Nuts/seeds

Folic Acid/Folate

Folic acid is a vitamin that plays a key role in the early fetal development. Women with low dietary folate levels are at a higher risk for having a baby with neural tube defects such as spina bifida. The neural tube closes early in pregnancy, often before the woman even knows she is pregnant, so folate has been added to a variety of foods in the U.S., cereals, breads, and frozen orange juice, for example. A folic acid supplement of at least 600 mcg (6mg) per day is recommended for all pregnant women

Foods that are naturally high in folic acid are:

  • Spinach
  • Asparagus
  • Kale
  • Whole grain breads & cereals

Iron

Our bodies need iron in order to make hemoglobin, which allows red blood cells to carry oxygen to other cells and tissues. Low levels of iron are associated with anemia, fatigue, increased risk of low birth weight, and premature delivery. Pregnant women need 30mg of iron per day, which is double the amount needed for non-pregnant women. Combining iron rich foods with foods and drinks high in vitamin C will helps aid with the absorption process. Although many foods are fortified with iron, this form is not absorbed into the system well as iron from an animal source.

Foods rich in iron include:

  • Lean red meat
  • Dark meat from poultry
  • Green leafy vegetables

Calcium

Calcium is important in the development of your baby’s bones and cartilage. It is also needed for blood vessel health, nerves, and muscles. Interestingly, the amount of calcium a fetus takes does not depend on the amount in a mother’s diet. Therefore, if the mother is deficient in calcium in her diet, her own bones, teeth, and tissues may become depleted. Some studies suggest that calcium may also reduce the risk of developing pre-eclampsia.

Most pregnant women need about 1000mg of calcium per day. However, young mothers in their teens are advised to take about 1300-1500mg per day, since their own bodies are still growing. If you are getting at least three servings of calcium per day in your diet, then you probably do not need a supplement.

Foods high in calcium include:

  • Yogurt
  • Milk
  • Cheese
  • Cottage cheese
  • Tofu
  • Almonds
  • Broccoli

Vitamin C

Vitamin C is necessary for building collagen, and is an antioxidant that helps protect our tissues from being damaged. People who are low in vitamin C are more prone to illness and infection and have an increased risk of preterm delivery. Pregnant women need about 85mg per day of Vitamin C.

Foods rich in vitamin C include:

  • Citrus
  • Strawberries
  • Tomatoes
  • Bell peppers
  • Broccoli

Hydration

Drinking the proper amount of fluids is extremely important because it helps your body deliver nutrients to the baby, and helps prevent constipation and fatigue. Water and skim milk are great beverage choices in pregnancy. Whole fruit and smoothies are another good way to add nutrients and fiber to your diet. Avoid soft drinks, fruit punches, and sweetened drinks. Limit your caffeine beverages to one or two servings per day (small cup of coffee).

Cravings and Aversions

During pregnancy the taste of certain foods can sometimes change. If you develop an aversion to meat, for example, you can substitute other foods rich in protein, such as yogurt, beans, nuts, tofu, lentils, or chickpeas.

To avoid cravings, it’s important to eat regularly to avoid drops in blood sugar which can contribute to your cravings. When possible, substitute a healthier low calorie, low fat option to help satisfy your craving. For instance, have baked chips instead of regular when you have a craving for something salty; or have a fun/mini size candy bar instead of a regular size when you want something sweet. Low fat frozen yogurt is a good substitute for ice cream, as well.

Distractions from cravings, like taking a walk, calling a friend, or completing small projects around your home are useful, too!

A Balanced Diet for Pregnancy

Component Recommended servings per day Examples of serving size
Breads and Grains 6 5 crackers, ½ bagel, 1 slide of bread, 1 tortilla, ½ c. rice or pasta.
Proteins 4 2 oz. meet, fish, or poultry, ½ c. dried beans, ½ c. nuts
Dairy 4 1 c. skim milk, 1 c. low fat yogurt, 1-2 oz. low fat cheese
Fruits & Vegetables 6 1 apple,  ½ banana, ½ c. orange juice, ½ c. strawberries, 1 stalk broccoli, 1 tomato, ½ c. spinach.

Healthy tips

  • Include foods from all food groups in each meal
  • Include vegetables and fruits in every meal and snack
  • Change your proportions- vegetables and fruits should take up half the plate.
  • Substitute health foods for high-fat or high-sugar foods.

Foods and Substances to Avoid

Alcohol

All pregnant women should avoid alcohol, as no amount of alcohol has been proven safe for pregnancy.

Smoking

Cigarette smoking is known to have many negative side effects, such as poor fetal growth, preterm birth, and SIDS (sudden infant death syndrome). Even second-hand smoke has been associated with pregnancy complications.

Saccharine (Sweet N’ Low)

Saccharine crosses the placenta and is potentially dangerous to the fetus. It is best to avoid it completely during pregnancy.

Other artificial sweeteners such as aspartame (Equal, Nutrasweet, and Nutrataste) do not cross the placenta and are considered to be safe in pregnancy. The accepted daily intake is about 2800mg per day (about 1-2 servings of aspartame containing foods) Surlacose or Splenda are also considered safe in pregnancy.

Fish

Fish is a good source of Omega-3 fatty acids, but fish may also contain levels of mercury that may be harmful. Fish you should avoid include: shark, swordfish, king mackerel, tilefish, tuna steak, or raw fish.

Tips for eating fish in pregnancy:

  • Eating only 2-3 servings per week
  • Choose fish lower in mercury such as salmon, Pollock, catfish, shrimp, and canned light tuna.

Food Bourne Illnesses

Listeria

Listeria lives in soil & water and can be found in vegetables, meat and dairy products. The bacteria is killed by cooking, but not by refrigeration. Pasteurization of milk products and cooking meat prevents contamination with Listeria. Deli meats can be contaminated after cooking and before packaging.

Toxoplasmosis

Toxoplasmosis infection sources include raw meat and unwashed vegetables.

Another Toxoplasmosis exposure risk is cat feces. First time exposure in pregnancy can cause the baby to become infected. If possible stay away from cat litter, and have someone else change the litter box. Otherwise use disposable gloves and wash your hands after changing the litter.

Other sources of food borne infections include sushi made with raw fish, raw or runny eggs, and un-pasteurized juices, as they can cause infection with salmonella or e. coli. Raw vegetable sprouts, including alfalfa, clover, mung bean, and radish sprouts are also potential sources of illness.

Tips to minimize your risk of exposure are:

  • Wash raw vegetables before eating them
  • Avoid raw or rare meat.
  • Separate raw and cooked foods during meal preparation.
  • Wash all knives, cutting boards, utensils and countertop very well.
  • Avoid soft cheeses like Brie, Feta, blue-veined cheeses and Mexican style soft cheeses unless the package states they are pasteurized.
  • Do not eat pate or meat spreads.
  • Do not eat smoked seafood, unless cooked thoroughly (Nova Lox, etc.)
  • Cook hot dogs or deli meats until steaming hot before eating.
  • Wash hands thoroughly after touching raw meats or vegetables.

 

When You’re Not Feeling Well

Perhaps the most common questions are what to do about colds, flus, and other illnesses during your pregnancy.

Unfortunately, your immune system is not as responsive to troublesome viruses and bacteria which then will make you more susceptible to sickness.

It’s important to avoid this problem whenever possible by getting plenty of rest, exercise, eat healthy, and be rigorous about hand washing after being out in public. Be assured that your baby is protected by your immune system’s antibodies and will ward off infections from affecting your baby, but it’s important you take care of yourself when you’re not feeling well.

Influenza vaccines are available between September and January through our office. The vaccines are safe in pregnancy and are very useful in protecting you from the most common flu viruses for the upcoming flu season. Experts suggest you get a flu vaccine either before or during your pregnancy, since women are particularly prone to colds and flus during pregnancy.

Heartburn

As you approach your due date, you may notice an increase in heartburn. This is often caused by the passage of food going back up towards the esophagus from your stomach resulting from the relaxed nature of the stomach muscles during pregnancy.

To avoid heartburn, try reducing the portion size of food during a single meal. Eating smaller meals 4-5 times a day will allow the stomach to empty more efficiently.

Avoid lying down for an hour or two after eating, particularly at night. Try sleeping slightly upright with a 2nd pillow. Over the counter Prilosec or Tagamet before bedtime will reduce acid secretion while you sleep.

Avoid spicy and fatty foods, particularly deep fried foods and stop the use of caffeine, chocolate, and cigarettes. Tums and Rolaids are safe to use and if symptoms persist. Maalox or Mylanta may help, also.

Prescription medications are available if more conservative measures fail to relieve the problem. Before using any over-the-counter medications other than what we have listed, you should first discuss this with your doctor.

Nausea and Vomiting

Nausea and vomiting are very common in early pregnancy. This typically resolves by the 16-18th week.

Morning sickness worsens when the stomach is empty for prolonged periods of time which is the reason it is more troublesome in the ‘morning’.

Some tips for dealing with N/V in pregnancy include:

  • Eat a bland/B.R.A.T. diet throughout the day: bananas, rice, applesauce, toast
  • Drink clear fluids: water, apple juice, Sprite, 7-UP, ginger ale, sports drinks, broth, Jell-O, frozen fruit pops, hard candies or any other liquid you can see through
  • Try not to skip meals. Keeping food in your stomach helps it “busy” and from becoming upset
  • Keep crackers by your bed and eat a little before getting up
  • Avoid strong odors
  • Drink plenty of fluids, even if you can only tolerate small amounts throughout the day

If you are having difficulty keeping food or liquids down due to morning sickness, there are effective ways to help. Morning sickness worsens when the stomach is empty for prolonged periods of time which is the reason it is more troublesome in the ‘morning’.

To maintain hydration, you should drink plenty of fluids throughout the day, especially during the periods when you feel better.

Keeping your stomach ‘busy’ by eating gum or sucking on hard candies, and have a small healthy snack at bedtime.

Taking vitamins during the early portion of the pregnancy can be irritating to the stomach. Try taking vitamins with food or with your bedtime snack. If this isn’t possible, stop taking the vitamins for week or two and look for natural sources of vitamin replacements with fruits and vegetables. Most women who eat a nutritionally sound diet actually do not need vitamin supplements.

If you are unable to keep liquids down, please contact our office right away. Dehydration is very serious during pregnancy.

Constipation

Constipation is one of the most common complaints of pregnancy. It occurs for a number of reasons. First and foremost, the high progesterone levels which occur during pregnancy tend to slow the function of the bowel. The slowdown causes increased absorption of water from the bowel contents, resulting in a hard, dense stool. This process, in combination with diet changes, makes constipation a significant worry for many. In addition, pregnancy has a tendency to worsen problems with hemorrhoids or cause hemorrhoids to appear where they did not previously exist. Constipation and straining aggravate hemorrhoids and correcting the constipation tends to improve the situation.

For this reason, a pregnant woman needs to take special care to avoid becoming constipated. The most effective means of doing so is through diet changes and increasing your water intake.

The first step is to increase the amount of fiber and roughage in the diet. Increase consumption of raw and cooked fruit and vegetables, as well as whole wheat grains and cereals. There is a variety of brain-containing breakfast cereals, which are excellent in this regard.

It is often helpful to add additional fiber by taking over the counter fiber preparations such as Metamucil, Citrucel, and Senakot. These work extremely well. Generic brands work as well as brand names. Find a form that is most palatable for you. Metamucil in the powder form is quite difficult for some to take because of its glue-like consistency. Tablet and granular forms are sometimes easier to take, as are fiber-containing wafers. These products should be taken according to package directions and should also be accompanied by increased fluid intake. They work by capturing and retaining moisture within the bowel, thus maintaining soft stools. They are not harmful to the baby.

If severe constipation occurs, occasional use of Miralax or Milk of Magnesia is reasonable. Two tablespoons taken at night will often relieve the problem by morning. However, we would prefer you not use these laxatives or similar products during pregnancy unless it is absolutely necessary. Laxatives work by irritating the bowel, which is not desirable during pregnancy.

Constipation can also be a problem after the baby is born. While the birth canal is healing, it may be painful to go to the bathroom. Under these circumstances, patients may develop constipation. Again, one time use of Miralax or Milk of Magnesia would be appropriate, but Colace can also be taken for up to a week at a time, two capsules daily of 100mg each. Colace is available over the counter without a prescription, available in generic form, but is not covered by insurance. We advise you continue with a high-fiber diet and fiber supplements after delivery.

While you are taking fiber supplements, it is important to remember to continue to take your prenatal or multi-vitamins. Fiber can bind some minerals in the digestive tract and multi-vitamins will help to ensure that nutrition is adequate.

Safe Medications During Pregnancy

Some drugs or medications should not be taken during pregnancy. The following medications are recommended ONLY as needed and if you have not had an allergic reaction to them in the past.

Please be sure to notify us which medications you have been taking during each office visit.

  • Fevers, chills, headaches or muscle aches: 2 Tylenol (regular or extra strength) every 6-8 hours should help with these symptoms. Avoid ibuprofen (Advil, Motrin, and Naproxen) during pregnancy unless you are specifically instructed otherwise by your doctor. Aspirin does have a role in certain conditions related to pregnancy, but should not be used for colds or flus.
  • Coughs:  Robitussin DM or similar generic cough syrups with dextromethorphan are preferred. If you begin coughing up excessive sputum or continue to incur fevers, please call the office.
  • Congestion: Sudafed (white/red box) or Actifed during daytime hours as directed on the packaging and Benadryl before bedtime to also help you sleep.Oral or nasal inhalers may be needed for more troublesome colds and asthma and are also considered generally quite safe
  • Constipation:  Metamucil, Milk of Magnesia, Colace, Citrucel, and Senakot.
  • Diarrhea:   Kaopectate, Increase clear fluid intake, and follow the B.R.A.T diet: bananas, rice, applesauce, and toast.
  • Indigestion: Tums, Maalox
  • Gas Pains: Simethicone, GasX, Mylicon
  • Hemorrhoids: Preparation H, Anusol, Tucks pads
  • Nausea/Vomiting: Vitamin B6 50mg twice daily, Emetrol, follow bland or B.R.A.T diet, and increase clear fluid intake.

When taking over the counter medications, choose one that will treat the particular symptoms you are experiencing at the time.

Antibiotics will be prescribed occasionally for bacterial infections, but they are not effective against viral infections.

Although all medications have potential risks, the medications mentioned have been in long-standing use without any reported safety concerns and therefore are considered safe to take during pregnancy.


 

Ultrasounds

Camelback Women’s Health offers on-site ultrasound services at both locations.  This is advantageous in sorting out possible concerns quickly and conveniently for our patients.

In most instances, an ultrasound will be performed by your physician at your first visit to verify the presence of a heartbeat, establish an accurate due date, and verify the number of fetuses present. Due to the small size of the fetus, the first ultrasound scan is a very limited vaginal ultrasound and cannot identify specific problems with the baby’s anatomy.

A second, more formal, Level II ultrasound examination will be obtained between 18-20 weeks and its purpose is to completely examine the fetal anatomy.  A normal ultrasound report does not guarantee the baby is anatomically perfect, but its purpose is to identify any future or potential problems.   Both vaginal and abdominal transducers may be used during the course of your ultrasound scans.

A full bladder will be necessary for this ultrasound.  We recommend you empty your bladder one and a half hours before your appointment time and then begin drinking 32 oz. of water within 30 minutes time, being sure to finish at least 1 hour before your appointment.

You are more than welcome to bring someone with you for the appointment, but due to the size of the room, only 2 adults will be allowed to accompany you.  Children are allowed, however, please be sure to bring another adult to watch your child while your scan is being conducted.  Without proper supervision, your appointment may need to be rescheduled for the safety of your child.

The sonographer has the very important responsibility of obtaining accurate images and careful measurements of each vital organ for the radiologist to review.   It can be a slow process due to the baby’s positioning, so please be patient as she conducts the thorough exam.

Sonographers are not licensed to practice medicine; so therefore, they cannot diagnose, disclose, or discuss any findings with you.

Formal results of the scan will be shared with you after they are received and signed off by the ordering provider.   Results can take up to 10 days to report.  If there are any concerns regarding the results, you will be contacted right away.

It is sometimes possible to identify the gender of the baby, but guarantees are not given and ultimately are not the sole purpose of the ultrasound exam.

Photography and videos during ultrasound scans are strictly prohibited.   You will be provided screen shots of your baby to take with you once the exam is complete.  We cannot replicate or replace lost photos.


 

Cord Blood Banking

Cord blood, the blood in your baby’s umbilical cord and placenta, contains potentially lifesaving cells called stem cells. Stem cells have the potential of developing into many different cell types in the body. These cells can grow into blood vessels, organs, and tissues.

In some organs and bone marrow, stem cells can divide themselves repeatedly to repair and replace worn out or damaged tissues which can be vital in treating dozens of diseases.

Your baby’s cord blood can be collected at birth directly from the umbilical cord and placenta and be stored for future use.

There are two options for storing cord blood, if you choose:

  • Public cord bank: You can donate it for anyone who may need it
  • Private cord bank: You can pay to store your baby’s cord blood for your family’s personal use if needed in the future

The collection process is painless, safe, and doesn’t interfere in any way with the baby or your labor/delivery. In fact, it’s so quick and painless that parents – caught up in holding and bonding with their new baby – are often unaware it has even happened.

If you decide that you would like to store your baby’s cord blood for private use, there are several different organizations available for you to choose from and you will need to notify the hospital of the company you’re choosing to work with. The hospital will assist you in making arrangements for cord blood donations for public use.


 

Traveling

Traveling during pregnancy is generally safe, but there are some important guidelines to follow when planning a trip.

As a general rule, it is not recommended to schedule trips out of town after 32 weeks (8 weeks before your due date).

If you’re planning to travel by plane, be sure to check with the airlines for any restrictions have on flying during pregnancy. They may require a letter to board your airplane, so please confirm their requirements before purchasing your ticket.

Plan to arrive at the airport early and have someone help with luggage, if necessary. Airline flight is in itself safe during pregnancy, but problems arise with the increased stress of travel (rushing to the gate, going through security, chasing luggage, time zone changes, flight delays, uncomfortable seating, etc.).

Be sure to get plenty of extra rest before and during your trip and be aware that traveling by air increases your risk of blood clots. It is important to stand and stretch every 1-2 hours. Booking an aisle seat will help allow you to do this more comfortably. Always wear your seat belt while seated in case of turbulence and remember to stay hydrated by drinking plenty of water.

Similar to air travel, extended road trips will also require you to stop and stretch every 2-3 hours to reduce the risk of developing blood clots. Also wear your seat belt and bring extra fluids to drink.

If you plan on traveling internationally, make every effort to do this early on in your pregnancy. Check with your travel agent about any illnesses, outbreaks, or epidemic reports coming from the countries you’re planning to visit and what vaccines are necessary when traveling to those destinations.

Ideally, vaccines should be given before you become pregnant, however your doctor can discuss with you the risks of a disease vs. the risk of each vaccine required.

Due to the possibility of contracting the Zika virus, travel to Mexico, South America, or the Caribbean is not recommended. There are no known vaccines against the Zika virus.

It is important to check the limitations of your health insurance, since many insurance plans have restrictions for coverage of medical costs incurred out of state.


 

Maternity Leave Forms

If your employer has more than 50 employees and/or you have short term disability coverage through your company to use for maternity leave, you will need to obtain your FMLA (Family Medical Leave Act) and/or short term disability enrollment forms from your company’s HR department 2 months prior to your expected delivery date and bring them with you to your 32 week appointment.

Our staff will complete the forms for you, as a courtesy, based on the information contained within your medical record. We will not be able to accommodate requests which cannot be substantiated without the proper medical documentation, so please be sure to report any days you have taken off from work due to illness or pregnancy related issues to our office as soon as possible so we can record the episode in your chart.

Forms will be completed and returned within 2 weeks of the date they are turned received in our office. All forms are completed on a first come, first service basis, so please be sure to plan ahead. We cannot accommodate last minute requests in consideration to those who have submitted their forms in advance.

We will complete one (1) set of disability forms and (1) set of FMLA forms complimentary. Fees will apply for duplicate and multiple requests.


 

Prenatal Classes

Prenatal labor classes are offered at Camelback Women’s Health as well as the hospital where you are planning to deliver your baby.

Typically, classes are conducted once a week for three weeks and cover a variety of different topics which will be important for you to know, such as infant CPR and newborn care. We recommend you completing your classes before your 36th week of pregnancy.

First time mothers and fathers are strongly encouraged to attend these classes to learn more about labor and what to expect in the hospital. Single refresher classes are available for parents who feel that an update on labor would be useful.

Classes provide an excellent opportunity to ask questions and learn more about the process of labor in a comfortable and informal setting. Relaxation and breathing techniques are reviewed and a film is shown with both natural childbirth and Cesarean sections. It’s a great way to meet other couples who are also eagerly anticipating their new baby and you can bond over similar experiences. You may find the other new parents in your class to be a great support system and valuable resource!

You can read more about the prenatal classes offered at Camelback Women’s Health on our website.

We also recommend scheduling a tour of your hospital to familiarize yourself with where to park, the admissions area, and where labor and delivery is located. The tour guide can help answer any of your questions regarding accommodations and additional services.

You should begin planning how you will get to the hospital when you do go into labor, make arrangements for someone to care for any small children or pets at home, especially if you have to leave for the hospital at a moment’s notice.


 

Labor Pain Relief

Modern obstetrics offers ever-improving options for control of labor pain. We have a common interest in helping you and your baby through labor as safely and as comfortably as possible.

Biofeedback is a very useful concept in approaching labor. This works on the basis that your brain receives pain signals from other parts of the body equally from all other signals, but these signals can be diverted if other signals are being processed first. Put simply: keep your mind doing other things; labor pain will be less noticeable.

Walking, long showers, massage, or even simple activities such as playing cards or doing puzzles can help divert your mind from uncomfortable contractions.

Try to decide which activities will interest you before you go to the hospital and be prepared. Walking slowly around the hospital unit as much as possible will be beneficial during the labor period, or even at home before you leave for the hospital.

We will provide you with options for managing your labor pain when you arrive at the hospital, including natural labor without medication, so please do not take pain medication before you arrive. We do not want there to be a possibility of negative drug interactions.

If you would like medication or an epidural, please ask your nurse. Timing of medication administration is extremely important when avoiding complications or slowing down your labor. We have no set dilation requirements for receiving an epidural or a cutoff when you cannot receive one. The nurses will refer to the orders and instructions we have left for them.

Epidurals are extremely safe and do not cause long-term back problems despite some reports. The risks of epidurals include: drops in blood pressure, which can be managed with fluids and medication; soreness around the epidural site for up to a week; and spinal headaches, which also can be managed with medication and added bed rest. These problems are very rare. We encourage women to get an epidural if the labor is long or difficult. Frequently, epidurals can hasten delivery by allowing you to relax and get your much needed rest.

Once you receive an epidural, you cannot get up or walk. A catheter may be placed in your bladder to prevent your bladder from becoming distended by allowing it to empty freely. Your legs and lower abdomen will lose sensation and it will be difficult to move. Complete sensation returns 2-3 hours after the epidural catheter is removed.

After delivery, oral pain relief medications will be offered. Ibuprofen or Tylenol will be adequate for most patients, but other medications including Tylenol #3, Vicodin, or Percocet are available, if necessary. Menstrual-type cramping after delivery usually lasts 3-5 days. Episiotomy discomfort is significantly better within a few days.


 

Do I Need A Cesarean Section?

The statistics both nationally and at our local hospitals for a Cesarean section is 15-20% for first time mothers. This rate goes up to 20-25% for patients having a repeat cesarean section. The risk for cesarean in a patient who has had a previous vaginal delivery is closer to 5-10%.

The three most common reasons for a first Cesarean section are:

  • Baby is having difficulty getting through the birth canal
  • Baby is in breech position (baby’s buttocks are coming first)
  • Baby is showing signs of not tolerating the labor (decrease in the heart rate)

There are numerous less common reasons for Cesarean sections, but the most common reason overall is a previous C-section.

Cesarean section is the most common surgical procedure in the United States and the risks associated with this procedure are quite low. Nonetheless, there are risks with any type of surgery and the risks of C-sections are no different. These risks include bleeding, infection, damage to internal organs and the risks of anesthesia. The risk of blood transfusion is below 3% and only would be done in cases where serious blood loss occurs.

Most often, Cesarean sections are done with an epidural or spinal anesthesia so you can be awake when your baby arrives. The baby’s father or family member can be in the room to share this experience with you. It is very rare that a patient is given general anesthesia for C-sections.

After a C-section, most patients stay in the hospital 2-3 days. You will be allowed to have clear liquids after your surgery and we ask that you begin walking in the halls 12 hours after your surgery. The incision is most often a bikini-line type of incision which heals very quickly and is cosmetically quite concealed.

Scheduled repeat C-sections are performed under spinal anesthesia, which allows for excellent pain relief for up to 24 hours, although other sensations and the ability to ambulate can return 2-3 hours afterwards.

Will I Need A Repeat C-Section?

If you would like to experience a vaginal delivery after having a previous C-section, we will discuss this with you at your 36 week visit. For most women, it is possible to have a successful VBAC (vaginal birth after C-section), but we will need to carefully review the likelihood of you needing to have another Cesarean section after we determine your baby’s size and the results of your cervical exam. We will also discuss with you the possible risks and complications associated with a VBAC.

You will be required to sign an informed consent if you wish to pursue a VBAC based on our conversation with you. We do not want to have you go through a difficult labor if the chances of you needing a C-section are too great, but this can occur. The most important thing is to make sure you and your baby are healthy.

The American College of Obstetrics and Gynecology (ACOG) has written very strict guidelines which require your obstetrician be able to perform a repeat Cesarean section quickly if you have had a C-section in the past. For this reason, any patient in our practice considering a VBAC are delivered at a facility where doctors are available in-house (residents or hospitalists) 24 hours a day, to care for you until we arrive.

The risk of uterine rupture in patients with a previous Cesarean section is quoted to be between 2-5%. Most often, signs of this occurring can be recognized before serious consequences occur. The most serious risks of a VBAC include injury or even death to the mother or the baby.


 

Episiotomies

Not every patient will require an episiotomy since each patient and each labor is different.

The chance of getting a tear or requiring an episiotomy depends on the number of children a patient has had in the past, the size of the baby, the size of the mother, and the duration of the labor. Most mothers who have had a baby before will not need an episiotomy, however, it is possible some tearing will occur and some tears can be serious enough to require suturing.

A great deal of controversy surrounds episiotomies in a first labor. It is not our policy to do routine episiotomies, however, in emergent situations and to help facilitate a safe delivery of the newborn; we will proceed with as small an episiotomy as needed. Otherwise, we prefer the perineum to tear slightly and naturally on its own.

Pain after a tear or episiotomy is usually well controlled with Ibuprofen or Tylenol. Topical anesthetic sprays are helpful to relief discomfort. Ice is recommended for most mothers for the first 6 hours after delivery. Showers and sitz baths can also offer comfort, but the use of a peri-bottle to keep the area clean and prevent an infection is highly recommended.


 

When To Call The Pediatrician?

Most pediatric offices have an office orientation session for new parents once or twice a month. If they don’t, ask their office what their policy is on meeting a pediatrician before delivery.

If you are first time parents and do not have a pediatrician yet, ask one of our doctors for recommendations of a pediatrician near your home. It will be very helpful for you to bring your insurance booklet so we can help you find a pediatrician who is on your insurance plan

Frequently, pediatric visits are needed on short notice for colds and flus and it is helpful to choose a pediatrician near your home.

Another suggestion would be to ask neighbors with children or nurses in the pediatric wards of local hospitals, who a recommended pediatrician may be. A list of pediatricians we are familiar with or have been recommended by other patients is available on our web site.

The hospital will take care of all contacts with your pediatrician. If your pediatrician does not come to the hospital where you are delivering, there is a set of on-call pediatricians for the hospital who will cover and care for your newborn. Hospital records can be forwarded to the pediatrician you’ve chosen after you go home.

Most babies are able to go home on day 1 or day 2 after delivery. The exception would be for babies of mothers who tested positive for Group B Strep and did not receive two doses of antibiotics before delivery. An extra day in hospital is usually recommended and is only precautionary- this of course, would be at the pediatrician’s discretion.

If you’re having a boy and considering a circumcision, the pediatrician will often do this on the day of discharge, but it’s also very common for this to be done in the pediatrician’s office.

A follow-up appointment with your pediatrician is recommended within 2-7 days of taking the baby home.


 

Labor: When To Go To The Hospital And What To Bring

The last few weeks prior to your labor can be the most exciting and the most anxious time in your pregnancy.

Despite all the aches, pains and emotions that occur during the last weeks of pregnancy, try to enjoy this time; pamper yourself as much as possible and reflect on the extraordinary changes your body has gone through to grow that little miracle of a human being inside you.

Your visits will be weekly with your doctor after 36 weeks, so you should have plenty of opportunity to ask questions or discuss your concerns or feelings about labor and delivery during these visits.

Your baby’s father should plan on attending the visit at 36 weeks when labor will be reviewed. We will discuss when to call us, our approach to labor management and try to accommodate your special requests. We will also discuss the pain management options available to you. Our office will generally check for cervical dilation starting at 36 weeks, at which point we will be able to give you an idea about how close to delivery you are.

In general, try to approach your labor with a very open mind. Breathing techniques, walking in the halls, showers and other relaxation methods are all intended to keep your focus on the short term goal of remaining as comfortable and in control as possible while still keeping in focus on the main objective of a safe and healthy delivery.

You should begin timing the intervals of any contractions when they start. If your contractions are regular, patterned, lasting more than 40 seconds and you are unable to walk or talk through the discomfort, call our office right away. We will also need you to call right away if your water breaks first, which occurs in about 20% of all pregnancies.

By this time, your doctor should have spoken with you about your particular pregnancy, and about what the frequency of your contractions should be before you leave for the hospital. It will also be important to discuss with your doctor if it will be possible for anyone other than the baby’s father or labor coach will be able to attend the actual delivery.

You should have a small bag ready to go with:

  • Your ID for hospital registration & insurance card(s)
  • Comfortable robe and slippers
  • Personal items
    • Toothbrush and toothpaste
    • Deodorant
    • Hair brush
    • Hair ties
  • Phone chargers
  • Cameras/batteries (it may be possible to record the first minutes after your child’s birth, in most circumstances)
  • A set of cards, puzzles, books, tablet/iPad, or magazines to help keep you distracted from discomfort
  • Comfortable clothing to wear home
  • One set of clothes for your baby to be photographed and go home in
  • A car seat (it will be mandatory to have this in order to take your baby home)

Plan on leaving jewelry and other valuable items at home.

Formula, diapers, and sanitary pads will be provided by the hospital.


 

One Last Thing

The anticipation of labor can be very exciting, but sometimes frightening. Friends, neighbors and even strangers seem to relate their labor stories to pregnant women- sometimes good and sometimes bad. Please do not let these stories scare you.

Every labor and every pregnancy is different. It’s far more likely that your labor will be much more different than anyone else’s than it will be the same.

What is certain is that your labor experience will be unique. There are risks to childbirth and we have chosen to work at hospitals that provide the very best in obstetric care.

Our goal as your doctor will be to guide you through the process as comfortably and safely as possible. Please ask questions both before your labor and at any time during the labor. Both our doctors and your labor nurse are there to help you throughout your labor experience.

Remember to discuss any special labor and delivery requests with us at your 36-week visit and let us know of any particular worries. If you know what to expect, labor can be much more tolerable and comfortable.

Try to get to bed early during the last month of your pregnancy since labors tend to start at night. Women who are well rested tend to have easier birthing experiences.

Cherish this experience as much as possible because this very unique time of your life will soon be over forever… and then your next chapter, holding your new baby in your arms, will begin.

…Thank you for allowing us to be a part of your special journey.

 

After Delivery

Please be sure to schedule your post-partum exam 6 weeks after your delivery.

At that time, an exam will be performed to make sure your body is recovering normally from the pregnancy and delivery. We will also perform a Pap smear at this visit, which will count as your annual wellness check-up.

If you had a C-Section, you will be asked to return to the office sooner for us to check your incision to make sure it is healing normally.

During this post-partum visit, we will discuss the options available to you for birth control. Because it possible to get pregnant again during this time, we strongly advise that you refrain from intercourse until you are seen. It is very important to allow your body this time to heal completely.

If you experience any of the following problems before your 6 week post-partum visit, please call us right away:

  •  Bleeding heavier than a normal menstrual period
  •  Discharge, pain or redness that doesn’t go away or gets worse – either vaginally or from your C-section scar
  •  Feelings of sadness lasting longer than 10 days after giving birth
  •  Fever higher than 100.5°F
  •  Pain or burning with urination
  •  Pain, swelling and tenderness in your legs, especially around your calves
  •  Red streaks or painful lumps in your breast
  •  Severe pain in your lower belly, feeling sick to your stomach or throwing up
  •  Vaginal discharge/odors

People choose Camelback Women’s Health because of our experienced staff and elite services! If you want to choose us, call 602-494-5050 or 602-468-3912 now to make an appointment with us. You can also request an appointment online. Camelback Women’s Health focuses on providing the highest quality care for women of every stage in life.

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