Prenatal Guide This booklet will serve as a basic reference for you and your partner. It is not intended to replace the most valuable source of information, your physician. A GUIDE FOR THE EXPECTANT MOTHER The goal of prenatal care, the reason that you have chose to come to a physician for your care, is to have a healthy baby and mom. We will strive to make your pregnancy and birth experience as meaningful and as pleasant as possible. The next nine months are going to be a joyous time in your life, a time of new experiences and adventures. Hopefully, you will learn a few things about your body and pregnancy will affect it. Our job is to make all of this possible, so please ask questions at any time about any concerns that you may have. A GUIDE FOR THE EXPECTANT FATHER As the father of the baby you have an important role also. You are there to provide support through all the stages of the pregnancy. Women with supportive partners have fewer health problems and more positive feelings in regards to their changing bodies. Also labor and delivery is easier and shorter for women whose partner takes an active role. Please feel free to ask questions and attend appointments. PRENATAL TESTS During the pregnancy, you will be offered many types of medical tests. Some are mandatory (test for syphilis) and others are optional (triple screen). However, all of these tests are offered because they provide valuable information. Be careful when talking with others about whether or not to have tests. There is a lot of misinformation out there about these tests. At the first visit, you will have a complete history and physical exam, Pap smear, cultures taken, blood work and often an ultrasound. Each of these tests is described. 1. Pap smear. The Pap smear is a screening test that is used to detect any conditions of the cervix that may increase a woman’s chance of getting cancer of the cervix. If the Pap smear is abnormal, a diagnostic test will be performed. This test is called colposcopy. Colposcopy is a procedure where the physician looks at the cervix with a powerful pair of binoculars. Any abnormal conditions of the cervix can be diagnosed this way. 2. Cultures. Cultures for chlamydia and gonorrhea will be taken. Ohio law requires this test to be done. The presence of these sexually transmitted diseases can cause pregnancy complications. You will be called with the results, either positive or negative. 3. Blood type. Blood type is tested on every prenatal patient. Women who are Rh negative will receive rhogam at 28 weeks gestation. 4. Rubella immunity. Women who are not immune to rubella will be vaccinated after delivery. 5. Hepatitis B. Women who have Hepatitis B or have been exposed to Hepatitis B can be detected by a blood test. This viral infection can be passed on to the newborn, so it is checked for in every pregnant woman. The virus is transmitted through sexual contact, blood transfusion, and occupational exposure (health care workers). 6. Syphilis. This is a sexually transmitted disease that can be passed on to the baby and should be treated when present. 7. HIV. This is an optional test. No one can make you take an HIV test (Federal Law), but it is highly recommended that every pregnant woman take the test. HIV transmission to the baby occurs about 28% of the time in the untreated woman. Women who receive good prenatal care, take HIV medicine and have an elective C-section have about a 3% chance of transmission. 8. Urine culture. Bladder infections are common in pregnancy and are checked for at the first visit. 9. Ultrasound. Finally, an ultrasound is done to determine if everything is starting out well with the pregnancy. A due date can usually be given at the conclusion of the first exam. Proper dating of the pregnancy is very important. Only your physician can give or change your due date, no one else. In the second trimester an ultrasound can help us find anatomic problems with the baby. In the third trimester, ultrasound can be used to help reassure us that the baby is not getting sick. DIET During pregnancy you need only about 300 more calories per day. You do NOT have to "eat for two". Your diet should be high in fruits, vegetables, and whole grain foods. Your diet should be low in fats and added sugars. Folic acid in your diet can help reduce the risk of neural tube defects such as spina bifida. Folic acid can be found in such foods as leafy, dark green vegetables; citrus fruits; beans, bread and cereals. Vitamin supplements should be taken as directed by your physician. You should drink six to eight glasses of water a day. Caffeine in large amounts has been shown to be harmful in experimental models. Based on this data, we recommend avoidance of caffeine containing products. Six mini meals may be preferable to eating three large meals. This is especially helpful if morning sickness is a problem. During this time eat whatever appeals to you. Carbohydrates such as toast, baked potatoes, and saltine crackers are usually best tolerated. Twenty-five pounds is an average weight gain. However, women who begin the pregnancy underweight should gain more, and women who are heavy should gain less. STAGES OF PREGNANCY Early pregnancy (up to 14 weeks) At the beginning of the pregnancy most women will experience fatigue, frequent urination, sore breasts, and morning sickness. Sudden mood changes are also common. These symptoms will lessen as the pregnancy progresses. The physician will be able to hear the baby’s heartbeat at about 12 weeks with a special instrument called a Doppler. Middle pregnancy (14 to 28 weeks) Around 18 weeks gestation you should begin to feel the baby move. It will be a "flutter" felt low midpubic area. As the baby grows your body will grow and stretch to accommodate the baby. Some cramping, and mild discomfort is normal. Round ligament pain is a pain felt in your lower abdomen and groin area caused by the ligaments supporting the uterus stretching. While causing discomfort it is not harmful and you may take Tylenol for the discomfort. It is now time to register for childbirth classes. During the second trimester there are other prenatal tests you must undergo. 1. Triple screen test (AFP). A screening test is something that can be given to a large low risk population of people that will try to separate high risk from low risk people. A triple screen (MSAFP, alpha fetal protein) is such a test. The purpose of the test is to try to identify women who are at higher than average risk of carrying a baby with specific types of birth defects. These birth defects include, spina bifida, Down’s syndrome, and Trisomy 18 to name a few. The test is not diagnostic of anything. It is only used to identify women we need to take a closer look at. If a woman’s chance of having a baby with a birth defect based on her age alone is 1 in 100, then the test will be reported as abnormal. However, this woman’s risk of having an abnormal baby is only 1%. There is a 99% chance that the baby is normal. 2. Sugar test. Gestational diabetes or sugar intolerance during pregnancy is a problem that affects 5% of pregnancies. In order to diagnose this problem, the pregnant woman is given a sugar test. She drinks 50 grams of a special soda and has her blood sugar checked 1 hour later. If the test is abnormal, then she needs another sugar test. The second test takes three hours. Gestational diabetes can be a major problem during pregnancy, especially if left undiagnosed. 3. Hemoglobin. A blood count is done to determine if anemia is present. Many women become anemic during pregnancy and require iron supplementation. 4. Rhogam. Women with a negative blood type should receive a Rhogam injection during this time. This will prevent the development of antibodies that may complicate future pregnancies. Late pregnancy (29-42 weeks) During this stage of pregnancy comfortable positions are limited due to your changing body shape and size. Sleeping may require placing pillows under your abdomen for support and behind your back. Braxton Hicks contractions begin. These are also known as false labor. It is your body preparing for labor. These contractions are irregular and are intermittent. There is one more prenatal test you must undergo before delivery. 1. Group B Strep. Late in the pregnancy, a culture for a common bacteria will be taken from the vagina and rectum. Group B strep is found in the vagina of 20% of all women. However, it can cause an infection in the baby during labor. Less than 1% of all babies born in the United States have an infection caused by Group B strep. So, we can culture all women and determine which to treat. If your culture is positive for Group B strep, then you will receive antibiotics in labor to prevent your baby from getting an infection. Preparing for delivery Natural childbirth or vaginal delivery is the most common type of delivery. It may be augmented with a medication known as Pitocin to stimulate contractions. There are different types of pain control available to you during labor. You may to choose to have medication given intramuscularly or intravenously. You may choose to have an epidural. This is where an anesthesiologist places a catheter in a space in your back. The medication is then given via this catheter. You are numb from the waist down. Relaxation techniques can be used alone or with any choice of medications. Prior to labor you and your partner should talk with your physician to develop a plan that best suits you. Sometimes it is necessary to do a cesarean section also known as c-section. This may be done if labor fails to progress, there is any concern for the health of the baby or the mother, or the baby is in breech position. If there is a history of a prior c-section you may elect to have another c-section or sometimes it is possible to have a VBAC (Vaginal Birth After Cesarean). Before it is actually time to deliver, you should consider the following: how far is it to the hospital, who is going to be available to take you to the hospital, and if you have other children who is going to watch them. You may have periods of false labor called Braxton Hicks contractions. It can be difficult to tell true labor from false labor. You may notice them more at the end of the day. One good way to tell the difference is to time your contractions for one hour. Usually, false contractions are less regular and not as strong as true labor. Contractions may even stop when you walk or change position. True labor will come at regular intervals, continue to increase in intensity and will not be altered by walking or change in position. False labor usually will be felt in the abdomen only. True labor usually starts in the back and moves to the front. Labor is different for each pregnancy. Sometimes, the only way to be sure is for the doctor to do a vaginal exam to evaluate the cervix for any changes. As labor begins the cervix opens or dilates. If ever you have any question about being in labor you should call Dr. DeSalvo immediately or for any of the following labor precautions. Labor Precautions 1. Bright red vaginal bleeding 2. Your water breaks or is leaking 3. Contractions are 5 minutes apart for one hour 4. Fetal movement is less than 5 movements in one hour of counting 5. Severe headache 6. Temperature above 100 degrees F 7. Sudden severe swelling of your hands and face 8. Any visual changes, for example, spots before your eyes. Post term pregnancy A normal human pregnancy lasts anywhere from 37 to 42 weeks. Your due date is based on 40 weeks gestation. Once your pregnancy goes past its due date, then we start thinking about delivery. Most pregnancies can safely continue with appropriate testing until 42 weeks. However, there are some clinical situations where you should not go to far past your due date. There are some simple tests done to determine this. A biophysical profile (BPP) is a very good test to help us determine if the baby is getting sick. Depending on the circumstances, this test may be done several times late in the pregnancy. A BPP looks at the amount of fluid around the baby, if the baby is moving and breathing. If all of these things are normal, then we are reassured that the baby is not getting sick. Sometimes, a non stress test is ordered. This is the most common test to check for fetal well being in the United States. This is done by hooking the mom up to a baby monitor and recording the baby’s heartbeat for 20 to 30 minutes. This is a very useful screening test. But if this test is not normal, then usually a BPP is done. If the BPP is normal then the baby is healthy. Post partum You will be discharged from the hospital in 24 to 48 hours after a vaginal delivery or 3 to 4 days after a c-section. After you are discharged you need to call the office to schedule an appointment for 6 weeks. You can expect to have some bleeding for up to 6 weeks. It should gradually decrease over this time. Your most important job during this time is to get plenty of rest and take care of your baby. Do not try to do too much to soon. You should refrain from sexual intercourse, using tampons, or douching for 6 weeks. Walking daily is all right but do not resume exercise until after your 6-week exam. Due to hormonal changes some women experience post partum blues or baby blues. In fact 70-80% of women have baby blues after childbirth. About 2-3 days after birth, they begin to feel sadness, fear, anger and anxiety. This is normal. The baby blues generally go away in 1 to 2 weeks without treatment. About 10% of women will experience post partum depression. These symptoms are more intense and last longer. A woman should suspect post partum depression if the baby blues don’t go away after 2 weeks, strong feelings of depression and anger come 1-2 months after delivery, she is not able to care for herself or the baby, or she fears harming herself or the baby. Post partum depression is likely to result from body, mind, and lifestyle factors combined. Many new mothers are surprised at how weak, alone, and upset they feel after giving birth. Their feelings don’t seem to match the feelings they thought they would have. Women who have an idea of the "perfect mother" are more likely to feel let down and depressed when faced with the needs of day-to-day mothering. Three myths about being a mother are common: 1. Myth #1: Motherhood is instinctive. First-time mothers often believe that they should just know how to care for a newborn. In fact, new mothers need to learn mothering skills just as they learn any other life skill. It takes time and patience. Mothers may also believe that they must feel a certain way toward their newborn or they are not "maternal." Bonding often takes days or even weeks. 2. Myth #2: The perfect baby. Most women have preconceived ideas about what the baby is going to be look like and act like. When the baby arrives, it may not match the baby of their dreams. Also, babies have distinct personalities right from birth. Some are easier to care for than others. A new mother may find it hard to adjust to the baby. 3. Myth #3: The perfect mother. A mother may think she is not living up to the ideal. Of course, no mother is perfect. Most women have trouble finding a balance between caring for a new baby, keeping up with household duties, other children, and a job. They often feel this way even with a lot of support. There are some things you can do to help relieve these symptoms. The first is to disregard these myths. You are who you are. Next you need to get plenty of rest. Don’t try to do it all yourself. You may have just become a mother but you are still a woman, take special care of yourself. You also need to spend time alone with your partner. If these feelings do not lessen after 2 weeks or you feel you just can’t cope Call Dr. DeSalvo immediately (330-856-7212).