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Am I in Labor?
This is a question that we often hear and one that concerns most of our pregnant patients.
Will I know if I am in labor?
How do I know if this is real labor or false labor?
How do I know if my water breaks?
While no labor follows an exact pattern, here are some suggestions of when to go to the hospital:
During labor, we will follow your lead in regard to administering medication for discomfort or epidural anesthesia, both of which are easily available at Missouri Baptist Hospital. For any of the above signs and symptoms, go to Labor and Delivery at Missouri Baptist Hospital, located on the 3rd floor of Building D.
You have been scheduled for a C-section at Missouri Baptist Medical Center.
Nothing to eat or drink after midnight before your C-Section. (Gatorade/Powerade/Water allowed up to three (3) hours prior to c-section.)
If your C-section is later in the day, you must fast for at least 8 hours prior.
Arrive at the HOSPITAL two (2) hours early. Please call Labor and Delivery at 314-996-7514 to CONFIRM YOUR arrival time before you leave.
Go to Labor and Delivery in Building D on the 3rd floor.
If you have any questions, please do not hesitate to call us at 314-432-3669.
Circumcision is the elective surgical removal of the foreskin of the penis.
How is it done?
Your obstetrician will perform the circumcision before the BABY leaves the hospital, usually one to two days after birth.
Your obstetrician will numb the penis with local anesthesia before the procedure starts. The numbing medicine may be injected at the base of the penis, or applied as a cream.
There are a variety of ways to perform a circumcision. Most commonly, the foreskin is pushed from the head of the penis and clamped with a metal clamp or ring-likeDEVICE. The foreskin is cut off and the metal device is removed. The wound heals in 5-7 days.
The baby may be given a sweetened pacifier during the procedure. Tylenol (acetaminophen) may be given afterward.
Why the Procedure is Performed
Circumcision is performed in healthy boys for cultural or religious reasons. In the United States, a newborn boy is usually circumcised before he leaves the hospital. Jewish boys, however, are circumcised when they are 8 days old.
In other parts of the world, including Europe, Asia, and South and Central America, circumcision is rare in the general population.
The merits of circumcision have been debated. Opinions about the need for circumcision in healthy boys vary among health care providers. Some believe there is great value to having an intact foreskin, such as allowing for a more natural sexual response during adulthood.
Rather than routinely recommending circumcision for healthy boys, many health care providers allow the parents to make the decision after presenting them with the pros and cons.
Risks related to circumcision:
Risks related to uncircumcised male infants:
The overall increased risk for these conditions is thought to be relatively small. Proper hygiene of the penis and safe sexual practices can help prevent many of these conditions. Proper hygiene is always important, but is thought to be especially important for uncircumcised males.
Newer research has suggested that uncircumcised male infants have an increased risk of certain conditions, including:
After the Procedure
Healing time for newborns after circumcision usually is about 1 week. Place petroleum jelly (Vaseline) onto the area after changing the diaper. This helps protect the healing area. Some swelling and yellow crust formation around the site is normal.Outlook (Prognosis)Circumcision is considered a very safe procedure for newborns.
Clomid or Letrozole?
You are starting a medication called Clomid which is designed to stimulate the ovaries to produce eggs in a regular monthly pattern. Your doctor is using this drug because you do not appear to be ovulating regularly. Clomid is considered quite safe for use by most women. It should only be taken as described here and only while your doctor is monitoring your response to the drug. It is very important that you are taking prenatal vitamins or a supplement with at least 400 micrograms, mcg (0.4 milligrams, mg) of folic acid. Most prenatal vitamins have 800 to 1000 mcg.
Clomid is usually prescribed in 50 mg doses to start. Letrozole is usually prescribed in 2.5 mg doses. Sometimes your dose will have to be increased or decreased based on your response. The most worrisome side effect of the drug is an exaggerated response which results in swollen, painful ovaries. This can lead to twisting of the ovary or leakage of fluid from the ovary. Your doctor will monitor you for this. You should also know that patients on Clomid have a twin rate of approximately 10%, almost 5 times the usual rate. The rates of twin pregnancy with Letrozole may be less than with Clomid.
Common Pregnancy Discomfort
Below is a list of Common Pregnancy Discomforts you may experience during your pregnancy. If you experience any of these, we have offered some suggestions for relief of the discomfort.
Nausea and vomiting are very common complaints in early pregnancy, and are related to many factors. They usually improve by the fourteenth week. Because low blood sugar levels can add to their severity, it’s wise to eat frequent small meals, and even to have a snack when (not if) you get up to go to the bathroom in the middle of the night. Avoid greasy, high-fat foods and foods with strong odors. Prenatal vitamins sometimes add to the problem, and if so, please discontinue them until you are feeling better. If you can, try taking at least 800 mcg of Folic acid daily or two childrens chewable vitamins. This usually does not worsen nausea.
To avoid gastric reflux, which is increased in pregnancy, and which causes heartburn, avoid lying down immediately after eating. To decrease the gag reflex, do not brush teeth immediately after eating.
Most pregnant women are appropriately concerned that they eat properly. However, if you are having significant nausea and vomiting, this may be difficult. It is far more important that you eat something than that it be absolutely nutritious. If you can’t keep anything down, your body begins to break itself down to furnish energy. On the other hand, if you can supply outside energy in almost any form, this breakdown can be prevented. Therefore, even food that might be considered less than perfect is much better than throwing up a balanced meal. During the difficult weeks, please eat whatever appeals to you and can stay down.
If the above suggestions do not work, try:
If your nausea is still severe, prescription medicine such as Phenergen or Zofran OR REGLAN may be recommended.
Headaches in pregnancy are quite common, due to many factors. They can occur at any time during the gestation, but are especially prevalent during the thirteenth through nineteenth weeks of pregnancy.
To help decrease headaches, avoid going long periods without eating, dehydration, excessive caffeine, noxious fumes, etc. Analgesics such as Tylenol may be used, but don’t forget simple measures such as cool compresses to the forehead, or resting in a quiet, dark room. You can take up to 1,000 mg of Tylenol (acetaminophen) every 6 hours (Total 4,000 mg in 24 hours). Do not take aspirin or Ibuoprofen (Advil). Relaxation techniques such as warm baths, walks in the fresh air, breathing exercises and massages may be helpful. If you are also experiencing sinus pressure, Mucinex is safe to take in this trimester and a cool humidifier may be helpful. If there is green or yellow nasal discharge in addition, and this is persistent, call the office. If the headache is accompanied by visual changes or neurologic symptoms such as numbness or weakness, please call. If you are prone to migraines, please discuss options for management with one of the providers.
Hemorrhoids are caused by the general increase in blood volume, as well as relaxation of blood vessels throughout the body, and by pressure from the enlarging uterus on veins in the rectum. Constipation and straining most definitely aggravate the problem, and should be avoided. Local application of Tucks pads, Anusol or Preparation H may be helpful. Soaking in a warm tub of water, or applying warm compresses can help relieve symptoms, too. Hemorrhoids usually improve dramatically after delivery.
A sudden and severe increase in pain from hemorrhoids may signal the formation of a blood clot, which although not hazardous, will usually take some time to resolve. Please let us know if this occurs so that we can see you in the office and confirm this disorder for consideration of surgical relief. The best way to manage hemorrhoids is to avoid them. Staying well hydrated, having adequate fiber in your diet and the use of a stool softener can all help prevent the formation of hemorrhoids.
Increased Vaginal Discharge
Most women note an increase vaginal discharge during pregnancy, due to increased estrogen levels. However, if the discharge becomes foul odored, or green or yellow in color, please let us know. If you think you have a yeast infection, Monistat is OK to use. If your symptoms are not improving, you will need to be seen in our office.
“Round Ligament” Pain
Many pregnant women experience sudden, brief pain in their lower abdomen, described as “pulling,” or sharp in nature, usually worse on one side. These often occur with standing up from sitting, rolling over in bed, coughing, sneezing, or other maneuvers which change the direction of stress on the abdominal wall connective tissue. Indeed, despite their name, these “round ligament” pains probably have nothing to do with the round ligaments, which are very loose structures attached to the upper uterus, and which become even softer and stretchier with pregnancy. Instead, these pains can be traced to hormone-induced changes in abdominal wall muscles and ligaments. They represent no hazard to you or the baby, but can be quite uncomfortable. If you have any question about abdominal pain, please let us know.
Shortness of Breath
Shortness of breath is quite common, and is due to hormonal changes causing a perceived “air hunger,” by elevation of the diaphragm by the enlarging uterus, and by several other factors. You will note that you get tired and out of breath more rapidly with exercise, also. However, if you notice a sudden change, or that you have significant difficulty breathing, please call.
Swelling of the Feet and Legs
Some swelling of the lower extremities, especially during the third trimester, is perfectly normal, and by itself causes no problem more hazardous than discomfort. If you are not uncomfortable, no measures need be taken. Elevation of the lower extremities, decreasing salt intake, and increasing fluid intake all seem to help. While swelling is almost always innocent, you should let us know if it becomes severe, or is accompanied by facial swelling, headache, visual changes or nausea. We will need to at least check your blood pressure if these occur. If swelling is one-sided or associated with pain in the deep muscles of the leg, this could be a blood clot. Please call our office to arrange an evaluation.
Varicose veins occur during pregnancy for several reasons, including increased blood volume and relaxation of blood vessels, combined with an inherited tendency to develop them. They are usually not hazardous, but can be quite uncomfortable. Moderate exercise, elevation of the legs, and full-length support hose can help somewhat. Try to avoid standing for long periods of time, crossing your legs at the knee, and constrictive clothing. Please notify us if you have severe calf or leg pain, especially if there is a specific area of tenderness or redness.
Cord Blood Donation
When you’re expecting, you have many decisions to make. So if you’ve heard about banking umbilical cord blood, you might be wondering what it involves — and whether it’s right for you and your family.
About Cord-Blood Banking
Cord-blood banking basically means collecting and storing the blood from within the umbilical cord (the part of the placenta that delivers nutrients to a fetus) after a baby is born. Cord blood contains blood-forming stem cells, which are potentially useful for treating diseases that require stem cell transplants (also called bone marrow transplants), such as certain kinds of leukemia or lymphoma, aplastic anemia, severe sickle cell disease, and severe combined immunodeficiency.
There are two types of banks that store cord blood:
Why Cord Blood Is Important
Up until the 1970s, the placenta and umbilical cord were discarded after birth without a second thought. But around this time, researchers discovered that umbilical cord blood could supply the same kinds of blood-forming stem cells as a bone marrow donor. They started collecting and storing umbilical cord blood. What are blood-forming stem cells? These are primitive (early) cells found primarily in the bone marrow that are capable of developing into the three types of mature blood cells present in our blood —red blood cells, white blood cells, and platelets. Cord-blood stem cells may also have the potential to give rise to other cell types in the body.
Some serious illnesses (such as certain childhood cancers, blood diseases, and immune system disorders) require radiation and chemotherapy treatments to kill diseased cells in the body. Unfortunately, these treatments also kill many “good” cells along with the bad, including healthy stem cells that live in the bone marrow. When this happens, some kids can benefit from a stem cell transplant, from a donor whose cells closely match their own. Blood-forming stem cells from the donor are transplanted into the child who is ill, and those cells go on to manufacture new, healthy blood cells and enhance the child’s blood-producing and immune system capability.
How Banking Works
Collection: Cord-blood banking isn’t routine in hospital or home deliveries. It’s a procedure you have to choose and plan for beforehand. Collection of the cord blood takes place shortly after birth in both vaginal and cesarean (C-section) deliveries. It’s done using a specific kit. If you are donating to a public bank, the kits are available on Labor and Delivery. If you are donating privately you will need to order the kit ahead of time from your chosen cord-blood bank.
After birth, the umbilical cord is cut and clamped on one side. To collect blood, a small needle is passed into the umbilical vein and the blood is collected by hanging a bag below the mother and letting gravity draw the blood down through a tube and into the bag. Blood collection can occur either before or after the placenta is delivered.
Storing: After collection, private cord blood is taken by courier to the cord-blood bank. Once there, the sample is given an identifying number. Then the stem cells are separated from the rest of the blood and are stored cryogenically (frozen in liquid nitrogen). How long can blood-forming stem cells last when properly stored? In theory, stem cells should last forever, but cord-blood research only began in the 1970s, so the maximum time for storage and potential usage are still being determined. Blood-forming stem cells that have been stored for more than a decade have been used successfully in transplants.
There is no cost involved when donating cord blood to a public bank. The cost for storing cord blood privately is approximately $1,500, in addition to a yearly maintenance fee (usually around $100). You also might pay an additional fee of several hundred dollars for the cord-blood collection kit, courier service to the cord-blood bank, and initial processing. Transplantation Cryogenic blood-forming stem cells can be thawed and used in either autologous procedures (when someone receives his or her own umbilical cord blood in a transplant) or allogeneic procedures (when a person receives umbilical cord blood donated from someone else — a sibling, close relative, or anonymous donor). In most cases, these transplants are done only with children or young adults. That’s because the volume of a cord-blood donation usually isn’t enough for an adult’s transplant. The larger a person is, the more blood-forming stem cells he or she needs for a successful transplant.
Private Banking Not Widely Recommended
Most medical organizations, including the American Academy of Pediatrics (AAP), recommend public donation of cord blood whenever possible. Currently, they do not recommend privately banking your newborn’s cord blood unless you have a child or family member with a current or potential need for a stem cell transplant. The likelihood of a healthy person ever needing stem cells is rare, and research has never confirmed that self-donated cells (rather than cells from a relative or stranger) make transplantations safer or more effective. Stem cells from cord blood from both related and unrelated donors have been successful in many transplants. That’s because blood-forming stem cells taken from cord blood are naive (a medical term for early cells that are still highly adaptable and are less likely to be rejected by the recipient’s immune system). Therefore, donor cord-blood stem cells do not need to be a perfect match to create a successful stem cell transplant.
There has been little experience with transplanting self-donated cells. Some experts are concerned that an ill baby who receives his or her own stem cells during a transplant would be prone to a repeat of the same disease. Most of the stem cell transplants that use blood-forming stem cells have been performed on relatives of the donating child, not on the donating child.
Is Banking Right for You?
If you are considering banking your newborn’s cord blood, be sure to discuss your options with your obstetrician.
What is Cystic Fibrosis?
Cystic fibrosis is a life-long illness that is usually diagnosed in the first few years of life. The disorder causes problems with breathing and digestion, because of altered mucus production in affected individuals. Cystic fibrosis (CF) does not affect intelligence. The average life expectancy of affected individuals approaches forty years.
How common is cystic fibrosis?
The rate of defective CF genes varies in different groups of people. In Caucasians, one in every twenty-nine individuals is a carrier of a CF mutation, and roughly one in every 3,300 newborns will have cystic fibrosis. In Hispanic populations, the carrier rate is lower, at one in forty six, with about one in 8,000 children being affected. In African-Americans, one in sixty-two are carriers, with a newborn rate of roughly one in 15,000. Among Asian-Americans, one person in ninety is a carrier, and among their newborns, only one in 32,000 will have CF.
How is cystic fibrosis inherited?
For CF to occur, a person has to inherit an altered gene from each parent. If a person inherits one copy of a CF gene with a mistake, that person is a “carrier” for CF, and does not have CF. There are no known health problems associated with being a carrier. To have CF, an individual must inherit a defective CF gene from both carrier parents. If both parents are carriers, there is a one in four chance that any one of their children will have CF.
How can I find out if I carry the gene for cystic fibrosis?
A DNA test on white cells from a blood sample can tell a patient whether they are likely to be a carrier of a defective CF gene. This DNA test looks for the most common defective genes but cannot detect every single abnormal gene. The detection rate for the problem is about 97% in Caucasians, while among other groups it can be as low as 57%. This means that among some ethnic groups with very low rates of being CF carriers, the blood test is only likely to detect this a little more than half the time.
What if the test is positive?
If the initial blood testing returns positive for a defective CF gene, your partner is then tested. If this test returns negative, the likelihood of having an affected child is very low. If the testing should be positive for both the patient and her partner, the likelihood that any child born to them will have cystic fibrosis is one in four. Additional testing during the pregnancy can show whether or not the fetus will have cystic fibrosis.
Diet & Exercise
A woman who is pregnant needs extra protein, calcium and calories.
A woman who is pregnant needs extra protein, calcium and calories.
Foods to limit:
Foods to avoid:
Weight gain is one of the few things about pregnancy that you do have some control over. Normal weight gain in pregnancy (limited to 20-30 pounds over the course of the pregnancy) can help ensure a more normal pregnancy with less risk of obstetric interventions, complications and C-sections. Excessive weight gain (over 35 pounds) increases your risk of preeclampsia, gestational diabetes, larger babies, difficult and longer labor and a higher C-section rate.
If you are overweight before pregnancy, your weight gain goal should be around 10 pounds. Weight gain of greater than 25 pounds if you are overweight increases risk for preeclampsia, gestational diabetes, larger babies, difficult delivery, stillbirth and a higher C-section rate. Excessive weight gain in pregnancy doubles your risk of having a baby larger than 9 pounds and may also increase risk of childhood obesity.
Don’t be discouraged if you weigh more by the end of pregnancy than you ever have in your life. The physiological changes associated with pregnancy (baby, placenta, fluid, increased blood volume) will add up to 15-20 pounds by the end of pregnancy. And don’t be discouraged if you see your weight going up faster than it ought to. We are happy to work with you to try and slow the weight gain and may refer you to a nutritionist to help with that. We don’t want you skipping meals or dieting. The best way to avoid gaining too much is to be conscious of calorie intake. Normal pregnancy calorie goals are an additional 100-300 kcal/day. This works out to about a pound a week in the second and third trimester.If you are pregnant with twins, weight gain goals are approximately 35-45 pounds if your pre-pregnancy weight is in a normal range. This works out to about an extra 600 kcal/day.
Adequate exercise in pregnancy is helpful, both physically and mentally. Some forms of exercise are discouraged for obvious safety reasons (no water skiing, jumping horses, kick boxing, etc.), and others for comfort; but in general, moderately vigorous exercise can and should be continued during pregnancy. You should take care not to overheat and to stay well-hydrated during exercise. Avoid saunas and hot tubs. There may be times when you will be asked to forego exercise for other reasons during your pregnancy.
If you were not exercising regularly before pregnancy, you can still be active with walking. Please talk to a provider before beginning any new exercise regimen in pregnancy.
Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy are said to have gestational diabetes. It is estimated that gestational diabetes affects 20% of pregnancies.
How gestational diabetes can affect your baby
However, untreated or poorly controlled gestational diabetes can hurt your baby. When you have gestational diabetes, your pancreas works overtime to produce insulin, but the insulin does not lower your blood glucose levels. Although insulin does not cross the placenta, glucose and other nutrients do. So extra blood glucose goes through the placenta, giving the baby high blood glucose levels. This causes the baby’s pancreas to make extra insulin to get rid of the blood glucose. Since the baby is getting more energy than it needs to grow and develop, the extra energy is stored as fat.
This can lead to macrosomia, or a “fat” baby. Babies with macrosomia face health problems of their own, including damage to their shoulders during birth. Because of the extra insulin made by the baby’s pancreas, newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems. Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes.
Diabetes can also cause increased risk of birth defects such as heart, kidney or spine defects; these occur most often in women who were diabetic prior to pregnancy. Hydramnios or too much fluid around the baby may occur, which can lead to preterm delivery. Respiratory distress syndrome can make it harder for baby to breathe after birth; this risk is more common in babies of mothers with diabetes.
Because gestational diabetes can hurt you and your baby, you need to start treatment quickly. Treatment for gestational diabetes aims to keep blood glucose levels equal to those of pregnant women who don’t have gestational diabetes. Treatment for gestational diabetes always includes special meal plans and scheduled physical activity. You will meet with the diabetic educator and nutritionist to come up with a meal and exercise plan. Your treatment will also include daily blood glucose testing.
If you’re testing your blood glucose, the American Diabetes Association suggests the following targets for women who develop gestational diabetes during pregnancy. More or less stringent glycemic goals may be appropriate for each individual.
You will need help from your doctor, nurse educator, and other members of your health care team so that your treatment for gestational diabetes can be changed as needed. For you as the mother-to-be, treatment for gestational diabetes helps lower the risk of a cesarean section birth that very large babies may require.
Keeping worry in perspective
While gestational diabetes is a cause for concern, the good news is that you and your health care team – your doctor, obstetrician, nurse educator, and dietitian – work together to lower your high blood glucose levels. And with this help, you can turn your concern into a healthy pregnancy for you, and a healthy start for your baby.
Gestational diabetes – Looking ahead
Gestational diabetes usually goes away after pregnancy. But once you’ve had gestational diabetes, your chances are 2 in 3 that it will return in future pregnancies. In a few women, however, pregnancy uncovers type 1 or type 2 diabetes. It is hard to tell whether these women have gestational diabetes or have just started showing their diabetes during pregnancy. These women will need to continue diabetes treatment after pregnancy.
Many women who have gestational diabetes go on to develop type 2 diabetes years later. There seems to be a link between the tendency to have gestational diabetes and type 2 diabetes. Gestational diabetes and type 2 diabetes both involve insulin resistance. Certain basic lifestyle changes may help prevent diabetes after gestational diabetes.
High Blood Pressure
Your blood pressure reading is given as two numbers: the top (first) number is the pressure when your heart contracts and the bottom (second) number is the pressure when your heart relaxes. A healthy blood pressure is 110/80. High blood pressure happens when the top number is 140 or greater, or when the bottom number is 90 or greater.
High blood pressure can stress your heart and cause problems during pregnancy. Some women have high blood pressure before they get pregnant. Others have high blood pressure for the first time during pregnancy. About 8 in 100 women (8 percent) have some kind of high blood pressure during pregnancy.
What kinds of high blood pressure can happen during pregnancy and how are they treated?
There are four main kinds of high blood pressure during pregnancy:
This is high blood pressure you already have before you get pregnant or that develops before 20 weeks of pregnancy. It doesn’t go away once you give birth. During pregnancy, your health care provider will make sure your blood pressure is normal. Your provider may use ultrasound and fetal heart rate testing to check your baby’s growth and health. You may need to give birth early if your hypertension gets worse or if you go on to have preeclampsia.
This is a high blood pressure that only pregnant women can get. It happens when you have both high blood pressure and protein in your urine. It usually starts after 20 weeks of pregnancy and goes away after you give birth. Preeclampsia can be a serious medical condition. In rare cases, it can become a life-threatening condition called eclampsia. Eclampsia causes seizures and can lead to coma. Even if you have mild preeclampsia, you need treatment to make sure it doesn’t get worse. Without treatment, preeclampsia can cause kidney, liver and brain damage. Treatment depends on how severe your preeclampsia is. Treatment can range from careful monitoring by your provider to inducing labor.
This is high blood pressure that only pregnant women can get. Unlike preeclampsia, women with gestational hypertension don’t have protein in their urine. This condition starts after 20 weeks of pregnancy and goes away after you give birth. Some women with gestational hypertension have preeclampsia later in pregnancy. We don’t know how to prevent gestational hypertension. But if you’re overweight or obese, reaching a healthy weight before pregnancy may lower your chances of having this condition. During pregnancy, your provider checks your blood pressure and urine at every prenatal visit to monitor your hypertension. She may use ultrasound and fetal heart rate testing to check your baby’s growth and health.
Chronic Hypertension with Preeclampsia
About 1 in 4 women with chronic hypertension (25 percent) have preeclampsia later in her pregnancy. During pregnancy, your provider monitors your condition at every prenatal visit. She may use ultrasound and fetal heart rate testing to check your baby’s development.
What pregnancy complications can high blood pressure cause?
If you have high blood pressure during pregnancy, your provider can help you manage most health problems through regular prenatal care. Pregnant women with high blood pressure are more likely than women without high blood pressure to have these complications:
This is when a baby weighs less than 5 pounds, 8 ounces. High blood pressure can narrow blood vessels in the uterus (womb). Your baby may not get enough oxygen and nutrients, causing him to grow slowly.
This is birth that happens too early, before 37 completed weeks of pregnancy. Even with treatment, a pregnant woman with severe high blood pressure or preeclampsia may need to give birth early to avoid serious health problems for her and her baby.
In this condition the placenta separates from the wall of the uterus before birth. It can separate partially or completely. If this happens, your baby may not get enough oxygen and nutrients. Vaginal bleeding is the most common symptom of placental abruption after 20 weeks of pregnancy. If you have vaginal bleeding during pregnancy, contact your health care provider immediately.
How is high blood pressure diagnosed during pregnancy?
Most women with high blood pressure during pregnancy have no symptoms. Some warning signs may include a sudden large weight gain, sudden onset of face or hand swelling, severe constant headache not relieved by Tylenol, blurry vision, or pain in the upper abdomen. It’s important to go to all your prenatal care visits. Your provider measures your blood pressure and checks your urine for protein at every visit. If you have high blood pressure, your provider can help you manage it.
Induction of Labor Instructions
Is it safe to...during pregnancy?
Below are commonly asked questions we hear from our patients. We have compiled this list to help you, but if you don’t see your concern or question listed below, please don’t hesitate to call our office or ask the provider at your next OB visit. Regarding exercise is acceptable to continue any exercise you were doing prior to conceiving unless you see it listed below.
These are safe during pregnancy:
These are safe BEFORE 20 weeks of pregnancy:
These are safe with limitations:
Medications Safe in Pregnancy
For Colds and Flu:
Call the office for a prescription if: You have a fever over 101, coughing up green phlegm, especially if you don’t feel better in 2-3 days.
Nausea and Vomiting:
Nose Bleeds or Gum Bleeding:
On Call Coverage
As many of you know, OB is literally a full-time job requiring 24-hour coverage at all times. Much of our on-call time is spent answering questions over the phone and, of course, some of our time is spent delivering beautiful babies. We know that most patients are disappointed when their own doctor cannot deliver their baby. We try very hard to attend all of our patients’ deliveries. When we cannot, we feel very confident that our partner is taking exceptionally good care of our patient and her baby.
We have expanded the number of physicians in our WEEKEND call rotation. We have joined forces with an excellent group of doctors at Healthcare Group for Women. We have very similar practice styles and philosophies. During the week, we will continue to cover the practice ourselves.
In the past, we have been able to attend 85-90% of our own patients’ deliveries. We do not expect to see that number change, even with this call rotation. We will make every effort when we are available but are “off call” to deliver our own patients.
As always, if you have any questions, please call us immediately at (314) 432-3669. Our exchange is (314) 991-3900. We want you to feel comfortable and confident with your care as you always have. We see our role in your pregnancy as a great honor and responsibility. Thank you for allowing us to be part of your baby’s first day.
Post Partum Instructions
Now the hard part’s over, right? We certainly hope that your pregnancy and labor and delivery have gone smoothly, and we offer the following suggestions to help you get through the next several weeks as easily as possible.
Nothing puts a better start to a day than a good night’s rest, and nothing keeps you up more than a newborn. Be a little selfish, and try to rest when the baby does. Let others help! Remember that they’ll get to sleep while you’re up with the new arrival.
Care of Stitches
If you had an episiotomy or vaginal tear, these stitches will dissolve on their own and need little additional care. Keep the area as clean as possible. Warm sitz baths or tub soaks two times a day will ease some of the soreness. Cesarean section stitches will likewise dissolve over time. These wounds should be kept dry and clean. You may shower after a C-section; just pat the wound dry afterward. No dressing or bandage is necessary.
Vaginal bleeding after your delivery will vary day to day but will end for the most part by four to five weeks postpartum. Especially with breastfeeding, however, intermittent and unpredictable bleeding can occur, though this will usually not be very heavy or prolonged. You may use a tampon four weeks after delivery, but douching is not recommended. If you are breastfeeding, regular periods may not begin again until after weaning.
This is a common problem in the postpartum period and should not be ignored. Breastfeeding, narcotic medications, lack of exercise and episiotomy pain can all make constipation worse. Drink lots of fluids, eat fruits and bran cereals, and if needed, use over-the-counter stool softeners such as Colace. If a laxative is needed, try a mild one such as Miralax or Milk of Magnesia.
Begin exercise again gradually but deliberately after delivery; pregnancy and childbirth have probably taken more out of you than you think. However, don’t consider yourself an invalid. You may begin walking and light exercise as soon as you feel comfortable doing so. Sit-ups and specific abdominal exercises should be deferred for at least six weeks in C-section patients, but then they are encouraged.
If you are breastfeeding, remember to drink lots of fluids to replace what is being used for making breast milk. The quantity of your milk may decrease if you are especially tired or dehydrated. Take your prenatal vitamins while you are nursing, and eat a well-balanced diet including plenty of calcium and protein .If you have decided to bottlefeed, you should wear a very supportive bra day and night for at least the first week or until breast swelling has decreased. If painful engorgement occurs, ice packs can be helpful. Do not do anything to stimulate the breasts, such as expressing or pumping milk or even allowing the shower to strike them during bathing.
Our concern with resumption of driving is that you be completely ready to drive well. This is less likely if your stitches are still uncomfortable, if you are requiring pain medication, or if you are exhausted. Therefore, wait until it is totally comfortable to ride before considering driving. This may be up to several weeks. Remember, we are concerned not only about you and your new baby’s safety but also everyone else on the road.
You should wait six weeks after delivery to resume intercourse. Even though you may be breastfeeding, use something for birth control. Condoms should be used every time you have intercourse until your postpartum visit. At that time, long-term plans for contraception can be made with your doctor.
Regular and Extra-strength Tylenol (or equivalent acetaminophen) may be used per the package instruction. Generally, ibuprofen is most effective. Doses up to 600 milligrams four times a day (three of the over-the-counter 200 milligram-strength tablets) may be taken if needed though you should find you need less over the first week. If you’ve had a C-section, you may be sent home with a prescription for narcotic tablets. Use these in addition if the above doses of ibuprofen are not giving adequate relief. You should let us know if these suggestions are not giving sufficient relief.
Once again, congratulations! Parenthood is a challenge but a rewarding one. With a good helping of common sense and the above suggestions, things should go well. However, some new mothers feel especially overwhelmed by their new duties. These feelings can be accentuated by lack of sleep, hormonal changes, and even by well-meaning comments of others. Postpartum “blues” are very common. These feelings may become severe, and outside help may be necessary to get things back on track. Do not hesitate to contact us if you think you need help. We may always be reached in case of this or other medical emergencies by calling our office number, 314 432-3669.
Your postpartum check-up appointment should be scheduled for about six weeks after delivery.
Pregnancy is a major life event. If you plan for it, you can make wise choices that will benefit both your health and that of your baby. You should take a multivitamin with 400-800 mcg of folic acid for at least 1-3 months before planning a pregnancy. Adequate intake of folic acid has been found to reduce open neural tube defects such as spina bifida. Folic acid can also be found in dark, leafy greens and vegetables, whole grain breads and cereals, citrus fruits, dried peas and beans and fortified breakfast cereals.
Proper Diet and Exercise
Good health depends on both a proper diet and exercise. Exercise is encouraged in pregnancy but this is not a time to begin a new exercise program. Use the time before pregnancy to become physically fit so that you will be able to continue to exercise during your pregnancy. As dieting is not appropriate during pregnancy, pre-pregnancy is the time for optimizing your weight. If you are currently overweight, achieving a normal weight before conception decreases the risk of complications to you and your baby. If you are unsure what your weight should be, we would be happy to help you set goals and make a plan for weight loss before conception.
Stop Smoking and Drinking
Smoking has been found to cause preterm delivery, premature rupture of membranes and low birth weight. Alcohol and other drugs also adversely affect pregnancy. No amount during pregnancy has been proven safe. For the sake of your health and your baby, stop smoking and drinking before getting pregnant.
Are you taking any prescription medicines? If so, please speak with your provider about whether it is safe to continue them when trying to conceive. Some prescription drugs can increase the risk of birth defects and you may need time before conception to change your medicines. Please do not stop taking any physician recommended medicine without talking with your provider first.
Are your immunizations up-to-date? Exposure to rubella in early pregnancy can cause several birth defects in the fetus. We recommend that you have a rubella titer drawn to see if you are immune to German measles. If not, we will give you the vaccine and you will need to wait another month before attempting to get pregnant.
The Tdap vaccine protects you and your baby against three diseases-Tetanus, Diphtheria, and Pertussis (whooping cough). You will be offered the TDaP vaccine DURING pregnancy.
The best way to protect yourself, your baby and your family against the flu is to get the shot, especially if you are trying to conceive or will deliver during the flu season (typically October through March).
Your work environment may expose you to things that might pose a risk to you or your baby. Your employer should be able to provide you with information regarding hazardous materials that you might be exposed to.
Assessing your family history and your partner’s family history is important. There are some disorders that are inherited or more common in certain ethnic groups, such as Ashkenazi Jews. This may include such diseases as cystic fibrosis, sickle cell disease and Tay-Sachs disease. You can be screened prenatally for some of these diseases and also be referred to a genetic counselor for more information to determine your risk.
Schedule a Preconception Counseling Appointment
Some patients will make an appointment to discuss concerns before attempting to conceive. At that visit, we will try to identify things that will help minimize risks and complications to you and your baby during pregnancy if…
Then we recommend that you schedule a preconception counseling appointment for more detailed counseling to maximize a healthy pregnancy and delivery for you and your baby.
We refer to the CDC website in regards to Zika virus and pregnancy risks.
Signs & Symptoms / When to Call
We can always see you for a problem. Patients with true emergencies can be seen at all hours of the day, whether in the Emergency Room at Missouri Baptist Hospital or in our office during business hours. Less emergent problems will also be evaluated as quickly as possible, usually here in the office. You may reach our office during business hours for less emergent problems; and you may reach our office or the doctor on call 24 hours per day, seven days a week, by calling our office number at 314 432-3669. If you are not called back within 30 minutes, please repeat the call as the physician may be attending another delivery.
Please call us if/when you have any of the following symptoms:
Please note that it is not necessary to contact our office if you feel you have lost your mucus plug.
If you cannot reach us after hours (ie our phones are down), you may dial Missouri Baptist Hospital Labor and Delivery directly at 314 996-7514. If for some reason you are unable to reach anyone by phone and you feel you are in labor, please go directly to Missouri Baptist. The on-call doctor will be contacted by other means upon your arrival there.
Especially for your first pregnancy, prenatal education classes may be helpful. They’ll provide another source of information, especially concerning labor and delivery. Be sure to register in your first trimester as there are limited spaces in classes offered in the area. Besides childbirth classes, breastfeeding, infant CPR, and labor and delivery tours can be arranged.
Please take a look at all your options at http://www.mobapbaby.org
Recurrent Pregnancy Loss
Recurrent pregnancy loss is a disease distinct from infertility, defined by two or more failed pregnancies. When the cause is unknown, each pregnancy loss merits careful review to determine whether specific evaluation may be appropriate. After two or more losses, a thorough evaluation is warranted. Although approximately 25% of all recognized pregnancies result in miscarriage, less than 5% of women will experience two consecutive miscarriages, and only 1% experience three or more. Couples who experience recurrent pregnancy loss may benefit from a medical evaluation and psychological support.
A chromosome analysis performed from the parents’ blood identifies an inherited genetic cause in less than 5% of couples. Translocation (when part of one chromosome is attached to another chromosome) is the most common inherited chromosome abnormality. Although a parent who carries a translocation is frequently normal, their embryo may receive too much or too little genetic material. When this occurs, a miscarriage usually occurs. Couples with translocations or other specific chromosome defects may benefit from pre-implantation genetic diagnosis in conjunction with in vitro fertilization.
In contrast to the uncommon finding of an inherited genetic cause, many early miscarriages are due to the random (by chance) occurrence of a chromosomal abnormality in the embryo. In fact, 60% or more of early miscarriages may be caused by a random chromosomal abnormality, usually a missing or duplicated chromosome.
The chance of a miscarriage increases as a woman ages. After age 40, more than one-third of all pregnancies end in miscarriage. Most of these embryos have an abnormal number of chromosomes.
Progesterone, a hormone produced by the ovary after ovulation, is necessary for a healthy pregnancy. There is controversy about whether low progesterone levels, often called luteal phase deficiency, may cause repeated miscarriages. Treatments may include ovulation induction, progesterone supplementation or injections of human chorionic gonadotropin (hCG), but there is no evidence to support the effectiveness of these treatments.
Poorly controlled diabetes increases the risk of miscarriage. Women with diabetes improve pregnancy outcomes if blood sugars are controlled before conception. Women who have insulin resistance, such as obese women and many who have polycystic ovarian syndrome (PCOS), also have higher rates of miscarriage. There is still not enough evidence to know if medications that improve insulin sensitivity lower miscarriage risks in women with PCOS.
Distortion of the uterine cavity may be found in approximately 10% to 15% of women with recurrent pregnancy losses. Diagnostic screening tests include hysterosalpingogram, sonohysterography, ultrasound, or hysteroscopy. Uterine abnormalities include a double uterus, uterine septum, and a uterus in which only one side has formed. Asherman’s syndrome (scar tissue in the uterine cavity), uterine fibroids, and possibly uterine polyps are acquired abnormalities that may also cause recurrent miscarriages. Some of these conditions may be surgically corrected.
Blood tests for anticardiolipin antibodies and lupus anticoagulant may identify women with antiphospholipid syndrome, a cause for 3% to 15% of recurrent miscarriages. A second blood test performed at least 6 weeks later confirms the diagnosis. In women who have high levels of antiphospholipid antibodies, pregnancy outcomes are improved by the use of aspirin and heparin.
Inherited disorders that raise a woman’s risk of serious blood clots (thrombosis) may also increase the risk of fetal death in the second half of pregnancy. However, there is no proven benefit for testing or treatment of women with thrombophilias and recurrent miscarriage in the first half of pregnancy.
Increasing evidence suggests that abnormal integrity (intactness) of sperm DNA may affect embryo development and possibly increase miscarriage risk. However, these data are still very preliminary, and it is not known how often sperm defects contribute to recurrent miscarriage.
No explanation is found in 50% to 75% of couples with recurrent pregnancy losses. Tests with no proven benefit for recurrent miscarriage include cultures for bacteria or viruses, tests for insulin resistance, antinuclear antibodies, antithyroid antibodies, maternal antipaternal antibodies, antibodies to infectious agents, and embryotoxic factors.Treatments with no proven benefit include leukocyte (white blood cell) immunization and intravenous immunoglobulin (IVIG) therapy.
A couple may be comforted to know that the next pregnancy is successful in 60% to 70% of those with unexplained recurrent pregnancy losses. A healthy lifestyle and folic acid supplementation is recommended before attempting another pregnancy. Smoking cessation, reduced alcohol and caffeine consumption, moderate exercise, and weight control may all be of benefit. Counseling may provide comfort and help cope with the grief, anger, isolation, fear, and helplessness that many individuals experience after repeated miscarriage.
Schedule of Prenatal Care
Initial visit with your physician and ultrasound to confirm pregnancy and due date. These may be done on different days depending on availability. Your complete history will be obtained by a phone nurse prior to these visits. Blood is drawn and tested, including State-mandated HIV testing. A pap smear may be done.
Routine prenatal visit. Fetal Heart tones will be detected by Doppler. Possible genetic testing performed by blood draw or ultrasound.
Routine pre-natal visit
Routine pre-natal visit. Screening ultrasound for the evaluation of the baby’s growth and anatomy.
Routine pre-natal visit
Routine pre-natal visit. One hour glucose test. Rhogam injection for Rh negative patients.
Routine pre-natal visit
Routine pre-natal visit. Possible ultrasound for growth and position.
Routine prenatal visit
Routine pre-natal visit. Group B Strep swab. Possible cervical exam.
37, 38, 39, 40 weeks
Routine pre-natal visit & cervix checkRoutine pre-natal visit includes weight, blood pressure, urine test, measurement of your uterus and listening to baby’s heartbeat with a doppler. Visit interval is approximate and dependent on maternal and fetal issues.
Any ultrasounds other than what are listed above will be done in the event of medical necessity, such as bleeding, hypertension, fetal growth problems or placental location.
Traveling during pregnancy can be fun and comfortable, especially during the second trimester (14 to 28 weeks) when nausea and fatigue have lessened or ceased. Air and automobile travel are safe during most pregnancies providing you follow a few simple rules and your own common sense. During pregnancy, blood volume is up, your center of gravity has changed and your joints are loosening… so take it easy.
If you are planning to travel and you are more than 34 weeks pregnant, or if you have a high-risk pregnancy, please consult your doctor. Likewise, if you are planning a trip to anywhere with extreme conditions (heat, cold or high altitude), please consult your provider.
If traveling abroad:
Cruise lines do not allow pregnant patients over 24 weeks to board the ship. If the patient is cruising prior to 24 weeks, they will need physician verification of gestational age and that it is safe for her to travel.
Seatbelt and air bag use
During pregnancy, your seatbelt is as important as ever. How do you position the belt? Start by sitting as upright as possible, and place the lap belt under your belly and as low on your hips as possible (so it pulls against your pelvic bones, not your abdomen). Then position the shoulder belt so it crosses your chest between your breasts. Fasten and adjust the seatbelt so it fits as snugly as possible – you may also need to adjust the seat itself.
Your baby is well cushioned by the uterus and amniotic fluid, and your uterus is well protected by your own body. There is no evidence that safety belts increase the chance of injury to the fetus, uterus or placenta. In most accidents, the baby recovers quickly from the safety belt pressure. However, even after seemingly blunt, mild trauma, please contact your doctor. We do not recommend turning off air bags for pregnant passengers or drivers.
We refer to the CDC website in regards to Zika virus and pregnancy risks.
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