Transcript What to Expect - Provena Health
Congratulations, Now What?
Dr. Nizar Olabi D.O., F.A.C.O.G
Timeline of Your Pregnancy
1
st
Trimester
Weeks 1-13
Expect to visit your obstetrician every month during this period
2
nd
Trimester
Weeks 14-27
Expect to visit your obstetrician every month during this period as well
3
rd
Trimester
Weeks 28-40
Beginning in the 7
th
month, your obstetrician will see you every two weeks After weeks 35-36, your obstetrician will see you every week until delivery!
Making Healthy Choices
Ideally, prenatal vitamins are started 3 monthsprior to conception.
Prenatal Vitamins
Folic Acid – helps prevent neural tube defects (defects of the brain and spinal cord) Calcium – promotes strong bones and teeth for both you and baby Iron – aids in the development of blood and muscle cells for mom and baby
Combined, these vitamins reduce the risk of low birth weight babies
Others
Omega-3 Fatty Acids – help with brain development Source: Vitamins or Seafood Vitamin D – important later in pregnancy Source: Low-fat Milk, Vitamin D Milk, Cheeses, or Yogurt
Making Healthy Choices
Alcohol
NO! However, do not be concerned with the drinks you may have consumed prior to knowing you were pregnant. As long as the habit is discontinued immediately, there should be no harm to your growing baby.
Caffeine
Limit caffeine intake to 1-2 cups of coffee or 200mg of caffeine daily.
Exercise
YES! Any pregnant woman is encouraged to discuss an exercise program with her practitioner; however, women who exercise regularly before pregnancy are typically encouraged to continue their routine.
Making Healthy Choices
Smoking
NO! Pregnant mothers should make every attempt to quit smoking cigarettes as soon as they believe they have become pregnant (or sooner in the trying phase). Although studies show quitting before 3 months gestation reduces harm to your baby, we recommend quitting as soon as possible. If you cannot quit, it is proven that reducing the amount of cigarettes consumed each day may limit effects to your baby.
Marijuana
NO! While any marijuana you may have consumed prior to conception will not affect your baby, it is imperative that you do not continue this habit while pregnant to avoid harm to your growing child.
Cocaine & Other Drug Use
NO! All of these substances will cause harm to your baby.
Making Healthy Choices
Cats
Keep them. Avoid changing the litter box of your furry friend while pregnant, or at least do so with disposable gloves. Cats can transmit a disease cause Toxoplasmosis, however most cat owners are already immune.
Hot Tubs & Saunas
Within reason. Hot tub use is safe during pregnancy, although we recommend feet only. The problem being that any prolonged period with a body temperature >102˚F may cause harm to the baby. This is similar for saunas or steam rooms.
The First Trimester
Your First Prenatal Visit (OB Intake)
Confirming your pregnancy Urine and/or Blood Test Date of your last period (LMP) We use this to calculate your Estimated Delivery Date (EDD) LMP + 7 days – 3 months + 1 year = EDD Laboratory Testing This will be covered in a separate session.
A History Medical History (illnesses, surgeries, medications, allergies) Family History Gynecologic History (date of your first period, typical cycle) Obstetrical History (past live births, miscarriages, abortions) Social History (occupation, alcohol or drug use, exercise) A Physical Exam Vital Signs (for baseline weight, height, blood pressure) Heart, Lungs, Abdomen Gynecologic Exam similar to your annual exams
The First Trimester
What to Expect
Breast Changes—
more common in women who have been pregnant before
Fullness, Heaviness, Tenderness, Tingling, Darkening of the Areolas Bloating, Flatulence, Heartburn Fatigue Frequency of Urination Heightened Sense of Smell Nausea typically begins at 6 weeks, but some experience nausea and vomiting as early as the first month
The First Trimester
What to Expect
Food Aversions and Cravings Excess saliva, possible Drooling Constipation Vaginal Discharge—white in color Mood Swings, Irritability, Irrationality, and Extreme Weepiness Anxiety
The Second Trimester
Exciting things to look forward to…
A baby bump around 4 months!
Which also means outgrowing your pre-baby clothes.
Fetal movements begin between the 4
th months and 5 th
No more morning sickness!
Your baby’s first (and typically only) ultrasound around week 20!
The Second Trimester
What to Expect
Fatigue However a decrease from first trimester Decrease in Urinary Frequency Aching in the lower abdomen and groin due to stretching of the uterine ligaments Constipation, Heartburn, Indigestion, Flatulence, and Bloating Breasts remain enlarged, but are less tender now Nasal congestion and nosebleeds; Ear Fullness
The Second Trimester
What to Expect
Sensitive Gums Increased Appetite Increase in Vaginal Discharge Varicose veins in the legs; Hemorrhoids Skin color changes on your abdomen (linea nigra) and face (melasma); as well as stretch marks Navel “pops” around month five Mood Changes Irritability, Irrationality, Inexplicable Crying Forgetfulness
The Third Trimester
Exciting things to look forward to…
Signing up for childbirth classes!
Forming your Birth Plan, if you so choose Choosing a Pediatrician for your little one!
Beginning around week 38, your doctor will begin examining you for labor progression.
Braxton Hicks Contractions
these tend to be painless, and are merely a sign of what is to come—labor & delivery!
The Third Trimester
What to Expect
Stronger and more frequent fetal movement This may be due to kicking or fetal hiccups Beginning in the 9 th month, you may seem to think your baby is moving less, but in reality he or she just has less room to move; so don’t panic!
Increasing Vaginal Discharge Achiness in the lower abdomen and groin
due to ligament stretching
Heartburn, Indigestion, Flatulence, Bloating, and Constipation Nasal congestion, and the occasional Nose Bleed Backache
The Third Trimester
What to Expect
Swelling of the Feet and Ankles Hemorrhoids; Varicose veins of the legs Itchy Abdomen Stretch Marks Difficulty sleeping Shortness of breath – your baby will be against your
diaphragm by this point
Colostrum – a milky discharge from the nipples, which is more
common following nipple stimulation
Strange and Vivid Dreams
W
HAT IF
?
Common Complications of Pregnancy
Common Complications of Pregnancy
Ectopic Pregnancy
A pregnancy that implants outside of the uterus—most commonly in the fallopian tube This may be caused by an STD, Pelvic Inflammatory Disease, or can be seen at a higher rate in women who have endometriosis or an intrauterine device Causes heavy bleeding, severe pelvic pain, dizziness and possibly death.
Patients with these symptoms must seek emergency medical attention immediately
Rh Negative Disease
Rh Factor is determined by checking your blood type at your first prenatal visit The Rh factor is the presence of a protein surrounding the red blood cells If a mother is Rh negative and her baby is Rh positive, the mother’s body will start to build antibodies against the baby If negative, RhoGAM is a medication given around 28 weeks to prevent the build-up of these antibodies.
RhoGAM is given again at birth, only if the baby is Rh positive.
Common Complications of Pregnancy
Group B Strep
The leading cause of infections in newborns.
Cultures are done after 35 weeks to predict if a patient is a carrier of the infection If you are a carrier, you will be treated during labor with IV antibiotics.
Preterm Labor
Defined as gestational age <37 weeks It may feel like menstrual cramping or a backache At some point your doctor may elect to keep you on bed rest or use medications to prevent the progression of labor
Low Birth Weight
Can be a result of poor maternal nutrition; substance abuse (cigarettes, alcohol, or other drugs); the result of an STD or other disease; or a lack of adequate prenatal care Concerns with low birth weight babies or premature births include: risk of respiratory infections, blindness, learning disabilities, cerebral palsy, and heart problems
Common Complications of Pregnancy
Gestational Diabetes
Diabetes that develops during pregnancy (usually second trimester), as your body is unable to make enough insulin (a substance that breaks down sugar in our bodies).
Most commonly this complication can be managed with simple changes in diet.
Preeclampsia
A diagnosis of high blood pressure during pregnancy; signified by a rise in blood pressure, water retention, and leaking protein in your urine Risks to Baby May decrease blood flow to the placenta and therefore decrease nutrition and oxygen available to your growing baby.
This can be managed throughout a pregnancy with the following precautions: Mild Disease: a healthy diet (high water intake, low salt intake) Moderate-Severe Disease: blood pressure medication
Eclampsia
The result of uncontrolled or unresolved hypertension during pregnancy or labor; manifested by seizures.
The risk is very small as a result of routine prenatal care and proper management of preeclampsia.
When to call your doctor…
Immediately if you have:
Heavy bleeding; bleeding with cramping Severe lower abdominal cramping, centrally or to either side—regardless of bleeding Decreased urination for 24 hours, combined with increased thirst. Painful urination accompanied with fever or chills Remember: a fever is defined as >101.5˚F Fever >101.5˚F without other symptoms Any change in vision (blurring, dimming, double vision) Severe headache for >2-3 hours Bloody diarrhea
When to call your doctor…
Within 24 hours if you have:
Blood in your urine Swelling of your hands, face, or eyes Painful or Burning urination Fainting or Dizziness Chills or fever >100˚F that is not reduced with Tylenol Severe nausea and vomiting late in pregnancy; or vomiting >2-3/day in the first trimester Itching skin With or without dark urine, pale stools, or yellowing of the
skin or whites of the eyes
When to go to the hospital…
If you are approaching your due date and experience any of the following, you should go to the hospital and notify your doctor:
Bloody Discharge consistent with your period Rupture of Membranes (your ‘water breaks’) Contractions 2-5 minutes apart for at least one
hour
W
HEN
T F
INALLY HE
T
IME
A
RRIVES
Labor & Delivery
Phase One: Early Labor
Dilation: 0cm – 3 cm This is the longest phase of labor; the period where your cervix thins (effaces) and dilates to 3 cm Contractions last 30-45 seconds in this phase, and are approximately 20 minutes apart You will most likely still be at home during this phase, or en route to the hospital You may experience: Back Pain Menstrual-like Cramps Lower Abdominal pressure Indigestion, Diarrhea Bloody Show – a discharge of blood-tinged mucus immediately before labor
Your amniotic sac may or may not rupture during this stage.
Labor & Delivery
Phase One: Active Labor
Dilation: 3cm – 7cm This phase may last 2.5-3 hours, with contractions that last 40-60 seconds, and occur 3-4 minutes
apart
You may experience: Increasing pain and discomfort with contractions Increasing back pain Leg discomfort Fatigue Rupture of Membranes (if this has not already occurred) Emotionally, you may feel restless, exhausted, and lose concentration. This is when your coach is key!
At this point the anesthesiologist will administer your epidural (if you so choose).
Labor & Delivery
Phase One: Transitional Labor
Dilation: 7cm – 10cm This is the quickest phase of labor, but typically the most demanding.
Contractions are now 2-3 minutes apart, and 60-90 seconds in duration.
You may experience: More intense pain with contractions Strong pressure in the lower back Rectal Pressure (much like the sensation you have when you need to make a bowel movement) Feelings of warmth, sweating, or chills Exhaustion
Labor & Delivery
Phase Two: Pushing and Delivery
Duration: 30 min – 1 hour on average You may experience: Pain with contractions Urge to ‘push’ Rectal Pressure Fatigue or an occasional Burst of Energy Visible Contractions An increase in blood-tinged discharge (the bloody show) Tingling, stretching, and burning sensation when the baby is crowning
Labor & Delivery
Phase Three: Delivery of the Placenta
At this point, your baby has arrived and you can enjoy every minute of it! Your practitioner will deliver the placenta and repair any tear or episiotomy, should they occur during delivery.
Labor & Delivery
Your Choices for Pain Management
IV Pain Medication
Your partner is not allowed in the room with you Sedates the baby as well as mom
Epidural Pain Relief
Advantages: Advantages: You can walk around during each phase of labor—or at least until your doctor requires continuous fetal monitoring Disadvantages: Sensation of drowsiness Side effects of the medication—which may include: nausea and vomiting If an emergency occurs during your labor, and an emergency cesarean is required, you will be put under general anesthesia for delivery—which comes with its own risks: You are not awake for the delivery Your baby does not get the medicine!
You may still feel pressure, but your pain receptors are blocked!
As soon as you ask for the epidural, you shall receive. The medication does not “wear off” until after delivery.
If there is an emergency during delivery, and a cesarean is required, you will still be able to have your partner in the operating room if you already have an epidural in place Disadvantages: You are unable to walk around during labor with an epidural
Resources for you!
What to Expect When You are Expecting
by: Heidi Murkoff and Sharon Mazel
The American Pregnancy Association
www.americanpregnancy.org
The Mayo Clinic
http://www.mayoclinic.com/health/pregnancy-week by-week/MY00331