Obstetrics

During the first trimester, nausea and vomiting are very common. For most people this is mild and doesn’t require any treatment. Other people may experience more severe nausea and vomiting, which may occur every day. If you find your symptoms to be more severe, the following suggestions can be helpful. If you have tried the suggestions below and find that you are unable to keep any liquids or food down, please call our office as there are prescription medications that can help.

1. Eat five or six small meals per day.
2. Avoid high fat and spicy foods.
3. Avoid food tastes, textures and/or odors that make you nauseous.
4. Drink small amounts of cold, clear, carbonated liquids between meals. Ginger ale is an excellent choice.
5. Drink herbal teas containing mint or ginger.
6. Take Vitamin B6, 25mg, three times a day and Unisom, one tablet, at bedtime.
7. Use Sea-Band or Relief Band acupressure wrist bands.
8. Dramamine, 50mg, every 6 hours.
9. Chew gum or ginger candies as often as needed.

During your pregnancy, you may travel by any means, including air, up until one month before your due date, as long as your pregnancy is uncomplicated. During the last month of your pregnancy, we recommend you stay within one hour of the hospital.

If you smoked prior to getting pregnant, then now is the ideal time to quit. Women who smoke during pregnancy have higher rates of complications including:

1. an ectopic pregnancy
2. vaginal bleeding
3. problems with the way the placenta attaches to the uterus
4. stillbirth
5. low birth weight babies ( less than 5 1/2 lbs)

Each time you smoke a cigarette during pregnancy, you are exposing your baby to harmful chemicals such as tar, nicotine and carbon monoxide. These chemicals cause less nutrients and oxygen to reach your baby. Women who continue to smoke after delivery put their babies at an increased risk for Sudden Infant Death Syndrome (SIDS).

The less you smoke, the less harm occurs. Decreasing the amount you smoke is better than not quitting at all. However, completely quitting is ideal for both you and your baby’s health.

There are several resources available to help you quit smoking. During your first prenatal visit, you and your doctor can discuss these options. The Colorado Quit Line and B4 babies both provide resources for smoking cessation.

Back pain is probably the most common discomfort encountered during pregnancy. It is usually caused by strain on the back muscles from various causes. There are several simple things that can be done to improve back pain, including awareness of how you sit, stand and move. A few suggestions from the American Congress for Obstetricians and Gynecologists (ACOG) are:

• Wear low-heeled shoes with good support
• Do not lift heavy items without assistance
• Place one foot up on a box or stool when standing for long periods of time
• Do not bend over from the waist to pick things up; rather squat down, bend your knees and keep your back straight
• Sit in chairs with good back support or use a small pillow behind your lower back
• Try to sleep on your side with one or two pillows between your legs for support
• Apply heat or cold to the area of discomfort or massage it
• Soak in a warm bathtub
• Tylenol may be used if the above suggestions do not help

There are also simple exercises and stretches that may relieve the pain in your back.

If you have tried all of the above and are still having severe back pain, you may buy a prenatal support belt to help give your back additional support. These can be purchased at local maternity stores or online at About Babies Inc.

Many over-the-counter and most prescription medications are safe to take during pregnancy. The following list of over-the-counter medications can safely be used to treat many common problems you may encounter during your pregnancy. However, if you ever have any questions regarding the safety of a medication, please call our office.

Aches, Pains, Fever and Headaches - Tylenol and Tylenol Extra Strength.
DO NOT take Motrin, Ibuprofen, Aleve or Naprosyn for any of these problems.

Heartburn - Rolaids or Tums are best to try first for heartburn.  Others that are may be used are Maalox or Mylanta liquid, Zantac, Pepcid, Prilosec or Prevacid.
DO NOT USE Pepto-Bismol in pregnancy.

Seasonal Allergies - Benadryl, Zyrtec, Claritin or Allegra

Sore throat - Any lozenges or spray can be used

Congestion or Runny Nose - Sudafed

Cough - Robitussin, Robitussin DM, Mucinex D or Mucinex

Insomnia -Tylenol PM, Unisom or Benadryl

Constipation - Colace or Dulcolax 2-3 times per day, any fiber supplement once a day, or Miralax once a day

As far as it is known, the medications listed below do not cause any harmful effects during pregnancy. They have been used extensively in pregnancy, but no formal studies have been done. There is no 100% safety guaranteed; therefore, if you can get by without medication, that is your best choice.

General: Cold and flu symptoms usually last a week regardless of what you do. Since these illnesses are viral, antibiotics are not effective. Taking ineffective medication may result in risk without benefit. It also results in bacteria becoming resistant to the antibiotic, so it will have no effect when it is needed. Sore throats are rarely strep if the sore throat is less than seven days old. If there is any doubt, come in for a throat culture.

Good home remedies

1. Increase your fluid intake by 50%. Juices high in vitamin C, such as orange juice, are especially good.
2. A humidifier for increasing moisture in the air is helpful. Consider one for the bedroom. Cool mist is best, but steam also works well.
3. Controlled studies show taking zinc will cut the time of your flu in half and taking zinc when not ill will reduce the number of illnesses by half. Take 100 mg per day when sick and 50 mg per day to prevent illness. Zinc can be taken in pill form or by lozenges.
4. Get plenty of rest.
5. Eat a healthy, well-balanced diet.
6. Avoid caffeine.  Caffeine is a diuretic and may lead to dehydration.

Congestion: There are several over-the-counter medications that will relieve congestion.

• Sudafed: Take as directed on the label. Be careful of any medication containing phenypropanolamine because it can elevate blood pressure. Please check with your doctor if you have a history of high blood pressure.
• Afrin: It can be purchased in nasal spray or drop form. Prolonged use can cause dependency.

Cough: The use of Robitussin DM or PE cough syrup should help. Use as directed on the label.

Sore Throat: Gargle with Chloraseptic or Cepastat four times per day. Each preparation comes in lozenges as well. A salt water gargle is acceptable if you want to try a more “natural” method.

Fever, Aches and Pains: Tylenol is recommended for fever, aches and pains from the flu. Drugs such as Motrin, Aleve and Nuprin have been on the market for a relatively short period of time and their safety has not been as thoroughly proven as Tylenol (acetominophin). Aspirin can delay onset of labor, irritate the stomach and cause clotting problems. Aspirin should be avoided.

When to call your doctor

• Fever over 101
• Symptoms over seven days that do not appear to be improving.
• Difficulty breathing. (Not including a stuffy nose)
• Coughing up bloody or rusty sputum.
• You are much more likely to be able to talk to your doctor if you call during office hours – 8:30 a.m. to 5:00 p.m. weekdays.

Note: Generics may be substituted for brand names in the suggested medications above.

During the last six months of your pregnancy, you need to eat approximately 300 more calories per day to promote a healthy pregnancy. A healthy weight gain for women starting at a normal body weight is between 25 and 35 pounds. If you start the pregnancy overweight, you should gain less. If you start the pregnancy underweight, you should expect to gain more. Discuss with your doctor what the right weight gain is for you. To learn more about nutrition and weight gain, click here.

It is important for you to get adequate exercise during your pregnancy. Many exercises done prior to pregnancy may be continued during pregnancy.  Even if you did not exercise prior to pregnancy, it is safe to begin an exercise program. Exercising in pregnancy has many benefits including improving your energy and mood, decreasing muscle aches and pains, promoting better sleep and helping during the labor process. Find out more on exercising in pregnancy here.

St. Mary’s hospital also offers exercise classes through the Life Center for pregnant women. For more information call 298-6100.

Your first visit to our office will be with one of the Medical Assistants. They will review your medical history, pregnancy history and family history. They will also review educational material with you, including information about prenatal vitamins, and answer any of your initial questions about your pregnancy. At the completion of this visit they will give you paperwork to have prenatal labs drawn, which include checking your blood type, an anemia check, STD screening, including HIV and, if you elect, cystic fibrosis screening. You can find more information about this optional test here.

Your next visit will be with the physician you have chosen to provide your obstetric care. This usually includes a brief review of your history, a physical exam, including a pap and pelvic exam, and an ultrasound to confirm your due date and check your baby’s heartbeat. We will also review your prenatal lab results with you. This is a good chance to ask any questions you may initially have about you and your pregnancy.

If you are at high risk for Down Syndrome or other chromosome abnormalities, our office does offer nuchal translucency ultrasounds at 13 weeks. You and your physician will decide if this test is needed. More information about this test is found here.

Each visit with your doctor will include a check of your weight, blood pressure and an evaluation of your urine for glucose, protein and bacteria. We will also check the baby’s heartbeat and your uterine growth. These visits are good opportunities to get to know your doctor and get answers to any questions you have about the pregnancy.

Between 15 and 20 weeks you may elect to have the maternal quad screen done. This is a second trimester blood test for neural tube defects and chromosome problems. There are many false positives with this test, so it is a good idea to discuss it with your doctor. Our office also offers ultrasound-guided amniocentesis for women at high risk for a fetal chromosomal problem. This test is usually done between 15 and 20 weeks of pregnancy. Determining whether this test is needed is something you and your doctor will need to talk about. Click here to learn more about these tests.

At 20 weeks your physician will perform a detailed ultrasound to evaluate the anatomy of the baby. This is also the opportunity to check for the gender of the baby. Some physicians prefer a full bladder for this ultrasound, so ask your doctor’s medical assistant before you void at this appointment.

Between 24 and 28 weeks you will be given an order for labs to recheck for anemia, test for gestational diabetes and, if you are RH negative, have an antibody screen. Please follow the instructions regarding eating and drinking before these tests, otherwise you may have to return at another time. You do not need an appointment for the blood tests.

If you are RH negative and need a rhoGAM injection, this will be done at approximately 28 weeks. You may need another rhoGAM shot after the baby is born depending on the blood type of your baby.

During 24 and 28 weeks, you will also be given information to pre-register for the hospital. You do need an appointment, which may be made by calling 298-2229. Now is also a good time to begin thinking about childbirth classes, which can be found on St. Mary’s website.

During the third trimester you will visit with your doctor more often. Between 28 and 36 weeks you will have an appointment every two weeks.  You will then visit your doctor every week for the last month of the pregnancy.

During these visits we will check the growth of your baby and look for any complications of pregnancy that may be developing. It is important to discuss any problems you are having with your doctor, including pre-term contractions and a decrease in your baby’s movements. These visits are an opportune time to ask any questions you may have about when to go to the hospital, labor, pain medication options during labor and the delivery of your baby.

At 35 weeks to 37 weeks you will have a vaginal culture taken to check for Group B strep. If your test is positive, your doctor will discuss what treatment options are needed. At this point, you may also begin having your cervix checked for dilation. These exams are similar to the pelvic exam done during your first visit.

You will experience many different changes after having a vaginal birth. The first few days you feel very sore and tired. You will also notice that your uterus continues to cramp for several days after having the baby and that you continue to bleed. It is not uncommon to bleed up to six weeks after giving birth. You will notice that some days the bleeding may seem heavy, while other days it is very light or none at all. This is typical. It is important during this time that you do not put anything in the vagina (no tampons, sex or douching), and that you call your doctor if you develop a fever more than 100.4 or begin bleeding more than two pads per hour for two hours.

If you had an episiotomy or vaginal tear, you will notice that these areas will be very sore and tender. They may even burn when you urinate. It is not uncommon for these areas to swell the first few days after delivery. It is important to use the pericare bottle the hospital gave you to clean this area regularly. You may also use Tucks pads or sitz baths to aid in comfort.

If you delivered by cesarean section, you may find you are very sore in the abdominal area for several weeks. This will gradually improve. To promote a speedy recovery, it is important to continue to be as active as your body will allow. During the initial two weeks you should:

• not lift more than 10 pounds
• not drive a car yourself
• avoid abdominal exercise for at least 4-6 weeks after your surgery
• keep your incision area clean and dry
• only take showers, as baths will affect the healing process

Initially you may notice some drainage from the incision, but this should stop within the first few days. If you notice a large amount of drainage from the incision, redness of the skin, or a fever greater than 100.4, you should call your doctor immediately.

During the first few weeks, it is common for your emotions to be all over the place, much like they did during the beginning of your pregnancy. During this time you will experience many hormone changes, exhaustion and the feeling of being overwhelmed with the care of your newborn. These all lead to the mood swings known as the “baby blues.”

The baby blues will usually resolve within a few weeks. However, if these feelings continue, you may be developing postpartum depression. It is important to talk with your doctor about these symptoms as you may require treatment. If you think you may be suffering from postpartum depression, this is a good information resource.

Engorgement - Three to four days after having your baby, your breasts may become swollen, heavy and sore. This is a sign that your milk production has increased and your breasts are now accumulating milk. This will usually lessen within 24 hours. If you are breastfeeding, having the baby feed every three hours will help to improve the symptoms. If you are not planning to breastfeed, then wearing a tight fitting bra, even while sleeping, will help to lessen these symptoms. Avoid expressing the milk, as this will allow the symptoms to continue longer. Cold compresses or cabbage leaves will also help with the discomfort.

Blocked Ducts - Blocked milk ducts occur frequently in breastfeeding mothers. When this occurs, you will feel a hardened area or lump that is often red and sore to touch. In order to resolve the symptoms, it is important to continue to feed frequently from both breasts, including the one with the clogged duct. While the baby is nursing you need to massage the affected area towards the nipple. Between feedings, apply warm compresses to the affected area and continue to massage the area towards the nipple. These techniques, when done diligently, will usually unclog the duct.

Mastitis - If the blocked duct persists, it may become a breast infection. At this point, you may develop a fever, chills and aches, and feel similar to when you get the flu. You may notice streaks of red in the breast or the breast may become entirely red. If you think you have mastitis it is important to contact your physician, as this does require antibiotics. It is also important to realize that breast tissue, not the milk, is infected. It is safe and recommended to continue feeding your baby from the affected breast. To help cure the infection, you want to continue frequent feedings and apply warm compresses to the affected area.