At Arizona Maternity & Women’s Clinic, our goal is to provide you with advanced and comprehensive care throughout your pregnancy.
At Arizona Maternity & Women’s Clinic, we believe in providing comprehensive care in all aspects of gynecology.
At Arizona Maternity & Women’s Clinic, we believe in providing comprehensive care in all aspects of midwifery.
Urinary incontinence is defined as the involuntary loss of urine. It can be stress, urge or mixed incontinence. When any part of the urinary system malfunctions, incontinence can result.
Urinary incontinence is reported to affect 13-25 million people in the United States. Many patients do not seek treatment due to embarrassment, or a misperception that nothing can be done about it. Many women believe that incontinence is a normal part of the aging process. It is important to know urinary incontinence can usually be successfully treated.
Urinary incontinence can be caused by many factors. A few of the most common causes are:
A cystometrogram or CMG is a test used to evaluate your bladder’s ability to store and release urine.
Your physician may instruct you to urinate every 2-4 hours, while awake. The goal of this therapy is simply to keep the patient dry. This will help to empty the bladder and avoid accidents.
This involves timed voiding, but the length of time between the bathroom trips is gradually increased. This therapy trains the bladder to delay voiding for larger time intervals.
Kegel exercises are easy to learn and simple to do. If you do them right, no one can tell your doing them, so they can be done anywhere.
Try holding each contraction for 5 seconds. This will be difficult at first but it will get easier as the pelvic floor gets stronger.
How often should I do them?
Thus Exercise can be done several times a day. The more you do, the stronger the muscles become. However, just like any exercise, the muscles can become fatigued if overworked.
Kegels can be done anywhere and anytime.
There are many types of different surgical procedures that may be used to treat incontinence. The type of surgery recommended will depend on the type and cause of your incontinence.
Slings: Urethral slings are used to treat stress incontinence (SI). SI is usually caused by sagging of the urethra and/or bladder neck, or by problems with the sphincter (muscular outlet of the bladder). This involves placing a “sling†around the urethra to lift it into place and to exert pressure on the urethra to aid in holding the urine.
Most women return home within 24 hours of the procedure. You will be sent home once you are feeling well and are able to urinate. If you need pain relief, mild analgesics are usually enough. It is important to rest after the operation and allow yourself to heal.
Urethral slings are used to treat stress incontinence (SI). SI is usually caused by sagging of the urethra and/or bladder neck, or by problems with the sphincter (muscular outlet of the bladder). This involves placing a “sling†around the urethra to lift it into place and to exert pressure on the urethra to aid in holding the urine.
Most women return home within 24 hours of the procedure. You will be sent home once you are feeling well and are able to urinate. If you need pain relief, mild analgesics are usually enough. It is important to rest after the operation and allow yourself to heal.
Myomectomy is the surgical removal of uterine fibroids without removing the uterus.
Fibroids are common solid pelvic tumors. They arise from the muscle tissue of the uterus; they may be single or multiple. About 25% of all women over the age of 35 have fibroids; among African-American women fibroids are even more common.
Submucousal fibroids (grow into the uterine cavity) may cause heavy bleeding, anemia, pain, infertility, or miscarriage. Mural fibroids (located in the uterine wall) and sub-serous fibroids (protrude outside the uterine wall) may reach a large size before causing symptoms. These symptoms may include pressure on the bladder with difficulty voiding or urinary frequency and urgency, pressure on the rectum with constipation, lower back and abdominal pain, as well as heavy bleeding.
Hysterectomy remains the most common surgical treatment for fibroids because it is the only definitive treatment. When fibroids are small and causing no symptoms, no treatment is required. In the presence of symptomatic or large fibroids, a woman who wishes to preserve her fertility may be offered a myomectomy, an operation that removes the fibroids while sparing the uterus. However, the conventional treatment for women 40 years of age and older is hysterectomy. Even women younger than 40 who have completed childbearing are usually offered hysterectomy.
My conviction as a physician is to respect the personal viewpoints of every patient. If an informed patient wishes to preserve her uterus in the presence of a benign condition and if her medical problem can be safely resolved without hysterectomy, the physician should comply with the patient’s desire, even if this involves referring her to another specialist.
Myomectomy, when performed by an expert, is a safe and effective alternative to hysterectomy. The gynecologic surgeon who has extensive experience with myomectomy is able to remove fibroids. The successful myomectomy should result in resolution of symptoms related to fibroids.
Depending upon the location of the fibroid(s), myomectomy can be accomplished by either an abdominal or vaginal approach. When the fibroid causing symptoms is bulging into the uterine cavity (sub-mucous), it is usually possible to remove it by using a hysteroscopic technique. This technique involves using an operating “telescopeâ€: which is inserted into the uterus through the vagina. Hysteroscopic myomectomy is performed on an outpatient basis; the short recovery period at home is 2-3 days before resumption of full activity. In the presence of large fibroids in the uterine wall (mural) or bulging out of the uterus (sub-serosal), abdominal myomectomy through an abdominal incision is usually required. In most cases this can be accomplished through a low horizontal incision along the bikini line. Following an uncomplicated abdominal myomectomy, discharge from the hospital is usually possible within 2-3 days. There is a variable recovery period at home of 2-6 weeks.
A critical part of successful myomectomy is optimal reconstruction of the uterus. A reconstructed uterus may rupture during a subsequent pregnancy or delivery. In this regard, removing large fibroids through the laparoscope (telescope inserted through the navel) is not advisable in most cases because optimal reconstruction of the uterus is not accomplished in this manner.
About 1 in 200 women with fibroids is found at surgery to have a malignant tumor of the uterus (sarcoma). Therefore, the preoperative discussion between the woman and her surgeon should include consideration of this unlikely circumstance. The patient should be counseled regarding the importance of hysterectomy and removal of both ovaries as a life-saving procedure if cancer is found during the operation.
Some physicians advocate hormone treatment with GnRH agonists, such as Lupron, in preparation for myomectomy. This treatment postpones the operation for 2-4 months. During this time the fibroids decrease in size and the bleeding is markedly reduced. Although some surgeons feel that this makes the operation easier and diminishes blood loss, many other experienced surgeons find this very expensive treatment unnecessary with few exceptions. However, it is generally agreed that if a woman is very anemic, hormone treatment along with iron supplements promotes recovery from the anemia prior to surgery. Concern has been raised that GnRH treatment may shrink small fibroids, which could, therefore, be missed at surgery only to enlarge again and cause problems later.
As women become increasingly aware of the important issues related to fibroids and hysterectomy, there is growing interest in alternative treatments. Many of these issues are controversial among both professionals and laypersons. The ethical physician should inform the patient of the issues and options and, above all, respect her convictions and her right to make the ultimate decisions regarding her body.
A large microscope called a colposcope to look at the vagina and cervix and possibly take a sample of tissue.
This test may be done after you have had an abnormal Pap smear. Colposcopy is a test used for diagnosing precancerous or cancerous changes in the cervix or vaginal cells. The results of this test will help your physician to make a plan for adequate treatment.
No particular preparation is necessary.
You will be positioned on the examining table just as for a regular pelvic exam. The physician will use a colposcope at the vaginal opening to look inside the vagina or look at the cervix.
If your doctor sees any abnormalities, he or she may take a small tissue sample. You may feel a pinch or slight cramp. The tissue will be sent to the lab for testing.
You could have some mild cramping and or bleeding or dark discharge for up to two weeks after the procedure. The test results should be ready in a about two weeks.
Ask your doctor what recommendations they have and when you should come back for a checkup.
To make a plan for future treatment.
Minor bleeding. Other risks include:
You should ask your physician how these risks apply to you.
Call the doctor immediately if you have these problems after the procedure:
Tubal Ligation is a form of birth control in which a woman’s fallopian tubes are surgically closed. Normally, the fallopian tubes carry the eggs to the uterus. Closing the tubes with surgery prevents pregnancy.
It is important to realize that sterilization is usually permanent and can not be reversed. However, if the fallopian tubes are clamped or tied, a woman may possibly become fertile again through the use of microsurgery.
A woman also becomes sterile if her uterus is removed (a hysterectomy). A woman cannot become fertile again after a hysterectomy.
Doctors generally recommend sterilization in the following situations:
A couple has had as many children as they want.
Your life may be endangered by pregnancy.
There is a high risk of passing on a serious hereditary disease.
In the U.S. nearly one in every four married women between the age of 15 and 44 chooses sterilization as a means of birth control.
Laparoscopy is the most common procedures used to seal the tubes. Surgery is done under a general anesthetic.
A hysterectomy is an operation to remove all or part of the uterus. Sometimes the ovaries and fallopian tubes are also removed; this is called an oophorectomy. Doctors do not recommend a hysterectomy unless there are reasons other than sterilization for having it.
You may feel some pain or discomfort for 24 to 48 hours after a laparoscopy.
The doctor will want to see you again to be sure that you are healing properly, usually around 2 weeks after your surgery.
If you were using birth control pills before the sterilization, you may notice menstrual changes after the procedure. These menstrual changes are not caused by the surgery. They occur because you are no longer taking the birth control pills.
Sealing of the fallopian tubes almost always results in permanent sterilization and is a very reliable form of birth control.
Complications after sterilization are rare. In some cases, an ectopic pregnancy (pregnancy outside the uterus) may occur, particularly if the fallopian tubes were burned. Other risks include infection, possible bleeding, and scar tissue formation (adhesions).
Call the doctor immediately if:
You develop a fever
You have bleeding or discharge from the vagina.
You are bleeding around the surgical site.
You notice a green or yellow discharge from the surgical site.
You develop redness or tenderness around the surgical site.
Call the doctor during office hours if:
You have questions about the procedure or its result.
You want to make another appointment.
Congratulations on the birth of your new baby. Many women focus on the pregnancy and forget to ask about what will happen following delivery. Recovery from vaginal and cesarean birth takes about six weeks, sometimes it can take longer. During this time, your body will gradually be returning to normal. When you leave the hospital, expect to be wearing maternity clothes (you will still look about 6 months pregnant). Below are a few things to expect when you return home with your newborn.
Your post partum visit is very important and should be scheduled as soon as possible (preferably before you leave the hospital). Please try to make your appointment with the same doctor that delivered your baby. If you had a c-section, see your provider or doctor 1-2 weeks following your surgery and again at 6 weeks postpartum.
You may notice cramping or “afterbirth pains”. This is the uterus contracting to return to its pre-pregnancy size. These pains are usually worse with each pregnancy. They also get stronger while breastfeeding. Therefore, you may want to take a mild pain reliever before each nursing session.
You will have vaginal bleeding for up to 6 weeks following delivery (even after cesarean sections). Flow will gradually decrease in amount and darken in color. Do not be alarmed if bright red bleeding reappears from time to time throughout the first 6 weeks. Increased activity can increase flow and change the color from brown to red. If your bleeding increases to more than a heavy menstrual flow, get off your feet and rest for a few hours. If it continues to be heavy after resting, please call your provider.
To prevent infection and promote healing:
Use pads instead of tampons
Do not insert anything into the vagina
No douching
No sexual intercourse for 6 weeks after delivery
It is not unusual for your first period to be heavier or different. You may notice an increased menstrual flow with clotting. Your period may also last longer than normal. If you are saturating a new sanitary pad every hour – get off your feet until the bleeding slows. If it continues, please call your provider.
Don’t be surprised if you are not feeling great on your first day home. You will notice a gradual increase in your stamina over time. It is important to rest when the baby rests, and sleep when the baby sleeps. If family and friends offer to help out, take them up on it. If no one offers, ask. Your energy should be directed toward taking care of yourself and your new baby.
Do not lift anything over 10 lbs (gallon of milk)
No heavy exercising
Light walking is okay
Do not drive while you are on prescription pain medication
It is very common to feel bruised and sore in the vaginal, perineal, and rectal areas after delivery. If you have stitches, these will dissolve gradually over the next six weeks. Keep the area as clean as possible. Pour water over the entire area, and then pat dry (front to back). Change your sanitary pad frequently. You may use a sitz bath for relief from discomfort (sit in a bath with 6-8 inches of warm water for 15-20 minutes, this can be done 3-4 times/day). You may use a topical anesthetic spray such as Dermoplast for additional relief.
Your staples may be removed before you leave the hospital or at your 1 week follow-up visit in the office. After the staples are removed, you may have clear plastic strips called steri-strips covering parts of your incision. If these strips have not fallen off on their own in a week, you may remove them. The easiest time to remove the tape is after a shower while the strips are damp. Be sure to keep the incision clean and dry. Leave the incision open to the air to facilitate healing. Call the office it you notice any increased redness, increased pain, pus-like drainage or odor from the incision site.
Wear a well fitting, sturdy bra day and night for the first few weeks following delivery. Keep all stimulation away from your breasts – stand with your back to the water in the shower. Even though you are not breast feeding, your body will begin to make milk. Your breasts may get engorged (hard, lumpy, tender, hot) as the milk is produced and not released. Expressing milk for relief may lead to more milk production. You may apply ice packs or cabbage leaves to your breasts 3 or 4 times/day for up to 20 minutes at a time. You may bind your breasts with an ace bandage for added support. Call the office if you have tenderness, redness, fever of a particular area of the areal.
Wear a good supportive bra. When showering, do not use soap on the breasts. Call your lactation consultant if you develop dry, cracked nipples. Lanolin cream may be applied to the nipple area. If you notice a warm, red, tender, lump or induration on the breast, have a fever and flu-like symptoms, please call your provider.
Now that you are no longer pregnant, you can be more liberal with your dietary choices. Continue with a balanced diet. You will need an additional 500 calories per day for breast milk production. Try not to skip meals. Take your prenatal vitamin as long as you continue to breastfeed. You should try to drink at least 8-10 glasses of water/day. It is helpful to have a glass of milk, water, or fruit juice available to drink every time you nurse.
The first bowel movement is usually within 2-3 days. To help alleviate or prevent constipation, you should consume 8-10 glasses of water a day. Eat high fiber foods, such as fresh fruits and vegetables, whole grain bread and crackers, high fiber cereals, raisins, and prunes. If you need a medication for constipation, you may try over the counter fiber supplements, such as Fibercon, Metamucil, or Citrucel, a stool softener such as Colace, or a mild laxative such as Milk of Magnesia. For gas, you may take Gas-X (simethicone 40-80mg) three to four times a day.
Hemorrhoids are varicose veins in the rectum. Pregnancy can cause hemorrhoids to develop when the growing uterus interferes with the blood flow in the region of the rectum. When you are constipated or strain with a bowel movement, these veins become enlarged and painful. You may notice some itching and slight bleeding. They are generally most uncomfortable in the first week following delivery. The hemorrhoids will begin to shrink and many go away. For comfort, you may use a sitz bath 3-4 times a day. You may also apply Tucks pads (witch hazel) to the area as needed. Drink plenty of fluids and eat a diet high in fiber. You may take a stool softener (Colace) as needed. Anusol and Preparation H may be purchased over the counter and used according to directions on the package.
Emotional lability, anxiety, irritability, sadness, anger, and fatigue are common after delivery. The postpartum period may be a time of anxiety and uncertainty for new parents, and when combined with hormonal changes and lack of sleep, a transient depression known as “baby blues”, is not unusual. While 70-80% of all women experience “baby blues”, only about 10% will have postpartum depression. With postpartum depression, the feelings of sadness, anxiety, or despair are more severe and interfere with the ability to function. Postpartum depression can develop many days later. If you feel you may be suffering from postpartum depression, if you are unable to care for yourself or your child, or if you feel you may harm yourself or your child, please call your provider.
| Condition | Approved | DO NOT USE |
| Allergies | Claritin, Benadryl, Chlortrimeton | |
| Artificial Sweeteners (limit quantity) | Nutrasweet, Splenda | Sweet & Low, Saccharine |
| Constipation | Colace, FiberCon, Metamucil, Citrucel, Milk of Magnesia | |
| Cough/Colds | Tylenol Sinus | Nyquil/Dayquil |
| Heartburn/Indigestion | Mylanta, TUMS, Pepcid, Maalox, Gaviscon | Pepto-Bismol |
| Hemorrhoids | Preparation H, Anusol HC | |
| Nasal Congestion | Saline Nasal Spray (Ocean Mist), Claritin, Robitussin | |
| Pain/Fever/Headache | Tylenol (regular & extra strength) | Aspirin, Advil, Ibuprofen, Motrin, Advil, Aleve |
| Rash/Itching | Benadryl, Benadryl Lotion, Hydrocortisone cream 1% | |
| Sleep Aid | Benadryl, Tylenol PM | |
| Sore Throat | Cepacol, Chloraseptic Spray | |
| Yeast Infection | Monistat 7, Lotrisone-7 |
*In general, try to avoid taking any medication in the first 12 weeks of pregnancy. However, if you do need to take something, the medications listed above are considered safe in pregnancy. If your symptoms persist after treatment, please call our office.
During pregnancy, certain lab tests are routinely performed on all women. They are done at specific times during the pregnancy to help your doctor identify possible problems with your pregnancy. They will also give clues to how your baby is doing. Other tests that may be done will depend on your medical history, age, family background, ethnic background, or exam results.
Pap Smear: Check cervical cells that could lead to cancer.
Cultures: To check for STD’s (sexually transmitted disease) such as Gonorrhea and Chlamydia.
Ultrasound: Used to determine the date of delivery
Blood Work: You will be given an order to go to the lab to have the following blood tests drawn:
Weight
Blood Pressure
Urine Dip: checks for protein and glucose
Fetal Heart Rate
Estimate fetal growth by checking the size of the uterus
Quad Screen. This is a blood test and does not pose a risk to the mother or the fetus. Positive results may indicate the baby may have:
Neural tube defects: problems with the brain or spine such as spina bifida or anencephaly.
Abdominal wall defects: problems with the body of the fetus.
Ultrasound: Used to screen for malformations and appropriate fetal growth.
Genetic defects: physical or mental defects such as Down’s Syndrome.
Please remember that this is a screening test and is not used to diagnose these conditions. If your test is positive, additional testing will be ordered to diagnose any abnormalities. These include ultrasound and amniocentesis.
Glucola or 1 hour glucose tollerance test (GTT): This is a blood test to screen you for gestational diabetes. If this test is positive, you will need the more comprehensive 3 hour glucose tolerance test.
Preparing for the 1 hour glucola:
On the day of your test, do not drink or eat anything for 2 hours before the test.
Plan to be at the lab for at least an hour.
The lab tech will give you a sweet drink called glucola. Exactly one hour after you finish the drink, your blood will be drawn. Do not eat, drink, or chew gum during this hour.
Bring a light snack to eat after the test. This helps to relieve nausea and shakiness that some people feel during the test.
Antibody screen and Rhogam injection.
Group B Strep Culture: A swab is taken from the vagina and rectum to determine if the mother is a carrier of the bacteria. This is a type of bacteria that is normally found in the vagina and/or rectum of some women, and causes no symptoms or problems in adults. However, sometimes it can cause a serious infection in the newborn as he/she passes through the birth canal.
If your test is positive, IV antibiotics will be given to you while in labor to prevent this infection in the newborn. If any problems or complications arise in your pregnancy, additional testing may be ordered, such as:
Ultrasound and/or Biophysical Profile
Amniocentesis
Non-Stress Test
Blood tests
This usually occurs during the first 13 weeks of pregnancy and is often referred to as “morning sickness”. However, these symptoms can occur at any time of the day or night. For some women, these symptoms continue throughout the entire pregnancy. This is caused by the reaction of the stomach and intestines to the increase in hormones related with the pregnancy.
Prevention & Treatment:
Eat small frequent meals
A light snack which may include carbohydrates (crackers, bread, etc…) before getting out of bed in the morning. For more information see information on Morning Sickness
This is usually described as a burning sensation, first in the stomach and then rising into the throat.
Prevention & Treatment:
Eat small frequent meals
Sit upright for 30-60 minutes after eating
Prop your head and shoulders up on a pillow while sleeping
See approved medication list
This is caused by a slowing of the intestinal activity and pressure of the growing uterus. There are several factors that contribute to this problem during pregnancy, such as iron supplements, insufficient fluid intake, lack of exercise, and lack of sufficient fiber in the diet.
Prevention & Treatment:
Keep feet elevated.
Lie on your left side to improve circulation
Reduce intake of foods high in salt. Do not use table salt.
Increase water intake
This is due to the interference of blood flow by the expanding uterus.
Prevention & Treatment:
Keep feet elevated.
When you have to be on your feet, move around to encourage better circulation
Support hose may be used to help relieve discomfort.
These are varicose veins of the rectum. They are extremely common during pregnancy and in the period after delivery. Usually they shrink or resolve within a few weeks following delivery.
Prevention & Treatment:
Use the steps described above to relieve constipation since straining with bowel movements can make hemorrhoids more uncomfortable.
Witch hazel compresses.
Sitz baths.
This is caused by a crowding of the diaphragm by the uterus.
Prevention & Treatment:
Some relief may be given by extending arms above head.
Sleep with head elevated on pillows.
If not better by above means call your doctor or providor immidiately.
This is due to several body changes in pregnancy: muscle fatigue, change in the center of gravity and pressure from the growing uterus.
Prevention & Treatment:
To avoid undue strain to the back, bend from the knees if possible.
When standing for long periods, try to keep one foot on a stool or book.
Alternate elevated foot as needed.
When you have to sit for long periods, try to get up and walk around every so often.
Heating pad or hot compress (low to medium heat) applied to the area, 20 min. on, 20 min. off.
This may be caused by several factors: stretching of muscles, circulatory impairment, or by a mineral imbalance.
Prevention & Treatment:
Change possition, stand or walk.
Apply counter pressure at the bottom of the foot
Speak with your provider about additional supplementation
This is caused by pressure on the bladder by the enlarging uterus.
Prevention & Treatment:
Drink plenty of fluids.
Keep bladder empty.
There are many possible causes, including shortness of breath, general discomfort, or anxieties about the pregnancy and baby.
Prevention & Treatment:
Use relaxation techniques and slow down breathing to help induce sleep.
Discuss any concerns with your provider
Discharge is normally increased during pregnancy.
Prevention & Treatment:
There is no specific treatment for normal pregnancy discharge, but if the discharge has an unpleasant odor or is accompanied by itching or burning, please call your provider.
Do not douche
Wear cotton underwear
This usually occurs on the abdomen in mid to late pregnancy.
Prevention & Treatment:
Use a non-irritating, unscented soap and rinse well
Creams and lotions may reduce itching but will not prevent stretch marks.
These are some simple remedies for the most common discomforts. However, if problems persist or if the discomfort is extreme, please contact your provider.
In the early months of pregnancy, you may experience some nausea and vomiting, which can occur any time during the day or night. This is believed to be caused by hormonal changes that slow the digestive system. This can be a serious medical problem if not controlled as it can leat to dehydration. Not everyone will be able to tolerate the same foods, so let your body dictate what you eat.
Have a “pre-breakfast” snack. Keep bread or crackers at your bedside and eat some before getting up.
Get out of bed slowly, sudden movements may increase nausea.
Eat multiple times per day as hunger can worsen nausia and vommiting.
Drink plenty of fluids and star hydrated.
Eat high protein foods such as eggs, cheese, nuts, lean meats, etc to help prevent drops in your blood sugar.
Avoid caffeine in coffee, tea, colas, and chocolate
Avoid greasy, fried, highly seasoned foods and foods topped with butter, margarine, sour cream, or gravy.
Sip soda water (carbonated water) or ginger ale when you begin to feel nauseated.
Get fresh air; take a walk, sleep with an open window… use an exhaust fan if you have to cook.
Take your prenatal vitamin in the evening after dinner or at bedtime.
Drink mint tea
If your nausea and vomiting is severe or prolonged, or you think you are becoming dehydrated, contact your healthcare provider. If you are unable to keep down any food or drink for more than 24 hours, call the office. Do not take any medication unless prescribed by your healthcare provider.
| Suggested foods to try: | |
|---|---|
| Solids
| Liquids
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| Once you can tolerate the above foods for at least 24 hours, try adding these foods one at a time. | |
| Solids
| Liquids
|
Preeclampsia is a condition that develops after the 20th week of pregnancy. There is high blood pressure and protein in the urine. Preeclampsia is also called toxemia or pregnancy induced hypertension. If preeclampsia is not identified and managed appropriately, it can have serious consequences for both the mother and the baby.
The cause of preeclampsia is unknown. It affects about 5-8% of all pregnancies. Preeclampsia is more likely to occur in:
The following are the most common symptoms of preeclampsia. However, many women report no symptoms. This is why it is so important to attend all your prenatal appointments.
Your healthcare provider will measure your blood pressure and test your urine at each prenatal visit. If preeclampsia is suspected, blood tests will be ordered to confirm the diagnosis.
How does preeclampsia affect the mother and the fetus?
Preeclampsia causes a constriction of blood vessels. It is currently the leading cause of preterm birth and maternal and neonatal death. In the mother, preeclampsia results in decreased blood flow to the liver, kidneys, and brain. This causes the organs to fail. It can also cause seizures (eclampsia) and more life-threatening disorders.
In the fetus, preeclampsia leads to decreased blood flow to the placenta (the organ that carries nutrients and oxygen to the baby). This can result in a low birth weight baby or in severe cases stillbirth. Rarely, it may cause placental abruption (the placenta separates from the uterus). This leads to severe bleeding in the mother and may result in maternal and neonatal death. Many of the effects of this condition in the newborn are related to prematurity.
This is a type of diabetes that happens only during pregnancy. This occurs when your body is unable to make and use all of the insulin it needs for pregnancy.
According to the American Diabetes Association, you are considered at high risk for this condition if:
Gestational diabetes occurs in pregnancy when the baby is busy growing. Because of this, gestational diabetes does not cause the kinds of birth defects seen in women with preexisting diabetes. However, if this condition goes untreated or is poorly controlled, it can have serious consequences.
The extra glucose in your blood goes through the placenta to the baby, giving the baby high glucose levels. Since the baby is getting more energy than it needs, it is stored as fat. This can lead to large babies. A macrosomic baby has a larger than normal head and/or shoulders, which can make it difficult for the baby’s head to enter the birth canal. Sometimes the shoulders get stuck. This is called shoulder dystocia. Shoulder dystocia can result in fractured bones and/or damaged nerves in the baby. Because of these risks, if your doctor suspects your baby may be overly large, he/she may recommend delivery by cesarean section.
Newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems. These babies are also at greater risk of becoming obese and developing type 2 diabetes later in life.
Treatment for gestational diabetes aims to keep blood glucose levels equal to those of pregnant women who don’t have gestational diabetes. Listed below are some of the most common ways to control your blood sugar:
If you have gestational diabetes, you will most likely have to start testing at 32 weeks which includes testing the baby by us. This includes non-stress tests, biophysical profiles, and additional ultrasound exams to monitor growth and determine the size of your baby. You may have to monitor fetal movements.
Once you’ve had gestational diabetes, your chances are 2 in 3 that it will return in future pregnancies. You are also at higher risk of becoming diabetic later in life.
To help prevent this:
Performing a non-stress test is a simple, painless, and non-invasive way to assess the well being of your baby.
The fetal heartbeat should be within the normal baseline range of 120-160. The baby’s heartbeat should accelerate in response to movement (these accelerations need to meet a certain requirement to be considered reactive). There should be no dangerous signs, such as a deceleration in the heart rate. If you are less than 36 weeks, there should be no contractions. If your NST is not reactive, don’t panic. Usually, there is nothing wrong with the baby. Additional testing, such as ultrasound, or prolonged monitoring, will be ordered to be sure your baby is doing okay.
Non-stress tests are frequently done in high risk pregnancies to determine if the fetus is well enough for the pregnancy to continue or if delivery should be considered, but they are also done in routine pregnancies. Some of the most common reasons for an NST are:
With a breech presentation, your baby is in a buttocks or feet first presentation. A breech presentation can make it hard for the baby’s head to fit through the birth canal during a vaginal delivery. This can cause a lack of oxygen or nerve damage in your baby.
Your doctor can tell the presentation of the baby by pressing on your belly or during a vaginal exam. If you are more than 35 weeks and your healthcare provider is unsure of the position of your baby, you may have an ultrasound to determine the baby’s position before delivery.
Although some breech babies are born vaginally, it can result in complications. For this reason, you will usually be scheduled for a cesarean delivery.
Just because your baby is in a breech position, it doesn’t mean that he or she will have health problems. Most likely, you and your baby will be fine.
Most expectant mothers will feel their baby move by the 20th week of pregnancy. Fetal movement is an indicator of fetal well being. One way for you to know if your baby is doing well is to record your baby’s movements. This is called a fetal kick count. Kick counts work best after the 27th week of pregnancy.
| WHAT IT IS | HOW IT HELPS | COMMENTS |
| Relaxation The goal of most of the other measures is to help you relax, as this is the most important thing you can do to be more comfortable. |
|
|
| Breathing | Helps you relax. | Slow deep breathing and vocalization usually works best. |
| Focusing | Keeps your mind focused so you have decreased ability to recognize pain signals. | You can focus inwardly or outwardly. |
| Position Changes |
| The more positions you try, the more comfortable you will be and easier your labor will progress. |
| Support | Labor can be very tiring, support people can give you a boost. | Helps the most when there is help give more than one support person. |
| Meditation | Clears your mind of disturbing thoughts and fills it with pleasant & calming thoughts. | Scripture can be wonderful to meditate on during labor. |
| Visualization |
| Rehearsing beforehand will make it more effective during labor. |
| Music Whatever music is soothing to you, but consider your birthing team also. |
| Studies show that moms usingmusic during labor need less pain medication. |
| Water
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| IV Pain Medication and Epidurals | Provides immediate pain relief and relaxation so you can rest. |
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Cesarean birth or c-section is the birth of a baby through surgical incisions made in the abdomen and uterus. There are many reasons why a c-section may be used to deliver your baby. A cesarean delivery may be planned in advance when certain conditions are known. In most cases, if problems arise, the decision is made during labor.
All cesarean births, scheduled or not, require certain steps. Below are some of the things you can expect to happen in preparation for your surgery.
In a cesarean birth, incisions are made in both the skin and the uterus. The skin incision may be transverse (side to side) or vertical (up and down), just above the pubic hairline. The muscles in your abdomen are moved and, in most cases, do not need to be cut. Another incision will be made in the wall of the uterus. This incision will also be either transverse or vertical. Your skin and uterine incisions may differ.
Once the incisions are made, the doctor presses on the top of your abdomen. You may feel a lot of pressure or find it hard to breathe when this is happening. This helps guide the baby out of the uterus. In some cases, a vacuum-like device may be needed. After the baby is delivered, the cord will be clamped and cut, and the placenta will be removed. The uterus will be closed with stitches that dissolve in the body. Stitches or staples may be used to close your skin.
A cesarean section is major abdominal surgery and recovery takes 6-8 weeks. During this time you should rest as much as possible and do little more than care for your self and your new baby. Please call the office before you leave the hospital to schedule your 1 week post-op appointment.
Unfortunately, no one can tell you the exact time you will go into labor. However, there are a few things you may experience as labor approaches.
This is when the baby “drops” down into the birth canal. With a first pregnant mother, this can happen 2-3 weeks before labor begins. You may suddenly find it easier to breathe but now feel the need to urinate more frequently. If this is not your first baby, “lightening” usually occurs immediately before or even during labor.
This is more commonly referred to as “show”, or your mucous plug. During pregnancy, a thick mucus plug covers the cervix to serve as a barrier against infection. When the cervix begins to thin and open, this discharge is expelled through the vagina. It may come out in one piece or in small amounts. The mucus can be green (snot-like) or blood-tinged (bloody show). This “show” may occur a few days or even a few weeks before labor begins. Many women do not even notice losing their mucus plug.
This is when the amniotic sac that surrounds the baby (“bag of waters”) breaks. This may happen a few hours before the onset of contractions, or at any time during labor. The fluid should be clear, but it may be green or blood tinged. If your “bag of waters” breaks, whether you are having contractions or not, you should go to the hospital.
Throughout the second half of your pregnancy, you may have noticed your abdomen getting hard, then soft again, or you may feel like the baby is “balling up”. These irregular contractions may increase in frequency and intensity as your due date approaches. They may become very uncomfortable or even painful. These irregular contractions “false labor pains” are called Braxton Hicks contractions.
Sometimes it is difficult to tell the difference between false labor and true labor without having your cervix checked by a doctor or nurse. A good way for you to tell the difference is to time the contractions. To time a contraction, put your hand on your abdomen. When your uterus begins to feel hard (pain/discomfort starts), that is when the contraction begins. When the uterus softens (pain/discomfort ends), that is when the contraction ends. To time the frequency of your contractions, start from the beginning of the first contraction to the start of the next contraction. This is how far apart your contractions are. You should time the frequency and duration of your contractions for at least an hour.
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For ongoing payment: After your initial payment, call Authorize.net at +1-877-477-3938 to set up ongoing payment.
For ongoing payment: After your initial payment, call Authorize.net at
+1-877-477-3938 to set up ongoing payment.
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