Pregnancy

Congratulations! You are pregnant!

Early pregnancy is a time of celebration, early nerves, butterflies and joy. You’ve shared your big news with the world…now, what?

• Make an appointment with doctor. As soon as your pregnancy is confirmed, or if you suspect you’re pregnant. Your practicioner may choose to wait until you’ve missed two periods to schedule your appointment, while others have you come in right away. Even if you don’t have an immediate appointment, we encourage our patients to call with questions about  medications, symptoms that are worrisome, chronic health conditions, etc. Please don’t hesitate to ask for an earlier appointment if you have a history that might suggest you need to be seen sooner.
• Celebrate! How and when you share your news is a completely personal decision and may be influenced by many factors. Either way, remember that by having fun, you’re releasing stress and relaxing, which is good for you and the baby.
• Look through things like the pregnancy calendar, buy a book and then follow your pregnancy week by week. Keep a diary and write down your feelings and memories. It can be great fun to go back and read how you felt as your pregnancy progressed.
• Take good care of yourself! Seemingly simple things like getting a good night’s sleep, eating healthy foods, taking prenatal vitamins and exercising as appropriate will help you feel be more comfortable and may make labor easier!
• Enlist the help of family, friends and fellow moms. If this is your first pregnancy, a support system is a must-have. Your life is about to change dramatically and you’ll be able to make those transitions much more smoothly if you have a team to lean on.
• Try to enjoy yourself! Time flies by so quickly and before you know it, you’ll be in labor and delivery. Take pictures. Keep a journal. Enjoy this very special moment in your life!

Pregnancy lasts about 40 weeks, counting from the first day of your last normal period. The weeks are grouped into three trimesters.

First trimester (week 1-week 12)

During the first trimester your body undergoes many changes. Hormonal changes affect almost every organ system in your body. These changes can trigger symptoms even in the very first weeks of pregnancy. Your period stopping is a clear sign that you are pregnant. Other changes may include:

• Extreme tiredness
• Tender, swollen breasts.
• Upset stomach with or without vomiting (morning sickness)
• Cravings or distaste for certain foods
• Mood swings
• Constipation (trouble having bowel movements)
• Need to pass urine more often
• Headache
• Heartburn
• Weight gain or loss

As your body changes, you might need to make changes to your daily routine, such as going to bed earlier or eating frequent, small meals. Fortunately, most of these discomforts will either go away or become less noticeable.

Second trimester (week 13-week 28)

Most women find the second trimester of pregnancy easier than the first. You might notice that symptoms like nausea and fatigue are going away, your belly will expand as your baby continues to grow. By the end of this trimester, you will feel your baby begin to move and kick. As your body changes to make room for your growing baby, you may have:

• Body aches, such as back, abdomen, groin, or thigh pain
• Stretch marks on your abdomen, breasts, thighs, or buttocks
• Darkening of the skin around your nipples
• A line on the skin running from belly button to pubic hairline
• Patches of darker skin, usually over the cheeks, forehead, nose, or upper lip. Patches often match on both sides of the face. This is sometimes called the mask of pregnancy.
• Numb or tingling hands, called carpal tunnel syndrome
• Itching on the abdomen, palms, and soles of the feet. (Call your doctor if you have nausea, loss of appetite, vomiting, jaundice or fatigue combined with itching. These can be signs of a serious liver problem.)
• Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight really quickly, call your doctor right away. This could be a sign of preeclampsia.)

Third trimester (week 29-week 40)

The final 12 weeks! Some of the same discomforts you had in your second trimester will continue. You may find breathing difficult and notice you have to go to the bathroom even more often because the baby is getting bigger and it is putting more pressure on your organs.

Some new body changes you might notice in the third trimester include:

• Shortness of breath
• Heartburn
• Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight really quickly, call your doctor right away. This could be a sign of preeclampsia.)
• Hemorrhoids
• Tender breasts, which may leak a watery pre-milk called colostrum (kuh-LOSS-struhm)
• Your belly button may stick out
• Trouble sleeping
• The baby “dropping”, or moving lower in your abdomen
• Contractions, which can be a sign of real or false labor
• As you near your due date, your cervix becomes thinner and softer (called effacing). This is a normal, natural process that helps the birth canal (vagina) to open during the birthing process. Your doctor will check your progress with a vaginal exam as you near your due date.

Ultrasound

Here at Tidewater Physicians for Women we believe in excellence. Our Ultrasound Department is an AIUM (American Institute for Ultrasound in Medicine) accredited facility. This means our practice has met accepted national standards and has shown consistent excellence in patient care when providing diagnostic ultrasounds. To become accredited, we have undergone a rigorous and detailed process. There are no state or federal laws to oversee the performance of diagnostic ultrasounds. So, the accreditation of our practice by the AIUM gives you the assurance we are qualified to perform your ultrasound examination.

Our sonographers (the person doing your ultrasound) are all registered with the ARDMS (American Registry of Diagnostic Medical Sonographers). This ARDMS registration assures our patients that we have consistently met high professional standards for sonographers, as well as achieved exceptional competency in patient care and technical procedures. To achieve this our sonographers have passed the ARDMS examinations and have fulfilled continuing education requirements to increase their knowledge and skill level.

What is Ultrasound?

Diagnostic ultrasound, also called sonography or diagnostic medical sonography, is an imaging method that uses high-frequency sound waves to produce relatively precise images of structures within your body. The images produced during an ultrasound examination often provide valuable information for diagnosing and treating a variety of diseases and conditions. Most ultrasound examinations are done using a sonar device outside of your body, though some ultrasound examinations involve placing a device inside your body.

Is Ultrasound Safe?

There are no known harmful effects associated with the medical use of ultrasound; however, The American Medical Association as well as the American Institute for Ultrasound in Medicine strongly discourages the used of ultrasound without a medical purpose.

Your Pelvic Ultrasound

Pelvic ultrasound may be performed to get detailed images of your cervix, uterus, and ovaries. This exam may be performed either transabdominally (using a probe on your abdomen) or transvaginally (with a probe inserted into your vagina). The most common approach is transvaginally. The transvaginal ultrasound exam is performed by a sonographer (ultrasound technician). There is no prep for this exam. The sonographer will place the probe partially in your vagina. You may feel some pressure, but the exam is generally less uncomfortable than a pelvic exam. Images of your pelvis can be viewed on the monitor. The sonographer will explain the images and will document them.

In some instances a transabdominal approach is necessary. This exam is also performed by a sonographer. You will be instructed to arrive for your ultrasound with a full bladder (drink 32-40 ounces of water 1 hour prior to your ultrasound exam and do not empty your bladder). For this exam, the probe will be moved across your lower abdomen to obtain images of your pelvis. The exam will take 10-22 minutes and then you may empty your bladder.

Your Obstetrical Ultrasound

The approach used for your obstetrical ultrasound may be transvaginal (a probe inserted into your vagina) or transabdominal (a probe moved across your abdomen). If you are in the first trimester, (the first 12 weeks of pregnancy) the sonographer will use a transvaginal approach. The sonographer will place the probe partially in your vagina. You may feel some pressure, but the exam is generally less uncomfortable than a pelvic exam. Images of your pelvis can be viewed on the monitor. The sonographer will explain the images and will document them. If you are in the second and third trimester of your pregnancy, a transabdominal approach will be used. For this exam, the probe will be moved across your lower abdomen to obtain images of your baby. Images of your uterus and baby can be viewed on the monitor. The sonographer will explain the images and will document them. Occasionally, in the second and third trimester a transvaginal ultrasound exam may be necessary.

What can I expect to see on my first trimester ultrasound?

You will learn the location of the pregnancy (inside or outside the uterus) and the number of embryos. You may see the heartbeat of the embryo, some women receive a new due date.

What can I expect to see during my second and third trimester ultrasound?

Your sonographer will be able to tell you how the baby is positioned, the location of the placenta, and the amount of amniotic fluid. Your baby’s growth may be measured. In addition, your baby’s anatomy and well-being may be evaluated.

Are there any limitations to ultrasound of my baby?

An ultrasound examination in pregnancy does not guarantee a normal baby. The ability of the ultrasound examination to detect problems with the baby depends on many things: the age of the baby at the time of the ultrasound, the position of the baby as well as your body size. Some problems cannot be seen by ultrasound because they are too small or not even visible by ultrasound.

How many ultrasounds of my baby will I have?

Most women will need only one ultrasound during their pregnancy. However, your provider may recommend additional exams to help monitor your baby.

Will I get ultrasound pictures of my baby?

Yes. When your exam is complete, you will be given some images to take home. The Group for Women does not allow videotaping, cameras, and recording equipment in the ultrasound exam rooms.

Will I find out the sex of my baby?

Maybe. It’s not always possible to determine the sex of the baby.

Can I bring my family and/or friends to my ultrasound examination?

Yes, but please keep in mind that this is a medical examination performed by a professional. The room will be dimly lit and the sonographer will require a quiet atmosphere in which to concentrate on the images.

Cesarean Delivery vs. Vaginal Delivery

A cesarean delivery (Cesarean section or “C-section”) is the delivery of the baby through an incision in the abdomen and through an incision in the uterus.

Reasons for Cesarean Delivery

Each pregnancy has its own unique characteristics and the reasons for performing cesarean delivery can be categorized as individual reasons. Generally, it is a decision reached by you and your physician based on a combination of factors.

• Conditions of the mother – If medical conditions exist that suggest a woman’s health may worsen if the pregnancy is allowed to progress or that she wouldn’t tolerate labor and delivery, a cesarean section may be performed. In addition, problems with the uterus or other pelvic organs, may necessitate a c-section.
• Conditions of the fetus – In some cases, the baby may have medical conditions that result in its inability to tolerate the stresses of labor. In other cases, the baby may be coming down through the birth canal in an unusual position so that a vaginal birth is not possible.
• Conditions of the mother/baby – It is not uncommon that the baby cannot be delivered as a vaginal birth due to the baby’s size, the shape of the bones of the mother’s pelvis, or the contractions of the uterus not being adequate.
• Conditions of the afterbirth – In some cases, the afterbirth (placenta) may be in the way of a vaginal delivery (placenta previa) or may separate prematurely (placental abruption) which would require cesarean delivery.

There is a higher risk associated with cesarean delivery over vaginal delivery. In some instances, the cesarean delivery is decided upon before labor and attempted vaginal delivery is started. In many cases, however, the cesarean delivery is only decided upon after extensive attempts to achieve vaginal delivery.

Once a Cesarean, Always a Cesarean?

In the past, fear that the uterus had been weakend by a previous cesarean section in the past, dictated the decision to have cesarean sections in the future. It is now believed that women who have had cesarean sections in which the incision is low transverse (across the womb) vs. high or low vertical, can be considered candidates to have attempts at vaginal delivery in subsequent pregnancies. You should feel free to speak with your physician about your birth plan and make your wishes clear.

Risks and Benefits of VBAC (Vaginal Birth After Cesarean)

Approximately 60% to 80% of woman who are given an opportunity to attempt a trial of labor after a previous cesarean delivery can successfully deliver as a vaginal birth. Unfortunately, there are no clear ways to determine who will deliver vaginally and who will need a cesarean after all. Those who are able to deliver vaginally can look forward to shorter hospital stays, less need for blood transfusions and a lower chance of infections. The most serious risk is that of rupture at the site of a previous incision. The liklihood of this event is less than 1% and most common when a woman has had more than one cesarean section or abnormally difficult labor. If you are attempting VBAC, you’ll closely monitored in the event that emergency surgery is needed.

The Operation and the Operating Room

Under some circumstances, the cesarean delivery is planned and scheduled. Sometimes, possibly during the labor process, a cesarean delivery is decided upon for emergency reasons. If this occurs, the patient will be rushed to the delivery room to perform the operation. The patient will be performed with anethesia so the patient doesn’t feel the cutting of the tissue.

If you do require a cesarean section, every effort will be made to have your support person with you in the room. That person usually sits at the head of the table, next to your head and out of the area where the surgery will be performed. The operation is then conducted by a surgical team, under sterile conditions. If the patient receives the kind of anethesia that allows them to be awake, she will hear her surgical team talking and may feel a pulling sensation as the baby is removed. Your baby will have its needs attended to, be cleaned up appropriately and given to the mother for bonding as soon as possible. While this is happening, the incision will be closed.

After the operation, the patient will initially have an intravenous (IV) line to provide medicine, fluids, and nourishment. There will also be a catheter that was placed in the bladder prior to surgery, which will continue to drain urine into a bag. When the anesthesia wears off after the operation, there will be some pain in the abdomen. The patient’s blood pressure, temperature, and pulse will be monitored closely every few hours and the incision will be examined on a regular basis. The patient will be encouraged to cough, deep breathe, and move about in bed, getting out of bed as soon after surgery as is practical. This promotes good, deep breathing which will prevent lung problems such as pneumonia.

It’s important to attempt short walks as soon as possible, even though there will be some discomfort and the incision will be sore and tender. The sooner you can get up and move around, the faaster your body begins the healing process. Hospital personnel are always available to help you in and out of bed and can answer questions as you have them. If you need medication for pain, nausea or other needs, you should speak up and ask.

Diet

Ideally, after surgery, clear liquids can be tolerated and the intestines begin working. Don’t be alarmed, however if things take a day or two to get moving. It’s not uncommon for bowels not to return to normal function until the patient returns to their regular diet. It’s not unusual to have gas pains in the lower abdomen, but extreme or sudden pain is cause for concern. Please notify your physician immediately if you have symptons that are causing you real pain.

Going Home

Because you have experienced a surgical procedure, you may find it more difficult to hold and feed your baby. Bonding with the newborn as well as recovering from the cesarean delivery at the same time is simply more challenging than after a vaginal birth. Mood swings, however, may occur just like they occur after vaginal delivery. Difficulty with emotions, depression or feelings of hopelessness should be discussed with the nurses or the woman’s physician to prevent any significant problems.

By the time you go home, you’ll be able to eat anything you like and your incision should be healing nicely. As you get stronger, you can increse your level of activity. Take longer walks, tolerate stairs and do more things with your baby. If you plan on breastfeeding, it will not be affected by your delivery, cesarean or vaginal.