TO OUR EXPECTING FAMILIES

Portrait of a happy young pregnant woman with her husbandWelcome to Pasadena Women’s Medical Group and congratulations on your pregnancy. This is an exciting and important time for you, your family, and your baby. We know that you will have questions and we encourage you to write them down so that you don’t forget to ask them. This handbook will answer many questions relating to you and your pregnancy. Childbearing is a normal event that is helped by partnership between you and your partner and your health care provider.

Office Hours
Our office is open from 8:00 AM to 6:00 PM Monday through Thursday and from 8:00 AM to 5:00 PM on Friday. The doctor’s answering service will receive calls after our usual office hours, seven days a week. When circumstances permit, we would like you to call us before you go to the hospital for an emergency or to deliver. We often can advise your best course of action over the telephone. We may wish to meet you at the hospital or at our office.

THE FIRST TRIMESTER

YOUR FIRST VISIT: This is a thorough examination including an extensive personal and medical history, physical exam, and blood work. The blood tests check your blood type, blood count (to check for anemia), immunity to rubella (German measles, hepatitis, and syphilis). We also do a pap smear, cultures for chlamydia and gonorrhea, and urine screen. If there is anything special in your medical history, other tests may be done. We will discuss the results on your next visit.

EARLY PREGNANCY SYMPTOMS: Your body is already undergoing many changes to accommodate your growing baby! Many early pregnancy symptoms, while not pleasant, are normal. These may appear in one pregnancy and not the next, or vice versa. They include:

  • Fatigue: What to do: Increase nighttime sleep and take a nap, if possible: Do only the essential housework or get someone to help with care for your older children. Listen to your body and do what you can. This will pass!
  • Nausea and/or vomiting: What to do: Eat small frequent meals of any food that sounds appealing. Some people find that potato chips, gatorade, ice cubes (crushed), and foods with ginger help. Avoid large, heavy, fried meals. If your prenatal vitamin makes you sick, you may stop taking it for a week. Be sure to keep drinking liquids.
  • Frequent urination: What to do: Continue to drink to thirst and don’t try to hold it.
  • Breast tenderness: What to do: Wear a well fitting bra (such as a sports bra).
  • Mild menstrual cramps: What to do: These are a sign of your uterus growing and do not require treatment.

WARNING SIGNS: You may contact the doctors by calling the office number, (626) 796-9114, any time of the day or night. Please call if you experience the following:

  • Bleeding: like a period, with clots, or spotting that lasts more than three days.
  • Cramping: any severe cramping or a sudden increase in cramping.
  • Lower abdominal pain: that is severe or located on one side, or a sudden onset.
  • Extreme nausea and vomiting: accompanied by decrease in urination, inability to keep any fluids down, or with a weight loss of more than 10 lbs.

LIFESTYLE ADJUSTMENTS: There is no better time to adopt a healthy lifestyle. Your baby will thank you and you will have a more comfortable pregnancy if you do. Diet: you are eating for two, but one of you is only an inch long! You need 300 more calories a day which is the equivalent of two glasses of low fat milk. While you shouldn’t eat anything and everything, there are ways to modify your diet to achieve the 25 to 30 pound weight gain recommended for average weight women:

  • 75 grams of protein
  • 2000-2500 calories per day
  • 30-40% of calories from fat
  • 4 servings of dairy (or a calcium supplement if dairy foods aren’t eaten)
  • Avoid soft cheese (cocique, feta) and raw fish or meat
  • Nutrasweet and caffeine in moderation appear to be safe, but it is best to avoid them.

EXERCISE: If you are already involved in an exercise routine you may continue with a few adjustments until around five months. We recommend keeping your heart rate below 140 and for no longer than a half hour of aerobic activity. Low impact aerobics, stationary biking, walking and running (if you already do so) are okay. If you aren’t exercising, now is a great time to start an exercise program of walking for twenty to thirty minutes per day. This will help increase your energy and contain your weight. If you have a history of complications we may tell you not to exercise. No scuba, sky diving, hot tubs or saunas, please.

SEX: It is okay, in the absence of any pain or complications, to continue your normal sexual relations. You may notice an increase or decrease in sex drive, and either is normal.

 

FIRST TRIMESTER FETAL DEVELOPMENT

guide_1It is now three inches long.

It weighs about one ounce.

It has a strong heartbeat, although we are unable to hear it before 12 to 14 weeks.

It has facial features, and its elbows, knees, fingers, and toes have formed.

It has a brain, organs, and body systems, all of which are developing rapidly.

Credit: Images reprinted from Planning for Pregnancy, Birth, and Beyond

(American College of Obstetricians and Gynecologists)

THE SECOND TRIMESTER

The period from 12 to 28 weeks is a time of many changes in your developing baby.

Your visits each month will be fairly brief compared to your initial visit. Each one is very important, though. We will check the following at all your visits:

  • Weight: we recommend a half pound per week gain until twenty weeks, then a pound a week after that.
  • Blood pressure
  • Uterine size: we measure the distance from you pubic bone to the top of your uterus, to be sure your baby is growing well.
  • Fetal heart rate: usually between 120 and 180 beats per minute.
  • Urine testing: we check for protein, glucose, and signs of infection. If any is found we may ask you to do a urine culture.

COMMON SYMPTOMS:

  • Headache: The best remedy is to drink lots of water (At least 10 glasses a day). Plain Tylenol may be taken, 650 mg every four hours as needed.
  • Constipation: Drinking lots of water help this symptom. Also, increase the fiber in your diet by eating fruits, vegetables, and high fiber cereals. You may use milk of magnesia to treat constipation. Stool softeners such as fiberol and metamucil are okay to use. Avoid enemas and suppositories.
  • Cold/sinus problems: You may use Sudafed 60 mg (without anti-histamine) every four hours for stuffy or runny nose. Robitussin DM is okay to take to help a cough, and Tylenol can be taken if needed for aches and fever. Call if your fever is greater than 101. Cough drops and throat sprays are okay.
  • Mood changes: As you get used to the idea of being pregnant, you may go from mood extremes of happiness to sadness in one day or even one hour. Be sure to share your feelings with friends and family. If you ever feel extremely sad or depressed, please let us know so we can help.
  • Backache: As your uterus grows you may develop a “sway back” that can lead to backaches. Bending at the knees when you lift objects, keeping one leg elevated on a stool with leg bent when you stand, and avoiding excess weight gain can help. You shouldn’t lift more than thirty pounds routinely during pregnancy (picking up kids occasionally is okay). Standing against a wall and pushing your lower back flat against it can help as can getting on hands and knees and rocking your palms back and forth.
  • Pubic bone pressure/pain: This gets worse with each pregnancy due to increased looseness of abdominal muscles. A pregnancy girdle or support sling for your belly can help (and helps also with a backache).
  • Round ligament pain: This is a sharp shooting type pain that you feel along your groin/sides of your pelvis caused by stretching of the ligaments that support your uterus. It usually is worse with movement. As long as it is occasional and not severe and not accompanied by bleeding or other symptoms, it is no cause for concern. Resting is the best treatment.Tests:
  • Multiple markers: Between sixteen and twenty weeks, we recommend a blood test called “multiple markers” or “AFP-plus.” This is a blood test that looks for three chemicals made by the fetus. This blood test screens for “neural tube defects” (problems with development of the brain or spinal cord) and chromosomal problems (such as Downs Syndrome). It doesn’t detect all babies with these problems but it is a useful test. If abnormal, you will be referred for further testing such as an amniocentesis.
  • Amniocentesis: This involves removing fluid with a needle from around the baby (amniotic fluid) for testing. We recommend this test to mothers who will be thirty-five years old or older at delivery, if the multiple markers test is abnormal, or if other medical or genetic problems are suspected.
  • Ultrasound: Routinely an ultrasound is done around eighteen to twenty weeks gestation to check for anatomical development of the baby. Ultrasound uses sound waves that “bounce off” the baby and create a picture on a screen. Ultrasound was not created to determine the sex of the baby and is not always accurate in this respect-so please don’t ask! It is an important tool in monitoring the continuing healthy, normal growth of your baby.

WARNING SIGNS: Please call if you experience:

  • Bleeding like a period or spotting that lasts more than three days.
  • Menstrual type cramps or abdominal pain that comes and goes.
  • Contractions or tightening of the uterus more than four times per hour.
  • Watery vaginal discharge with or without other symptoms
  • Sudden weight gain of more than two pounds in one day, with increased swelling, especially in your hands or face.
  • Fever of more than 100.5, chills, or other signs of illness.
  • Severe headache, blurred vision, or spots before your eyes.
  • Pain when you urinate, sores, or blisters on your genitals.
  • Pregnancy induced hypertension or pre-eclampsia is a condition that occurs more frequently in mothers having their first baby or in older mothers. It results in high blood pressure in the mother and decreased oxygen to her baby. Although the only cure for this condition is delivery, supportive treatment needs to be started as soon as possible to prevent complications for both mother and baby.

SECOND TRIMESTER FETAL DEVELOPMENT

guide_2

 

 

 

By 28 weeks, your baby is 14 to 17 inches long.

It weighs about 2 to 2 1/2 pounds.

Its body systems are continuing to develop.

Its skin is red and wrinkled and is covered with fine downy hair and a creamy white coating called vernix.

It can suck, swallow, have the hiccups, and exercise (as you well know!).

Credit: Images reprinted from Planning for Pregnancy, Birth, and Beyond

(American College of Obstetricians and Gynecologists)

THE THIRD TRIMESTER

The third trimester or the last 12 weeks of your pregnancy is a time of preparation and a time of waiting!

As your pregnancy progresses you will continue your regular visits with us. We will see you every two weeks after thirty-two weeks and weekly after thirty-six weeks.

TESTING

Between twenty-four and twenty-eight weeks you will be given lab slips for a complete blood count, a syphilis blood test, and a screening test for gestational diabetes. At the lab you will drink a glucose solution (on an empty stomach) and have your blood drawn one hour later. If your one hour test is abnormal you will be asked to do a three hour glucose test.

If your blood type is RH negative you will be given an injection of rhogam around twenty-eight weeks.

SYMPTOMS

  • Fetal movement: an active fetus is almost always a healthy fetus! We ask that you monitor your baby’s movements daily after twenty-eight weeks. You should feel ten movements per hour during your baby’s normally active time. If you don’t, eat something, drink some water and lay on your left side. If you are ever concerned about decreased fetal movement, call us.
  • Leg cramps often occur at night and can be relieved by stretching out your calves before bedtime. Also try drinking a glass of milk , or taking a calcium supplement just before bedtime. Regular exercise such as walking can help.
  • Problems sleeping: Due to your changing shape, you may need to make changes in your favorite sleeping position. The best position is lying on your side (preferably left) with a pillow between your knees and possibly under your belly. Insomnia is normal and can be due to a worrying mind as well as an uncomfortable body. Try a warm bath or shower, warm milk, and a gentle stretching before bedtime.
  • Shortness of breath: You may feel like you can’t catch your breath or that you are taking deep breaths. This is due to the baby crowding under your lungs, as well as hormonal changes. You are getting enough oxygen! However, if you experience shortness of breath with chest pain, rapid pulse, or a fever, call us right away.
  • Numbness of fingers/Pain in hands: The carpal tunnel in the wrist can become swollen, causing numbness, burning, tingling, a pain in the hand, wrist or arm. Wearing a wrist splint can help, as can increase your water intake and left-sided rest to reduce swelling.

LIFESTYLE

It is best to avoid traveling at all in your third trimester. If you must travel after your twenty-eighth week, keep the distance and travel time short. Pregnant women should never travel to high altitudes or to developing countries. Avoid prolonged sitting (never more than two hours) and be sure to drink lots of water. Please ask your doctor for clearance before you travel in your third trimester. Travel in the last month should be avoided.

KICK COUNT

Starting at about 28 weeks, we will ask you to count how long it takes your baby to move 10 times once each day, and to keep a daily record of these times to show to your doctor when you come for your office visits. We will give you a special sheet to write these times on. It is important to bring this sheet with you to your office visits.

WORKING

Most working women are eligible for disability starting at thirty-six weeks. Ask your employer. The disability forms are filled out at our front desk. Your doctor will advise you if you should stop working sooner.

WARNING SIGNS

Preterm labor is labor that begins before your 36th or 37th week of pregnancy. Preterm labor can usually be stopped if medical attention is obtained before the cervix (mouth of the uterus) opens. If in doubt, it is better to call and find out that your symptoms are normal instead of waiting too long and delivering a premature baby.

Preterm labor (PTL): symptoms of PTL Include:

  • Menstrual cramps
  • Abdominal cramps with or without bleeding
  • Uncomfortable tightness of the uterus
  • Pressure sensation in your vagina
  • Dull, low backache, different from your usual backache
  • Increase in vaginal discharge
  • If your baby moves less than usual, call the office. Keep up your daily fetal movement counts – they’re even more important now!

WHAT TO DO

If you feel uterine contractions before thirty-seven weeks of pregnancy, lie on your left side and drink two large glasses of water. If this doesn’t quiet things down after an hour, call us. Call sooner for a sudden increase in symptoms. Also call us if you experience:

  • Painful urination
  • Vaginal bleeding
  • Fever more than 101
  • Leaking fluid from your vagina

 

THIRD TRIMESTER FETAL DEVELOPMENT

guide_3

 

 

 

Its length will be about 20 inches.

Its weight will be about 7 1/2 pounds.

Its skin will be pink with some creamy coating (vernix) on it.

The fine downy hair will have almost disappeared from its body.

Its fingernails will have grown beyond the ends of its fingers.

Its skin may be peeling a little.

Credit: Images reprinted from Planning for Pregnancy, Birth, and Beyond

(American College of Obstetricians and Gynecologists)

PAIN RELIEF DURING LABOR AND DELIVERY

Options for pain relief most commonly used include:

  • IV medication: narcotics such as Demerol or stadol can be given through your IV during labor. This helps with the pain but does not completely eliminate it. Also, it can make both mother and baby sedated so it will usually only be given in early labor.
  • Epidural: This is numbing medicine introduced into the area surrounding the spinal cord. A catheter will be placed in you lower back.

THINGS TO THINK ABOUT

Circumcision: your obstetrician can circumcise your baby before he leaves the hospital. Circumcision is not a routine procedure and you will be asked to sign a consent form before the procedure. The decision to circumcise or not is up to you.

GENERAL TIPS

Nutrition

Milk Group – 4 servings for pregnancy, 5 servings for breastfeeding

Milk, American cheese, yogurt, ice cream, kefir, milk-based pudding, and tofu. You need 4 or more glasses of skim or low-fat milk every day. Other dairy products can be substituted for part of the milk. If you cannot drink milk, talk to your physician regarding calcium supplements and eat calcium-rich foods.

Protein Group – 4 2-oz. Servings for pregnancy and breastfeeding

Meat, fish, poultry, eggs, dried beans, nuts, seeds, and peanut butter. Examples of 1 serving are:

  • 2 oz. of meat, poultry, or fish
  • 2 eggs
  • 4 tablespoons of peanut butter
  • 1 cup of cooked beans

Try to have 1 serving each week from the vegetable protein group (peanut butter, beans, or nuts).

Bread and cereal group – 6 servings for pregnancy and breastfeeding

Bread, cereal, rolls, noodles, and rice — select whole-grain or enriched. Examples of 1 serving are:

  • 1 slice of bread
  • 1 tortilla or 1 small roll
  • 1/2 cup cooked cereal
  • 3/4 cup dry cereal
  • 1/2 cup noodles or rice

Fruit and Vegetable Group — 4 to 6 servings for pregnancy and breastfeeding

This group is subdivided into 3 groups:

  1. Vitamin C-rich fruits and vegetables – 2 servings per day. Examples are: oranges, grapefruits, tomatoes, or their juices. Others are cantaloupe, watermelon, strawberries, kiwi fruits, papaya, mango, tangerine, cabbage, chiles, green or red peppers, broccoli, and cauliflowers.
  2. Dark green vegetables — 1 serving every day. Examples are: asparagus, broccoli, leafy greens, lettuce, and peas.
  3. Other fruits and vegetables — 1 serving every day. Examples are: carrots, corn, head lettuce, green beans, apples, peaches, peas, raisins, or other dried fruits and all other vegetables.

Guide to Foods High in Iron

Iron is an important mineral found in foods needed by our bodies every day to help build hemoglobin, the red substance in blood that carries oxygen throughout the body. The foods highest in iron are red meat, fish, poultry, beans, eggs, leafy green vegetables, dried fruit, and iron-fortified cream of wheat cereal.

Because not all of the iron you eat is completely absorbed, it is important to eat more than your daily requirements. Vitamin C foods taken at the same time as an iron-rich food may help iron absorption. Citrus juices, tomatoes, strawberries, or melons are examples of vitamin-C rich foods.

The following list contains foods that are good sources of iron. This will help you in your menu planning:

You also need:

  • 1 to 2 tablespoons of low-fat margarine, vegetable oil, or salad dressing daily
  • 6 to 8 glasses of liquid every day. Drink water, milk, or juice
  • Prenatal vitamins as prescribed by your doctor
Protein: Dried beans, 1 cup cooked Sardines 3 oz., Red meat, 3 oz. Dried Fruits: Raisins, 1/2 cup Prunes or prune juice, Apricots, 10 halves
Iron-fortified cereal: Cream of wheat, Malt-o-Meal, 40% Bran Flakes Leafy green vegetables: Spinach, Mustard greens, Swiss chard, Broccoli

Other Food Supplements

What about salt?

Stay healthy — use iodized salt in moderation. It is not necessary to restrict salt unless advised to do so by your physician.

Calcium Supplements

During your pregnancy and while breastfeeding, your body will have extra demands for calcium. You can begin good eating and exercise habits during your pregnancy that will help your baby now and prevent osteoporosis as you grow older. Pregnant women and women over 30 years of age need 1500 to 1800 milligrams of calcium daily. There are approximately 300 milligrams of calcium in one glass of milk or in 2 ounces of mozzarella cheese.

If you have an intolerance to dairy products, ask your physician about calcium supplements.

Prenatal vitamins and other vitamin supplements

You will usually be given a prescription for prenatal vitamins and iron tablets. It is important to take these tablets as directed by your doctor in order to provide the vitamins and minerals necessary for your baby to grow well during pregnancy. Occasionally your doctor will recommend that you take additional folic acid or vitamin B-6. If so, you will be given a prescription for this also.

Take Good Care of Yourself

  • Listen to your body. Rest when it tells you that it is tired and needs to take a break. Get plenty of rest.
  • Good dental care is important. Is it time to see your dentist?
  • Be sure to discuss any travel plans with your health care provider.
  • If you have a job, ask how long you can continue working.
  • It is usually safe to have sexual intercourse at any time during your pregnancy unless you are having a problem with bleeding or preterm labor.
  • Avoid douching during your pregnancy.
  • Protect yourself from illness. Try to avoid contact with sick people.
  • Medicine, alcohol, smoking, and any illegal drugs you take during your pregnancy may harm your baby. Take medicine only if your doctor approves.

Medications

There are some medications that are safe to take while you are pregnant:

  • Cough: Robitussin DM — 2 teaspoons 3 times a day
  • Sore throat:
    • Salt water gargle — 1 teaspoon of salt in 8 ounces of warm water.
    • Chloraseptic spray can also be used if needed. If you do not get well within a few days, or have a fever, come in to make sure that you don’t have an infection.
  • Stuffy nose: Sudafed (without histamine) or clortrimeton — 1 or 2 tablets every 6 hours.
  • Headache: Tylenol (acetominophen) — 2 tablets every 4 to 6 hours. Do not take more than 6 tablets in 24 hours.
  • Heartburn: Maalox Plus — start with 1 teaspoon 30 minutes to 1 hour before each meal. Try not to eat spicy foods or foods fried in fats or oil.
  • Indigestion or leg cramps: Tums antacid tablets as directed.

NOTE: If any of these symptoms cannot be relieved with the medications indicated above, please call our office.

Prenatal Education Classes

We recommend that you and your partner attend some classes, which are offered through this hospital:

  • Huntington Hospital (626) 397-8768

When Should I Go to the Medical Center Labor Evaluation Room?

Normal labor can begin any time from 2 to 3 weeks before your due date to 2 weeks afterward (36 to 42 weeks). Call the office and go to the hospital immediately if:

  • Your water breaks
  • You feel any leaking of fluid vaginally
  • You have bleeding, which is bright red and more like a period.
  • Your baby is not moving

If this is your FIRST baby, go to the hospital when:

  • You feel painful tightening of your uterus that are 4 to 5 minutes apart and last a whole minute for more than one hour when you are on your feet walking.

If this is NOT your first baby, or you live more than 60 minutes away from the hospital go when:

  • You feel painful tightening of your uterus 7 to 10 minutes apart and lasting a whole minute for more than one hour when you are on your feet walking; or
  • IF YOU HAVE A HISTORY OF VERY FAST LABOR, GO TO THE HOSPITAL AS SOON AS CONTRACTIONS BECOME REGULAR AND 15 TO 20 MINUTES APART.

When you arrive at the hospital, go to the Labor and Delivery Department Check-In window.

Since early labor can take a long time, especially with first babies, we recommend that you drink fluids and eat lightly when your labor starts, unless your doctor has told you not to. If you are going to have a cesarean delivery, do not eat or drink when labor begins.

What to Expect After Arrival At the Hospital

In the Labor Evaluation Room, several things will happen:

  • Electronic fetal monitoring for about 20 minutes
  • An ultrasound examination may be done for amniotic fluid amount and the position of the baby, if necessary.
  • Blood may be taken for laboratory tests.
  • A vaginal examination to determine how far along you is in your labor.
  • A speculum examination if your water may be broken.

What Happens After You Are Admitted

  • Admission to labor room — this may be a labor/delivery room where you will both labor and deliver, or it may be a labor room, and you will be moved to the delivery room when it is time to deliver the baby.
  • Active participation — with a normal labor, you are encouraged to walk, sit in a chair, change position frequently, drink fluids, empty your bladder often, and stay relaxed.
  • Fetal monitoring — we will listen to the baby’s heart and monitor your contractions frequently, either with a hand-held monitor similar to what you have seen in the office or with continuous monitoring.
  • Comfort measures — some choices are: position change, pain medication, or epidural analgesia.
  • Support people — your coach, your labor nurse, and/or the physician.

What Happens After The Birth of Your Baby

After your delivery, you will be in the labor/delivery room or in the Recovery Room for about an hour. Your baby will stay with you

for most of this time, and then will go to the Nursery for a phsyical exam, bath, and observation. You will be transferred to your room on the Postpartum Floor.

Visiting Hours

Visiting hours on the Postpartum Floor are from 1 to 8 p.m. (Check with the hospital to verify visiting hours.) The birth of your baby is a very happy time, but it is also a lot of work. You may want some of your family members with you, but remember that you also need time to rest. Because you will be staying only a day or two, it is probably best to show the baby to other close family members and friends after you go home.

Get lots of rest and fluids. Limit visitors and your activities for the first few weeks. Breast-feed every 2 to 3 hours to prevent breast engorgement in mom and jaundice in the baby.

Follow-Up Health Care

Your baby will need to be seen by a pediatric health care provider within 2 to 4 weeks. You may make an appointment with your private pediatrician.

You will need to return to the office for a postpartum checkup at 6 weeks after delivery. If you had a C-section, you will need to make an appointment 7-10 days after delivery to check the incision. At the 6-week checkup, we will check to make sure that you are healing well, and you will have a final physical exam. This will also be the time to discuss the various methods of birth control and to start or continue the method that you choose. Please call the office after you get home form the hospital for an appointment.