Prenatal Care

Image result for congratulations new pregnancy

This is the beginning of a new–and exciting time in your life!

So—you’ve made your appointment to see the doctor.

What can you do while waiting to be seen?

Figure out when the FIRST day of your last period was–your last NORMAL period.  We will need to know that to figure out your due date.

Here is a calculator to help figure out your due date

Start a prenatal vitamin, or at least some FOLIC ACID.  I recommend 5 MG a day for 12 weeks for everybody. The spinal cord forms at 25-30 days after conception–so you need to get folic acid into you ASAP.  It is BEST if you start folic acid 2-3 months before you conceive.  You can get folic acid without a prescription.    You can get them over the counter in -usually-400mcg (you’d need to take TEN)–they’re just like NERDS candy   —tiny tiny.  Take them all at once.  Your prenatal vitamin also has folic acid in it (typically 1 mg).  DO NOT TAKE MORE THAN ONE PRENATAL VITAMIN A DAY–just add the folic acid.

You will get folic acid in your diet too if you eat veggies and oranges etc–so you can judge how much you need to supplement.

Here is a list of foods that have a lot of folic acid!

You will see that IF you HAVE a baby WITH a spinal cord problem, the recommendation is 5 mg.  My opinion is WHY WAIT FOR A DEFECT?—just take the folic acid.  Really–no downside!

PICTURE OF SPINAL CORD ABNORMALITIES

THYROID AND PREGNANCY

All women who are pregnant, or trying to get pregnant, need to make sure they are getting adequate IODINE in their diet—most of us are in North America (iodized salt we sprinkle on everything).  If you look at your prenatal vitamin, you need to see close to 150 ug (micrograms)–and NOT as kelp–better Potassium iodide.  Kelp may only deliver 50% of what it says–Potassium Iodide delivers over 76%.

ALCOHOL USE IN PRENANCY

It is estimated that up to 1 in 20 children may have some degree of fetal alcohol syndrome.  Alcohol causes many appearance problems, and also brain abnormalities.

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No alcohol—there is no safe amount–so we don’t recommend drinking it at all.

SMOKING??

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Smoking—if you need help with this,  ADDICTION SERVICES  in towns across Nova Scotia is ready to help.   Give them a call at the number on link above.

It is hard to quit smoking, but we would really like you to try.  The risks of smoking: are:

You CAN use a nicotine patch while you are pregnant, and you can use the nicotine gum.  You can smoke while using the patch–the hope is that you won’t get the craving to light up.  Now—if those fancy cook/chemists can make chocolate flavored calorie-free gum!

OMG–someone told me about chocolate-flavored gum!  YUM YUM GUM–click here!!

OTHER MEDICATION

Call, and ASK about other medications–don’t just stop them.

If you are on an antidepressant, you are not advised to stop cold turkey.  You may be better off ON the meds than OFF the meds.  We will get you in as quickly as possible to discuss meds.  IDEALLY, it would be best to see us BEFORE you get pregnant if you are on meds that concern you–but most pregnancies are unplanned, so not usually the case.

If you call about meds, we need to know the NAME AND DOSAGE.  I am really not interested in the color of the pill–telling me you are on a little white pill for blood pressure is no help at all!

Image result for white pills

Here is a very useful link, where you can search out many medications, and the risk during pregnancy and breastfeeding.

ROUGH GUIDE TO MEDS:

ANTIBIOTICS:

Obviously, avoid things you are allergic to!

ALL PENICILLINS, AMOXICILLINS  are FINE!!!

MACROBID is often used for urinary tract infection and if OK too.

Azithromycin may be used to treat chlamydia etc–OK

AVOID TETRACYCLINE

FOR ALLERGIES:

Benadryl is OK

OTHER MEDS:

Tylenol is OK–just do not exceed 4000mg in 24 hours!

HEARTBURN:

Try avoiding food and liquids that can aggravate heartburn—caffeine, spicey foods.

Try putting the WHOLE head of the bed up on concrete blocks.

The 6 degrees is a guide–so put away the protractor!

This will keep your stomach lower than your throat, and can keep acid from coming up.  This works better than propping up the bed on pillows–that actually puts MORE pressure on the stomach, and can make heartburn worse.

DENTAL WORK

Anesthetic such as Lidocaine, marcaine, are OK to use, and you can also have it with epinephrine if having needed dental work

DO NOT TAKE ASPIRIN OR ALEVE/MOTRIN/ADVIL ETC

 

ASSESS YOUR RISK OF TUBAL PREGNANCY

If you have had a history of infertility (more than one year of TRYING to get pregnant), a history of previous ectopic pregnancy, an IUD still in, or a history of tubal ligation, YOU MUST BE SEEN ASAP.   We MUST make sure that this pregnancy is where it is supposed to be, and NOT in your tubes!

If you have any pain, fainting, or bleeding you must seek help–for the same reason–we need to make sure the pregnancy is OK. HERE IS ECTOPIC PREGNANCY.    (tubal pregnancy–but ectopic can be in the ovary, the cervix, the belly, the muscle of womb).  I will cover ectopic —in another post!

FIRST VISIT!!!    HERE WE GO!!

You will be seen every 4 weeks until 28 weeks

then every 2 weeks until 36 weeks

then weekly until you deliver.

So—first visit tends to take a while.  We start a prenatal record on you, and figure out how far along you are.

Somewhere between 9-12 weeks we like to get an ultrasound —this time is the BEST for determining your due date.  If you have problems, such as bleeding, you may have to get one sooner than that.

You also get a bucketload of bloodwork done!                          Image result for blood test

We check your blood count for anemia, your blood type (try to remember this–I tell patients to put blood type on back of Driver’s License with a Sharpie). syphilis test, hepatitis B test, German Measles immunity test (if you are immune ask for a copy of the test for future pregnancies–it never has to be repeated if you are immune).

We also check for HIV status, with your permission, and a chickenpox immunity (another test you never have to repeat if immune).  If you are testing for Thalassemia, Cystic Fibrosis, or other genetic diseases–WRITE down results and get a copy of lab slip–put it with your passport and other important papers–YOU NEVER NEED TO GET RECHECKED.   some will say to me “just do it again”–AAARRGGGHHH!!!   The country is going broke–we don’t need to WASTE money.  Even if your insurance covers it,  we all pay with higher premiums for it!

Your thyroid may be tested, if not done recently.  A urine is also checked for sugar, protein, and infection.

Between 9-13 weeks, you would get your first MST (maternal screening test).  This is a BLOOD TEST to check for genetic problems such as Down’s syndrome, and other chromosome problems, and also to see if you are at higher risk for having a baby with spinal cord abnormalities.  This test is optional–but please read the information we provide and ask questions.  Make sure you understand why we offer this test.

At 15 1/2 to 16 1/2 wks the SECOND part of the MST testing needs to be done.  You CAN have the second test “done” up to 20 wks and 6 days—but realistically, you need to get it done ASAP.  If there IS a problem, the earlier you detect it the better—-just in case you have to make decisions–and we need further testing http://www.blogbigtime.com/assets/user-uploads/userYSg55/posts/fetus-ultrasound.jpgdone to give you all the information you need to MAKE that decision.    A higher level ultrasound would be done–the baby is VERY closely looked at – even the length of the nose bone is measured–all to give us an idea of what could be going on.

In the end, the FINAL decision will be up to you.  NOBODY is going to force you to terminate your pregnancy if a problem is found.  Our goal is to provide you with all the information that we can, to help you to make any decision you feel is right for YOU!

 

Image result for pap smear stirrups

Now, you also will get a pap smear, and cultures for infection, if you are due for a pap or in a “risk” group.

Pap smears will not be done until you are 21–according to the Canadian pap smear guidelines.

Testing for infection is usually done if you felt to be at risk (being young, never tested, unstable relationship etc).

Because there is a higher blood flow to your womb when you are pregnant, you may have some spotting after a pap smear for a day or two–don’t be alarmed.  Sometimes, you will have spotting after sex too.

If the bleeding doesn’t settle in two days, or if bleeding becomes like a period, or you have cramps that are getting worse—come on back to see us!  I tend to wait until you are about 12 weeks to do a pap smear, since the risk of miscarriage is higher in the first 12 weeks of pregnancy anyway—I just want to get past that time, so that the pap smear is not blamed for a miscarriage.

Which brings up the next topic—MISCARRIAGE

We all worry about it–and we are asked “What can I do to prevent it?”   Really–unless you have a known risk factor, the answer is, “Nothing!”

What causes a miscarriage?

I look at this as a simple explanation.  You get 23 chromosomes from the father, and 23 chromosomes from the mother.  Picture that they all have to line up—like a zipper.  You have all had a time when the zipper seems to lock in, and go to zip up your jacket –but then—the zipper sticks–it just won’t go any farther.  You can tug, pull, try to pry it along–but it is not going anywhere.  You’ve got to take that zipper back,  unlock, and start all over again.

Some pregnancies are like that–you just won’t go any farther, and you have to go through a miscarriage—-and –if you want—try again.  In MOST cases, the chromosomes didn’t line up right, and Mother Nature says, “Hold on!   STOP RIGHT THERE!”

It is NOT because you lifted a heavy box. or because you got too tired, or because you were on the swings–it was decided at the moment of conception!

I certainly do not want to make a miscarriage seem like nothing—it is a VERY sad time.  You have been all excited–and now you are left sad, angry, and hurt.  Women take it in different ways–from “Let’s get on with it, and try again” to devastated and depressed.  Talk with us about how you are coping.

The risk of miscarriage is highest in the first 12 weeks of pregnancy.   I tell women that once I can HEAR the heartbeat with my little Doppler (the electronic listening device)–then your risk drops to about 3%.

I will cover miscarriage further in another post.

CONTINUATION of pregnancy

VACCINATIONS

We recommend you get a flu shot, if it is that season.  When you are pregnant, your immune system is NOT working as well (it kind of mutes itself, so that you don’t reject this foreign body called “your baby”.  This means that if you get the flu, you can get WAY WAY sicker than a non-pregnant woman.

I have seen one woman die at 34 weeks from the flu—the high risk center managed to get the baby out alive before she died.  I PERSONALLY also know of TWO other women who died in 2009 from the flu (H1N1), and my children’s high school principal’s teenage daughter almost died from the flu–(was in ICU for a week)–so the FIRST TIME YOU GET THE FLU CAN KILL YOU—and I can tell you from personal experience–seeing children crying over their mother’s coffin is not something I want to see again!  These were all young HEALTHY women–they had NO OTHER health problems!  I get NO kickback from any company to tell you this—it is a belief born of science-and life experience.  Getting a flu shot does not guarantee you won’t get a flu–or some other illness, but it is the BEST way we know of to reduce your risk!

            FIRST OBIT        SECOND OBIT    THIRD OBIT

Another vaccination is the PERTUSSIS/WHOOPING COUGH (given with tetanus and diptheria).  We recommend that EVERYBODY who will be around your baby get their booster for this!  There was an outbreak of whooping cough in Moncton, in 2015.  For those who don’t know what this is–check out THIS VIDEO AND OTHERS BESIDES IT!

Babies airways are tiny–they cannot take much swelling.  WHOOPING COUGH is amongst the TEN LEADING CAUSES OF DEATH in babies around the world.  THE COUGH LASTS FOR WEEKS!!!  Could you watch your baby cough like this for weeks?

The vaccine is about 85% effective–NOT 100%—but it’s all we have!

HERE IS INFO about the TDAP vaccine.

We are offering this vaccine at about 28 weeks.  If you want your partner vaccinated –have him register downstairs–we can do both of you!

Most of you who are pregnant don’t even KNOW about these disesases!  How LUCKY are you!

20 week ultrasound

When you are about 20 weeks along, you will get an ultrasound to check out the baby.  It is a basic scan.  You only get a VERY detailed scan if the blood work shows there could be a problem.  High risk obstetricians do the very detailed scans–so you don’t get that unless blood work shows a problem, or there is some other risk factor we are concerned about.

The basic ultrasound looks at:

  • Face–if it is facing a way we can see it we look for “hair-lip”  Cannot guarantee that picture can be seen.
  • Brain
  • Skull
  • Spine
  • Heart
  • lungs
  • Abdomen -stomach, kidneys, liver, bladder, wall,  cord,
  • Limbs
  • BOY OR GIRL (NOT guaranteed to see)
  • Cervix (length and opening)
  • Placenta location

We do not count the fingers/toes.

Image result for ultrasound of baby boy         BOY               http://www.thecaterpillaryears.com/wp-content/uploads/2011/07/BabyGIRL.jpg       GIRL

We make an effort to see what sex your baby is,if you would like to know, BUT  there is NO GUARANTEE that the baby will open the legs enough to see!   No more ultrasounds are ordered in order to see what the sex is—it is NOT covered by insurance.  Even at private baby ultrasound centers, they cannot guarantee they will see the sex!

No more ultrasounds are done UNLESS there is a REASON–so just because your friend may have had one every month, doesn’t mean YOU will, or that you are not getting “good care”—HER pregnancy may have shown a concern.  Be glad that you are not showing anything we are concerned about!

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Oh— this picture brought something to mind.  When I was pregnant (a few decades ago), I was kind of miffed that people would just touch my belly, or ask–out of the blue– about the pregnancy—until I read an article at the back of some women’s magazine–I wish I could find it!  It changed my whole outlook on this!

What the author had written about was this very thing–strangers coming up, and asking how you are, and clucking all over you.  She said that for many people, they are remembering their own pregnancies—decades before for some, recently for others.  Maybe they remember it fondly–maybe they lost a baby, and suffered tremendously–maybe they have lost a child–who knows what they have been through–but they are showing an INTEREST in you, and your baby.  I like the expression –“It takes a village to raise a child”.   Just think–what if nobody gave a tweet about you–or your pregnancy?  What if you were kicked out of your home when you told your parents you were pregnant?  I’ve seen this happen.  What if your partner is beating you?  What if your parents are no longer alive?  What if your CHILDREN are no longer alive?  What if we lived in a world where NOBODY GAVE A HOOT!??

Women tell me they are tired of getting phone calls from friends, and family asking how they are doing.  CONSIDER THE ALTERNATIVE!!!  WHAT IF NOBODY CARED HOW YOU WERE DOING?   What if nobody came to visit you at the hospital?  What if nobody sends you flowers?

Next time someone asks–think of this alternative–it just may lead to a more pleasant encounter–try asking “Do you have children?”  “I’m doing quite well, thank you–thank you for caring!”  I’d rather live in a world where people rejoice that you are having a baby–than a non-caring world.

YOU MIGHT MEET A NEW FRIEND.    Now I still wouldn’t answer an ad, and go to someone’s house by myself close to term—-one or two crazy people spoil it for everybody!

OK  OK—RANT OVER!     It just really changed MY attitude!

THE SUGAR TEST!

http://1.bp.blogspot.com/-Y2RJOXudMxc/UPgXy_ZE6WI/AAAAAAAALcA/gACZlZM03LU/s1600/Glucose+Drink.JPG

—at about 26-28 weeks you get the   SUGAR DRINK TEST  –the test your girlfriends have all warned you about!

You get the test done–and you don’t have to fast beforehand.  We would recommend that you eat something non sugary for breakfast—cereal, pancakes and syrup generally not good!  Try an omelet, or some cheese, or some cheese rolled up in meat.

You drink that drink (best COLD), in about 2-3 minutes, then you show up for blood work 40 minutes later. The blood work will actually be done ONE HOUR later—but you can’t just show up with 5 minutes to spare—the technician may in the middle of drawing blood on another patient—and, believe me…they WILL send you home to do it again!

AFTER YOU DRINK THAT DRINK, DO NOT EAT OR DRINK ANYTHING BUT PLAIN WATER, IF YOU MUST, UNTIL YOUR BLOOD IS TAKEN

IS YOUR BLOOD TYPE NEGATIVE?

You will also be getting your blood count to check for anemia, and if your blood type is negative, you will also be getting a RHOGAM SHOT (click for info)http://pregnancytips.org/wp-content/uploads/2015/02/When-Rh-negative-blood-is-exposed-to-Rh-positive-the-Rh-negative-person-begins-producing.jpg

If you are negative, your baby could be positive  (for example, you may be O NEGATIVE–and your fetus could be A POS).  The baby has someting that you don’t have—a “positive”.  YOUR immune system will start to make antibodies against the positive blood, if any of the baby’s blood gets into your blood stream–which can happen if you bleed during pregnancy, or have an ectopic pregnancy, a miscarriage, an amniocentesis–and during BIRTH!

The first baby is usually OK–BUT   — if your next baby is positive, then the antibodies cross over the placenta, adn start to destroy your baby’s blood cells.  The baby needs blood cells.  If they are destroyed the baby goes into heart failure trying to get blood to the organs–and can die.   This has literally becomea “non-issue” with the discovery of RHOGAM.  The link above gives more information.

35-37 weeks

Next time anything is done is at 36 weeks–a swab is taken to check for GROUP B STREP   in the vagina.   Like strep throat in the …um  throat–   this is a check for strep in the vagina.

If you test positive for strep,  the recommendation is that you receive PENICILLIN in labor.  If you are ALLERGIC to penicillin, another drug will be used–you will be discussing this with us.

NOW—–nothing to do but wait–and wait—most women are now getting tired of waiting—the sore back, the heartburn, the hemorrhoids, the peeing,peeing, peeing,   the PRESSURE!

Image result for miseries of pregnancy

You are seen every week now.  At any of these visits you may say something that makes us want to check your cervix—-things like, “I think my water broke last night”, or “I’ve been up all night with cramps!”  OR,we check your blood pressure and we don;t like that it is high–we always have to watch for toxemia/pre-eclampsia.HERE IS A VIDEO THAT IS QUITE GOOD ABOUT TOXEMIA

The video is from England where midwives are a huge part of medical team.  So when they say-“-CALL THE MIDWIFE”–you would actually call the hospital and ask for advice–they can get through to your doctor.   COME INTO THE HOSPITAL immediately if you have a really bad headache, or if you have a bad pain in your upper right side, or if your FACE is swelling–and certainly come in if you are worried, and don’t  feel well!

AM I IN LABOR?                                                                 http://cdn.meme.am/instances/51545291.jpg

Well, I’d say that if you have to ask–you are probably NOT!–especially on your first baby.  It is more like–“What is taking you so long to get your stupid shoes on, and get the car in gear!”  (Pain can make you a wee bit cranky).

Anyway, if you are having cramps–although some women have “skewer -like” shooting pain in the vagina–and it is getting worse—you may well be in labor.  If you are still smiling and talking –see how they go for a few more–like an hour or two.

 

Real labor can really wipe the smile of your face–it can be hard work.  You may have to stop talking, or texting, just to breathe your way to the end of the contraction!

If you think your water has broken–come in.  Now some babies like to kick that old bladder–and you may pee yourself, and think your water has broken.  The difference is usually that pee will stop–broken water just keeps on coming out!   BRING A REALLY WET PAD with you –in a plastic ziplock–so we can test it.  So, if you keep on trickling, and it just keeps on–best come in!

When you come in –register!

When you get to Labour and Delivery, a nurse will greet you, and become your best friend.  She will check you out, and then call your doctor –and a decision is made as to if you are in labor, or not.

If it is uncertain, we may ask you to stay for a few hours, and see if you kick in.  You may be kept in, if you having painful contractions, but your cervix has not yet started to open.

You will be examined to see if your cervix is thinning out (effacement), and opening up (dilating).  Dilation is done by placing fingers into the cervix opening and seeing how far apart you can spread two fingers.  See diagram below.

https://www.families.com/wp-content/uploads/media/effacement.jpg

http://www.newhealthadvisor.com/images/1HT03717/dilation.png

https://31.media.tumblr.com/6250cf434e288eda4cc57c8e052fd8d7/tumblr_inline_nkjdtq5IRM1r4fw78.png

So   now labor—I will do that in a separate post!

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