Pregnancy Resources

CONGRATULATIONS ON YOUR PREGNANCY!

We would like to take this opportunity to congratulate you on your pregnancy and welcome you to our practice.  We are very honored to be participating in your care during such a wonderful time in your life.  Pregnancy can be exciting but also occasionally stressful or confusing.  Whether this is your first pregnancy or your third, you will have questions about what to expect.  The providers and staff at South Denver OB/GYN have created this information to help answer some common questions that many women have.

Our goal is to provide you with the highest level of care, through a team approach.  Our physicians and nurse midwives want you to have a happy and healthy pregnancy and birth.  We encourage you to communicate with us, so that we can help answer your questions and address your concerns.

We are sure you have lots of questions, even if this isn’t your first baby.  the resources below will help you be confident and prepared for your pregnancy.  Click on any of the questions to learn more:

Where do your providers deliver babies?

Our providers serve the following hospitals.  To learn more about the BirthPlace at these hospitals, click on hospital picture or name.

Castle Rock Adventist Hospital in colorado. Home of south denver midwives, obstetrics and gynecology

Castle Rock Adventist Hospital 2352 Meadows Blvd, Suite 255 Castle Rock, CO 80109 Click here for directions Hospital: 720.225.1000

 

Littleton Adventist Hospital home of South Denver obstetrics and gynecology in littleton

Littleton Adventist Hospital 7700 South Broadway Littleton, CO 80122 Click here for directions Hospital: 303.778.8900

What is an ultrasound? When are they done?

We generally do a dating ultrasound at your first visit to confirm the pregnancy and to help determine your estimated due date.  We will order a second ultrasound to be down at 20 weeks gestation.  This ultrasound is used to make sure your baby is developing as expected, and is done by a trained ultrasonographer.  Often times, you will be able to find out the gender of the baby at the 20 week ultrasound.  If there are no complications in your pregnancy, these are the only two ultrasounds we will recommend.   Additionally, if you decide to do the first trimester genetic screening test (see section on Tests), we will do an ultrasound at this time as well.

What should I do about breastfeeding

While we understand that some women are not comfortable with the idea of breastfeeding, we want to take a moment to encourage you to consider this method of feeding your new baby.  Breastfeeding is nature’s best way to nourish your child and your milk is uniquely suited to your own baby’s nutritional needs and stage of life.  Breastfeeding confers many benefits to both you and your baby!

Infants who are breastfed have fewer illnesses and are less likely to suffer from allergies and wheezing illness.  They are less likely to develop diabetes, and breastfed babies are less likely to have SIDS (sudden infant death syndrome).  Breastfed babies score higher on IQ tests as well as on measures of social and cognitive development.  Mothers who breastfeed also may have an easier time losing the weight they gained during pregnancy.

A recent study suggested that there is no difference in the amount of sleep of babies who bottle feed or breast feed-it is a myth that bottle fed babies sleep better.  Most moms also relate how special they found the mother-baby breastfeeding bond to be, and breastfeeding releases beneficial hormones into the mother’s bloodstream.

Here is a good website that discusses breastfeeding benefits (including research supporting this method of feeding your child):  http://www.womenshealth.gov/breastfeeding/

Littleton and Castle Rock Adventist Hospitals Birth Place has certified lactation consultants available to you in the hospital and after you go home  with weekly lactation support groups and by appointment, to help you with any breastfeeding questions or problems.

What foods should I avoid during pregnancy?

You should only drink small amounts of caffeinated drinks (one or two per day), as high caffeine consumption is not good for pregnant women.  Most women feel better if they drink adequate water.  Drinking plenty of water helps prevent constipation, urinary tract infections, and swelling in your legs and feet.  Your urine should be pale yellow (sometimes bright yellow after taking your prenatal vitamin).  If your urine appears very dark yellow or tea-colored or concentrated, you probably need to drink more water.

Listeria is a bacteria found in unpasteurized milk, some luncheon meats, and smoked seafood.  Foods to avoid in pregnancy include soft, unprocessed or unpasteurized cheeses, such as Brie, feta Camembert, blue-veined cheeses, and Mexican-style cheeses such as queso fresco, queso blanco, and panela.  Also be cautious when eating hot dogs, luncheon meats, or deli meats, unless they are heated to steaming (at least 160 degrees F).  Do not eat refrigerated smoked salmon unless it is in a cooked dish, such as a casserole, and avoid cold pate or meat spreads.  Heating the foods listed above to steaming hot will kill any dangerous bacteria, making them safe to eat.  Wash all raw foods well before eating.

Semi-soft and hard cheeses including mozzarella are safe.  You can safely enjoy any cheese that has been pasteurized and also processed soft cheeses such as cream cheese and cottage cheese.

You may have questions about what fish are safe to eat in pregnancy.  We recommend you eat no more than two servings of fish per week.  Fish and shellfish do contain omega-3 fatty acids and other important nutrients.  While pregnant, avoid eating shark, grouper, marlin, orange roughy, king mackerel, swordfish, and tilefish, as these are known to contain high levels of mercury.  Also, eat only three 6 oz. servings a month or less of the following:  bass saltwater, croaker, canned white albacore tuna, fresh Bluefin or ahi tuna, sea trout, bluefish, and American lobster (Maine lobster).  You can eat a serving of chunk light canned tuna once or twice per week.  You can safely enjoy other fish in moderation, once or twice per week (12 oz per week).  Avoid raw fish, found in sushi.

For more information about food safety in pregnancy, go to the Food and Drug Administration (FDA) website 

When is your estimated due date?

Due Date Calculator
 
Just enter the approximate date of the first day of your last menstrual period and click “Calculate”.

If you are pregnant, or planning to become pregnant, it is important to see us as soon a possible to help protect the health of your baby and yourself.

When will I normally see my doctor or nurse? What happens?

Prenatal Care

Your “estimated due date” (EDD) is based on a 40 week gestational period, starting with the first day of your last menstrual period (LMP).  The EDD is either confirmed or changed based on your first ultrasound.  Most babies are born between 38 and 42 weeks.

Your prenatal visits are scheduled according to your due date and gestational age.  During your pregnancy, diagnostic studies (such as lab work, cultures, and pap smears), are done to check your health and check for any potential risks to the baby.  If the test results are normal, we will discuss them with you at your next visit.  If the tests come back abnormal, we will notify you of the results, as well as any additional testing or follow-up needed.

Please keep your phone number and contact information up to date, so that we can reach you if needed.  If you have worries about a test result and don’t want to wait until the next visit, please feel free to call our office during regular office hours.

In an uncomplicated pregnancy, your prenatal care visits will be approximately as follows in the table.  We will check your urine, weight, and blood pressure at each visit.

What medications can I safely take when pregnant?

Please note, the content on this page is not intended to be a substitute for professional medical advice.

Although you should try to minimize medication during your pregnancy, sometimes it is necessary for your health and comfort to take some type of medication. This list includes medicines that have been deemed safe for consumption during pregnancy and have been reviewed by your provider at South Denver OB/GYN.

  • Take your prenatal vitamin daily with food.

  • Avoid caffeine as much as possible, specifically no more than 2 cups of any caffeinated liquid per day.

  • Try not to take any medication during your first 13 weeks of pregnancy. If you must take something, the following medications are generally considered safe during pregnancy.

 

Return to Pregnancy Resources, or read more about common issues:

Yeast Infection:

Monistat 7, Mycelex 7, or Gyne-Lotrimin – 1 applicatorful in the vagina at bedtime. You can also spread some on the outside if needed.  DO NOT USE THESE MEDICATIONS BEFORE 13 WEEKS.

 

Congestion or Allergies:

Actifed – 1 every 4-6 hours. Maximum of 4 capsules in 24 hours.

Sudafed 60 mg – 1 every 4-6 hours. Maximum of 4 capsules in 24 hours.
Take the above medications only in the daytime, otherwise they may keep you awake at night.

DO NOT USE THE ABOVE MEDICATIONS BEFORE 13 WEEKS

Benadryl – 1 every 4-6 hours. Maximum of 4 capsules in 24 hours. May make you sleepy, therefore you may want to take it at night.

Claritin or Claritin D – 1 tablet daily
Saline Nasal Spray is safe to use.
Rest and Drink plenty of fluids. Use a vaporizer.

 

Cough:

Robitussin (plain, DM, or PE without alcohol) – 2 teaspoons every 4 hours
Cough Drops are safe to use in pregnancy.

 

Sore Throat:

Sucrets – dissolve 1 lozenge slowly in your mouth every 2 hours.

Chloraseptic Spray or Lozenges (alcohol free) – spray as needed

 

Fever, Headache, General Body Aches:

Tylenol 325 mg or 500 mg – 1 or 2 every 6 to 8 hours. Maximum of 8 tablets in 8 hours. Call the office with a persistent fever over 100.4 degrees.

 

Diarrhea:

Kaopectate – 2 tablespoons or 2 capsules after each loose stool. Maximum 7 tablespoons or 12 capsules in 12 hours.

Imodium AD – 4 teaspoons or 2 capsules after each loose stool; then 2 teaspoons or 1 capsule after each additional loose stool. Maximum of 8 teaspoons or 4 capsules in 24 hours.
Drink plenty of clear liquids.

 

Constipation:

Try eating prunes, bran, fresh fruit and vegetables or drinking prune juice before taking any medication.

Metamucil (orange flavor) – 1 rounded tablespoon in 8 oz. glass of juice or water, 1-3 times per day. You may need to use this 2-3 days before you see results. Drinking an extra glass of liquid after each dose is helpful.

Milk of Magnesia – 2-4 tablespoons followed by a full glass of liquid
Do not use for more than 72 hours without consulting your physician

Colace – 1 tablet twice daily

 

Heartburn:

Rolaids – Chew 1-2 tablets every hour. Maximum of 24 tablets in 24 hours.

Tums – Chew 1-2 tablets every hour. Maximum of 16 tablets in 24 hours.

Maalox – 2-4 teaspoons 4 times per day. Best taken 20 minutes to 1 hour after meals and at bedtime.

Zantac and Pepcid AC– Can be taken twice daily as needed

 

Gas Pains:

Gas-X – Chew 1-2 tablets after meals and at bedtime or as needed. Maximum 6 in 24 hours.

Mylicon-80 – 1 tablet after meals and at bedtime or as needed. Maximum 6 in 24 hours.

 

Hemorrhoids:

Tucks – Use as a wipe following each bowel movement or as a compress applied to the area for up to 15 minutes.

Preparation H Ointment or Suppositories – Can be used 3-5 times per day, especially in the morning, at bedtime, and after each bowel movement.

Anusol – same as Preparation H
Warm baths are suggested 2-3 times daily – Also see suggestions for constipation

 

Nosebleeds:

Saline Nasal Spray – Squeeze twice in each nostril as needed

 

Nausea / Vomiting:

Vitamin B-6 50-100 mg – twice daily

Unisom 25 mg – use 1/2 tablet up to 4 times daily

Ginger Capsules – As recommended by manufacturer


If you have persistent vomiting, weight loss or inability to tolerate fluids for 24 hours, call your provider.

What vaccines should I have during pregnancy?

Our practice recognizes that pregnant women are a high-risk group for influenza and occasionally other preventable diseases.  Often, the benefits of receiving a vaccine in pregnancy outweigh the risks from the vaccine.  Live vaccines (including live attenuated virus and live bacteria) should never be given to women in pregnancy.  You will find an excellent table on the CDC website regarding vaccines in pregnancy at the Centers for Disease Control (CDC) website.

What types of prenatal tests should I have during pregnancy?

Prenatal Tests

Genetic Screening Tests:  These include the first trimester screen (done at 12 weeks of pregnancy), the Alpha-feto-protein (AFP) test (done between 15 and 20 weeks of pregnancy), and the MaterniT21 Plus test (done at any time after 10 weeks in the pregnancy).  These are screening tests which means they cannot diagnose a genetic problem, only identify babies who might be at higher risk for genetic problems.  A diagnostic test can be done to diagnose a problem.  If you have an abnormal genetic screening test, we will offer you a diagnostic test including amniocentesis which carries a 1 in 300 risk for miscarriage.

We generally counsel women and families to consider what they will do with the information from any genetic screening test very carefully before deciding to do the test.

  • First trimester screen –The First Trimester Screen is an optional noninvasive evaluation that combines a maternal blood screening test with an ultrasound evaluation of the fetus to identify risk for specific chromosomal abnormalities, including Down Syndrome Trisomy-21 and Trisomy-18. In addition to screening for these abnormalities, a portion of the test (known as the nuchal translucency) can assist in identifying other significant fetal abnormalities, such as cardiac disorders. The screening test does not detect neural tube defects.  The first trimester screen has been available in the U.S. for several years, but has only recently been determined an effective means of early chromosomal abnormality screening.   The combined accuracy rate for the screen to detect the chromosomal abnormalities mentioned above is approximately 85% with a false positive rate of 5%.  It is important to realize that a positive result does not equate to having an abnormality, but rather serves as a prompt to discuss further testing.  The blood screen measures two pregnancy related hormones: hCG and PAPP-A.  The ultrasound evaluation measures nuchal translucency (fluid beneath the skin behind baby’s neck).  This non-invasive procedure combines the results from the blood tests and the ultrasound, along with the mother’s age, to determine risk factors

  • Alpha-feto-protein (AFP) –The quad screen — also known as the quadruple marker test or simply the quad test — is a prenatal test that measures levels of four substances in a pregnant woman’s blood: Alpha-feto-protein (AFP), a protein made by the developing baby; Human chorionic gonadotropin (HCG), a hormone made by the placenta; Estriol, a hormone made by the placenta and the baby’s liver; and Inhibin A, another hormone made by the placenta.  Typically, the quad screen is done between weeks 15 and 20 of pregnancy — the second trimester.  Results of the quad screen indicate your risk of carrying a baby who has certain chromosomal conditions, such as Down syndrome. The alpha-fetoprotein part of the test can help detect neural tube defects, such as spina bifida.  Remember, the quad screen is optional. Test results only indicate whether you have an increased risk of carrying a baby who has Down syndrome, for example, not whether your baby actually has the condition.

  • MaterniT21 – The MaterniT21 PLUS test was clinically validated in a population of pregnant women with increased risk for chromosomal aneuploidy, including one or more of the following: advanced maternal age (35 years and older), personal/family history of chromosomal abnormalities, fetal ultrasound abnormality suggestive of aneuploidy, or a positive serum screening test. The MaterniT21 PLUS test is a laboratory-developed test (LDT) that analyzes circulating cell-free DNA extracted from a maternal blood sample. The test detects an increased amount of chromosomal 21, 18, and 13 material.   This test can be performed in the first or second trimester as early as 10 weeks gestation.  The test is currently not covered by most insurance.

A few other tests we recommend:

  • One hour glucose test – This test is done at about 28 weeks of pregnancy (sometimes we ask women at higher risk for pregnancy-related diabetes to do an earlier test and then repeat the test at about 28 weeks). You don’t need to be fasting for this test, or do any special preparation.  We do advise against eating a high sugar meal just before your test.  On the visit before the test, we will give you a special drink to take home and put in the fridge.  The day of the test, you are asked to drink the glucola drink about 30 minutes before you plan to arrive at your appointment.  You need to finish the glucola drink in about 5 minutes, and be sure your blood is drawn exactly one hour after you finish the drink.  Don’t eat or drink anything during that hour before you get your blood drawn.  We recommend you bring a snack with you to the visit, so you can eat after your test is complete.  If your blood sugar is high, we will notify you of the need to do a diagnostic test for gestational diabetes, known as the 3 hour glucose tolerance test (GTT).

  • Three hour glucose tolerance test – This diagnostic test is for women who demonstrate a high one hour gestational diabetes screening test. The test requires you to do some preparation.  We recommend you eat at least 150mg of extra carbohydrate for three days prior to taking the test (about the amount of glucose in two slices of bread).  Then, you are asked to not eat or drink anything except water for 12 hours before the test.  On the day of your test, when you arrive to the office, you will have your blood drawn, then be given a very concentrated sweet glucola drink.  You then will stay in the office and have your blood drawn at one hour, two hours, and three hours after drinking the glucola.  Please have someone available to drive you home, as some women don’t feel well after this test.  It is also a good idea to bring a snack with you, to eat after you have completed the test.  If the test shows that you do have gestational diabetes (GDM), we will contact you to see a high-risk specialist who will help you manage this condition.  You can get more information about GDM at the American Diabetes Organization website.

  • Group Beta Strep test (GBS) – About 25% of women are carriers for group beta strep. There are rarely any symptoms and women who are carriers don’t need any special treatment.  However, a few infants who are exposed to GBS in labor can get sick, so we test all women for this bacteria between 35 and 37 weeks of pregnancy (unless they are planning a scheduled cesarean section).  Using a small Q-tip swab, we will gently swab just inside your vagina, down your perineum, and barely into your anus.  If you are found to be GBS positive, we will let you know and plan to give you intravenous antibiotics during labor, which helps to prevent the infant from getting ill.  Even if you need the antibiotics, the nurse can use a saline lock, so that you don’t have to be attached to an IV line during the entire labor.  You can find more information on GBS at the Centers for Disease Control (CDC) website.

  • Cystic Fibrosis screening– Cystic fibrosis (CF) is a genetic disorder. A child must inherit two defective CF genes (one defective gene from each parent) to have the disease. A person who has inherited only one defective CF gene is a carrier of CF and does not have the disease but can pass it on to his or her children.   This person can also pass on carrier status.   Cystic fibrosis (CF) carrier screening is a blood test that determines if you are a carrier of the defective gene that causes CF.  The test can help you determine if you and your partner have an increased chance of having a child born with CF.  CF carrier screening is recommended for:  adults with a positive family history of CF, partners of people with CF (if one partner has CF and the other partner has the defective CF gene, a child will have a 50% chance of having CF), if you or your partner have Ashkenazi Jewish or French Canadian ancestry, or if one or both of you are Caucasian.

What do I do about my nausea?

Nausea in Pregnancy

Nausea, with or without vomiting, is known as morning sickness, but frequently occurs at other times of the day or evening. Since it is more apt to occur when the stomach is empty, nausea is usually worse in the morning. The cause of nausea in pregnancy is not known, although the rapidly rising hormone levels in early pregnancy are believed to be a factor. Fortunately, it usually only occurs during the first three months of pregnancy. There are numerous techniques to reduce nausea, which are listed below. Not all of them work for all women. Try any one, or all, or any combination until you find what works best for you.

  1. Do not let your stomach get completely empty. This is a vicious cycle. You are not hungry because you are nauseated, but if you go too long without eating, the nausea can get worse. Also, small meals are tolerated better than large ones. Plan out what you need to eat for the day to meet your minimum nutrition requirements. Then eat a few bites every hour or two, spacing the total amount of food out over the day. If you get up at night to go to the bathroom, eat a little then.

  2. Keep some crackers, dry toast, popcorn or other dry carbohydrate foods at your bedside and eat a little of it before you get out of bed in the morning.

  3. Low fat foods are easier to digest (low fat milk, yogurt, lean meat, broiled or canned fish, poultry without skin, apple sauce).

  4. Eat carbohydrates that are easy to digest (rice, pasta, potatoes, cereals, crackers and ginger snaps).

  5. Avoid highly seasoned food and fats in your diet. These can be especially nauseating.

  6. Avoid foods that give you gas (cabbage, broccoli, onions, buttermilk, pinto or pork beans).

  7. Eat or drink something sweet (like fruit or fruit juice) before going to bed at night and before getting up in the morning. Sometimes nectars are better tolerated.

  8. Avoid spicy foods and foods with strong or offensive odors.

  9. Peppermint tea settles the stomach and can relieve nausea. Do not drink liquids at the same sitting with solid foods. Space out small meals so that you wait 30-60 minutes after a solid meal before drinking anything. This prevents the stomach from getting over full.

  10. Most women discover a certain food that just does not agree with them during pregnancy, even though they had no problem with it before pregnancy. If you get extremely nauseated after eating a particular food two or three times in a row, you may have to give it up for the duration of the pregnancy or suffer the consequences.

  11. Suck on lemon drops, mint candy or lifesavers throughout the day.

  12. The stomach secretes less acid during pregnancy. Sometimes drinking half a glass of grapefruit juice with a meal will increase the acid and allow you to digest the food more easily.

  13. Guard against dehydration.

  14. Accupuncture

GENERAL GUIDELINES:

  1. Get plenty of fresh air.

  2. Remove strong odors from your surroundings.

  3. Rise slowly from bed; give yourself a few minutes to adjust.

  4. Wear non-restrictive clothing

  5. Rest

  6. Use a heating pad or hot water bottle to sooth sore abdominal muscles from vomiting.

MEDICATIONS:

DO NOT take any anti-nausea medicines without consulting your healthcare provider. You may want to avoid taking your prenatal vitamin for a couple of days. Some women are very sensitive to the iron and the concentrated vitamins. You may also take ½ of your prenatal tablet at bedtime and the other ½ at lunchtime. Other helpful over the counter supplements include:

  • Vitamin B6 – 50-100 mg twice daily

  • TUMS – Chew 1-2 tablets every hour. Maximum of 16 tablets in 24 hours.

  • Unisom 25 mg – use 1/2 tablet up to 4 times daily

  • Ginger Capsules – As recommended by manufacturer

If, despite the above suggestions, you are still unable to tolerate food or liquids, please call the office to speak with our nurse or to make an appointment to see your provider.

What options do I have for labor?

The best part of South Denver OB/GYN is that we offer you options for your care at the office and at the hospital.  If you’re looking for a provider who is more likely to take a holistic approach to your care – and to see birth as a normal process, intervening only when necessary and not routinely – you may prefer a midwife.

Births attended by CNMs(Certified Nurse Midwives)  usually have fewer interventions – such as continuous electronic fetal monitoring, epidurals, and episiotomies – without any difference in outcomes for women or their babies. Women who opt for midwifery care tend to have a lower rate of cesarean section, too.

We have Certified Nurse Midwives who specialize in labor support whether you have anesthesia or not.  The Birth Place at Littleton Adventist Hospital or Castle Rock Adventist Hospital has birthing balls, squat bars, birthing stools and Jacuzzi tubs to assist in labor.

What should I do about exercise and activity?

Exercise and Activity

Exercise is good for you and your growing baby.  If you are already involved in a regular exercise routine, you may continue as long as you feel comfortable and we haven’t placed you on any specific activity restrictions.  We recommend that you avoid contact sports and sports that could be dangerous, including scuba diving, rock climbing, horseback riding, downhill skiing, mountain biking, etc.  Low-impact activities such as walking, biking, and swimming are highly recommended.

You may continue to have sex throughout pregnancy without any fear of harming the baby, unless we advise otherwise.  However, if you are actively bleeding or think your water might have broken, please do not put anything into your vagina, and give us a call right away.

Generally, if an activity won’t cause you to hit or strike your uterus, and does NOT cause bleeding or contractions, it is most likely safe.  We are happy to discuss you usual activities with you, if you have concerns.  We also want to remind you that it is very important to wear your seat belt every time you are in a car.  Wear it low, across your pelvic bones, just below your pregnant belly.  Wearing a seat belt could save you and your baby’s life!

What are some common discomforts and problems during pregnancy?

Common discomforts and problems in pregnancy

Vaginal spotting

Vaginal discharge

Cramping

Swollen feet and ankles

Hemorrhoids or varicose veins in the vulvar region (near your vagina)

Varicose veins in the legs

Back Pain

Morning sickness or nausea/vomiting in pregnancy

Heartburn

Constipation

Round ligament pain

Insomnia

Return to Pregnancy Resources, or read more…

Vaginal spotting

Vaginal spotting occurs in half of all pregnancies, especially in the first 12 weeks.  Most of the time, this spotting will resolve on its own.  It sometimes occurs after intercourse or after straining to use the bathroom when constipated, and is not a sign of miscarriage.  There is nothing you can do to prevent or provoke the spotting.  If the spotting is light, avoid intercourse for a few days.  If the spotting becomes heavy, like a period (with or without cramping), avoid intercourse and please give us a call.

Vaginal discharge

Many women have an increase in vaginal discharge in pregnancy.  This discharge is usually white, cloudy, or clear, and thin.  If the discharge has a foul or fishy odor, causes itching or vaginal pain, or seems to be water instead of mucus, then please give us a call.

Cramping

Some cramping and uterine contractions are normal in pregnancy, as long as they are mild and don’t occur every 10 minutes or closer.  If you notice cramping pain in your lower abdomen or back that lasts for about a minute then relaxes, especially with pelvic pressure and a hard uterus, it is most likely a contraction.  If you have six or more contractions in one hour (every 10 minutes or less), drink two big glasses of water and either lie down or take a warm bath.  If the contractions do not stop, please call us.

Swollen feet and ankles

Swelling of the feet and ankles is very common in pregnancy.  It is caused by fluid retention, and it usually gets worse late in the day.  Drinking enough water and limiting your salt intake can help reduce swelling, as can elevating your feet periodically during the day.  We also recommend comfortable shoes and full-length support hose.

Note:  Rapid onset of swelling in the face and hands can be a sign of complication of pregnancy, if accompanied by a severe headache unrelieved by Tylenol.  Please call us if these symptoms occur.

 Hemorrhoids or varicose veins in the vulvar region (near your vagina)

Hemorrhoids are a common problem in pregnancy, and many women notice pain, bleeding after bowel movements (BM), and tenderness or irritation at the rectum from this condition.  Straining while trying to have a BM can also lead to hemorrhoids.  To prevent, eat a diet high in fiber and stay well hydrated.  If you suffer from hemorrhoids, you can use a stool softener daily, if needed.  One brand is Colace, which is available over the counter at the pharmacy.  You can also buy Tucks pads or witch hazel (make your own compress by soaking a disposable cosmetic pad or small cloth with witch hazel).  These can soothe and help shrink hemorrhoids or vulvar varicosities.  Some women find that wearing a maternity belt, which lifts the pregnant uterus, can help reduce pelvic varicose veins.  This type of garment can be purchased online or at specialty maternity stores.

Varicose veins in the legs

These are also common in pregnancy.  Resting frequently with your legs elevated can help reduce the pressure in your leg veins.  Consider purchasing support hose and wearing those each time you are up and about.  You may find that a maternity support belt also helps.

Back Pain

Sadly, lower back pain is a common problem in pregnancy.  As your uterus grows, it causes your lower back to become more curved.  We become concerned if you have an intermittent and regular cramping pain in your lower back (every 10 minutes or more), which can be a sign of preterm labor.  We are also concerned if you have a severe pain on one side of your back, over your kidney (especially if accompanied by a fever or urinary tract infection symptoms), which can be a sign of a kidney infection.

Some measures that might help lower back pain include taking Tylenol, warm baths, having someone massage your back for you, and being sure to use correct posture.  Stretching your back muscles in the morning and night by touching your toes is often helpful in preventing your muscles from getting too stiff.  Some women find that wearing a maternity belt, which lifts the pregnant uterus, can help, too.  This type of garment can be purchased online or at maternity clothing shops.

 Morning sickness or nausea/vomiting in pregnancy

This is a common issue in pregnancy, and luckily for most women, it resolves by about 13 weeks or so.  As long as you are able to keep down some food and fluids, it should not cause any long-term problems for you or the baby (except that you might feel miserable).  Some measures you can take are to keep well hydrated (try drinking about 1 ounce of Gatorade, water, or diluted fruit juice every 15 minutes to stay hydrated).  Unisom and vitamin B6 together have been shown to be helpful (see medication section in this booklet).  You can also take Tums, Emetrol, or papaya tablets (which can be found at natural food stores).  Some find that ginger tea, ginger ale, or ginger candy may also be helpful.  Some women find the scent of fresh cut lemon (or cotton ball soaked in lemon extract) provides some relief, as does sucking on sour lemon candies.  You can try using “Sea Bands”, which fit over your wrists and put pressure on an acupressure point.  Small frequent meals and snacks are a good idea, too.  If you can eat a high protein bedtime snack and bland foods, that might help (bananas, rice, applesauce, and toast).

If you should become dehydrated or are losing significant amounts of weight, or are just feeling awful, call us for a prescription medication.  We also want you to call if you are unable to keep down anything for more than 24 hours, or if you are unable to urinate, or your urine becomes scant and dark colored.

Heartburn

Pregnant women often begin to get heart burn in the third trimester when your pregnant belly begins to push upwards on your stomach.  This pressure causes some of the acids in your stomach to linger and travel up your esophagus.  You then feel a burning sensation in your chest, which can be accompanied by nausea.  Preventing heartburn is the best way to deal with it!  Some ways to avoid heartburn include eating five to six smaller meals throughout the day rather than three large meals, waiting one hour or more after eating to lie down, and avoiding spicy, greasy, and fatty foods.

If you are experiencing heartburn, there are a few natural things you can do to relieve the symptoms including eating yogurt or drink a glass of milk or try a tablespoon of honey in a glass of warm milk.  Over-the-counter antacids like Tums may prove helpful in relieving you of heartburn problems.  (See medication section in this booklet)

If your heartburn symptoms are severe, your physician or midwife may prescribe medication for you.

Constipation

The hormones of pregnancy as well as other factors tend to increase constipation in pregnant women.  We recommend the following:

  • A diet high in fiber (fruits vegetables and whole grains), including prune juice and dried plums

  • Enough water (your urine should be pale yellow in color – if there is a strong odor and dark color, you are most likely not drinking enough water)

  • Walking every day (this helps your bowels to move and has the added benefit of being good for your pregnancy and your baby, too).

  • Supplemental fiber, such as Metamucil, Citrucel, Fiber One cereal, high fiber bars, etc.

Round ligament pain

As your uterus grows, the ligaments that help support it also stretch.  The ligaments then might spasm briefly.  Sometime, women get fairly sharp pains down low in the abdomen, just above the pubic bone, or on the sides of the uterus, where the ligaments attach.  These pains might increase after being more active, especially after activities involving bending and twisting motions.  If the pains are short and go away quickly, this is probably normal.  Try a warm bath, sleeping with a pillow between your knees, Tylenol, and avoiding twisting motions while you work (turn your entire body versus just twisting your trunk).  If your pain is severe, does not go away, is rhythmic like contractions (regular pains every 10 minutes or less, lasting for a minute, then relaxing) or cause you worry, please call.

Insomnia

The physical and hormonal changes of pregnancy contribute to the quality of a pregnant woman’s sleep.  In addition, our minds during pregnancy can be never ending, especially when we attempt to sleep at the end of a long day.  Each trimester of pregnancy brings its own unique sleep issues.   Most sleep problems occur in the third trimester.  There is growing discomfort from the baby and the due date is quickly approaching.  It is more common for pregnant women to be able to fall asleep initially, but then wake after a few hours and then remain awake until the morning.  This causes a great deal of fatigue throughout the day-time hours.   Here are some suggestions to help you get to sleep in pregnancy:

  • Pillows! Pillows!  Use as many supportive pillows as you need to support your tummy and back.  Also place a pillow or wedge between your knees for low back support.  A full-length body pillow is often popular because it can snake around your body entire body in several different ways.

  • Eat a light snack before bed. Warm skim milk and turkey contain a natural sleep inducer called L-tryptophan.

  • Regular exercise promotes physical and mental health.  It can help with sleeping more deeply.  Avoid exercising 2-4 hours before bedtime.

  • Relaxation techniques. Deep breathing, stretching, massage, yoga, soothing music, or a warm bath helps promote relaxation to ease your mind.

  • Take short naps (15-30 minutes) during the day, if possible.

  • Practice good sleep hygiene:

    1. Avoid alcohol, caffeine and nicotine (which you should be doing anyway – you are pregnant)

    2. Establish a regular bed time and waking time. Do not go to bed when you are wide awake.

    3. Take your television and computer out of your bedroom.

    4. Avoid staying awake in your bed for long periods. If you have not fallen asleep or become drowsier within 20 minutes of lay in bed, get out of bed and do activities that make you sleepy, such as reading or a warm bath.  Once you feel sleepy, try going to bed again.

What about my job? Do I need to stop working?

Employment

If you are employed outside the home, it is your responsibility to take care of yourself and communicate your needs with your employer.  While we don’t place any restrictions on healthy pregnant women, we do recommend you consider these sensible tips:

  • Limiting your work hours to 8 hours a day, 40 hours a week, if possible

  • Avoiding prolonged standing or sitting (you will feel better if you can take a 5 minute break at least every two hours).

  • Limiting lifting heavy items to 25-35 lbs without additional assistance, unless you are accustomed to this sort of heavy work prior to pregnancy

  • Be sure to have adequate ventilation and try to avoid extremes in temperature

If you choose to stop working before your baby is born, it is your responsibility to discuss this with your employer and make the appropriate arrangements.  Most Family & Medical Leave Act (FMLA) leave begins when you go in to labor.  If there is employment associated paperwork you need completed by our office, drop off the forms and give us as least two weeks to complete the forms.  There is a nominal charge to prepare your Short Term Disability or FMLA paperwork

I think I am in labor…when do I call?

Your contractions should be five minutes apart or less (from the start of one to the start of the next one), about one minute long, for at least one hour. An easy pneumonic for when to call for labor is 5-1-1. Your contractions should be strong enough that you must stop what you are doing, including talking, and breathe through them. If you feel you could sleep through your contractions, you are unlikely to be in labor. If you have a history of rapid labor, please discuss this with your provider at your prenatal visit. When your membranes rupture (water breaks), the fluid will gush or leak. You will not be able to control it. Usually the fluid will run down your leg if you do not have a pad on. Even if you are not having contractions, you should still call the office if your water breaks. If you are unsure if your water has broken, please call us. If the baby is not moving as much as he/she normally moves:
  • Eat or drink something
  • Lay down on your side
  • Count the baby’s movement. If you do not count 10 movements within one hour, call the office.
  • If you are bleeding abnormally:
    • Call the office if you are bleeding as heavily as a period.
    • It is not uncommon to spot or bleed after an exam or at the start of labor.
    • It is not uncommon to see a large strand of bloody mucous, also known as your mucous plug. You do not need to worry about the timing of your mucous plug and can wait to call until your labor signs meet the above criteria.
  • Call the office 24 hours a day, 7 days a week when you go into labor: 303-738-1100. If it is after-hours or during the weekend, your call will be forwarded to our Provider on call.