Congratulations on your pregnancy! It's true what they say - having a baby changes everything. Thank you for allowing us to be a part of your pregnancy! When you find out that you're pregnant, you're probably filled simultaneously with joy and anxiety. Quality prenatal care is of the utmost importance, and we have experienced physicians who can answer your questions, calm your fears, and celebrate joyous milestones with you. Our group of physicians share call and will take care of you throughout your pregnancy. Please call our office if you have any questions. We have an answering service after hours, which will route emergency calls to the physician on call. The office will address non-urgent calls (refills, appointment changes) the following business day. If you're pregnant, call us to schedule an obstetrics appointment. We look forward to celebrating with you!
We will deliver your baby at Los Robles Hospital and Medical Center, which features nine private labor, delivery and recovery (LDR) rooms and a level III neonatal intensive care unit (NICU).
Patients can download/print the following information in our Obstetrics Information Packet.
Make this as soon as you think you're pregnant (6-10 weeks is average). Please set aside enough time because this will be your longest visit. Your partner may want to come to this visit. Your physician will ask about your medical history (menstrual cycle, contraception, past pregnancies, medical history, family history and medications). Your due date will be established using your last menstrual period and possibly an ultrasound. Very few women give birth on their actual due date, but it gives a timeline to schedule tests and procedures at appropriate times. Your doctor will perform a physical exam and perform routine lab tests. We will also discuss screening tests for fetal abnormalities.
Remainder of visits in first trimester
You will be seen every 4 weeks and each of these visits should be much shorter than the first visit. We will check your blood pressure, weight and urine at each visit. The urine test is looking for signs of bladder infection or protein. After about 10 weeks, your doctor will listen to the baby's heartbeat with a small device called a Doppler at each visit.
Each visit will occur every 4 weeks. Again, you will have your blood pressure, weight and urine checked. Your baby's heartbeat will be measured by Doppler. Your doctor will start measuring your uterus or "fundal height" after 20 weeks to make sure your uterus is growing appropriately. Generally at 20 weeks, you will start to notice flutters and kicks. You will have an ultrasound around 20 weeks to look at your baby's anatomy and to determine gender if you would like to know.
Now your visits will occur every 2 weeks until 36 weeks and then every week until you deliver. Again, we will measure your blood pressure, weight, urine and baby's heartbeat. You will have a test for diabetes during pregnancy at 24-28 weeks. You will also be tested for Group B streptococcus around 36 weeks to test for a bacteria that can cause serious infections in newborns. Your doctor may check your cervix as you approach your due date and check to make sure your baby is in the head-down position.
|Type and Rh Factor:||Determine blood type and Rh factor (for example - O positive)|
|Antibody Screen:||Screens for abnormal antibodies in your blood|
|CBC (complete blood count):||Screens for anemia or abnormal antibodies in the blood|
|Rubella Antibodies:||Tests for immunity to Rubella or German measles|
|Hepatitis B Surface Antigen:||Screens for Hepatitis B|
|RPR:||Screens for syphilis|
|HIV:||Screens for HIV|
|Cystic Fibrosis:||Screens for CF carrier status|
|Urine Culture:||Evaluates for bladder infections|
|Hemoglobin Electrophoresis:||Screens for sickle cell trait or disease or other abnormal blood cells|
|Pap Smear (pelvic exam):||Screens for cervical cancer if needed based on your age and previous results|
|Gonorrhea and Chlamydia (pelvic exam):||Tests for gonorrhea and chlamydia|
|Ultrasound:||Done at your first or second visit to confirm estimated due date|
|Ultrasound and genetic screening:||Offered between 11-14 weeks to screen for Down Syndrome and Trisomy 18|
Second & Third Trimester Visits
|Ultrasound:||At 18-20 weeks, Looks at the anatomy of the baby|
|CBC (complete blood count):||At 24-28 weeks, screens for anemia again because your level can drop at this time in pregnancy|
|Glucose Tolerance Test:||At 24-28 weeks, a 1 hour, non-fasting test to screen for gestational diabetes|
|Type and Rh Factor:||At 28 weeks, needed for patients with a negative Rh factor (example - A negative)|
|Group B Streptococcus test (vaginal/rectal):||At 35-37 weeks, tests for bacteria that is carried by some women but does not cause an infection in adults. If it is positive, you will need antibiotics when you're in labor to prevent transmission to your baby|
Here is a list of medications generally considered safe in pregnancy. Please talk to your doctor if you have any questions about the medications on this list or other medications you are taking. Do not take aspirin, Motrin, Aleve or Advil unless recommended by your doctor. If your symptoms do not improve after a few days, or if you notice high fever, please call the office.
Tylenol - do not exceed 3000 mg in 24 hours
|Headache||Tylenol - do not take more than recommended|
Oatmeal bath (Aveeno)
|Nausea and vomiting||
Emetrol oral solution
|Constipation||Colace (stool softener)
Metamucil (fiber supplement)or Citrucel
Milk of Magnesia
|Leg Cramps||Calcium 500 mg at bedtime
Potassium (1/2 banana per day)
Monistat 7 or Monistat 3
How often will I see my doctor?
Each pregnancy is unique, but in general you will be seen every 4 weeks until you reach 28 weeks. You will then have appointments every 2 weeks until 36 weeks. After this, you will be seen every week. We will have you see each doctor in the practice during your prenatal visits so you are sure to know the doctor attending your delivery. The first visit is usually the longest - about 45 minutes. The rest of the visits are usually 10-15 minutes.
When will I receive an ultrasound?
Your physician will perform an ultrasound at your first or second visit to determine how many babies and confirm your delivery date. Dr. Dan Kahn, a high risk OB and ultrasound specialist, will be available in the office approximately once weekly. He will perform first trimester ultrasounds for genetic screening if you desire. He will also perform a comprehensive anatomy survey around 20 weeks - the gender of your baby can be determined by this ultrasound if you wish. After this, ultrasounds are generally performed if there is an indication determined by your doctor.
Is it normal to have bleeding early in pregnancy?
First trimester bleeding can occur frequently and does not necessarily mean there is a problem. Bleeding can be caused by intercourse, cervical infection or other normal changes in pregnancy. Slight bleeding often stops on its own. If you notice bleeding, please contact our office.
Is it normal to have cramping in early pregnancy?
It is common to have some cramping in early pregnancy as your uterus grows and stretches to accommodate your growing baby. You can take 1-2 extra-strength Tylenol, rest and drink plenty of fluids. If there is no improvement, please call the office.
What is round ligament pain?
This is a common problem that often causes discomfort by the groin. As the uterus grows, the normal ligaments that attach the uterus to the side of the abdomen are stretched. This can be treated with Tylenol, heating pads, warm showers. Sometimes a pregnancy or maternity belt can help with this pain. Typically, this pain will go away as you pass into the second trimester.
How much weight should I gain during pregnancy?
For normal weight women (BMI <25) the average weight gain should be 25-35 pounds.
If you are starting at a higher weight, your doctor will recommend more modest weight gain during pregnancy.
Is it safe to exercise while pregnant?
Yes. Exercise has many benefits and staying in shape helps increase your energy, improves your mood, helps prevent back pain and will make you ready for labor. Safe exercises include walking, swimming, low impact aerobics, and cycling. You should avoid exercises with higher chance of injury such as gymnastics, skiing, deep sea diving, and horseback riding. You should avoid contact sports like soccer or basketball. Keep in mind that your balance will be off as you progress through pregnancy.
How vigorously can I exercise?
You should avoid activities that require quick changes in direction. If you were active prior to pregnancy, you will have an easier time exercising while pregnant. Drink plenty of fluids and wear cool, loose fitting clothing to prevent dehydration. After the first trimester, avoid lying flat on your back. Stop exercising if you notice vaginal bleeding, contractions, chest pain, dizziness, or shortness of breath.
What vaccinations are recommended in pregnancy?
The flu shot is recommended for pregnant women and can be given at any time during pregnancy or during breastfeeding. It should be the shot, not the nasal spray. Pregnant women and their newborns are at risk of much more severe complications of the flu. TDaP vaccination is recommended to help prevent pertussis infection in the newborn. The optimal time to give this vaccination is after 28 weeks. All adults who have close contact with babies less than 12 months old should be vaccinated at least two weeks prior to having contact if it has been more than 10 years since last administration.
Can I travel during pregnancy?
Yes. The best time to travel is between 14-28 weeks as most problems happen early or late in pregnancy. During a long car trip, make sure you stop to stretch at least every 2 hours to help prevent blood clots. Airplane travel is safe, although some airlines will not let you travel after 36 weeks. If you choose to travel late in pregnancy, you may deliver elsewhere. Please let your doctor know about travel plans and obtain a copy of your prenatal records to take with you.
How should I wear my seatbelt in pregnancy?
You should always wear your seatbelt in the car. It is important to wear both the lap and shoulder belt. The lap belt should be low on your hips, below your belly. Place the shoulder belt off to the side of your belly and between your breasts. It should fit snugly to protect you and your baby from harm.
Are airbags safe in pregnancy?
Yes. They are designed to be used with seatbelts for an added measure of safety. If you are driving, the steering wheel should be 10 inches from your chest. This may be difficult as your pregnant belly grows. Try to angle the steering wheel toward your chest to avoid trauma to the abdomen in the event of an accident.
How do I avoid back pain in pregnancy?
Back pain is common in pregnancy and is often a result of changes in posture, hormones and stretching of muscles. To avoid problems, wear low-heeled shoes with good arch support (not flats). Always lift objects by bending your knees and ask for help with heavy objects. Sleep on your side with 1-2 pillows between your knees. When sitting, use a small pillow for lower back support. A regular exercise routine with walking or swimming can help prevent back injury.
How can I treat back pain?
You can try heat or ice to your lower back - but never apply heat directly to your belly. Your partner can massage the affected area. Pregnancy massages are also safe. You can try Tylenol.
Can I still have sex while pregnant?
Yes. You can safely engage in intercourse throughout pregnancy unless you have bleeding, preterm labor, ruptured membranes or your doctor recommends avoiding sex.
Which prenatal vitamins should I be taking?
Pregnant women should be taking a daily prenatal vitamin to provide additional nutrients needed in pregnancy. Most over-the-counter preparations are acceptable options. Just make sure your vitamin has at least 400 mcg of folic acid (folate or Vitamin B9). Other vitamins that should be included are iron (40 mg), calcium (1000 mg), zinc, manganese, iodine and vitamin B6.
What can I take for morning sickness?
Many women experience some morning sickness, which despite the name, can occur at any time of day. Most women notice worsening symptoms up until 9-10 weeks and it usually improves by 14 weeks or the end of the first trimester. Eating smaller, more frequent meals about 6 times per day and avoiding spicy or greasy foods can help limit symptoms. Ginger can be a natural way to help decrease nausea. Eating bland crackers in the morning may help. Vitamin B6 can be taken up to three times per day and can help symptoms. If symptoms are still bothersome, there are several medications that can be prescribed by your doctor that may be helpful. Occasionally pregnant women need to be seen in the emergency room for IV fluids and medication.
Do I need more calories now that I'm pregnant?
Most pregnant women only need an extra 300 calories per day during pregnancy. Your diet should be well balanced and include fruit, vegetables and protein. The USDA has a great resource for moms and breastfeeding women. http://www.choosemyplate.gov/pregnancy-breastfeeding.html
Can I drink caffeine during pregnancy?
Moderate caffeine consumption is safe in pregnancy. It is not recommended to drink more than 200 mg of caffeine (2 8oz cups of full caffeine coffee) per day. High caffeine intake has been associated with preterm birth and low birth weight infants but the data is inconclusive.
Should I avoid fish during pregnancy?
Fish containing high mercury levels should be avoided in pregnancy - this includes predatory fish such as shark, swordfish, king mackerel, and tilefish. Raw fish should also be avoided. Try to limit fish intake to 12 ounces per week of lower mercury fish such as salmon, light tuna, shrimp or cod.
What other foods should I avoid in pregnancy?
Unpasteurized milk and soft cheeses, raw or undercooked meat, poultry or shellfish, prepared meats such as hot dogs, deli meats unless they are heated until steaming hot. Listeria is a bacteria that can be housed in these foods and when a pregnant woman is infected, this disease can cause miscarriage and stillbirth. Washing all fresh fruits and vegetables before eating will also help prevent listeria.
Here is a list of birth control options.
|Method||How to Use||Advantages||Disadvantages||Breastfeeding|
|Birth control pills||Take one pill daily||Safe, effective, cheap (some as low as $10/month); regulates cycle, improves acne; decreases risk of ovarian cancer||Have to remember to take every day||Can be started weeks after delivery after milk supply established|
|NuvaRing||Ring placed in vagina - three weeks in, one week out||Safe, effective. Convenient - once monthly dosing||Requires vaginal placement||Can be started weeks after delivery after milk supply established|
|OrthEvra Patch||Patch placed weekly for three weeks, then one patch-free week||Effective, convenient - once weekly dosing||Skin irritant||Can be started weeks after delivery after milk supply established|
|Mirena IUD||Small device placed in uterus in the office 6 weeks after delivery||Effective, convenient. Lasts 5 years, can be removed anytime. Improved bleeding||May cause irregular bleeding for first 3-6 months; expensive if used for < 2 years||Safe for breastfeeding|
|Copper IUD||Small device placed in uterus in the office 6 weeks after delivery||Effective, convenient. No hormones for up to 10 years||Causes heavier periods||Safe for breastfeeding|
|Nexplanon||Small rod placed in the arm in the office||Effective, convenient. Lasts for 3 years||Irregular bleeding for 3-6 months||Safe for breastfeeding|
|DepoProvera||Shot every three months in the office; can start prior to discharge from hospital||Effective, convenient dosing 4 times per year||Irregular bleeding; slow return to fertility after stopping; weight gain, can worsen depression||Safe for breastfeeding|
|Tubal ligation||Can be done after delivery in hospital or laparoscopically or hysteroscopically 6 weeks after delivery||Permanent||Permanent||Safe for breastfeeding|