What is prenatal care?

Prenatal care means health care during your pregnancy before your baby is born. Take care of yourself and your baby by:
-Getting early prenatal care. If you know you are pregnant, or think you might be pregnant, call your healthcare provider as soon as possible and schedule a visit.
-Getting regular prenatal care. Follow your healthcare provider's schedule for visits and don't miss appointments.
-Doing everything you can to keep yourself and your baby healthy during your pregnancy

Pregnancy is an exciting time and new mothers-to-be can soon become overwhelmed with emotion and by alternating feelings of joy and fear. Your body is changing and you are being thrust into a new role as parent. It all seems so far off, but before you know it, you are a mom. Pregnancy raises many questions and is plagued by many myths. This page will be your guide and will answer many questions that will develop as your pregnancy progresses. If, however, a question arises that is not addressed here, please feel free to contact any of our physicians, nurse practitioners, or physician assistants during office hours from 9:30 - 5:00p.m. Monday - Friday at 508-730-1666.

 

1.
Due Date
Your due date or Expected Date of Confinement (EDC) is calculated from the first day of your last menstrual period. Often, we will perform an ultrasound examination early in the pregnancy to help confirm this due date. The EDC is an approximate time of delivery. The baby may arrive up to 3 weeks prior to that date and still be considered "full term". Also, some babies may deliver past their due dates, but no more than 2 weeks.
2.
Nutrition
A healthy diet is important for both you and your growing baby. We recommend a well-balanced diet comprised of food from all the food groups. You should increase your calories by 300-500 per day, but remember moderation is the key. The recommended weight gain during pregnancy will depend on your pre-pregnancy weight. The average weight gain is between 25-35 pounds for those women at or near their ideal body weight prior to pregnancy. For women who are overweight, 15 to 20 pounds would be more appropriate. Obese women (>30% above ideal) should limit their weight gain to about 15 pounds and underweight women can exceed the 35 pound limit. At no time during your pregnancy should you try to diet. A healthy diet is key. Caffeine intake is allowed but limited to 1-2 servings per day. Also, products containing Nutrasweet and Sucralose are allowed throughout the pregnancy. Alcohol should be avoided during your pregnancy, as the safe levels for alcohol have not yet been determined.
3.
Exercise
Moderate exercise such as walking or light aerobics will help keep your muscles in tone and may help prevent unwanted extra pounds. Heavy weight lifting and other strenuous activities such as long distance running or high impact aerobics should be avoided. Abdominal exercises such as sit-ups or crunches should also be avoided after the first trimester.

 

4.
Smoking
The use of all tobacco products should be eliminated during your pregnancy. Smoking is associated pregnancy loss, pre-term labor, low birth weight, placental abruption, pre-term delivery as well as SIDS in the newborn. Second-hand smoke may be also harmful, so we encourage you to ask your family members and visitors to smoke outside.

 

5.
Office Visits
You initial office visit will include a detailed medical and obstetrical history and a discussion of any risk factors you may have for problems during your pregnancy. Routine lab work will also be obtained at the first visit. A complete physical exam including Pap test and a pelvic exam will be performed on your next visit, approximately one to two weeks later. Following this, you will be seen in the office every 4 weeks until 27-28 weeks, every 3 weeks up to 30 weeks, and every 2 weeks until 37-38 weeks, and then every week until delivery. These intervals may change at any time during the pregnancy if problems needing closer observation develop. Internal exams to determine cervical changes will be performed starting at 37-38 weeks or at any time there is a question of labor.

 

6.
Routine Screening Tests
There are several screening tests which will be performed at different times during the pregnancy. Your initial blood work checks for your blood type and count, whether you are immune to Rubella(German Measles) and whether you have been exposed to hepatitis or syphilis. We offer HIV testing to all prenatal patients at the first visit or anytime after that at your request. We also offer a blood test which can determine whether or not you are a carrier of the gene which causes Cystic Fibrosis. If you are, there is a greater chance that your baby could have Cystic Fibrosis. The next test, the AFP test, is done between 16 and 18 weeks. This test screens for two types of birth defects. The first involves problems with the normal development of the spine and central nervous system. These defects include anencephaly(incomplete or absent development of the brain), Spina Bifida(incomplete closure of the spine), and other central nervous system defects.The AFP test can also determine your risk for having a baby with Down's Syndrome and other related chromosome defects. It is important to remember that this is just a screening test and a result of POSITIVE does not mean there is a problem but rather that you fall into a category that requires further testing. If you have any questions regarding the AFP test, please discuss them with one of our healthcare providers. You will be given additional information regarding these tests later in your pregnancy.

At 26 to 28 weeks you will undergo a screening for gestational diabetes called a glucose tolerance test. Elevations in your glucose levels following the test may necessitate dietary changes or insulin treatment. The final test is a vaginal culture for Group B Strep. This bacteria is present in 23-25% of all women and normally doesn't cause a problem. Complications can develop if your baby is infected during delivery; however, treatment will be with antibiotics during labor.

 

7.
Heartburn
The best treatment for heartburn is prevention. Certain foods can lead to heartburn, such as chocolate, caffeine, spicy or high fat foods(fried foods). Try to avoid those foods that cause you discomfort. Also, you may want to avoid lying down soon after eating or you can try eating smaller, more frequent meals. You can try TUMS or ROLAIDS as needed or even over-the-counter PEPCID AC or Zantac twice a day.

 

8.
Constipation/Hemorrhoids
Constipation ia a common problem during pregnancy and is often worsened by the iron supplement in your prenatal vitamin. Hemorrhoids are also fairly common during pregnancy, even if you have never had them before. Increase in pressure in the veins below the enlarged uterus can lead to hemorrhoids, which can then be worsened by constipation. Again, the best treatment is prevention. Plenty of water, along with fruits, vegetables, and a high fiber cereal, can help reduce your constipation. If you have not had a bowl movement for 2-3 days, you should try Metamucil or Citrucel each morning with a large glass of water. If your stools are hard, you may take an over-the-counter stool softener. If you go longer than 2-3 days, a mild laxative such as Milk of Magnesia may be helpful. If your hemorrhoids become painful, try an anesthetic spray such as Dermal directly on the hemorrhoids. Then apply pads soaked in Witch Hazel(Tucks) and a hemorrhoid ointment(Anus or Preparation H). Keep the pads in place with a thin panty liner. If the discomfort persists or if there is bleeding, contact one of our healthcare providers

 

9.
Fetal Movement
You may initially notice some signs of fetal movement as early as 17-18 weeks. These movements are often described as feeling like "butterflies in you stomach" or as gas bubbles. As your pregnancy progresses, the movements will become stronger and more noticeable. You should feel the baby move every day after 20 weeks. Sometimes, babies move at different times of the day and some prefer to exercise at night while you are trying to sleep. As you approach your due date, you may notice a decrease in the intensity of the fetal movements. Your baby is running out of room and cannot make those big flips or strong kicks anymore. This does not mean your baby's activity should be less, only that the degree of movement will seem less. If you haven't felt amy movements for 3 to 4 hours of if you feel that there has been a noticeable sudden decrease in the amount of fetal movement, you should perform a fetal movement count. Go to a quiet room free from distraction and lie in a comfortable place with your hands on each side of your belly. It is important that you count each movement, no matter how slight, as a fetal movement. It can be just a flutter or the baby rolling over. It does not have to be a strong kick or jump. You should be able to count 5 fetal movements in one half-hour. If you don't get 5 in the first 30 minutes, wait another half-hour and see if you get a total of 10 movements then contact Obstetrical Associates at 508-730-1666 right away.
10.
Signs of Pre-term Labor
A full-term pregnancy is one that has reached 37 weeks of gestation. Labor or delivery prior to 37 weeks, is called pre-term. If you are less than 37 weeks(one month early) and you notice more than 4 to 5 contractions per hour, repetitive cramping in your lower back, or menstrual-type cramps, you may be in pre-term labor. First, you should drink 4 to 5 eight-ounce glasses of water. You should then empty your bladder and lie down on your left side in a comfortable place without distraction. Keep counting the frequency of the contractions. If after one hour there are still 4 to 5 per hour or if they have increased in intensity, contact us right away. Also, if you notice any of the following: a sudden gush of fluid, red blood from the vagina, severe abdominal pain, or fever, you should contact Obstetrical Associates immediately at 508-730-1666.

 

Problems - Questions
If questions arise during your pregnancy that are not answered here, please contact us during office hours. E-mail us:info@oba-ma.com

If a question or problem is urgent or a emergency, a physician on call will be able to help you 24 hours a day by calling 508-730-1666. Rhode Island patients can reach us by calling 888-543-4121.

Extreme emergency - Dial 911

If your concern is not an emergency, remember to write it down and bring it to your next office visit. We look forward to helping you to have a safe pregnancy and a healthy, beautiful baby.
Obstetrical Care:

The person you choose for your obstetrical care can have a major influence on how satisfied you are with your pregnancy experience. You may have a doctor or midwife in mind before you become pregnant, and your friends undoubtedly will pass along recommendations. But your needs and expectation may not be the same as those of your friends. And your needs may change during pregnancy.

Before choosing your caregiver, consider all of your options - family physicians, obstetricians, certified nurse-midwives and perinatologists. And remember, no matter what type of obstetrical caregiver you choose, the goal is the same - healthy mothers having a healthy babies.

When choosing an obstetrical care provider, keep in mind that you will be seeing this person regularly in the coming months and will depend on him/her for vital information and care. It is important to have an open and trusting relationship with the person you choose. You will want to find an obstetrical provider who suits your needs and personality. Take some time to educate yourself about pregnancy and childbirth to help you form a clear idea of your needs. Some women are most concerned with specifics of practice (such as wanting a particular method of childbirth) while others will base their decision on environment, personality, etc. It is helpful to talk with other women about their experiences.
The selection of an obstetrical care provider/midwife for prenatal care and the delivery of your baby needs to be made hand-in-hand with the decision of where to deliver. Because obstetrical care providers are affiliated with particular hospitals, a strong preference for a doctor or facility may determine the other. Choosing both are personal decisions and having as much information as possible will make these decisions easier. The choice of an obstetrical care provider and hospital for the birth of your baby may be influenced by your insurance plan.

It is usually a joyful event when a woman gives birth to a baby she wants. Despite the pain and discomfort, birth is the long-awaited culmination of pregnancy and the start of a new life. However, birth is also a critical time for the health of the mother and her baby. Problems may arise that, if not treated promptly and effectively can lead to ill-health and even death for one or both of them. Nonetheless, the postpartum period is often neglected by maternity care. The lack of postpartum care ignores the fact that the majority of maternal deaths and disabilities occur during the postpartum period and that early neonatal mortality remains high.

The postpartum period, or puerperium, starts about an hour after the delivery of the placenta and includes the following six weeks. Postpartum care should respond to the special needs of the mother and baby during this special phase and should include: the prevention and early detection and treatment of complications and disease, and the provision of advice and services on breastfeeding, birth spacing, immunization and maternal nutrition.

1.
In the postpartum period, women need
information/counselling on:

- care of the baby and breast feeding
- what happens to their bodies - including signs of possible problems
- self care - hygiene and healing
- sexual life
- contraception
2.
Support from:

- health care providers
- partner and family: emotional, psychological

-healthcare for suspected or manifest complications
-time to care for the baby
-help with domestic tasks
-maternity leave
-social reintegration into her family and community
-protection from abuse/violence.

3.
Women may fear:

-inadequacy
-loss of marital intimacy
-isolation
-constant responsibility of caring for the baby and others

The postpartum period, or puerperium, starts about an hour after the delivery of the placenta and includes the following six weeks. Postpartum care should respond to the special needs of the mother and baby during this special phase (see tables 1 and 2) and should include: the prevention and early detection and treatment of complications and disease, and the provision of advice and services on breastfeeding, birth spacing, immunization and maternal nutrition.

Postpartum hemorrhage is the single most important cause of maternal death. It kills 150,000 women each year and nearly nine out of ten of these deaths take place within four hours of delivery. A woman who is anemic is usually less able to cope with blood loss than a woman who is well nourished. During the first hours after the birth, the care-giver has to make sure that the uterus remains well contracted and that there is no heavy loss of blood. If the bleeding is particularly severe blood transfusion may be the only way of saving a woman’s life.

Puerperal infections such as sepsis are still major causes of maternal mortality in many developing countries. Fever is the main symptom and antibiotics the main treatment, though prevention by ensuring cleanliness and hygiene at delivery is obviously the best course of action.

Eclampsia is the third most important cause of maternal mortality worldwide. A woman suffering from eclampsia or severe pre-eclampsia the first days postpartum should be hospitalized. The treatment of choice is magnesium sulphate.

1.
Needs of women

In the postpartum period, women need information/counseling on:
- care of the baby and breast feeding
- what happens to their bodies - including signs of possible problems
- self care - hygiene and healing
- sexual life
- contraception
- nutrition

support from:
- health care providers
- partner and family: emotional, psychological
- health care for suspected or manifest complications
- time to care for the baby
- help with domestic tasks
- maternity leave
- social reintegration into her family and community
- protection from abuse/violence

Women may fear:
- inadequacy
-loss of marital intimacy
-isolation
-constant responsibility of caring for the baby and others

2.
Needs of newborn infants

In the postnatal period newborn infants need:
- easy access to the mother
- appropriate feeding
- adequate environmental temperature
- a safe environment
- parental care
- cleanliness
- observation of body signs by someone who cares and can take action if necessary
- access to health care for suspected or manifest complications
- nurturing, cuddling, stimulation

protection from:
- disease
- harmful practices
- abuse/violence

acceptance of:
- sex
- appearance
- size
- recognition by the state (vital registration system)

Other common postpartum complications include urinary tract problems such as infections, urine retention or incontinence. Many women also experience pain in the perineum and vulva for several weeks, especially if there was tissue damage or an episiotomy during the second stage of labor. The woman’s perineum should be regularly inspected to make sure it is not infected.

Psychological Problems in the postpartum period are also not uncommon. These problems can be lessened by adequate social support and support from trained care-givers during pregnancy, labor and postpartum period.

The nutritional status of the woman during adolescence, pregnancy and lactation has a direct impact on maternal and infant health in the puerperium. Women’s intake postpartum should be increased to cover the energy cost of lactation. The three main vitamin or mineral nutritional deficiencies in the postpartum period are iodine deficiency disorders, vitamin A deficiency and iron deficiency anemia. The main causes of micronutrient malnutrition are inadequate intake of foods providing these micronutrients and their impaired absorption or utilization. Preventive and treatment measures include ensuring regular intake of appropriate foods, food fortification, giving supplements to pregnant and lactating women and infants and children.

The newborn's health and well-being can also be affected by a variety of conditions. The most common causes of death and disability in the postnatal period include prematurity, neonatal sepsis, respiratory infections, neonatal tetanus and cord infections, congenital anomalies, and birth trauma or asphyxia. Babies that are pre-term or have a low birth weight are more prone to low body temperature, more likely to succumb to infection, more often need to be resuscitated, and are more difficult to feed. Mothers and health workers can help avoid dangerous heat loss by making sure the room is warm and that the baby is kept next to its mother.

Infections are still a major threat to newborn infants in developing countries. Like puerperal sepsis in the mother, the extent can be reduced dramatically by making sure that the birth takes place in hygienic conditions and that those present observe basic rules of cleanliness such as hand washing.

Jaundice is quite common in newborns and usually clears up without treatment, but it can be especially dangerous in pre-term or low birth weight babies. Ophthalmia neonatorum is a discharge from the eyes that occurs within the first two weeks of life but can be prevented by application of ointment or eye drops in the first hour after birth.

The establishment and maintenance of breastfeeding should be one of the major goals of postpartum care. Breast milk provides optimal nutrition for newborn infants, protects them against infections and allergies and promotes mother-infant bonding. The baby should be given to the mother to hold immediately after delivery, to provide skin-to-skin contact and for the baby to start suckling as soon as s/he shows signs of readiness - normally within ½-1 hour after birth. In institutions babies should be kept with their mother and unrestricted breastfeeding should be allowed. Mothers need help and advice on how to breastfeed. Supplementary feeds should be avoided.

During the postpartum period women need counseling on contraception. Methods include the progestin-only pill, a depot-medroxyprogesterone acetate (DMPA) injection, an intrauterine device (IUD), or barrier methods such as a diaphragm or condoms. Combined oral contraceptives should be avoided during the first months of lactation.

The postpartum period is an important opportunity to counsel women, their partners and their families about the decision to carry out an HIV test if the opportunity was missed during pregnancy. If a test is positive, counseling needs to be given on possible treatment or preventive measures. In many resource-poor settings, the risks of diarrhoeal disease or malnutrition due to improper or inadequate preparation of artificial milk outweigh the risk of contracting HIV through breastfeeding. Maternity services should take the necessary preventive measures to protect health care workers and mothers against infection.

All mothers should be immunized with at least two doses of tetanus oxide to protect both themselves and their newborns. The third dose is given 6 months after the second and the last two doses are given after at least one year or during a subsequent pregnancy. Where there is a high risk of tuberculosis infection, BCG immunization should be given to infants soon after birth. Diphtheria-pertussis-tetanus vaccine is recommended for all children at 6, 10 and 14 weeks. A single dose of oral polio should be given at birth or within the first two weeks of life, and the normal polio immunization schedule should follow at 6, 10 and 14 weeks. Where perinatal transmission of hepatitis B is frequent, the first dose of hepatitis B vaccine should be given as soon as possible after birth and should be followed by further doses at 6 and 14 weeks.

Postpartum services should be based on the needs and health challenges outlined above, incorporate all the essential elements required for the health of the mother and her newborn, and should be provided in an integrated fashion. Skilled care and early identification of problems could reduce the incidence of death and disability, together with the access to functional referral services with effective blood transfusion and surgical capacity. With regard to timing of postnatal visits, there seem to be "crucial" moments when contact with the health system or caregiver could be instrumental in identifying and responding to needs and complications. These can be resumed in the formula (which should not be interpreted rigidly) of "6 hours, 6 days, 6 weeks and 6 months". Table 3 below summarizes the broad lines of care that can be offered at each point of contact during the puerperium. More important than a rigid but unfeasible visiting schedule is the possibility for all women to have access to a health care provider when she needs it.

There is a need to provide a solid infrastructure for the provision of a service which is comprehensive, culturally sensitive and which responds to the needs of childbearing women and their families. Elements of this infrastructure include policy, service and care provision, tool development, training and human resource issues, health protection and promotion and research

Key elements of postpartum care:

6-12 hours
3- 6 days
6 weeks

6 months

For Baby:

breathing

warmth

feeding

cord

immunization

feeding

infection

routine tests

weight/feeding

immunization

development

weaning

For Mother:

blood loss

pain

BP

advice/warning signs

breast care

temperature/infection

lochia

mood

recovery

anemia

contraception

general health

contraception

continuing morbidity

 

If questions arise during your pregnancy that are not answered here, please contact us during office hours.

If a question or problem is urgent or a emergency, a physician on call will be able to help you 24 hours a day by calling 508-730-1666. Rhode Island patients can reach us by calling 888-543-4121.

Extreme emergency - Dial 911

If your concern is not an emergency, remember to write it down and bring it to your next office visit. We look forward to helping you to have a safe pregnancy and a healthy, beautiful baby.

Safe Medications during pregnancy

There are many over-the-counter products that can be taken during pregnancy without consulting your physician. Here is a list of safe medications that you may take at your discretion. Generic products are OK too.

Please take all medications only as directed on the label.
CLICK HERE FOR A COMPLETE LIST

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