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. General
questions may also be submitted via our on-line form.
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.
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.
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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.
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.
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.
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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.
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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.
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
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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.
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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.
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