OB Patient Guide
A Guide to Pregnancy and Feeding Your Baby
A baby changes everything, and it all starts with pregnancy—a time that’s filled with as many questions and concerns as it is anticipation and joy. Each trimester (the three 'segments' of pregnancy) brings with it new questions and worries about your health, the tests you might need and what the results mean, the baby’s growth, and the impending birth. Whether you’re newly expecting or in the planning stage, and whether this is your first go-round or you’ve been pregnant before, this guide is for you. To learn what you need to know to have a healthy pregnancy, read on.
Planning for Pregnancy
If you’ve decided to try to have a baby, your first step should be to make an appointment with your healthcare provider for a preconception care checkup. Why? It’s smart to find out if there's anything in your health status or history that could affect your pregnancy, as well as to get advice that will help increase your chances for a healthy baby. The early weeks of pregnancy are crucial to your baby’s growth and development, and giving him or her the best beginning you can should ideally start before you even conceive. Here are some things you can expect at a checkup:
A FAMILY HEALTH HISTORY: Knowing your family’s medical history is important. If there are diseases or conditions that run in your family, consider talking to a genetic counselor.
A PELVIC EXAM: This is to be sure everything’s in good working order and to detect, and, hopefully correct, any issues that would interfere with fertility. You’ll also get a Pap test, which looks for precancerous cells on your cervix.
A BLOOD TEST: You’ll be screened for your blood type and Rh factor, which is important to know when you are pregnant. You’ll also be tested for sexually transmitted diseases and HIV.
A LOOK AT MEDICATIONS YOU TAKE: This includes both prescription and over-the-counter meds, some of which may be harmful to a fetus (though many are not). However, don’t stop taking any medications for conditions like diabetes or depression without first talking to your doctor. He or she will help you find the safest alternatives.
A DISCUSSION OF LIFESTYLE ISSUES: Do you smoke or drink alcohol? Stopping these habits goes a long way toward reducing risks to your baby’s development.
A VACCINE UPDATE: You’ll find out if you need immunizations before you conceive, especially for the flu, hepatitis B, human papillomavirus (HPV), MMR (measles, mumps, rubella), and varicella (chicken pox).
A TALK ABOUT VITAMINS: Although most of your nutrition should come from your diet, you might want to start taking a prenatal vitamin that also contains iron. Folic acid is another important supplement. This B vitamin has been shown to prevent neural tube defects. It’s recommended that all women who may become pregnant take 400 micrograms of folic acid a day.
Having a Baby After 35: 35 and up and contemplating your first baby? The medical community considers that to be “advanced maternal age.” While many women easily get pregnant in their 30s and beyond, fertility does decline as you age, which may make it harder to conceive. There are also health risks associated with later-in-life pregnancy, such as high blood pressure, diabetes, the greater chance of multiple pregnancy or preterm birth, and birth defects. You’ll likely get more tests and screenings at 35-plus than you would otherwise to assess your baby for chromosomal disorders (such as Down syndrome). Many women can and do have perfectly normal, healthy pregnancies and babies after 35. The key is to take good care of yourself and get good prenatal care.
Seven Helpful Tips When Your Significant Other is Expecting
When your significant other is expecting, there are a few things you can do to help each other prepare before your little one comes into the world.
- INSTALL AN INFANT CAR SEAT. Take your time in purchasing a safe infant car seat. Install the car seat before the baby arrives, and practice using it by strapping in a doll or stuffed animal. Keep it in the car, so it is ready when the baby comes home from the hospital.
- MAKE THE DIAPER DECISION. Are you going to use disposable or cloth diapers? Make the decision together while she is still pregnant and stock up on the desired choice.
- BABY PROOF YOUR HOME. Although your new baby will not be mobile for six months or so, you can get a head start on baby proofing your home. Hiding electrical cords and installing plug covers are a good start to help keep your little one safe.
- STOCK UP ON POST-BABY MEALS. During the last few weeks of pregnancy, take time to fill your freezer with pre-made meals for you and your significant other. Placing the frozen meals in the oven or microwave can save precious time you could spend with the baby.
- PREPARE THE BABY’S ROOM. Take some time to make sure the baby’s room—or wherever the baby is sleeping—is ready, including furniture, wall paint, curtains, bottles, baby monitor and any other accessories the baby may need. A week or so before the birth, do one last clean-up of the room and the rest of the house. You may not have as much time to do this the first few weeks of having the baby home.
- HAVE PLENTY OF BABY CLOTHES. Initially, toys and other accessories will not be as important when caring for your baby. You will need plenty of seasonally-appropriate clothes since the baby is likely to go through multiple outfits per day.
- COMMUNICATE WITH POTENTIAL VISITORS. Your friends and family are beyond excited for your new family. Prepare them by communicating about the right time to visit. You can also send updates and photos as time allows, so they can share in the excitement. A close friend might also be willing to do this on your behalf.
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Labor and Delivery
In movies and on TV, pregnant women always know when it’s time! Real life is less neat, but there are definite signs of labor you can watch for as you get close to your due date. One is called lightening, or the feeling that the baby has “dropped”
lower into your pelvis. Then, of course, there are contractions. You should know that false labor—irregular uterine contractions that aren’t the true start of labor—are fairly common. How to tell the difference: In true labor, contractions
start in the back and “move” to the front; get stronger and closer together over time; and don’t stop when you move around. False labor contractions (also called Braxton Hicks contractions) are usually only felt in the front, and
may stop if you change position.
Once labor is underway, it tends to progress in stages—three in all. How long you spend in each stage is individual. Here’s what happens:
The Three Stages
This has two steps. Early labor is when you start feeling contractions that get closer and stronger. The contractions are gradually opening up your cervix. Then there’s active labor. Now, your contractions will be even stronger, often with little to no space in between. You’ll reach 10 cm dilation of your cervix now, which is when your baby’s ready to be born.
You’ll feel the urge to push now, which feels like a lot of pressure in your rectum and perineum. Your healthcare provider will guide you on pushing, timed to your contractions. Once your baby’s head “crowns,” which is when it’s visible at the entrance to your vagina, you’re nearly there. Soon, your baby will be born, and the umbilical cord cut.
Usually within 5 to 10 minutes after the birth, you’ll have more contractions that help you deliver the placenta, which is what your baby was attached to in your uterus. As soon as possible after your baby is born, he or she can go straight into your arms so you can lie skin-to-skin and start breastfeeding right away.
There are a few ways to cope with and relieve pain without drugs, such as various breathing techniques, warm baths or showers, changing positions (sitting, walking, squatting, using an exercise ball) and massage. Mom and her support partner are encouraged to attend the childbirth preparation class offered at Abrazo. The idea here is to help you relax, distract you from pain, and help your body release endorphins, which are natural painkillers. You also might want to consider hiring a doula, a support person (in addition to your partner and healthcare provider) who stays with you throughout the process.
These are drugs that dull pain. You can get a narcotic through an IV or by an injection. The pros of narcotic pain relief are that they may allow you to rest without making you lose feeling entirely. Among the cons are that if you get too much, your breathing and that of your baby may slow down. They may also make you groggy or upset your stomach.
In this pain-relief procedure, a catheter is inserted into your epidural space, and medication that decreases feeling in your lower body is continuously delivered directly into your epidural space where nerves live. It takes about 20 minutes to take full effect, and can be left in place for hours. While you’re awake and aware of contractions, you can’t usually walk around once you have an epidural.
A spinal block eliminates feeling in the lower half of your body. But unlike an epidural, it’s a single injection, put directly into your spinal column, that works immediately, but that only lasts 1 to 2 hours. A block is something you may have if you have a C-section.
When You Need a C-Section
Sometimes, a cesarean section (C-section), or surgical birth, is necessary. Reasons for a C-section include:
- A breech presentation Labor that fails to progress
- A very large baby Fetal distress (your baby doesn't get enough oxygen or his heart rate slows too much) Placenta problems
- A maternal infection like HIV or herpes Multiple birth Most C-sections are done with an epidural or spinal block.
What to Pack
As you approach your due date, it’s smart to toss some essentials in a grab-and-go bag so you’re ready to head to the hospital with no delay.
What you need for yourself:
Toiletries, a nightgown, robe, slippers, socks, underwear, a bra or nursing bra. Your own pillow, music, your phone and/or camera (and a charger), snacks, personal comfort items and clothes to wear home.
What you need for your baby:
Not much! The hospital provides diapers and swaddling blankets, so just pack a going-home outfit for those all-important photos (you’ll also need a car seat).
Other items:
Insurance info and your birth plan, if you have one. Please leave all jewelry and valuables at home.
Newborn Tests and Care
Standard Requirements:
As per the American Academy of Pediatrics.
Vitamin K: Administered at birth, Vitamin K is part of the mechanism needed for blood to clot. Low levels of Vitamin K can cause rare but serious bleeding problems. This is especially a concern if you have a male child and plan a circumcision.
Eye Care: The State of Arizona and the American Academy of Pediatrics recommends that all newborns receive erythromycin eye ointment shortly after delivery. In order to be effective, the ointment is applied within the first hour of birth, as certain eye infections can cause blindness if left untreated.
Hearing Test: A hearing test is administered to all newborns before discharge to screen for hearing deficits. If reduced hearing is identified, newborns will be referred for further diagnostic testing or to a specialist for further evaluation.
Newborn Metabolic Screen: This screening test is done prior to discharge and repeated in 7-14 days to check for several diseases which may be treated if detected early.
Most of these disorders have no visible signs at birth. Your pediatrician or family physician will call if results are abnormal.
Abrazo Health Recommended Procedures
Hepatitis B Vaccine: The American Academy of Pediatrics recommends that your baby receive this vaccine at birth or shortly after to protect against the Hepatitis B virus. Hepatitis B can cause lifelong infection, serious liver damage and even death.
Your newborn may also undergo monitoring and/or testing for low or high blood sugar, feeding issues, infection, elevated bilirubin (jaundice), or other medical concerns.
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