What happens at a prenatal appointment?
In the beginning of your pregnancy we will see you about every 4 weeks. As you get closer to your due date the visits will become more frequent. At every visit we will listen to the baby’s heartbeat and check the baby’s growth; check your blood pressure, weight, and urine; and review any test results that may have been done the previous visit. We encourage you to come in with a list of questions so that we can discuss your concerns.
Your “due date” is defined as 40 weeks from the first day of your last menstrual period. If your last menstrual period is uncertain, then your “due date” will be determined by your first ultrasound. Most babies are born between 37 and 42 weeks. Your prenatal visits are scheduled according to your due date. An uncomplicated pregnancy will be scheduled for the following visits:
Initial visit: Exam, Confirm pregnancy, PAP smear, labwork, discuss genetic screening
12 week visit: Labs reviewed, first trimester genetic screening if requested
16 week visit: Second trimester genetic screening or AFP if requested
18 week visit: Ultrasound
20 week visit: Review ultrasound and genetic screening results
24 week visit: Routine evaluation, preterm labor review, prenatal classes
28 week visit: Diabetes blood test, lab work, rhogam if needed
30 week visit: Review diabetes blood test
32 week visit: Routine evaluation, TDaP vaccine
34 week visit: Routine evaluation, hospital registration
36 week visit: Group B streptococcus test
37 – 42 week: Weekly visit with routine evaluation until delivery
Do you offer prenatal classes?
Prenatal classes are available through Piedmont Fayette Hospital or The Better Birth Foundation. More information on these classes is available upon request. We strongly recommend a prenatal class to prepare you and your partner for labor and delivery. Sibling and breastfeeding classes are also available and can be very helpful. We recommend that you schedule early for these classes as they tend to full up quickly.
What are some common lab tests in pregnancy?
During your pregnancy, diagnostic studies (lab work, cultures, pap smears) will be performed or offered. If you have an appointment within two weeks of the test, we will inform you of the results at the time of your next visit. If you do not have an appointment within the next two weeks, we will notify you of the results by phone or mail. It is very important that we have your current phone number(s) and address. If you have not heard from us within two weeks of a test, call us. No news is NOT good news. No news is NO NEWS.
Down Syndrome and Trisomy 18 Screening
Down syndrome, or Trisomy 21, and Trisomy 18 are both genetic syndromes that cause severe mental retardation and major birth defects. There are screening tests available that help predict the risk of your baby having these disorders. These tests can either be done in the first trimester, between 10 and 13 weeks gestation, or in the second trimester, between 15 and 22 weeks gestation.
For both of these tests it is important to understand that the results do NOT tell you that your baby definitely does or does not have a problem. They only tell you whether the risk is high enough that you should consider having other tests.
If your testing comes back with an increased risk for any of the associated disorders, we will send you to a perinatologist for further evaluation and counseling. At that appointment they will perform a more in depth ultrasound looking for any associated problems. They will also discuss your options including having an amniocentesis or chorionic villi sampling (CVS) done. These tests will give you definite results. If you are 35 years of age or older, we will offer CVS or amniocentesis without the screening tests because your age alone puts you at a high enough risk.
Please see our handout on Down Syndrome and Trisomy 18 screening for more in depth information.
We provide obstetric ultrasounds in our office. At approximately 18 weeks gestation an ultrasound will be performed to measure fetal growth and organ development. No other ultrasounds will be performed in an uncomplicated pregnancy so that we can decrease your exposure to unnecessary energy sources. Ultrasounds are not performed for identifying a baby’s sex.
Pregnancy can affect the way your body handles the food you eat, and this can result in gestational diabetes. We routinely screen all of our patients for gestational diabetes at around 28 weeks gestation.
The test results normally come back to us in a week or less. If your results fall out of the normal range, we will call you to schedule additional testing. If the results are normal we will wait until your next appointment to give you the results.
Group B Streptococcus (GBS)
Group B Streptococcus or GBS is a normal intestinal bacteria. Up to 40% of pregnant woman have GBS, but it is not a sexually transmitted infection and does not pose a danger to a women’s health. You will be tested in the office for GBS with a sample taken from the vagina between 35-37 weeks gestation. A pregnant woman can pass this bacteria to her baby during delivery. Most babies do not have problems however, a few babies may become ill, therefore, if the culture is positive, you will need to receive antibiotics during labor. If the culture is negative, no further treatment is necessary.
What should I do about my diet? How much weight should I expect to gain?
Diet is an important part of a successful pregnancy. Weight gain is to be expected, 25-35 pounds on average. Much individual variation exists, however. What really matters is that you eat well, get a regular amount of low impact exercise, and do not diet. You will need about 300 extra calories a day while you are pregnant.
We will provide you with a prescription for prenatal vitamins which you should take every day. These are available in chewable form, if desired. Take your vitamins during your pregnancy, for 6 weeks postpartum, and for as long as you are breastfeeding.
Pregnant women should get most of their calories from the five largest food groups of the pyramid. These five groups will provide you with the vitamins and minerals that you and your baby need to be healthy. It is important to keep variety in your diet. It will ensure that you get all that you need and not too much of something you don’t need.
The most important item to remember about nutrition is that you need 2 liters of water every day. Limit caffeinated beverages and soda.
Click here for the list of foods to avoid.
Is it safe to exercise?
Exercise is good. It can help you feel better during your pregnancy by reducing problems with swelling, back pain, and decreased energy. Being fit also helps you get through labor more easily. Being overweight can increase your risk of gestational diabetes as well.
If you are already involved in a regular exercise program, or you would like to start an exercise program, talk to us about it at your next visit. If your pregnancy is uncomplicated, most gentle aerobic exercise is fine. There are many safe activities and many specific prenatal exercise classes available. Just ask us.
You should definitely avoid contact sports or other sports that increase the risk of trauma to you such as rock climbing, horseback riding, downhill skiing, etc. after the first trimester. As your pregnancy progresses, you will find that your center of gravity will change causing you to be more prone to falls. Because of this, you may need to limit activities requiring good balance like biking, tennis, etc. SCUBA diving should be avoided completely during pregnancy secondary to fetal intolerance of the pressure changes involved. You should also avoid anaerobic exercise.
Click here for a handout on exercise during pregnancy.
How much fetal movement should I expect?
If this is your first baby, you will normally feel the baby move for the first time when you are 18-20 weeks pregnant. If this is not your first baby, you may feel the baby move as early as 16 weeks. If you are overweight, you may not feel the baby move until after 20 weeks.
Movements can be described as rolling, punching, kicking, or stretching in your womb. Once you become 28 weeks pregnant, you can monitor your baby’s movement DAILY by following the directions below:
Count the number of times the baby moves in ONE HOUR each day. (During your baby’s usual “active times.”)
If the baby moves at least four times in ONE HOUR, your baby is behaving normally.
If the baby does not move at least four times in the hour, do the following:
- Eat some food and drink 32 ounces of fluid.
- Lie down on your side.
- Count the number of times the baby moves the next hour.
- If the number is four or more, you are done.
- If the baby does not move at least four times, call us.
What are common ailments during pregnancy?
Vaginal spotting occurs in almost half of all pregnancies, especially in the first 12 weeks. Most of the time, the spotting will stop on its own. If the spotting is light, avoid intercourse and call us to discuss the problem. If the bleeding is as heavy as a period or if it is associated with any pain, you should call us immediately.
Vaginal discharge normally increases in pregnancy. It should be thin and white. If the discharge is irritating, causes itching, has an odor, is yellow/brown, or is watery, call us.
Cramps and contractions are normal in pregnancy. When they occur, empty your bladder, lie down on either side, and drink two large glasses of water. If they continue, occur more than 4 times in an hour, or are painful, call us. If you are less than 36 weeks pregnant, please try the above pain relief measures and call us if you are still experiencing pain in an hour.
Round Ligament Pain
The round ligaments are fibers that support the uterus. When stretched they can cause groin pain. Usually this pain is worse with position changes, and better when you are sitting still. If you are unsure about the pain you are feeling, you should call us. If you have been told that your pain is round ligament pain, you can wear support garments (belts, girdles, bike shorts) and make your position changes slowly. Please call us if the pain worsens, changes in character, or does not improve with the above suggestions.
Acid reflux is when the acid that is normally in your stomach backs up into your esophagus. The esophagus is the tube that carries food from your mouth to your stomach. Another term for acid reflux is “gastroesophageal reflux disease,” or GERD. Many women get acid reflux during pregnancy. Acid reflux usually gets worse over the course of the pregnancy. It usually goes away after the baby is born. Women who have acid reflux in one pregnancy are likely to get it again in future pregnancies.
Click here for a handout on Acid Reflux in Pregnancy.
Morning sickness is common and causes no significant problems. It usually starts at around 5 to 6 weeks gestation and usually ends by 16 to 18 weeks gestation. However, for some women, it may continue throughout the pregnancy.
The most important thing with morning sickness is to make sure you do not become dehydrated from prolonged vomiting. Try drinking water, diluted sports drinks, or diluted fruit juice. Drinking 1 ounce every 15 minutes will provide adequate fluids. Try to eat multiple small meals each day. Unlike when you have a viral illness, you should eat even if you were recently vomiting. The key is to try to keep something on your stomach. If your regular diet is not working for you, try a bland diet of bananas, rice, applesauce, and toast. Also, it often helps to just go with your cravings.
In terms of medications, the best treatment to start with is 10-25 mg vitamin B6 three times a day alone or in combination with 12.5 mg of doxylamine (1/2 tablet of Unisom) three times a day. Tums, ginger tablets or powder, or Emetrol may also help.
If you are unable to keep any food or liquids down for 24 hours, you become dizzy with standing, or if your urine becomes dark and scant, call us.
If you have nausea and vomiting that starts after 12 weeks gestation, then you probably do not have morning sickness. In this case you should give us a call as well. In this case you should give us a call if the above symptoms last more than 24 hours or are accompanied by fever or pain.
Diarrhea can cause intense cramping and discomfort and can lead to dehydration. Begin treatment by consuming only liquids for 24 hours. If the diarrhea improves then you can advance to a bland diet of bananas, rice, apples, and toast. It is fine to take Immodium. Avoid Pepto Bismol. If diarrhea is not improved after 24 hours call us. Also, if you have severe cramping or tightening of your uterus with the diarrhea, give us a call as well.
Constipation is very common in pregnancy. You should try to avoid constipation by eating a diet high in fiber (such as fresh fruits, vegetables, whole grains, bran cereals, and dried fruits) and drinking 8 to 10 glasses of water every day. A good idea would be to have a bowl of raisin bran or other high fiber cereal every morning. You may also use a fiber supplement such as Metamucil, Citrucel, or Senna. Some women find that using a stool softener like Colace twice a day also helps. If you still have problems with constipation, it is fine to use Milk of Magnesia as necessary.
Colds, Flu, Allergies
During pregnancy, women are more susceptible to respiratory ailments like and colds and the flu. It is also common for it to take longer to recover as well. Most over-the-counter medications are safe to use. See our list on the previous page. If you develop a fever of 100.4°F or greater, you have green or bloody nasal discharge, you are feeling short of breath, having chest pain, or you are coughing up green or bloody sputum, call us. Flu shots are recommended for pregnant women who will be in their 2nd or 3rd trimester during flu season.
Most women have back pain at some point during pregnancy. The pain can be mild or severe, but it can usually be treated. In some cases, it can be prevented.
Click here for a handout on back pain in pregnancy.
What is gestational diabetes? What is the glucose test?
Diabetes is a health problem that results in too much sugar in the bloodstream and not enough in cells where it can be used for energy. The problem occurs when the body is not able to make the hormone insulin (type 1 diabetes) or the insulin that is made doesn’t work very well (type 2 diabetes). Gestational diabetes (GDM) is diabetes that occurs during pregnancy.
Click here for more information about gestational diabetes and the glucose test.
What medication is safe during pregnancy?
In general, although you should be careful about all medications in pregnancy, you should not worry if there are medications you have to take. A healthy mom is the most important ingredient for a healthy baby.
There is a list of medications enclosed that can be obtained over the counter and are generally considered safe in pregnancy. There are a few medications that are truly dangerous in pregnancy, so be sure all of your doctors, including your dentist, know that you are pregnant.
Safe medications include:
- Zantac 75
- Phillips MOM
- Afrin Nasal Spray
- Throat lozenges
- Cough drops
- Vicks Vapor Rub
- Gas X
- Pepto Bismol
Some medications are combinations of the above medications. We recommend buying only the needed individual medication.
When should I call? How should I call?
To reach us call our main number, 770-997-5714, day or night, 24 hours a day. If it is after hours, the answering service will answer. They will then page the physician or midwife on call. If there is a problem with the main number, you can call labor and delivery at Piedmont Fayette Hospital at 770-719-6530. They will be able to get in touch with us.
At any point in your pregnancy call us if you experience:
- Fever greater than 100.4°F
- Leaking fluid
- Symptoms of a bladder infection (frequent or painful urination)
- Decreased fetal movement. See fetal movement section.
- Headache that does not improve with acetaminophen (Tylenol)
- Rapid onset of swelling, especially in hands or face
In addition to any of the above, if you are preterm (less than 36 weeks), call us if you experience:
- Regular contractions (more than 4 per hour)
- Constant, crampy low back pain
- Significantly increased pelvic pressure
- Increased vaginal discharge
- Mucus discharge (A word about the “mucus plug”. The “mucus plug” is often imagined as a plug that acts like a cork to hold the baby inside. It is really just the mucus that sits in the cervix. As your cervix starts to dilate, you can have some mucous discharge from your vagina. If you are fullterm and you think you have lost your mucus plug, you do not need to worry or think that labor is about to start. If you are preterm you should call us as it may be a sign of your cervix dilating early.)
In addition to any of the above, if you are fullterm (36 weeks or greater), call us if you experience:
- Regular, painful contractions that are becoming closer and stronger over time
What Can I expect during my second trimester?
Most women who didn’t feel so great in the first trimester of pregnancy usually start to feel much better in the second. The nausea and vomiting of morning sickness should taper off, mood swings may lessen, and you’ll probably have more energy. This will be a good time to tackle many tasks necessary to get ready for your baby.
Click here for a handout on second trimester expectations.
What Can I expect during my third trimester?
The third trimester is the “home stretch” of your pregnancy! As your baby grows, your body will feel even more awkward and heavy. Everyday things—like getting out of bed or rising from a chair—will require extra effort. The tiredness you felt early in pregnancy may return, making naps a good idea. You might also start to feel more emotional as you prepare for labor, delivery and parenthood. But you’ll enjoy feeling your baby move. The “nesting instinct” may kick in, and you may feel an urge to clean the house and make final preparations for bringing your baby home. Take it slowly so you don’t wear yourself out.
Click here for a handout on third trimester expectations.
Am I In Labor?
False/Early Labor Symptoms:
- Cramping, contractions, or back pain (regular or irregular) that lasts less than 60 seconds and does not get stronger or closer with time
- Loss of mucous plug or faint spotting
- Loose stools (diarrhea)
Actions to take:
- Drink 2 liters of liquids daily (water, sports drinks, Popsicles, juice)
- Take warm bath or shower
- Rest on your side or try walking around
- Body massage
- Take Tylenol PM (2 tablets) or Benadryl (50 mg) to help you sleep
True/Active Labor Symptoms:
- Regular, painful contractions 5 minutes apart for at least one hour, lasting 60 seconds or more, and getting stronger over time
- Ruptured bag of water (leaking of fluid) with or without contractions
- Vaginal bleeding heavier than spotting
Actions to take:
- Call (770) 997-5714 24 hours a day, 7 days a week to reach the physician on call.
- In a true emergency such as heavy bleeding, seizures, or trauma call 911.
- If you have difficulty reaching the physician on call, call labor and delivery at Piedmont Fayette Hospital at 770-719-6530.
More information about Am I In Labor?
More information about Preterm Labor
What happens after the baby is delivered?
Postpartum Vaginal Bleeding
It is normal to have vaginal bleeding after a vaginal delivery or a cesarean section. Your bleeding should slowly decrease until approximately 4 to 6 weeks after delivery. You may find that when you are active it may increase slightly. This is normal. However, you should not be soaking more than 1 pad every 2 hours. If you have a fever over 100.4 °F, heavy bleeding, or a foul smelling vaginal discharge please give us a call.
You may find that your breasts become engorged with milk 2 to 3 days after delivery. This can be very painful. It can even cause you to run a low grade fever.
If you are breastfeeding, you may find that you are so engorged that the baby cannot latch on. In this case you can go in a warm shower and hand express some milk. You may also use a breast pump to express some milk before allowing the baby to try latching on again.
We recommend that if you are NOT breastfeeding make sure that you wear a very supportive bra after you deliver. If you become engorged, do NOT express milk or put warm water or warm packs on your breasts. This will only cause you to make more milk. You can put ice packs on your breasts. Also, you can take cabbage leaves from the freezer and put them on your breasts. Acetaminophen (Tylenol) can also help with the discomfort. The engorgement should improve within a day or two.
Whether or not you are breastfeeding, if you run a fever over 101°F in the setting of breast engorgement or if you have a red area on one breast that is especially tender, then you should call us. You may have an infection.
Baby Blues/Postpartum Depression
Most people expect that after having a baby, you should feel very happy. However, it is quite common to experience mood swings from happiness to crying spells, sadness, irritability, anxiety, and insomnia. This is called the “baby blues”. It is thought that this is probably caused by hormonal shifts after delivery. The “baby blues” have been found to effect as many as 80% of women postpartum. It usually occurs 2 to 3 days after delivery and usually improves by 2 weeks after delivery.
Postpartum depression on the other hand does not resolve within those 2 weeks. It can also even start during the pregnancy. Signs of postpartum depression include sadness, tearfulness, guilt, irritability, helplessness, difficulty sleeping, increased or decreased appetite, difficulty enjoying things. If you have any of these symptoms, you should let us know. If you have thoughts of hurting yourself or hurting your baby, hallucinations, or scary thoughts, you should call us immediately, day or night. Postpartum depression is common and it is treatable. Let us know so we can help you.
Swollen feet and ankles
Some swelling in your legs and ankles is normal after delivery. Changes in your fluids levels are the cause of swelling. Should you experience swelling accompanied by a headache, changes in your vision, pain under your right breast, or vomiting, call us. If the swelling occurs only in one leg and the leg is red, warm to touch, or tender, you should also call us.
If you received stitches after delivery, you can expect these stitches to dissolve on their own in about 7-10 days. You will not have to have them removed. Tub baths are not permitted until you are seen for your post partum visit. Dermaplast and Witch Hazel pads are available over the counter and can be used as needed to help with discomfort. In addition, you may use ice packs or sitz baths. Call for any pain not relieved with these measures or your pain medication.
What happens if I need dental work?
Getting your teeth regularly cleaned, as well as having any other necessary dental work done, during your pregnancy is recommended. Routine x-rays should be deferred until after delivery. A letter for your dentist with information on approved pain medications and antibiotics is available upon request.
Do you have information about vaccination during pregnancy?
It is recommended that women in their second and third trimesters of pregnancy between the months of October and March be vaccinated against seasonal flu. You may check with your local health department, pharmacy, or primary care office for vaccine availability. In addition, the Tdap (Tetanus, diptheria, and pertussis) vaccine is recommended in the third trimester for all pregnant women. You may ask your nurse in the hospital for this vaccine. Women’s Medical Center participates in the GRITS (Georgia Registry of Immunization Transactions and Services) and all vaccinations you receive in our office are recorded in this system should you need proof of immunization.
Click here for more information about vaccination during pregnancy.
What about saving or donating cord blood?
Currently both private and public cord blood donation is available. According to the American College of Obstetrics and Gynecology, “It cannot be estimated what the chances are that a child will use his or her own saved cord blood later in life”. You can get more information about public and private cord blood collection at www.ParentsGuideCordBlood.org. The decision on whether to bank your child’s cord blood is a personal decision. We encourage you to read the information on the web site listed above and ask your provider if you have further questions.