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Prenatal Care Overview
Keeping all of your regular appointments as well as any other recommended visits or testing is a vital part of good prenatal care. Diagnosing problems early and beginning any necessary treatment is very important to having a healthy pregnancy. It is a good idea to keep a list of questions or concerns and bring this in with your visits.
Three Trimesters of Pregnancy:
First trimester –
you will have visits with one of our providers monthly.
Second trimester –
at approximately 32 weeks you will begin having visits every 2 weeks.
Third trimester –
At 36 weeks, you will begin weekly visits.
First and Second Trimester:
The first trimester is the time from conception to 13 weeks gestation. On your first appointment, the physician will conduct a physical exam and take a thorough history. We typically perform an ultrasound at this first visit as well so that we can determine the health of the pregnancy and estimate your due date. We will be discussing nutrition, medical history, and exercise and will answer any questions you may have. Several physical changes occur early in pregnancy. You may experience nausea, vomiting, breast tenderness, or frequent urination. Nausea and vomiting usually fade after the first trimester. Relief measures include eating small frequent meals, avoiding spicy food and, if need be, using Emetrol, which you may buy over the counter. Eating smaller more frequent meals is sometimes helpful. You may also try vitamin B6 50mg twice daily in conjunction with Unisom at night. This combination works well for many women. Much of this nausea will pass after the 13th week.
The fetal heart beat can usually be heard around the 12th week of pregnancy. We will check the heart rate on each visit. You should start feeling fetal movement around 18-20 weeks gestation. It is commonly described as a “flutter” low in the abdomen. A thorough ultrasound will be scheduled around 18 to 20 weeks to determine growth and carefully check baby’s anatomy. We can often tell if it is a boy or a girl at this time.
The baby grows fairly rapidly during the last three months. During this time it is important to make sure you are getting ready for the baby’s arrival. What about an epidural? Will you bottle feed or breast feed? Do you have a car seat? And don’t forget about choosing a pediatrician. We will be happy to assist you in any way we can in making these decisions.
Tests Performed During Pregnancy:
Blood pressure: Taken at each visit.
Urine: Checked at each visit to see if your body is producing excess protein or glucose and make sure there is not an early bladder infection.
Fundal height: We will measure the uterus with a tape measure at each visit to make sure the pregnancy is growing properly.
Fetal heart tones: We should be able to hear the baby’s heartbeat around 12 weeks gestation.
Ultrasound: Ultrasound can be performed after approximately seven to nine weeks gestation to determine the due date and check on baby’s wellbeing. The ideal time is 18 to 20 weeks to evaluate organ development. We can often determine the baby’s gender at this 18-20 week ultrasound.
Glucola or Gestational Diabetes Testing: The glucose test screens for gestational diabetes. It is performed around 25 weeks and takes about one hour. Make sure you do not have ANYTHING to eat or drink other than water for at least ONE HOUR BEFORE your appointment. This includes no gum, candy, mints, or smoking.
Around 35 weeks gestation we will perform a culture for Group B Strep (also known as GBS or Beta Strep). The test is simple and quick and involves a Q tip just inside the vagina and near the rectum and only takes about 2 seconds to perform. (Nothing to dread!) This is a very common bacteria and is not sexually transmitted. It poses no immediate threat to the unborn baby. But if the test is positive then you will receive an antibiotic through your IV while you are in labor. If the bacteria is not there…..then one less thing to worry about!
What to Expect
• Enema – An enema is available if necessary or if you request it but is not required.
• Shave or “Prep” – You will not have to be shaved or “prepped” unless a Caesarean section is performed.
• Eating in labor – You will be allowed to have ice chips, hard candy, or popsicles.
• IV – An IV is necessary for administering antibiotics, pain medication, an epidural, or fluids for hydration. Keeping moms hydrated is better for the baby. An IV provides a way to give medicine to help stop your bleeding once the baby is born.
• Bedpans or urinary catheters – Bed pans are only necessary if you are restricted to bed. Urinary catheters are sometimes necessary with an epidural or if the baby’s head is low. A full bladder will prevent the baby’s head from descending into the pelvis.
• Activity – During the early or “latent” phase of labor, it may be helpful to be up and moving around. You may take walks with your labor coach, sit in a chair, relax, sleep if you can, or take a warm shower. As labor progresses, walking or sitting may help the baby descend into the pelvis. The nurse will help you by making suggestions about walking or activity. If medication is needed to help your labor progress, if you have an epidural, or if continuous monitoring of your baby is required then you will need to remain in the bed.
• Monitoring – The baby’s heart rate and your contractions will need to be monitored during labor. It may be done periodically during early labor if all seems well. In most cases the baby will need to be monitored continuously during active labor. This may be done by external belts or internal devices placed through the dilated cervix. The doctor or nurse will explain which is best in your case.
• Labor Management – The doctor or nurse will be checking your cervix periodically to evaluate your progress. At some point the doctor may break your water. This is not a painful procedure because the membrane around the baby does not have nerves. The doctor may recommend a medication called pitocin, a naturally occurring hormone in pregnant women, to be given by IV to strengthen the contractions. These methods can sometimes help prevent a prolonged labor or a Caesarean section.
• Pain relief – Your nurse and labor coach will help you with measures such as positioning and relaxation techniques to relieve discomfort. Pain medication can be given through the IV in small doses to help you relax. An epidural is often a great choice. An epidural does NOT slow the progress of labor.
• Pushing – Positions for pushing include lying down, squatting, or kneeling. Squatting and kneeling may be difficult if you have an epidural for pain relief. Your nurse will help you find the best position for you. She and your labor coach will help you push. This sometimes takes one to three hours. The doctor will evaluate pushing periodically to determine progress.
• Episiotomy – An episiotomy is not routine, but may be done to prevent excessive tearing of the vaginal area or to assist in a difficult delivery. A local anesthetic may be needed to numb the vaginal area if the patient does not have an epidural.
• Forceps or vacuum – Forceps or vacuum are used only if absolutely necessary for the health and safety of both you and your baby. The doctor will discuss these measures if it becomes necessary.
• Breast feeding – If there are no complications, you may hold and nurse the baby soon after delivery. It is best to try to nurse the baby within the first hour because they are usually very alert at that time.
• Postpartum care – under most circumstances with a vaginal delivery you will deliver your baby in the same room you came to when you were admitted to the hospital. You will also remain in this same room for the remainder of your hospital stay. If you have a C-section you may be transferred to a different room on the same floor
What information you will need at the Hospital
What to bring to the Hospital
About 12 weeks (or second visit):
About 16 weeks:
About 20 weeks:
About 24 week:
About 28 weeks:
About 30 weeks:
About 32-36 weeks:
About 36 weeks:
About 38 weeks:
About 40 weeks:
Optional Fetal Abnormality Tests Available
There are several optional tests available to all pregnant women. While there are no prenatal therapies or cures for fetal abnormalities, parents can use early diagnosis to prepare for the birth of the baby. Screening tests are noninvasive and can determine if there is a high or low risk for certain abnormalities. Diagnostic tests are invasive and can determine if a certain abnormality is present or not. Testing is not perfect and is only available for certain abnormalities. Fetal abnormality testing is not required but is an option that may be chosen by the patient in consultation with her care providers. These tests are not for the purpose of deciding whether or not to keep the pregnancy but to provide information that may guide you and your doctor in following the pregnancy as it progresses.
NONINVASIVE SCREENING TESTS
• Cystic Fibrosis Carrier Status
Cystic Fibrosis is an inherited genetic disease that is characterized by severe respiratory and digestive problems. The test for cystic fibrosis is a Maternal Blood Test that evaluates whether the mother is a carrier of the disease. If this test is positive we then screen the father’s blood for the gene mutation. If both are positive, the parents may opt to have an amniocentesis to determine if the baby has cystic fibrosis. Of course your pediatrician can proceed with testing after delivery if needed.
• First Trimester Screening + Second Trimester AFP
This screening pairs an Ultrasound to evaluate specific measurements of the baby with Maternal Blood Tests done at the same time. This determines if the baby is at high or low risk for specific chromosomal abnormalities. This screen can detect 90% of Down’s Syndrome cases and 97% of Trisomy 13 or 18. This test has a 5% False Positive Rate. If this screening shows that the risk of abnormalities is high, you may opt to have an invasive test to confirm the diagnosis.
Patients may also opt to have blood drawn again in the second trimester to screen for spina bifida. This screen can detect 98% of open neural tube defects. There is a 6% False Positive Rate. If this screening test shows that the risk is high, you may opt to have an invasive test to confirm the diagnosis.
• Second Trimester Screening
This Maternal Blood Test that determines if the baby is at high or low risk for specific chromosomal abnormalities or open neural tube defects/spina bifida. This screen can detect 80% of Down’s Syndrome cases, 70% of Trisomy 13 or 18, and 98% of spina bifida. There is a 6 % False Positive Rate. If this screening test shows that the risk is high, you may opt to have an amniocentesis (drawing amniotic fluid from around the baby) to confirm the diagnosis.
INVASIVE DIAGNOSTIC TESTS
• Chorionic Villus Sampling
This diagnostic test is an ultrasound guided needle aspiration of cells from the placenta, and it can detect 99% of chromosomal defects as well as some other inherited disorders. The risk of complications, including fetal injury and miscarriage, is approximately 1/100. This test is only performed by the doctors at the Perinatal Center or UT High Risk Obstetrics.
This diagnostic test is an ultrasound-guided needle aspiration of fluid from around the fetus, and it can detect 99% of chromosomal defects and open neural tube defects as well as some other inherited disorders. The risk of complications-including infection, bleeding, fetal injury, rupture of membranes, and miscarriage-is approximately 1/300.
This is a consultation between a patient and an expert in the field of inheritable diseases. The visit involves evaluation of the patient’s family history and discussion of testing options available. This service is widely available; however, it is commonly utilized in patients who are at high risk for fetal abnormalities.
The typical weight gain recommendation during pregnancy is 25 pounds. The recommendation may vary depending on your prepregnancy weight and in the case of a twin gestation.
Prenatal vitamins are an important dietary supplement during pregnancy. You may use 2 children's chewable vitamins with iron during the first trimester if prenatal vitamins make you sick, but try to use a prenatal vitamin again once you are feeling better. If the prenatal vitamin makes you sick, try changing the time of the day you take it or taking it with meals.
General Food Information
• Use hard cheeses, like cheddar, instead of soft cheeses.
• Soft cheeses must be cooked until bubbling or boiling.
• Eat only thoroughly cooked meat, poultry or seafood.
• Reheat all meats (20 seconds in the microwave) purchased at deli counters, including cured meats like salami, before eating them.
• Avoid eating shark, swordfish, king mackerel, and tilefish more than twice a week due to the risk of high levels of mercury in those fishes.
• Avoid raw sushi.
• Avoid fish from lakes and rivers that might be exposed to high levels of pollutants.
• Wash all fruits and vegetables with water.
• Do not eat raw eggs (avoid raw cookie dough, tiramisu, Caesar dressing, and homemade ice cream).
• Avoid alcohol and all illegal drugs including where a one and any other drugs not specifically prescribed by your physician.
• Keep caffeine intake to 8 ounces per day or less.
• If you are a vegan, maintain a balanced diet of: protein, vitamins B and D, calcium, zinc, and iron. Vitamin B12 can be obtained from fortified soy milk or with a supplement.
Anemia is a common issue during pregnancy. Follow these guidelines to get more iron.
Lean Red Meat: Hamburgers, beef stew, meatballs, spaghetti with meat sauce, chili
Liver: Pork, beef, or chicken liver or liverwurst
Canned Corned Beef: Corned beef sandwiches or corned beef hash
Whole Grain Bread: Whole wheat, rye, oatmeal, multi-grain breads, or whole grain, bran, or oat muffins
Whole Grain Cereals: Instant oatmeal, whole wheat cereal, raisin bran
Peanut Butter: On toast, sandwiches, crackers, celery sticks
Dark Green Vegetables: Broccoli, green beans, romaine lettuce, collards, mustard greens, peas, spinach, beet Greens, Kale and Bok Choy
Beans: Baked beans, kidney beans, split pea soup, refried beans, black-eyed peas, bean soup, and tofu
Dried Fruit: Raisins in your cereal, raisins in muffin mix, raisins or prunes as a snack, stewed prunes
Eggs: Hard or soft boiled, egg salad sandwich, eggs in potato salad
Converted or Brown Rice: Converted rice has more iron than plain rice
Enriched Spaghetti and Macaroni: Check labels to make sure iron has been added.
Combine Food High in Vitamin C with Food Rich in Iron
Vitamin C helps your body use the iron in foods. Raw fruits and vegetables have more vitamin C than cooked ones.
Some foods with a lot of vitamin C are:
Oranges, orange juice, grapefruits and juice, apple juice with added Vitamin C, tomatoes and juice, raw cabbage, green pepper, broccoli, new potatoes, cauliflower, turnips, melons, cantaloupe and strawberries
Avoid these foods that make it harder for your body to use Iron
Coffee, Tea, Bran
Do NOT Take NSAIDS
(nonsteroidal anti-inflammatory drugs)
Motrin, Advil, Aleve
During pregnancy taking NSAIDS may cause birth defects especially if taken during the firs trimester
The following medications are safe to use during your pregnancy:
Colace (Docusate Sodium)
Tylenol Cold and Sinus
Unisom (for nausea and sleep)
Vicks Formula 44
If you have questions about other over-the-counter medications, please call and speak with our nurse.
Preferred Dental Medication List
Mepivacaine 2% with Levonordephrine 1:20,00 (Carbocaine)
Lidocaine 2% with Epinephrine 1:100,00 (Xylocaine)
Bupivacaine 0.5% with Epinephrine 1:200,00 (Marcaine)
Mepivacaine #5 without Epinephrine
Analgesic (pain medication)
Lortab or Vicodin (both contain hydrocodone)
Percocet (contains oxycodone)
Discomforts of Pregnancy
• Wear a good, well fitting support bra. You can take Tylenol
• Tums, Maalox, Mylanta are safe to use. Zantac, Tagamet, or Pepcid are also fine to use during pregnancy.
• Unisom Nighttime Sleep Aid or Emetrol over the counter liquid. Take 1 tsp when nausea first occurs,
then follow bottle instructions. Using Vitamin B6 50mg twice daily and Unisom at night can be a good combination
• Crackers, toast, soup, or broth
• Maalox or Mylanta
• Eat regular, small meals every two to three hours
• Try peppermint or cinnamon candy.
It is possible that your nausea may be related to your prenatal vitamins, so changing the time of day you take them may relieve the problem.
• Clear liquid diet (i.e. popsicles, Jell-O, Gingerale, Sprite, Gatorade)
• Gradually add soup and broth, then advance to regular foods. If vomiting resumes, stay on clear liquids. If vomiting continues, especially for more than 24 hours, and fever arises, call your doctor (865) 524-3208 .
• Increase fluid intake, vaporize at home. Normal saline nasal drops two to three times a day. Tylenol Cold & Sinus, Claritin, or Benadryl are okay to use.
• Regular Strength Tylenol or Extra Strength Tylenol. If headache continues and is associated with blurred vision, swelling of the hands, face, or feet, call your doctor.
• Pin the nose and hold for five to ten minutes. Ice to back of neck. Frequent use of a saline nasal spray may be helpful. Also applying a thin layer of Vaseline to the inside of each nostril may help (almost like Chap stick to the inside of your nose.) Nosebleeds occur more often in pregnancy due to increased blood volume.
Imodium and Kaopectate are okay to use during pregnancy.
• Gradually stand from sitting or lying position. Eat regular meals. Do not skip meals. Drink plenty of fluids. Avoid hot showers. If more than twice a week, notify your doctor.
Colds or Sinus Problems:
• Increase fluid intake. You may use Tylenol Cold & Sinus, Benadryl, Sudafed, Tylenol PM or Chlor-Trimeton (as directed on package) for nasal drainage not accompanied by fever. Robitussin or Vicks Formula 44 may be used for cough. Vaporize at home. Normal saline drops to both nasal passages two to three times a day. If you develop a fever, colored nasal drainage, or persistent cough (productive or non-productive) call your doctor.
• Gargle with warm salt water two to three times a day. Tylenol as directed on package. For sore throats, Cepacol or Chloraseptic Spray or Lozenges are okay.
• Increase fluid intake. Increase dietary fiber (i.e. fruits, vegetables, and bran). Miralax and Citracel are good brands to use for fiber supplementation as they may produce less gas. Stool softeners such as Colace/docusate sodium. Milk of Magnesia. Enemas and glycerin suppositories are also safe.
When to Call the Doctor
• Contractions may begin 15-20 minutes apart and last 30-45 seconds. Usually, you will not need to go to the hospital when your contractions begin.
• It is time to call the doctor when your contractions are 5 minutes apart, last at least 60 seconds and you have to breathe through the contractions.
• The contractions should be five minutes apart for about 2 hours.
• If you think your water has broken (a sudden gush of fluid or constant trickling down your leg) you should call the doctor.
• Call the doctor if you experience bleeding more than spotting or decreased fetal movement, or have questions regarding symptoms you are experiencing.
• We have an answering service relaying calls to the physicians. If for some reason you do not receive a call back from a physician in 30 minutes, please call the exchange again–there are some situations when the pages may not be answered immediately such as when the physician is in surgery or a delivery.
• False labor – It may be difficult to tell the difference between false and true labor. Be prepared for the possibility of being sent back home if you are having false labor.
Early labor at home
• Activity – try to rest in order to conserve your energy. However, some patients find walking helpful.
• Eating (while at home) – You may drink liquids or eat soup or jell-o, but avoid eating a heavy meal to prevent nausea and vomiting when labor progresses.
Where Do I Go
When you arrive at LeConte Medical Center there are two places you may check in. If it is a regular weekday and between the hours of 6:30AM and 6:00PM you may check in at the registration desk at the main entrance at the front of the hospital. If it is a weekend or after hours you need to check in through the Emergency Department where they will sign you in and then send you on up to the Birthing Center.
Admission to the Hospital
• You will be evaluated by a nurse in the triage area and she will contact the doctor. Your cervix will be examined and the baby will be monitored.
• If you are in labor you will be admitted to a room. You may be sent home if you are in false or early labor. (It is best to avoid admission until active labor begins.)
• Sometimes patients may be observed for an hour or so and then re-examined to see if the cervix has changed. You may be allowed to get up and walk during this time.
Attending a prenatal class is a great way to become acquainted with our Dolly Parton Family Birthing Unit at LeConte Medical Center and some of our staff. This half-day class covers many different aspects of the labor process, vaginal delivery, Cesarean section, epidurals and after care for you and your newborn. Classes are usually recommended in the last 4-6 weeks of your pregnancy. Early sign up is recommended. You can enroll by visiting the birthing unit on the second floor of LeConte Medical Center or call (865) 446-8210 for more information.