Information about your pregnancy

Why prenatal care is important

Pregnancy is almost always a normal, healthy event in a woman's life. However, sometimes complications do occur. The purpose of prenatal care is for the obstetricians and midwives to watch for abnormalities which might threaten the health of you or your unborn baby. We watch your blood pressure, check for the presence of protein and sugar in your urine, help you with your diet so that you gain the appropriate amount of weight, and monitor the growth and heart-beat of your baby.

With regular prenatal care, you will have the opportunity to have optional genetic testing at the appropriate time, and will be offered tests to monitor the status of the pregnancy.

Although we believe that pregnancy is a normal life event for most women, we do understand that it is a time of great psychological and physical change, and that you will have lots of questions. With regular prenatal care, you'll be able to ask us these questions .

Schedule of prenatal visits

Please call the office as soon as you think you might be pregnant. If you aren't sure yet, the office staff will order a blood test for pregnancy for you. Once the pregnancy is confirmed, schedule your first prenatal visit. This visit will take a little longer than usual, for it involves reviewing your history, performing a physical exam and pap smear as necessary, ordering bloodwork, and discussing a wide variety of topics to get the pregnancy off to a good start.

In general, you will be seen every 3 weeks until you are 28 weeks pregnant, every 2 weeks from 28-36 weels, and then weekly until 41 weeks, which is one week after your due date. These visits will involve checking your weight, urine for protein and sugar, blood pressure, monitoring the growth of your fetus, reviewing your diet, and discussing any problems and concerns which you may have. After 41 weeks, we will see you twice a week. These visits will involve ultrasounds and fetal monitoring to make sure your baby continues to be healthy.

If your pregnancy developes complications, you will, of course, be seen more frequently.

What tests will be done?

Usually the initial prenatal labs include a blood count, a blood type and determination of your rh status, an antibody screen to check for unusual red blood cell antibodies, a test to see if you are immune to rubella (German measles), and tests for syphyllis and hepatitis B. If you don't know if you have had chickenpox, we will check that too. An HIV test will be recommended. Depending on your ethnic background, we might order a hemoglobin electrophoresis to check for sickle trait or thalasemia.

If you want genetic screening or testing, this will be done during the early 2nd trimester. This might include chorionic villus sampling (CVS), amniocentesis or Maternal Quad Screen.

Between 25 and 28 weeks, we will check your blood count, check again for syphyllis (as required by Connecticut state law), and do a glucose screening test to make sure that you do not have any problems with breaking down blood sugar. Because of a hormone put out by the placenta, some women cannot metabolize glucose as well during pregnancy. This could potentially cause problems with the fetus. We will offer HIV testing again, as required by Connecticut state law.

These are the tests which are done routinely for all pregnant women. Should there be abnormalities in any of these tests,additional testing might be required.

Breast feeding

We would encourage you to breast feed your baby. There are many physical, as well as emotional, advantages for nursing. Breast fed babies have less diarrhea, fewer ear infections , respiratory infections, urinary tract infections, allergic disorders and fewer chronic diseases later in life. The American Academy of Pediatrics recommends breast feeding for the first year of life. Most of the time, nursing proceeds normally with support and encouragement from us, your partner and your family members. Should you have difficulty, please let us know. There are lactation consultants in the hospital to help you get off to a good start, and we can refer you to lactation consultants after you go home if there are problems we can't help you with.

For getting off to a good start, dispelling common breast feeding myths, management of common breast-feeding problems, please browse through our extensive breastfeeding links.

Circumcision

The decision whether or not to circumcise your son is a very personal choice and is one that you should decide after consideration of a number of issues. Circumcision is the surgical removal of the foreskin, a fold of skin covering the end (tip) of the penis. It is done when the baby is about one day old by a physician in our practice.

The debate concerning the medical benefits of newborn circumcision continues within the medical community. The incidence of urinary tract infections, penile cancer, and some sexually transmitted diseases are potentially reduced by circumcision, but it is not entirely clear to what degree it effects these things. Each decade the pendulum swings between pros and cons as new information becomes available and professional organizations such as the American Academy of Pediatricians (AAP)adopt new positions with respect to circumcision. While circumcision may have some medical benefits for some, "these benefits are not compelling enough to warrant the American Academy of Pediatricians to recommend routine newborn circumcision" says Carole Lannon, MD, Chairperson of the AAP Taask Force on Circumcision in 1999. The AAP Policy Statement on Circumcision is available here.

Historically, the prevalence of circumcision has varied greatly from region to region and with ethnic and religoius affiliation. Neonatal circumcision continues to be performed with relatively high frequency throughout the United States. Circumcision is not as widely performed throughout the rest of the world except for medical indications and religious preferences.

Circumcision, as with any surgical procedure, involves some risks. These include bleeding, infection, and adhesions, or scar tissue formation. The risks are relatively infrequent and occur in 1 out of 200 to 1 out of 500 circumcisions. Problems are usually small and easily taken care of without permanent problems.

The decision on whether to use either topical or injected local anesthesia (like the Novocain or lidocaine used at the dentist) is also controversial with regard to safety and how well it works. Scientific evidence and ethical principles have supported a recent increasing trend towards trying some sort of pain relief. Talk to your Doctor about this if you want your son circumcised.

Ultimately, the decision to perform a circumcision belongs to you. It is primarily a pediatric issue, and you should therefore discuss this with your Pediatrician . As your Obstetricians and Midwives, we are always sensitive to you and to your childs interests, and are also most willing to talk with you about it.

More information on circumcision is available on the AAP website., and at sites sponsored by other groups and individuals (who usually have strong feelings or opinions that circumcision should, or should not, be performed). A good,balanced discussion with illustrations of the procedure is available at the this site.

Glucose Testing

Pregnant women are less able to metabolize, or break down, blood sugar during the second and third trimesters. If the mother's blood sugar is too high throughout the end of her pregnancy, the fetus can grow too big, and can have problems maintaining its blood sugar following birth. Babies with very low blood sugar can have problems with seizures, maintaing their temperatures, and adapting to life outside the uterus. If the mother's blood sugar is within normal range during pregnancy, the fetus generally does very well.

Because of the problems which elevated maternal blood sugar levels can cause to the fetus and newborn, we will check your ability to metabolize, or break down, glucose. Between 25 - 28 weeks, we will ask you to drink a sweet sugar solution and one hour later, we will draw a sample of blood to check your glucose level. If the glucose level is normal after one hour, no further testing is done. If the glucose level is high, we will ask you to have a 3 hour glucose tolerance test (GTT). If 2 of the 4 values (fasting glucose, and one, two and three hours after drinking the glucose solution) on the three hour test are elevated, we will consider that you have gestational diabetes.

Group B Strep

Group B beta-hemolytic streptococcus (GBS) is a very common bacteria. It resides in the gastrointestinal tract of up to 40% of men and women. In women it can grow in the urinary tract or reproductive organs as well. People who have this bacteria are said to be "colonized", or are called "carriers". There is no way to permanently get rid of GBS. It tends to come and go, and rarely causes symptoms in adults.

Why is this important during pregnancy? 15-40% of women are colonized with GBS during their pregnancies. Usually there are no symptoms, and colonization may come and go. GBS is not treated during pregnancy unless it is present in high amounts in the urinary tract.

If the mother passes GBS to her baby, the baby may develop GBS infection. For those few babies (0.5 - 1% of babies born to colonized mothers), there can be serious problems. GBS infection in the newborn can cause infections of the blood stream, brain or lungs.

This is very rare, however. Approximately 99% of babies exposed to GBS do not become infected. The babies that are most likely to be infected are premature, or have prolonged rupture of membranes.

There are tests that can detect GBS, but they are not perfect. The usefulness of cultures is limited because of some facts about GBS. Because a woman may be colonized at some times and not at others, test results may be negative (not colonized) at the time the sample was taken, but positive (colonized) at another time during pregnancy. Thus, the test cannot always detect woman who will be colonized at the time of delivery.

The best way to try to prevent GBS infection in the baby is to treat the mother with antibiotics during labor, if she has a positive culture or if she has certain risk factors during labor. Treating the woman before labor cannot be relied upon to prevent infection in the baby, and is not advised. If she is treated during pregnancy, a woman can become positive again after treatment, before her baby is born. There is no recommendation to treat GBS in the vagina during pregnancy.

A woman in labor may be treated even if she was not treated during pregnancy. Certain risk factors increase the chance that the baby of a mother with GBS will become infected. Treatment is most effective in these women. Women with these risk factors are more likely to have babies with GBS infection, and would benefit from treatment during labor and delivery:

In this practice, we will obtain a GBS culture from the outer part of your vaginal and rectal areas. This will be done between 35-37 weeks of pregnancy. If this culture is negative, you will not need any antibiotic treatment in labor. If this culture is positive, or if you have had a GBS urinary tract infection or a previous baby infected with GBS, iv antibiotics will be given during your labor.

For more information on GBS, you might want to visit the CDC (Center for Disease Control) web page at

http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupbstrep_g.htm

HIV Testing and the law

Effective October 1, 1999, there is a new state law that all pregnant women be offered an HIV test twice during pregnancy. The reason for this is that there is medicine for moms with HIV that lowers the chances of a baby getting HIV. This can save a baby's life. Moms who aren't tested in pregnancy will be given the chance to have the test when they come in to deliver. If a mom doesn't have the test in pregnancy, the baby will be tested unless the mom signs a paper that she refuses testing for herself and the baby.

When the test is done during the pregnancy, there is time for all positive tests to be checked by another more exact test. If you test positive in labor or after the baby is born, you will be offered medicine for both you and your baby while waiting for the second test. The baby's medicine should be started as soon as possible after birth. You will also be advised not to breastfeed until the second test is back. It may be very stressful to get a positive test after delivery.

Please talk with your doctor, midwife or nurse about HIV testing during your pregnancy. Remember that all your records are confidential!

 

Medications during pregnancy

In general, it is best to avoid drugs and medications during pregnancy, especially during the first trimester. Tylenol is safe for headaches, but please avoid ibuprofen (Motrin) and aspirin (unless prescribed for a particular problem with your pregnancies).

This site provides a general overview on the safety of medications during pregnancy.

While many of the medications referrenced above are safe for use by pregnant women, it is sometimes necessary to know additional information about your pregnancy before determining whether a medication is safe of not. Please contact us if you need to use medication; we will be happy to advise you .

 

Nutrional Information and Weight Gain

Pregnancy is a time of great anatomic and physiologic change for a woman. Varying and increasing amounts of nutrients are needed to ensure nutritional adequacy for both the fetus and the mother. There is a wealth of information available describing the changing nutritional requirements in pregnancy, required for both the development of a normal fetus, the health of the mother, and the avoidance of complications for the fetus and mother. Here's a place to start.

A calculation using your weight and height is necessary to evaluate your body mass index. This can guide you when thinking about how much weight gain is an optimal target for you in pregnancy. In general, low body mass index (<19.8) means that you should gain between 28 and 40 pounds in pregnancy; someone with a normal BMI (19.8 to 26.0) should gain between 25 and 30 pounds in pregnancy; and, finally, someone with a high BMI (>26 to 29) should gain between 15 and 25 pounds. These are general recommendations, and can be reviewed with your health care provider.

 

If you are Rh negative

There are 4 main types of blood : A, B, AB and O. In addition, each of these main types may have an additional protein called the Rh , or rhesus, factor. This is a protein which is attached to your red blood cells. Your blood type is either A+, A-, B+, B-, AB+, AB-. O+. O- depending whether or not you have the rh factor. The incidence of the Rh factor varies in different ethnic groups. Approximately 85% of people in the United States have the Rh protein, and are called Rh positive (rh+). The remaining 15% are called Rh negative (Rh-).

The baby often has a different blood type than its mom. Most of the time this is not a problem; however, if some of the baby's blood mixes with the mom's blood during pregnancy, the mom may recognize this blood as foreign, and develop antibodies against it. The time when this is most likely to happen is around the time of birth; however, it can happen at other times during the pregnancy as well.

If Rh positive blood from the baby gets into the mother's bloodstream, the mother recognizes this foreign protein , and makes antibodies against it. The antibodies attack the Rh positive red cells and destroy them. This is rarely a problem during that pregnancy, but can cause serious problems in future pregnancies, when these antibodies can cross the placenta and attack the developing red blood cells in the fetus.

There is a medicine called Rhogam which we give to Rh (-) women who have Rh(+) partners. Rhogam "blocks" the formation of antibodies, and prevents breakdown of the fetal red blood cells. Rhogam is given if there is bleeding during pregnancy, after amniocentesis, at 28 weeks gestation and also following the birth of an Rh(+) baby.

Video Library

Our New Haven office has a large collections of videos on a variety of pregnancy and gyn topics. Some of the videos are on exercise during and following pregnancy, breast-feeding, birth control methods, menopausal issues. Please speak with one of the midwives if you wish to borrow one.

When to call - warning signs during pregnancy

At any time during pregnancy you should call us if you have


Obstetrics-Gynecology-Infertility Group, PC
203-562-5181

   Last updated 4/1/2001