Complete Obstetric Prenatal Care

What to expect when you are expecting?

 

On your first visit: Once you have a positive at-home pregnancy test and have called the office, we will calculate when you are about 7 weeks pregnant. Then we will schedule you for an appointment for a “confirmation of pregnancy” ultrasound. This will be a transvaginal ultrasound to confirm the heart beat and give us an accurate dating for your pregnancy. You will have blood drawn that checks for anemia, bloodtype, Herpes, HIV, Hepatitis, Syphilis, and sickle cell anemia (if appropriate).  A urine sample will also be taken to check for a urinary tract infection. If it is necessary, we will also perform a drug screen.

New OB Visit: The doctor or nurse practitioner will obtain a thorough medical history, perform a pelvic exam, pap smear (if due), and cultures for gonorrhea and chlamydia (which are sexually transmitted diseases). All of these tests are standard for every patient despite history.

Subsequent visits: You will be seen every four weeks until 30 weeks gestation. Then you will be seen every two weeks. At 36 weeks you will have appointments weekly. You will alternate visits with the doctor and nurse practitioner. If you become high risk during your pregnancy, the doctor will see you regularly.There may be times when the doctor has an emergency at the hospital. In this case, the nurse practitioner will see you on your visit. The nurse practitioner works in CLOSE collaboration with the doctor, and therefore will be aware of your condition at all times.

 

At 7+ weeks: Ultrasound to confirm your pregnancy.

At 11 weeks-13 weeks gestation: Ultrasound for First Screen Nuchal Translucency. An ultrasound will be performed to measure the thickness of the back of the baby’s neck. Then your finger will be pricked. This test is sent to a special lab and the results take around 7-10 working days. This test checks to make sure your baby is not at high risk for chromosomal abnormalities such as Down Syndrome (a genetic condition which causes mental retardation). This will also check for Cystic Fibrosis (a genetic condition that causes lung disease). 

At 16-18 weeks gestation: A blood test called an AFP will be done. This checks for Neural Tube defects or Spina Bifida.

At 20-24 weeks gestation: A detailed ultrasound will be performed to assess the fetal anatomy. This can include the sex of the fetus, but is done mainly to look at the baby’s development, heart, kidneys, spine, brain, and placenta. If any of these tests are abnormal, the doctor or nurse practitioner will notify you and an appointment with a perinatologist, a doctor that specializes in high-risk pregnancy, will be made. Dr. Boddy is located in Macon and an appointment will be set up with him for a special ultrasound. He may also suggest an amniocentesis to test the baby for abnormalities.

At 24-26 weeks gestation: You will be asked to drink a very sweet orange drink (a glucola). You must be prepared to stay at least one hour after finishing the drink. During that time, the doctor or nurse practitioner will check you. Before you leave, the nurse will draw blood to check your blood sugar. This checks to make sure that you are not a diabetic during your pregnancy (gestational diabetes). If this test is abnormal, you must do a similar, but more extensive test at the hospital. This will last for 3-4 hours and be prepared to stay during that time. The nurse will schedule this test. Once again, if you do not hear from the nurse you should assume this test is normal.

At 28 weeks gestation: You may need an injection called Rhogam. This DOES NOT apply to every patient. This is for patients with RH-negative blood typing. Please ask the doctor or nurse practitioner for your blood type. If you have a positive blood type, this injection is not needed. If you have a negative blood type, then there is a chance that your baby has a positive blood type (positive blood types are more common). We will not know this for sure until the baby is born. If you have a negative blood type, please talk with the doctor or nurse practitioner about this in detail at your visit.

At 36 weeks gestation: A vaginal culture will be performed to check for a bacterial infection, which is NOT sexually transmitted. This bacteria is called Streptococcus B. It is a bacteria that normally lives in the bowels but can migrate into the vagina. Most times you have no symptoms and the bacteria will not cause you any harm. However, if you have this bacteria in your vagina when you deliver, the baby can become very sick and could possibly die. If the culture is negative, no treatment is needed. If the culture is positive for the bacteria, then you will receive an antibiotic when you go into labor. Please make sure you know the results of this test. If you are positive, the nurses will need to know when you go into labor.

 

At the beginning of your pregnancy:
During the first trimester (the first 12 weeks), you may experience nausea, vomiting, breast tenderness, fatigue, and frequent, nonpainful urination. You also may experience some pulling muscular pains in your groin region that is most obvious with walking and changing positions. These pains are related to the ligaments (round ligaments) that support the uterus. These ligaments stretch when your uterus grows. This is normal and can be relieved by Tylenol. These stretching pains may continue further into your pregnancy, but typically resolve during your second trimester (the second 12 weeks).

If you have a history of sinus allergies, your symptoms may greatly increase during your pregnancy. Over the counter medicines that you can safely take are Claritin D or Tylenol Cold and Sinus. If these symptoms are accompanied by a bad cough, fevers, or headaches, please call the office.

You will also notice that bumps and scratches may bleed more. This is normal and is related to the increase in blood volume during pregnancy. Vaginal bleeding is NOT normal.

Some ladies report shakiness and dizziness between meals. If this is the case, you may be experiencing hypoglycemia (low blood sugar). Eating small frequent meals every 2-4 hours will help maintain your blood sugar. If this does not help, please notify the office.
You may notice an increase in the amount of your vaginal discharge. This is related to the hormonal changes of pregnancy. Normal discharge related to pregnancy is white and milky, but DOES NOT cause itching, burning, or have an odor. If you have itching or odor, please call the office for an appointment.

During your pregnancy, you may notice some brown discharge or even mild spotting a few days after sexual activity or strenuous activity. If there is no cramping associated with it, avoid sex or excessive activity. Rest for a day. If it continues, becomes bright red, or you begin cramping, call the office.

At 16-20 weeks: You will begin to feel the baby move in your belly. These movements feel like butterflies or gas waves. Most ladies begin to show at this point in the pregnancy.

At 24+ weeks: You will be able to feel the baby move more, but may not be feeling all the movements the baby is making.

As your uterus enlarges, it can cause some heartburn related symptoms. An over the counter medication that you can safely take is Zantac, twice daily.

At 32 weeks: You should feel the baby moving daily. The movements become more coordinated and you can feel legs kicking you. The baby should be moving at least 10-14 times daily. If you have not felt the baby move, drink orange juice or a caffeine drink and turn on your left side. The baby should respond to this and begin to move. If you cannot count at least 10 movements within a reasonable amount of time, please call the office.

You may also start experiencing some back discomfort and mild cramping. If the pains are irregular (coming and going) or if they resolve with activity and if they do not last for more than 2 hours, they are most likely false contractions called Braxton-Hicks.

At 34+ weeks: You will begin to feel some pressure on your bladder or in your vagina. This is normal and is often due to the baby moving down into the pelvis. Though you may feel this pressure, it does not imply that you will go into labor soon. If you begin to have contractions with this pressure, begin timing them. If they become regular (every 5-8 minutes), call the office.

You may also notice some minimal swelling of the feet and hands. If your blood pressure is normal, then this swelling is most likely normal. It is related to the normal fluid changes with pregnancy. You will need to avoid salt, elevate your legs, and may need to wear support hose to help with the swelling.

At 38+ weeks:  You may continue to experience the pressure and your contractions will become more frequent. If you have regular contractions (as described above), experience bleeding, or begin to leak clear fluid that looks like urine, please call the office. Despite what people say, babies are just as active at this time in the pregnancy. It is NOT NORMAL for the baby to move less. They should still move at least 10-14 times daily. If the baby seems to have slowed down, drink orange juice or a caffeine drink and turn on your left side. If the baby does not move at least 10 times, please call the office as soon as possible. Decreased fetal movement can be a sign of distress in the baby.

 

Cramping pains (feels like very intense menstrual cramps) that occur every 5-8 minutes for 2 or more hours AND/OR Vaginal bleeding AND/OR Gushing of clear, urine colored fluid (this may be a big gush or may be a slow, constant trickle. Like you are urinating on yourself and cannot stop.)

 

  • Cramping
  • Bleeding
  • Burning with urination/blood in urine.
  • Excessive nausea or vomiting unrelieved with medication
  • Vaginal discharge that burns, itches, or has odor
  • Decreased fetal movement
  • Headaches unrelieved by Tylenol
  • Fluid leakage as described above
  • Significant side or back pain
  • Fevers
  • Excessive swelling of the feet, hands, or face
  • Rash
  • Significant leg pain
  • Dizziness
  • Heart palpitations
  • Numbness of face, legs, or hands

 

  • Tylenol products (Tylenol ES, Tylenol Cold/Sinus, Tylenol PM, Theraflu, etc)
  • Robitussin products (cough, congestion)
  • Benadryl (sinus allergies or rash)
  • Zantac (heartburn, gas pains)
  • Claritin D (NOT Clarinex or Singulair)
  • Milk of Magnesia (for constipation)
  • Immodium (for nonbloody diarrhea)
  • Colace or Surfak (constipation)
  • Maalox, Rolaids or Tums (heartburn, gas pains)
  • Short term OTC hydrocortisone creams/Cortaid (insect bites, rashes)
  • Monistat (yeast infections)
  • DO NOT TAKE Ibuprofen, Motrin, Aleve, or Pepto Bismol

 

Most exercises are safe during pregnancy. If you have not been exercising regularly before your pregnancy do not start a rigorous routine at this time. Walking, Yoga, Pilates, and aerobic activity are safe. You may continue light weight training but avoid heavy weight training utilizing the abdominal muscles since this may cause cramping. If you experience cramping or bleeding, stop your exercise routine until you see the doctor.

 

  • Cat litter and/or cat feces
  • Raw meat and/or vegetables (vegetables that grow in the ground)
  • Digging in dirt/soil (always use gloves)
  • Children with unexplained rash and fever
  • Radioactive materials
  • Horseback riding or sports that cause much jarring
  • Hot tubs/spas/heating pads to abdomen

 

You may work up until you go into labor. Most ladies do. If you become high risk, begin bleeding or cramping, a temporary leave of absence may be granted. This is at the discretion of the doctor or nurse practitioner. If you call in sick to work because of pregnancy related problems, you must call the office the same day and be seen by the doctor or nurse practitioner. Otherwise you CANNOT get a work excuse. In some instances, the doctor or nurse practitioner may grant you a work excuse without seeing you in the office. You MUST call the same day you call in sick to see if the doctor needs to see you.

 

Please talk with your doctor or nurse practitioner before taking a trip greater than 3 hours or getting on a plane.

 

Maternal screening test is a non-invasive test performed between the 10th and 14th week of pregnancy. It consists of a blood test which shows if you are at increased risk of having a baby with Down Syndrome or trisomy 18. It requires a sample of your blood and a special ultrasound measurement performed in the first trimester.

A small amount of blood is drawn from your arm and the levels of two proteins, PAPP-A and hCG, are measured. These proteins are made by the developing baby and the placenta, and are found in every woman’s blood. However, when a fetus is at risk for Down Syndrome or trisomy 18, the amount of these proteins may be abnormal. The results of a special ultrasound measurement, called nuchal translucency, are combined with the blood test result to yield the final screening assessment.

Nuchal translucency (NT) is a measurement of a fluid filled space in back of a developing fetus’ neck. Extra fluid in this space indicates that the fetus is at a higher risk for birth defects.

Maternal screening test does not provide a diagnosis but rather predicts the likelihood of a problem occurring. If the result is “screen negative”, the measurements are normal and the chance of you having a baby with Down syndrome or trisomy 18 is low. If the result is “screen positive”, the measurements are abnormal and there is an increased chance of you having a baby with Down Syndrome or trisomy 18.

Maternal screening test is available but is optional. You are not required to have it but we recommend it. It is your choice.

For more information about maternal screening test, visit www.genzymegenetics.com