Pregnancy

Women reviewing a pregnancy testCongratulations!
The pregnancy test says it’s true: You are pregnant!

Early pregnancy is when the fun begins, despite what some may have told you. This is where you get to start celebrating your pregnancy and telling the world your big news, whether you tell them right away or wait awhile. The problem is many women aren’t sure what the next step is after their pregnancy is confirmed. Here is a handy list of things to do when the test is positive!

  • Do make an appointment with doctor  Call for a prenatal appointment as soon as your pregnancy is confirmed or you suspect you are pregnant. The big surprise is that you may feel a sense of “hurry up and wait.” Many practitioners don’t schedule the first appointment until after you have missed two periods, while others have you come in right away. Even if you don’t have an early appointment, do feel free to call with questions about things like medications you’re currently taking, symptoms that are worrisome, chronic health conditions, etc. Also do not be afraid to get an earlier appointment if you’ve had a history that might suggest you need to be seen sooner.
  • Do celebrate! While you shouldn’t have alcoholic beverages during pregnancy, that doesn’t mean you should stop having fun. A great glass of sparkling cider is a great way to liven up the night and to toast your new bundle of joy. Some women plan a romantic dinner to surprise their partners with the news of the pregnancy, others have bigger parties. How and when you celebrate may depend on many factors. Either way remember that having fun is perfectly acceptable part of pregnancy. By having fun, you’re releasing stress and relaxing, which is good for you and the baby.
  • Do share your news! Telling your family and friends about the new addition, is fun and exciting. Some families wait until after 12 weeks, the first ultrasound or a special date to begin telling everyone, while others begin telling everyone right away. There isn’t a right or a wrong answer to when the appropriate time to tell is for you.
  • Do learn about pregnancy. Look through things like the pregnancy calendar and follow your pregnancy week by week. See if you can sign up for our early pregnancy class. This will give you a bit of knowledge to start making the appropriate decisions for you and for baby. Books are also a great source of knowledge about pregnancy, birth and postpartum.
  • Do take care of yourself  Getting a good nights sleep, eating well, taking a prenatal vitamin and exercising in an appropriate way are all healthy ways to encourage a great pregnancy, easier labor and healthy baby. Listening to your body’s signals, whether it be morning sickness or exhaustion, will help you cope more easily with symptoms of pregnancy.
  • Do find a support system  Whether you’re talking to your family, old friends or new, the support you get is a must-have for pregnant women. So much will change in your life and you’ll have so many questions, you will need to surround yourself with people to help you answer the questions and gain the knowledge you need. Sometimes that will be your doctor and other times that will be your friends and family. Consider finding others who are due when you are due to share the ups and downs of pregnancy with.
  • Most of all, enjoy your pregnancy! After all, it’s only nine or ten months, depending on how you count…

Pregnancy lasts about 40 weeks, counting from the first day of your last normal period. The weeks are grouped into three trimesters. Find out what’s happening with you and your baby in these three stages.

First trimester (week 1-week 12)

During the first trimester your body undergoes many changes. Hormonal changes affect almost every organ system in your body. These changes can trigger symptoms even in the very first weeks of pregnancy. Your period stopping is a clear sign that you are pregnant. Other changes may include:

  • Extreme tiredness
  • Tender, swollen breasts. Your nipples might also stick out.
  • Upset stomach with or without throwing up (morning sickness)
  • Cravings or distaste for certain foods
  • Mood swings
  • Constipation (trouble having bowel movements)
  • Need to pass urine more often
  • Headache
  • Heartburn
  • Weight gain or loss

As your body changes, you might need to make changes to your daily routine, such as going to bed earlier or eating frequent, small meals. Fortunately, most of these discomforts will go away as your pregnancy progresses. And some women might not feel any discomfort at all! If you have been pregnant before, you might feel differently this time around. Just as each woman is different, so is each pregnancy.

Second trimester (week 13-week 28)

Most women find the second trimester of pregnancy easier than the first. But it is just as important to stay informed about your pregnancy during these months.

You might notice that symptoms like nausea and fatigue are going away. But other new, more noticeable changes to your body are now happening. Your abdomen will expand as the baby continues to grow. And before this trimester is over, you will feel your baby beginning to move!

As your body changes to make room for your growing baby, you may have:

  • Body aches, such as back, abdomen, groin, or thigh pain
  • Stretch marks on your abdomen, breasts, thighs, or buttocks
  • Darkening of the skin around your nipples
  • A line on the skin running from belly button to pubic hairline
  • Patches of darker skin, usually over the cheeks, forehead, nose, or upper lip. Patches often match on both sides of the face. This is sometimes called the mask of pregnancy.
  • Numb or tingling hands, called carpal tunnel syndrome
  • Itching on the abdomen, palms, and soles of the feet. (Call your doctor if you have nausea, loss of appetite, vomiting, jaundice or fatigue combined with itching. These can be signs of a serious liver problem.)
  • Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight really quickly, call your doctor right away. This could be a sign of preeclampsia.)

Third trimester (week 29-week 40)

You’re in the home stretch! Some of the same discomforts you had in your second trimester will continue. Plus, many women find breathing difficult and notice they have to go to the bathroom even more often. This is because the baby is getting bigger and it is putting more pressure on your organs. Don’t worry, your baby is fine and these problems will lessen once you give birth.

Some new body changes you might notice in the third trimester include:

  • Shortness of breath
  • Heartburn
  • Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight really quickly, call your doctor right away. This could be a sign of preeclampsia.)
  • Hemorrhoids
  • Tender breasts, which may leak a watery pre-milk called colostrum (kuh-LOSS-struhm)
  • Your belly button may stick out
  • Trouble sleeping
  • The baby “dropping”, or moving lower in your abdomen
  • Contractions, which can be a sign of real or false labor

As you near your due date, your cervix becomes thinner and softer (called effacing). This is a normal, natural process that helps the birth canal (vagina) to open during the birthing process. Your doctor will check your progress with a vaginal exam as you near your due date. Get excited!! The final countdown has begun!

Ultrasound

Here at Tidewater Physicians for Women we believe in excellence.  Our Ultrasound Department is an AIUM (American Institute for Ultrasound in Medicine) accredited facility.  This means our practice has met accepted national standards and has shown consistent excellence in patient care when providing diagnostic ultrasounds.  To become accredited, we have undergone a rigorous and detailed process.  There are no state or federal laws to oversee the performance of diagnostic ultrasounds.  So, the accreditation of our practice by the AIUM gives you the assurance we are qualified to perform your ultrasound examination.

Pregnant woman getting ultrasound from technician

Our sonographers (the person doing your ultrasound) are all registered with the ARDMS (American Registry of Diagnostic Medical Sonographers).  This ARDMS registration assures our patients that we have consistently met high professional standards for sonographers, as well as achieved exceptional competency in patient care and technical procedures.  To achieve this our sonographers have passed the ARDMS examinations and have fulfilled continuing education requirements to increase their knowledge and skill level.

What is Ultrasound?

Ultrasound refers to sound waves that are higher in pitch or frequency than the human ear can hear.  These “ultrasound” waves are sent into the body via a transducer (probe) and are reflected off structures within the body.  The reflections return to the transducer, are converted into an image by a computer, and can be seen on a monitor.

Is Ultrasound Safe?

There are no known harmful effects associated with the medical use of ultrasound.  However, its prudent use is highly recommended.  The American Medical Association as well as the American Institute for Ultrasound in Medicine strongly discourages the used of ultrasound without a medical purpose.

Your Pelvic Ultrasound

Pelvic ultrasound may be performed to get detailed images of your cervix, uterus, and ovaries.  This exam may be performed either transabdominally (using a probe on your abdomen) or transvaginally (with a probe inserted into your vagina).  The most common approach is transvaginally.  The transvaginal ultrasound exam is performed by a sonographer (ultrasound technician).  There is no prep for this exam.  The sonographer will place the probe partially in your vagina.  You may feel some pressure, but the exam is generally less uncomfortable than a pelvic exam.  Images of your pelvis can be viewed on the monitor.  The sonographer will explain the images and will document them.

In some instances a transabdominal approach is necessary.  This exam is also performed by a sonographer.  You will be instructed to arrive for your ultrasound with a full bladder (drink 32-40 ounces of water 1 hour prior to your ultrasound exam and do not empty your bladder).  For this exam, the probe will be moved across your lower abdomen to obtain images of your pelvis.  The exam will take 10-22 minutes and then you may empty your bladder.

Your Obstetrical Ultrasound

The approach used for your obstetrical ultrasound may be transvaginal (a probe inserted into your vagina) or transabdominal (a probe moved across your abdomen).  If you are in the first trimester, (the first 12 weeks of pregnancy) the sonographer will use a transvaginal approach.  The sonographer will place the probe partially in your vagina.  You may feel some pressure, but the exam is generally less uncomfortable than a pelvic exam.  Images of your pelvis can be viewed on the monitor.  The sonographer will explain the images and will document them.  If you are in the second and third trimester of your pregnancy, a transabdominal approach will be used.  For this exam, the probe will be moved across your lower abdomen to obtain images of your baby.  Images of your uterus and baby can be viewed on the monitor.  The sonographer will explain the images and will document them.  Occasionally, in the second and third trimester a transvaginal ultrasound exam may be necessary.

What can I expect to see on my first trimester ultrasound?

You will learn the location of the pregnancy (making sure that the pregnancy is located in your uterus) and the number of embryos.  You may see the heartbeat of the embryo and receive a new due date.  Your ovaries will also be evaluated.

What can I expect to see during my second and third trimester ultrasound?

You will learn how the baby is positioned, the location of the placenta, and the amount of amniotic fluid.  Your baby’s growth may be measured.  In addition, your baby’s anatomy and well-being may be evaluated.

Are there any limitations to ultrasound of my baby?

An ultrasound examination in pregnancy does not guarantee a normal baby.  The ability of the ultrasound examination to detect problems with the baby depends on many things:  the age of the baby at the time of the ultrasound, the position of the baby as well as your body size.  Some problems cannot be seen by ultrasound because they are too small or not even visible by ultrasound.

How many ultrasounds of my baby will I have?

Most women will need only one ultrasound during their pregnancy.  However, for a variety of reasons, your provided may recommend additional exams to help monitor your baby.

Will I get ultrasound pictures of my baby?

Yes.  When the sonographer has completed the exam, she will give you some images to take home.  Videotaping, cameras, and recording equipment are not allowed in the ultrasound exam rooms.

Will I find out the sex of my baby?

Maybe. Sometimes it is not possible to determine the gender due to baby’s position/or age. Ultrasound exams are not done for gender determination.

Can I bring my family and/or friends to my ultrasound examination?

Yes, but please keep in mind that the ultrasound is a medical examination.  The sonographer requires a quiet, respectful atmosphere in which to concentrate on performing the exam.  Also, be advised that the ultrasound rooms are relatively small and will be dimly lit for the exam.

Cesarean Delivery vs. Vaginal Delivery

A cesarean delivery (Cesarean section or “C-section”) is the delivery of the baby through an incision in the abdomen and through an incision in the uterus. Much has been written in the lay press about C-section and the number of C-sections performed in the United States. Nationally, about 20% of pregnancies are delivered by C-section.

Reasons for Cesarean Delivery

There are no hard and fast rules with regard to cesarean deliveries because each pregnancy has its own unique characteristics. The reasons for performing cesarean delivery can be categorized as individual reasons, but it should be recognized that often a combination of individual factors must be considered.

  • Conditions of the mother – The woman may have medical conditions that worsen as pregnancy progresses or a condition that will not allow the woman to tolerate labor and vaginal delivery. In addition, there may be problems with the uterus or other pelvic organs, which would prevent a successful vaginal birth.
  • Conditions of the fetus – The baby may have medical conditions that result in its inability to tolerate the stresses of labor. The baby may also be coming down through the birth canal in an unusual position so that a vaginal birth is not possible.
  • Conditions of the mother/baby – It  is not uncommon that the baby cannot be delivered as a vaginal birth because it will not “fit” through the birth canal. This may be due to the baby’s size, the shape of the bones of the mother’s pelvis, or the contractions of the uterus not being adequate.
  • Conditions of the afterbirth – In  some cases, the afterbirth (placenta) may be in the way of a vaginal delivery (placenta previa) or may separate prematurely (placental abruption) which would require cesarean delivery.

Because there is a higher risk associated with cesarean delivery over vaginal delivery, the physician tries to consider every possibility to get both a healthy mother and healthy baby. In some instances, the cesarean delivery is decided upon before labor and attempted vaginal delivery is started. In many cases, however, the cesarean delivery is only decided upon after extensive attempts to achieve vaginal delivery.

Once a Cesarean, Always a Cesarean?

In years past, once a woman had a cesarean delivery, it was expected that all subsequent deliveries would also be by cesarean. This was due to a fear that the uterus had been weakened by the previous cesarean section. It is now felt that patients who have had a cesarean delivery in which the incision of the uterus (womb) is across (low transverse) the uterus rather than up and down (high or low vertical), are considered candidates to have attempts at vaginal delivery in subsequent pregnancies (vaginal birth after cesarean section – “VBAC”). The physician and the patient should be able to discuss the need for future cesarean deliveries if that is a consideration for the patient.

Risks and Benefits of VBAC

Approximately 60% to 80% of woman who are given an opportunity to attempt a trial of labor after a previous cesarean delivery can successfully deliver as a vaginal birth. Unfortunately, there are no ways to tell which patients are more likely to be able to deliver vaginally in pregnancies after a cesarean delivery. The primary benefits of a VBAC include shorter hospital stays, less need for blood transfusions, and a lower chance of infections. The most serious risk associated with VBAC is the possibility of the uterus rupturing at the site of the previous incision. The likelihood of this is less than 1%. This has been found to be more likely when a woman has had more than one cesarean delivery or may have had an abnormally difficult labor during the current pregnancy. In order to minimize risks to the mother and the baby, close monitoring of the mother and baby’s condition as well as the ability to perform emergency surgery are needed if a trial of labor is being considered.

The Operation and the Operating Room

Under some circumstances, the cesarean delivery is considered “elective” in which the decision for cesarean delivery is planned and scheduled. Sometimes, possibly during the labor process, a cesarean delivery is decided upon for emergency reasons. If this occurs, there may be a great sense of urgency as the doctors, nurses, and other hospital personnel rush the patient to the operating room to perform the procedure. In either situation, the operation itself is performed with adequate anesthesia so the patient does not feel the actual cutting of tissue.

Depending on the policies of the particular hospital, the patient may or may not be able to have a support person in the operating room with her as the procedure is done. If so, that person will sit at the head of the table next to the patient’s head, out of the area in which the surgery will be performed. The operation is performed by a surgical team under sterile conditions. If the patient receives the type of anesthetic in which she is awake, she will hear the surgical team talking and feel the pulling of the tissues but should not feel any pain. The baby, once delivered, is handed over to personnel who will tend to its needs. Sewing up or “closing” the procedure will take several minutes after the delivery is accomplished.

After the operation, the patient will initially have an intravenous (IV) line to provide medicine, fluids, and nourishment. There will also be a catheter that was placed in the bladder prior to surgery, which will continue to drain urine into a bag. When the anesthesia wears off after the operation, there will be some pain in the abdomen. The patient’s blood pressure, temperature, and pulse will be monitored closely every few hours and the incision will be examined on a regular basis. The patient will be encouraged to cough, deep breathe, and move about in bed, getting out of bed as soon after surgery as is practical. This promotes good, deep breathing which will prevent lung problems such as pneumonia.

Even though there will be discomfort in the lower abdomen, short walks in the hospital room or in the hallways of the hospital will make for a more rapid recovery. Initially, hospital personnel will help the patient in and out of bed. The incision will be sore and tender. Medication is always available for pain, nausea and other needs the patient may have.

Diet

Often, immediately after surgery, clear liquids can be taken. Under certain conditions, the intestines may be delayed a day or two before they start working again. The doctors will decide what type of diet the patient’s system can tolerate. Similarly, the bowels may not return to normal function until the patient is on a more regular diet. It is not unusual to also have gas pains in the lower abdomen.

Going Home

Both in the hospital and the first few days after the patient goes home, she may feel discomfort such that holding or feeding the baby may be more difficult that she would like. Bonding with the newborn as well as recovering from the cesarean delivery at the same time is more challenging than after a vaginal birth. In addition, mood swings may occur just like they occur after vaginal delivery. Difficulty with emotions should be discussed with the nurses or the woman’s physician to prevent any significant problems.

By the time the patient goes home, she will be able to eat anything she wants. She will not have an IV or catheter and the incision should be healing well. Activities will be gradually increased as the new mother gets stronger and more confident in her ability to walk up and down stairs, take longer walks, and provide for the baby. Breastfeeding, if desired, is not affected by a cesarean delivery.