There are many questions and challenges to think about when considering pregnancy. Obstetric providers can help patients understand the options available through every stage of pregnancy, to ensure they make informed and safe decisions for themselves and their growing family.
Here are a few common questions women ask. Of course, every pregnancy is different, so be sure to consult your provider if you are unsure about any of the information provided.
Preconception:
Who should consider preconceptual consultation?
Some diseases can be intensified during pregnancy such as diabetes, high blood pressure, heart problems, lung problems, thyroid disease, and kidney disorders. Many issues can be discussed or addressed with thorough annual exams, but there are certainly some women who should plan their pregnancies carefully. Women who have health concerns outside of pregnancy should consider consulting their physician prior to conception.
When should a woman begin taking folate?
Folic acid helps prevent neural tube defects, like spina bifida, a disorder in which the baby’s vertebrae fail to fuse the way they should. Folic acid supplementation should be started at least 1 month prior to attempting to get pregnant. The easiest way is to begin taking a prenatal vitamin when contraception is discontinued.
During Pregnancy
When should I plan my first prenatal visit and what can I expect from that encounter?
Most women schedule their first prenatal visit one to two months from the first day of their last menstrual period. The first visit includes a detailed review of medical history, physical exam, and routine labwork. I also discuss what the patient can expect from her physician during prenatal visits and at delivery.
Other testing performed during routine prenatal care includes glucose testing (end of 2nd trimester), testing for group beta Streptococcus bacteria ~36 weeks gestation and information regarding genetic testing options like the ultrascreen, quad screen, and testing for the cystic fibrosis gene are also discussed.
When can I expect ultrasounds?
An early ultrasound in the first trimester (<13 weeks) may be necessary to establish accurate dating of the pregnancy. The best time to look at the baby’s anatomy is around 19-21 weeks gestation. At that point, most organs can be evaluated and parents can usually find out the sex of their baby. Repeat ultrasounds may be required if there are concerns with the baby’s growth, amniotic fluid levels, or placental location.
Can I travel during pregnancy?
I typically discourage travel during the first trimester (<13 wks) and in the last 4-6 weeks of pregnancy. Miscarriages are more likely to occur in the early stages of pregnancy and because due dates estimates, mom should stay nearby to deliver with her provider(s).
The Big Day Arrives
What are signs of active labor and when should I head to the hospital?
Active labor usually requires contractions 5-10 minutes apart for at least 2 hours. These contractions are typically painful and will be hard to talk through. Although irregular contractions can begin weeks before delivery, usually only consistent contractions will cause cervical change. Leaking of fluid, vaginal bleeding, and decreased fetal movement are also good reasons to seek immediate care.
Will delivery be vaginal or by cesarean section?
From a maternal standpoint, it is better to have a vaginal delivery because the recovery is easier in most circumstances. Cesarean delivery when is recommended when it is really necessary for either fetal or maternal health reasons. Cesarean sections are the most common surgery performed in this country; however, there are still some risks involved including bleeding, infection, or damage to nearby organs like the bladder or intestines.
What options are available for pain management in labor and at the time of delivery?
There are a few different options for pain control and the mom can decide which is right for her and the baby. IV pain medication and narcotics are available, but these do not eliminate the pain completely, it affects the baby more and cannot be given if delivery will happen in the next 1-2 hours. Spinal or epidural anesthesia is better for addressing both the vaginal discomfort and contraction pain. This route also affects the baby less after delivery.
After Delivery
How long will postpartum bleeding persist?
Bleeding after delivery can last for up to 4-6 weeks. Bleeding that fills more than 1 pad per hour for over 2 hours requires evaluation. Although the bleeding after a cesarean section may be lighter, it can still last just as long.
What about recovery time?
This depends if delivery was vaginally or by cesarean section. Usually moms recover from a vaginal delivery in about 2-4 weeks, depending on the amount of tearing mom endured. C-sections take about 4-6 weeks for recovery and moms may still be sore for weeks thereafter.
Are there any restrictions in the postpartum period?
Vaginal intercourse and use of tampons should be avoided for 4-6 weeks to allow for healing. After a c-section, moms should not lift more than 10-15 pounds and will need help with basic tasks. Mom can get the cesarean incision wet after 24 hours, but the area should be dried carefully after showering to avoid infection. Reasons to call a physician in the postpartum period include: heavy bleeding, fever/chills, yellow or green drainage or discharge, increasing pain, or any other concerns the patient may have.
What issues are addressed at the postpartum visit?
Healing, pain issues, bleeding issues, problems with recovery or breastfeeding. Screening for postpartum depression and discussion and/or administration of contraception are also important parts of this visit. I review the patient’s chart and update any immunizations, labs, or perform a pap smear if necessary.
Kyla Carlson, DO Billings OB-GYN Associates