Your special pregnancy deserves special care. You’ll have one physician providing that care throughout your journey and answering all your questions. You’ll have that same physician there for your delivery - 97% guaranteed.
- Our obstetrics philosophy
- Your 9 month journey
- Common “miseries of pregnancy” and comfort measures
- Medications in pregnancy
- FAQs (i.e. Do I really need to give up my coffee?)
We build a foundation of trust during your pregnancy journey through continuity—you see me for every pregnancy visit and no visit ends until all your questions are answered. We encourage you to bring question lists!
When I see you for your fist pregnancy visit, I will give you contact numbers that will allow you to reach me or the on-call physician at any time. It is important to me that any anxieties or fears that you have are eased—suffering through a weekend makes no sense!
Over the last several years, I have delivered 97% of my own patients. I am on-call Monday through Friday and every 5th weekend. However, even on weekends that I am not on-call, I still deliver my own patients with rare exceptions.
Though we will spend quite a lot of time together over 9 months, generally, what should you expect in each trimester?
First trimester (0-13 weeks): at your first visit, we will usually perform an ultrasound to confirm your due date and see a heartbeat. We will review therapies for nausea if this troubles you. Even at this early stage, you will feel and notice many changes in your body—we’ll provide lots of education and reassurance. We will also discuss screening strategies for Down’s Syndrome (Trisomy 21) and help you to decide whether such tests are right for you.
Second trimester (14-28 weeks): you will typically have blood tests performed around 15 weeks—these include checking your blood type, screening for anemia, and others. At 18-20 weeks, you will see your baby in much more detail during an anatomy ultrasound—this is finally when you can find out what you’re having!
Third trimester (29-40 weeks): Lots of changes nearing the birth of your baby—we talk about strategies to help with swelling, back pain, sleep, heartburn and other challenges. We will spend time together discussing labor pain relief options, your birth plan, and what to expect during labor. By the end, we are seeing you every week—bring your questions from your birthing classes!
Edema: During pregnancy, you carry about 40% more fluid in your blood vessels than when you are not pregnant. As your uterus increases in size, it becomes more difficult for fluid in your legs to return to your heart. When you add in gravity, no wonder it becomes hard to see your ankles in the 3rd trimester! While this is normal, it can be uncomfortable and can make finding shoes that fit a special challenge.
Elevating your feet/lying down helps blood and fluid to return to your heart—you will notice that swelling is often better upon awakening in the morning. Spending time in a pool (up to shoulder level) is another effective way of pushing fluid back into your blood vessels—one hour in a pool equals four hours of elevating our legs. A great reason to consider water aerobics in pregnancy!
Heartburn: A burning sensation in your upper abdomen, chest or throat after meals (especially when lying down after a meal) usually means that heartburn has arrived. The hormones in pregnancy slow the emptying of your stomach and help to relax the lower part of your esophagus. Combine this with the pressure on your stomach from a growing uterus, and most women develop heartburn at some point in their pregnancies.
What can help? Eat smaller meals. Don’t lie down immediately following a meal. If you find that certain foods trigger these symptoms, don’t eat them (unless you think it’s really worth it!). There are many medications that can improve your symptoms—I usually recommend “stair-stepping” medications depending upon the severity of your heartburn:
- antacids (Tums, Rolaids)
- Zantac (ranitidine) up to 150 mg twice daily
- Prilosec OTC (omeprazole) up to 40 mg daily
Headache: If you’ve had challenging headaches prior to pregnancy, we may need to adjust your medication regimen to minimize risk to the fetus. Many women report new onset headache, especially in early-or mid-pregnancy. Commonly, this is due to dehydration, low blood sugar or both. To start, I encourage fluid intake to deep your urine looking like water or pale yellow. Eat multiple small meals throughout the day to keep your blood sugar up. If these measures plus Tylenol (acetaminophen) up to 1000 mg every 6 hours are not effective, we may need to discuss other therapies. Generally we DO NOT want you to take non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin, Motrin, Ibuprofen, or Excedrin migraine while you are pregnant.
As a general rule, new onset headaches in the third trimester are not normal and can be associated with a high-risk pregnancy condition called pre-eclampsia or toxemia. Call or page me if this occurs.
Nausea: Often, this can be the earliest tip-off that you may be pregnant. “Morning sickness” is rarely accurate—most women struggle with nausea throughout the day. When it truly is only in the morning, eating starchy foods (crackers, bread) before you lift your head off the pillow can help.
Fortunately, nausea usually largely disappears by the end of the first trimester. What can help during those first 13 weeks? Try to avoid odors that bother you—these are different for different women. Keep something on your stomach by eating multiple small meals or snacks during the day. Be careful with your toothbrush—most women have a more sensitive gag reflex during pregnancy. Some women find remedies such as ginger, lemon scent, or peppermint to be helpful; I’ve also seen use of pressure points and acupuncture sometimes work.
Over-the counter remedies include Vitamin B6 (50-200 mg) combined with Unisom tablets (yes, the sleeping medication). The active ingredient in the tablets (NOT the capsules) is doxylamine—the combination with Vitamin B6 can often help. If other measures don’t work, I encourage patients to call me for prescription medications such as Phenergan or Zofran. Though we try to avoid medication use in the first trimester, these medications have been shown to be generally safe, and severe nausea can be debilitating.
Constipation: Pregnancy causes the entire digestive system to slow down. The stomach empties more slowly which can lead to acid reflux/heartburn and the need for smaller meals. Slower transit time through the colon means more fluid resorption and less frequent, harder bowel movements.
On the dietary side, lots and lots of water plus fruits and vegetables are the starters. Prunes and apricots contain substances that can stimulate the bowels. In my experience, fiber supplements such as Metamucil or Fibercon are hit-or-miss?if they work, great; if they simply cause bloating without results, don’t continue to use them.
Medications include Colace (docusate), which can be used in doses up to 200 mg 2 times daily. If this is not sufficient, a powder called Miralax often does the trick. Many women will experiment with some combination of the two to achieve a balance between regular, soft bowel movements while avoiding diarrhea.
The fetus gets exposed (at least in part) to most medications that you ingest. The fetus’s organ systems (such as the heart, brain, and limbs) form during the first 13 weeks of pregnancy. Because this process is so important, we generally try to avoid any medications during this time (except prenatal vitamins). Common medications that should be avoided include non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, Motrin, Ibuprofen, and Advil. As a general rule, Tylenol (acetaminophen) and Benadryl are safe throughout pregnancy at the standard doses listed on the bottles.
Though there are many cold remedies that are safe, I usually recommend that you call me with questions on these. This not only allows you to “check-in”, but we can tailor therapies to your individual symptoms.
With regards to prescriptions medications that you were taking prior to pregnancy, we review each one. Whether to continue them depends upon your overall health benefit versus the potential risk to the fetus. I always encourage my patients to call me if they have any medications or concerns.