FAQ – The Childbearing Year

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Congratulations! You will have many questions during your pregnancy, birth and postpartum year. At Generations we make time to listen and to discuss anything that is on your mind. Below we’ve touched on some of our most frequently asked questions. We consider pregnancy to be a normal physiologic process of a woman’s body rather than a medical condition.

Beginning Care
For most pregnancies we recommend beginning care at 8-10 weeks. You will meet with a nurse and go over your history. She will also review some personalized recommendations for activity, diet and safety in pregnancy, as well as advice about common early pregnancy symptoms. We will draw a standard “new OB” panel of blood work, which includes items such as your blood type, immunity to rubella, and exposure to infectious diseases. These tests are recommended by both the American Congress of Obstetrians and Gynecologists (ACOG) and the American College of Nurse Midwives (ACNM). After this visit, you will have a longer visit with a midwife or a doctor which includes a basic physical. We’ll discuss any questions you have and discuss our plan of care. Our visits after that will be a combination of checking on your physical well-being and discussing issues that are appropriate to your stage in pregnancy.

We accept most transfer patients. Please call us to discuss your situation so we can recommend the best way to begin your visits.

Early Concerns
Please let us know if you have bleeding or hyperemesis (nausea and vomiting of pregnancy in which you are unable to keep down any foods or fluids).

Fetal Screening
Fetal screening refers to a group of tests that can be done to either screen for, or diagnose, problems with your baby. Fetal screening is optional, but we would like you to understand the choices. Most of our patients do have an ultrasound at around 20 weeks, to observe the growing baby and all the organs that have developed by that time, and also to determine the location of the placenta.

First trimester genetic screenings can be done at our clinic. They are done between 11-14 weeks and they consist of an ultrasound and a blood test. This test can detect whether your baby is at higher risk of having a trisomy, such as Down Syndrome. It is not a diagnosis. If your risk is shown to be high, you will be offered a more invasive test called chorionic villus sampling (CVS) or amniocentesis, which is done later in pregnancy. We refer you to a maternal fetal specialist for these tests. (Some women with certain risk factors choose to go directly to the CVS or amniocentesis). You will want to check with your insurance company about coverage for these tests.

A new test is now available for mothers who are older or who have other risk factors for having a baby with chromosomal defects. It looks at fetal DNA in the mother’s blood sample. Currently we refer women to maternal fetal specialists to have this test done. In most cases it will be considered a diagnostic test rather than a screening. It can be expensive but there may be coverage or assistance with the cost.

We may also draw your blood in the second trimester for a screen for neural tube defects such as spina bifida, or a full screen if you did not have the first trimester screening done. Again, this will only show a raised or lowered risk of problems, and a more invasive test called amniocentesis is the corresponding diagnostic test.

All families make decisions about testing differently, using a combination of their own feelings about them and information we can provide. We are happy to help you consider the options.

The Second Trimester
Many women find renewed energy and well-being in the second trimester (about 14-28 weeks). In your second trimester we’ll begin to talk about options for prenatal classes (please see our “Links” page for some suggestions). When you are 24-26 weeks we will further discuss symptoms of preterm labor and preeclampsia, and discuss monitoring fetal movements. At 28 weeks we recommend a glucose challenge test (GCT), a screening test recommended by the ACNM, ACOG, CDC, and others. (If you have certain risk factors we may have recommended this test even earlier in pregnancy). If a woman’s blood glucose level is elevated on her GCT, we do a diagnostic, 3-hour test called a glucose tolerance test (GTT). Two elevated levels out of four diagnose gestational diabetes.

Gestational Diabetes: Pregnancy affects the way a woman’s body handles glucose (blood sugar that most foods are converted to for energy). Sometimes it is altered enough to cause high levels of circulating blood glucose, which can present problems to her and her baby. When the level reaches a certain limit, she is diagnosed with gestational diabetes mellitus (GDM). This limit was determined by research that examined at what point problems may begin to occur.

We send our patients with this diagnosis for diabetes education and discuss diet and exercise with them. Most women are able to control their blood glucose levels with diet alone, by following a recommended diet and observing their resulting blood glucose measurements. Good control can help avoid problems such as macrosomia (a large baby), poor blood glucose control and resulting stress in the newborn, and possibly even later-in-life problems for the baby.

Uncontrolled GDM is also linked to higher risks of preeclampsia and high blood pressure of pregnancy. There is also a correlation between developing GDM in pregnancy and developing type 2 diabetes later in life. Pregnancy can be an opportunity for a woman to learn to reduce her risk of diabetes by changing lifestyle habits such as diet and exercise. More information can be found at National Institutes of Health and Mayo Clinic websites.

Some women are concerned that the glucose drink we give is harmful to their baby. There is no evidence that this one-time testing dose is harmful. We balance the concern about the high sugar content of this drink with concern about baby’s potential exposure over time, if mother has undiagnosed or uncontrolled diabetes.

The Third Trimester
In the third trimester the family begins to realize the baby really is coming! Parents may be in the midst of prenatal classes, preparing their homes and other children, and beginning to visualize life with a new baby. We will begin to see you more frequently. We will discuss questions you will have about labor, birth, the postpartum period–anything from when to go to the hospital to plans for time off of work. We’ll discuss the position of your baby in the uterus. At 36 weeks we recommend a culture for a bacterium called Group B Streptococcus (GBS). These bacteria may colonize in a woman’s body and, like many bacteria in our bodies, cause no problem for her. However, it can cause early-onset pneumonia, meningitis, or sepsis. Not all babies exposed become ill, but when they do, they become very ill at a very early age when their systems are not ready to fend off infection. The CDC, ACNM, ACOG and other groups recommend universal screening and treatment to help avoid these serious infections. The most effective treatment known at this time is IV antibiotics given to the mother when she is in labor. This does not need to derail your plans for a normal birth–the antibiotics (depending on any allergies you may have) run for 30 – 60 minutes and then can be disconnected if you have no other need for an IV. You can still have a water birth. More information can be found at the Centers for Disease Control website.

Sometimes a woman may develop something called preeclampsia, a serious complication involving elevated blood pressure, kidney changes, and possibly liver involvement (HELLP syndrome). One way to watch for this is to keep all your appointments so we may watch your blood pressure and other developing symptoms. We will discuss things you can watch for at home. Preeclampsia is typically diagnosed with blood pressures above 140/90 and protein in the mother’s urine, with or without some other symptoms such as excessive edema (water retention) and changes in liver enzymes and blood components. It is treated by the birth of the baby by induction of labor or cesarean, and some women may also need medication during the birth and postpartum period. Thankfully, it is rare in healthy women but can develop suddenly. While there is no particular proven prevention, a healthy diet, plenty of vitamin D, and regular exercise may be helpful. The Preeclampsia Foundation has an informative website.

My Due Date has Come…and Gone!
Normal pregnancy is defined as between 38 – 42 weeks long. We give you a due date that is 40 weeks. This is a guideline only. Most first babies actually come after the mom’s due date! If mom and baby are healthy we recommend normal activity, good nutrition, and patient waiting. Enjoy the last days with your partner. Life will soon change–in a good way, but definitely change! Meals out, movies, shopping, intimacy…all will become a bigger project with a newborn at home. If 41 weeks should come along, we do recommend fetal surveillance, which consists of a periodic “nonstress test” (NST), which is simply a period of fetal heart rate monitoring on an external fetal monitor, typically 20-30 minutes long. This may be followed by a biophysical profile (BPP) which is a targeted ultrasound, done at our office, which looks at signs of fetal well-being (if the placenta is still doing an adequate job oxygenating your baby). If any of these tests are concerning we may recommend induction. Otherwise, we normally allow a normal pregnancy to continue to 42 weeks, in discussion with the family and their wishes. If your blood pressure rises or other concerns arise, we will discuss our recommendations with you.

Other Questions
No question is silly or unimportant! We welcome your concerns at your visits, or phone calls for things that can’t wait. If you have any questions about our care prior to coming to our clinic, please call during business hours and someone will get back to you.

Breastfeeding Questions and Concerns
Breastfeeding questions are usually very particular to the mother/baby situation. We recommend you call the clinic or a lactation consultant that we’ve referred you to. Also helpful can be information from reliable websites such as Breastfeeding Online or Positively Breastfeeding.