Obstetrics

Being up to date on your vaccines is a big part of a healthy pregnancy for you and your baby. The doctors at Dublin OB/GYN recommend being up to date on the following vaccines:

Influenza “flu” vaccine

Pregnant women are at higher risk for serious complications from the flu, including hospitalization and death. The inactivated flu shot can be given at any point during your pregnancy, whenever it becomes available.

Tetanus, Diphtheria and Pertussis vaccine (Tdap)

This vaccine protects against tetanus, diphtheria, and pertussis or “whooping cough.” A woman should get a Tdap shot during every pregnancy, and the best time to receive the shot is during the last trimester, between 27 and 36 weeks of gestation. Getting vaccinated during this time provides your baby with the most protective antibodies right before birth. This is important because newborns under 3 months old are at the highest risk for serious complications and death from whooping cough. Since babies do not get their first pertussis vaccine until 2 months of age, being vaccinated with Tdap during pregnancy can help protect your infant during this vulnerable time.

You can receive these vaccines at your local health department.

In women who are low risk, visits usually occur:

• Every 4 weeks until 28 weeks
• Every 2 weeks until 36 weeks
• Every week until delivery

Frequency of visits may increase if a pregnancy is determined to be high risk.

First Trimester (0 – 13 weeks)

Each assessment is to ensure the pregnancy is progressing properly.

• Assessment of weight, blood pressure, urine analysis, uterine size, fetal heart rate
• Time to answer questions

Second Trimester (14-27 weeks)

The second trimester is very similar to the first in terms of routine evaluation of weight, blood pressure, urine analysis, uterine size, and fetal heart rate.

The other important tests that are offered during this trimester are:

• Downs Syndrome Testing (if desired) between approximately 9 – 30 weeks
• Fetal Anatomy Ultrasound — looks at the development of vital organs, placental locations, and amniotic fluid level (20 weeks)
• Neural Tube Defect testing (if desired)

Third Trimester (28 – 40 weeks)

Prenatal visits still include evaluation of weight, blood pressure, urine analysis, uterine size, and fetal heart rate.

• Gestational diabetes testing (28 weeks)
• Ultrasound: (30 weeks) Note: if your doctor deems necessary you may be required to have Biophysical Profiles with nonstress test. Things that will qualify you for the extra testing: gestational diabetes, diabetes, pregnancy-induced hypertension, hypertension, etc
• Group B Streptococcus Screening (GBS) (36 weeks): This is a swab of the lower vaginal and rectal area to screen for colonization of the GBS bacteria organism. GBS colonization is not harmful to the pregnant woman but may be harmful to the baby if it passes through the birth canal. A baby’s immune system is immature at birth and may be unable to fight off GBS bacteria. This, in turn, can cause a deadly infection such as sepsis, pneumonia or meningitis

Another goal of third-trimester screening is to diagnose fetal malposition and preeclampsia.

Detection of a baby presenting in the wrong direction after 36 weeks will require a cesarean section to be scheduled for when you will be at 39 weeks gestation. The C-section can be canceled up until the time of surgery if the baby turns “head down.”

Detection and treatment of preeclampsia are known to improve pregnancy outcomes.

• Eat a well-balanced diet: meat, fruits, and vegetables — Don’t be a food junkie!
• Limit sugary foods and drinks — no sports drinks like Gatorade or Powerade and limit sodas to 2 cans a day
• NO energy drinks
• Decrease salt intake — no added salt at the table — limit fast foods and canned foods
• Limit saltwater seafood to once or twice a month — freshwater fish is okay — no sushi or raw seafood — no tuna
• Eat meat well done
• Drink a lot of water — half of your body weight in ounces is a good daily goal!

• Walking is good! 3–5 times a week in 30–45 minute intervals — avoid the hottest times of the day
• If you are currently in an exercise program, discuss it with Dr. Chism

• Extra Strength Tylenol — 2 every 6 hours as needed for fever or any ache and pain
• Tums, Maalox or Mylanta — heartburn, reflux or indigestion
• Claritin 10 mg or Benadryl — allergies or cold
• Tylenol PM — to rest at night
• NO aspirin, ibuprofen, or naproxen (Example: Goody Powder, Advil, Motrin, Excedrin, Alka Seltzer, Aleve, etc.)
• Colace — take 1 twice a day to help prevent constipation — increase fiber in your daily diet (Google sources that you will like) — increase fluid intake — if constipated despite this, leave off Colace & take Peri-Colace 1 twice a day until you have a good bowel movement then resume taking Colace — if no bowel movement after taking Peri-Colace for 3 days, call the office
• Do NOT take any medicine without checking with us first — if you have a problem that these medicines do not cover, call the office

• Do NOT ride horses, bicycles, motorcycles, 4-wheelers, motorboats and lawn mowers, fair rides, amusement park rides, or water park rides
• Do NOT jump on the trampoline
• NO hot tubs, saunas, or Jacuzzis — warm tub baths are okay
• Be careful in the sun — you may blister easily — wear sunscreen or you will be miserable
• If you plan any long trips discuss with your doctor — more than 2 hours from home
• Sex is okay until 36 weeks unless you have been advised otherwise
• You can dye your hair and get perms — sometimes it may not take
• If you paint, stay off of the ladder and ventilate the room well — open windows and have fans turned on
• Avoid lifting more than 10 pounds
• NO smoking or drinking of alcohol
• Avoid strong smelling or harsh chemicals
• Avoid ALL cats — do NOT change kitty litter
• Seatbelts should be worn during pregnancy at all times

• During office hours, call the office before going to the hospital
• NO elective inductions prior to 39 weeks — we have to have a medical reason to do it earlier
• Working is okay until delivery unless you are having problems — feel free to discuss details with Dr. Chism or Dr. Banks-Jackson at your visit
• Dental work is okay after 12 weeks
• Avoid routine eye exams – they are not accurate while pregnant
• If you are 21 or older and would like your tubes to be tied, ask to sign a consent form at 28 weeks
• If you have a problem that cannot wait until regular office hours, we have an answering service. After hours, call the office number and the on-call doctor will be paged — if you have not heard from the physician in 20 minutes, call back and if you do not hear from a doctor, call Fairview Park Hospital at 478-275-2000 – ask Labor & Delivery and tell the nurse that you are trying to get the physician on call for Dr. Chism and Dr. Banks-Jackson – sometimes the beeper tower causes problems
• If you are having nausea, leave off pre-natal vitamins until the nausea has been gone for 1 week — they can make nausea worse — even if you aren’t hungry or thirsty, drink plenty of fluids and try to eat
• Yeast infections and UTIs are very common in pregnancy — if you have any problems discuss with the nurse or doctor

• Severe headache unrelieved by Tylenol
• Blurred vision
• Severe abdominal pain or cramping
• Sudden increase in swelling
• Vaginal bleeding (stay calm — all bleeding is NOT bad!)
• Gush of water fluid coming from the vagina – appears like you can’t stop peeing
• Decrease in fetal movement
• Persistent fever or fever that will not break with Tylenol – over 100.4 °F

A cesarean section is an operation that is performed to deliver a baby through an abdominal incision. There are many reasons why a woman may require a cesarean section. Some of these reasons are known in advance of your delivery date, but most are not encountered until labor.

Breech Baby

The breech presentation is when the buttocks or feet is the presenting part in the pelvis rather than the baby's head.

Fetal Intolerance of Labor

A fetal monitor is used during labor to monitor your baby's heart rate. If your baby is not tolerating labor well, the fetal heart rate may be abnormal. If treatments to correct the abnormal heart rate are not successful, your doctor might recommend a C-section.

No Progress in Labor

Once you are in active labor (-4 cm), you should dilate 1 cm per hour thereafter. Your labor may not progress normally if your baby is too big for your pelvis or your pelvis is too small to allow for the baby's passage. You may reach 10 cm dilation, but may be unable to push your baby out because of its size or head position. If your labor does not progress because of these abnormalities, your doctor may recommend a C-section.

Infection

If your water has been broken for many hours, you can develop a uterine infection that can affect your baby's health. If your baby shows signs of infection and you are far from delivery, your doctor may recommend a C-section for your baby's safe delivery.

Placenta Previa

Placenta previa occurs when the placenta is partially or completely covers the cervix, thus blocking the passageway of the baby. A placenta that attaches to the cervix can bleed if it becomes detached or if you have contractions. There are times when vaginal bleeding is so severe that it threatens the lives of mother and baby. In this case, an emergency C-section may be performed even if the baby is premature. If a placenta previa has not caused problems with the pregnancy, a cesarean section will be scheduled 2-3 weeks before your due date.

Herpes

If you have an outbreak of herpes at the time of delivery, your doctor will recommend a cesarean section to reduce the risk of transmission to your baby. Medication will be prescribed to take at least 4 weeks before your due date to decrease the risk of an outbreak whenever you go into labor.

HIV

HIV-positive mothers may be offered a cesarean section to reduce the risk of neonatal transmission.

Multiple Gestation

Twins are often delivered by cesarean section if one or both of the babies are not head down.

Previous Cesarean Section

At Fairview Park Hospital, having a vaginal delivery after a cesarean section is not allowed. This is due to increased risks for mama and baby. Your repeat section will be scheduled for when your baby is at 39 weeks gestation.

Most women stay in the hospital for 2 days after a cesarean section. You will be discharged with prescription pain medicine (narcotic and anti-inflammatory). During your first week at home, you should not participate in any strenuous activity. You may not have an appetite, but you need to drink a lot of water to stay well hydrated.

You should have a bowel movement within the first week after a cesarean section. Unfortunately, the narcotic medicine that you are prescribed may slow down your bowel function causing constipation. To decrease constipation, you may decrease narcotic use and / or use a stool softener / laxative such as:

• Colace (Docusate): 1 tablet 2-3 times a day
• Pericolace (Docusate + Sennosides): 1 tablet 1-3 times a day
• Laxatives: Milk of Magnesia, Correctal, Fleets enema, Miralax

Your incision will be tender and swollen for 2-4 weeks. As the pain subsides, you can increase your physical activity. Refrain from heavy lifting — do not lift anything heavier than your baby in its car seat.

Do not drive for 3 weeks after your cesarean section. Do NOT drive even after the 3 weeks if you are still taking narcotic pain medicine.

You will come to the office a total of 3 times before you are released to normal activity. You will return at week 1 for staple removal, week 3 for a tummy check to ensure that the incision is healing properly and week 6 for a tummy check, pelvic exam, to discuss what you want to use for birth control, and to be released to go back to work. You are also allowed to return to normal activity after this office visit, but pace yourself and listen to your body.

You should call your doctor if you:

• Have a fever >100.4 on two occasions in the same day
• Have drainage from your incision
• Have an increase in vaginal bleeding or pain (even with using pain medication)