What Every Woman Needs to Know about Pregnancy [Must Read]

Congratulations! You're pregnant! Now what? So, it is a fascinating thing after you take your 5 pregnancy tests to confirm it. You should know a few things. First of all, is that you should take a prenatal vitamin. Your prenatal vitamin can be any brand as long as it has DHA and folic acid.

Often, you can supplement DHA and folic acid if your current prenatal vitamin does not have it, whether it be a gummy, a capsule, or a chewable or a swallowed pill; it doesn't matter as long as it's a prenatal vitamin. You can start this prenatal vitamin, in fact, while before pregnancy, or once you find out you are pregnant.

We encourage healthy habits when you find out you're pregnant. This includes stopping smoking, stopping drinking, continuing with exercise, getting proper nutrition, and sleeping at least 6 to 8 hours every night. Decreasing stress levels can also help in a healthy pregnancy.

At this point, once you have your positive pregnancy test, you should call your obstetrician to make your first OB visit. This visit is usually done at approximately 8 weeks after your last menstrual period. Your last menstrual period is the date of which you had the first bleeding of your period, which preceded this pregnancy.

What happens at the first prenatal visit?

So, your doctor will take a history. Your doctor will ask your questions about medications you're on, medical problems you may have, the surgeries you've had in the past, any prior pregnancies. He or she will also ask you how you feel so that they can help you to feel as well as possible in the first trimester.

You will also answer questions about your social history as well as your family history with regards to diabetes, babies born with problems, as well as cancer.

Next, your physician will perform an exam. If you haven't had a well-woman review within the last year, it is recommended that a good woman exam be completed at this time. This will include a breast exam as well as a pelvic exam and a pap smear if you haven't had one recently.

Once the exam and history are completed, the next step is to perform an ultrasound. So, at 8 weeks of pregnancy, the ultrasound is a transvaginal ultrasound. This gives us the best look at the developing baby. The ultrasound will show you if all is going well.

A healthy pregnancy will demonstrate a living fetus with a heartbeat, and your doctor will be able to confirm that your dates of a pregnancy are correct as well, and a due date will be fixed based on your last menstrual period as well as this ultrasound.

Finally, in the first prenatal visit, you will have a counseling and education, so your doctor will review what usual tests are performed in pregnancy, they will consider genetic testing, your doctor will also discuss foods to avoid, foods to eat, weight gain, and all other issues you may have. There should be time to answer questions that you may have, as well.

Let's talk a little bit about genetic testing. So, genetic testing will be offered to you at your first prenatal visit. The state does a prenatal screening, which incorporates a blood test in the first and second trimesters.

With these blood test results, your doctor will be able to tell you your risk of having a baby with Down Syndrome, trisomy 13, trisomy 18, as well as Smith-Lemli-Opitz, which is a rare disorder, and finally, open neural tube defects, like spina bifida.

Nowadays, we offer non-invasive prenatal testing to our patients, so this is actually a blood draw that can be performed on the mother whereby the company can isolate the baby's DNA from the patient's bloodstream, and sequence it for chromosome 21, which is Down Syndrome, chromosome 13, chromosome 18, as well as the gender of the baby.

This test can be done as early as 9 weeks of pregnancy, and the results take about 7 to 10 days to come back. You will also be offered, possibly, an ultrasound to evaluate the baby in the first trimester. This is called a nuchal

translucency scan.

This scan evaluates the back of the baby's neck. If the fold is very thick, it could be considered suggestive of Down Syndrome. Other parts of the baby can be evaluated at this time, as well.

Finally, there is blood testing whereby we can look at genetic mutations in the mother, so this is a blood test that's offered to the patient. Your chromosomes are evaluated for mutations that can lead to diseases like cystic fibrosis, spinal muscular atrophy, Tay-Sachs Disease, and many others.

If the patient is positive for a genetic mutation, the next step would be to evaluate and test the father of the baby.

What are some routine lab tests that are offered at the beginning of pregnancy?

First of all, we look for infection, so we're screening for HIV, syphilis, hepatitis B, we check your blood type to make sure that we know what your Rh status is, and finally, we will check for immunity to diseases, such as rubella or varicella, which is chickenpox.

One of the most common complaints at that first visit at 8 weeks, or in the first trimester, is nausea and vomiting. Most patients will have some nausea or food aversions in the first trimester. It is widespread.

We often recommend homeopathic remedies, which include ginger, vitamin B6, or sea bands, as you see on these patients' wrists. These are acupressure bands, which place pressure inside the wrists to help alleviate nausea.

We can also prescribe medications. So, these medications can include doxylamine/vitamin B6 in an extended-release form--this is a newer medication on the market, which is FDA- approved for nausea and vomiting in the first trimester.

We can also prescribe Zofran and Reglan, which are anti-nausea medications. What foods should you avoid in pregnancy? So, we usually counsel our patients about this as well on the first visit. We recommend avoiding high mercury fish. This includes tilefish, shark, mackerel, swordfish, as well as even canned tuna can be considered a high mercury fish.

I usually recommend to my patients not to consume more than one tuna fish sandwich per week. All other fishes are considered healthy and beneficial in pregnancy. We also are concerned with the risk of listeria in pregnant women. For this reason, there are several foods that we recommend avoiding.

This includes unpasteurized milk or soft cheeses, any raw or undercooked meat or sushi, deli meats or hot dogs that are not warmed to steaming, and we recommend washing all your fruits and vegetables. 

What about exercise during pregnancy?

We consider exercise safe in a healthy pregnancy. It's actually recommended that you exercise at least 150 minutes per week. This would be equivalent to approximately five 30-minute exercise sessions per week. It is important to avoid exercises or activities whereby you may be at risk of having trauma to the abdomen or falling.

This can include contact sports, as well as horseback riding, skiing, anything where you may lose your balance. Some great activities in pregnancy include walking, swimming, as well as stationary biking. You can also do prenatal yoga, which is lovely for pregnancy. Many patients ask me about their heart rate.

What is their heart rate supposed to be when they exercise during pregnancy?

It has been recently discovered that your heart rate is not as important as how you feel when you are exercising, so for instance, as long as you're able to carry on a conversation, you're not feeling too short of breath, you're not lightheaded or dizzy, you're not having heart palpitations, that level of exercise is perfect. So you can tailor your intensity to how you're feeling.

So, what happens at a routine visit?

You will be seeing your doctor once every 4 weeks. At that time, you will have your weight checked, and generally, for a normal weight woman, we expect a 25 to 35-pound weight increase during pregnancy, so we monitor that. There will be a blood pressure check, and also after 20 weeks, we do measure the fundal height.

This is done with a tape measure, as seen here, which can basically go from the pubic bone. The doctor measures up to the fundal height, or the top of the uterus, and the number of centimeters that your fundal height is correlated to the number of weeks that you are in the pregnancy, plus or minus 2 centimeters.

Then, we also do listen to fetal heart tones with a Doppler, as you can see here on this slide. The average fetal heart tones should be between 110 and 160 beats per minute. Now you're entering your second trimester. This is weeks 13 through 28. 

What should you expect?

So, as I mentioned previously, your prenatal visit is every 4 weeks. There is state screening for neural tube defects, so this is a blood test that's done by the state on the mother of the baby to detect whether there may be an increased risk for spina bifida or other neural tube issues.

Around 20 weeks of pregnancy, we recommend that all patients get a scan to look at the anatomy of their baby. The scan is generally done by a perinatologist or a particular OB doctor who has done a fellowship in how to perform an ultrasound on babies in a very nice way as well as perform high-risk obstetrics.

This anatomy scan will give you information about your baby's structures. The doctor will look at the brain, the heart, the spine, the face, pretty much any fabric that you can imagine will be evaluated to make sure that your baby is growing normally. 

Finally, around 24 to 28 weeks, you will have testing for gestational diabetes and anemia. This is a blood test that is done during that 4-week timeframe. 

How about in the third trimester?

So, this is 28 weeks to delivery. At this point, you will have visits every 2 weeks, and after 36 weeks, you will have a visit every week. At this time, we do recommend fetal kick counts. So, your fetal kick counts mean that at some point during the day, you should fill at least 10 fetal movements within 2 hours.

If you're not able to feel your baby move well, we usually recommend drinking some cold juice and really paying attention to see if you can count to 10 movements before 2 hours. If you can't, this would be an excellent time to come to Labor and Delivery. We also counsel our patients about preterm labor precautions.

So, if you start to have excruciating contractions that don't subside with rest or hydration, if you begin to notice any fluid leaking, which could be a gush or a trickle, if you have any bright red bleeding, these are all excellent reasons to come to Labor and Delivery for an evaluation, as well.

Around 36 to 37 weeks, your doctor will check you for Group B strep. So, Group B strep is a healthy bacteria that 1 in 5 women has in the vaginal area. The test is performed by placing a swab inside the vagina as well as down around the rectum. This test will tell us if you have the bacteria. If you do, we don't want the baby to get infected with it during the time of labor and delivery.

For this reason, you will be offered antibiotics to kill it if you do test positive for the bacteria. And usually, in the third trimester, we will perform an ultrasound to check on the size and position of the baby. This gives us a better sense as the time comes to deliver whether the baby's in the correct place, which is head-down, and also to evaluate the size of the baby and make sure the baby has grown appropriately.

We may offer cervical exams. So, in my practice, I usually like to check the cervix of my patient at 39 weeks to see if they're still closed or if they're already dilated, which at times can happen with women who have had more than their first pregnancy. During the cervical exams, it can be uncomfortable, but it is usually fast, and a membrane sweeping or stripping can be offered at that time, as well.

So, the membrane sweeping involves sweeping a finger inside of the cervix, which can then release prostaglandins and help promote labor if your body is ready for work to occur. I usually counsel patients that it will occur within the next 24 hours. If your organization is not prepared, often nothing will happen.

You can notice some bleeding after the membrane stripping as well, so you can call your doctor about it, but it's usually not of concern. It's time to deliver your baby, and you're wondering, what are some good reasons to go to the hospital? If you have excruciating contractions every 3 to 5 minutes for at least 1 to 2 hours, that would be an excellent time to proceed to the hospital and to Labor and Delivery.

By painful contractions, I mean they're so strong that you can't talk through them. There are many apps out there nowadays to time your contraction. It may be worth exploring one to use at that time. If you notice any fluid leaking, this could be a gush or a trickle, it could be leaking, and then it can stop this would be an excellent time to proceed to the hospital, or at least to ask your physician for some advice.

You may have bright red bleeding, which can be suggestive of an issue or of labor impending. This would be the best time to call your doctor or come into Labor and Delivery, as well. If you notice decreased fetal movement, meaning you can't get your kick counts, we do worry about the baby's status, and we can further evaluate the baby in Labor and Delivery.

We also do worry, especially in the third trimester, about preeclampsia. Preeclampsia is a condition whereby the woman can have elevated blood pressures, possibly protein in the urine, and lab abnormalities. 

Sometimes preeclampsia is asymptomatic, but frequently women may notice headaches, changes in their visions, particularly seeing black spots or pain in the upper abdomen. If you have any of these symptoms, please call your doctor and proceed to Labor and Delivery.

What about induction and delivery?

So, the full-term is considered 37 weeks of pregnancy. After this point, we feel that the baby is well grown and can deliver at any point in a safe fashion. Induction, in recent studies, is considered safe after 39 weeks. The researches have shown that there is no increased risk of C-section due to induction after 39 weeks, and also there's no harm to the baby.

In my practice, I recommend induction by 41 weeks if labor has not occurred, and this is to mitigate issues that can arise after 41 weeks of pregnancy due to the placenta being more aged. 

How about immunity in pregnancy?

So, we do check for immunity to rubella as well as chickenpox, or varicella, during the pregnancy. If you are not immune, it is something to be aware of, and the vaccine can be administered after the pregnancy. We do not give these live attenuated vaccines during pregnancy.

I just want to briefly mention vaccinations in pregnancy, as well, because it is so important. So, you will be offered the flu vaccine during your pregnancy if you are pregnant during the flu season. You will also be provided the Tdap vaccine in the third trimester for protection against whooping cough for your baby, otherwise known as pertussis.

So, the thinking behind vaccinations in pregnancy is that when you receive the vaccine, your body makes new antibodies to that vaccine, and these actually travel through the placenta and provide antibody protection for the baby against the infection. For this reason, we do recommend getting vaccinated for these two things during the pregnancy.

It is important to note that adults who are around the baby once it's born to need to be vaccinated as well. This includes the flu vaccine during flu season as well as Tdap, or the whooping cough pertussis vaccine. For any adult who has not had the Tdap within the last five years, we're trying to protect the baby as much as possible before the baby itself can

receive its vaccines.

So, I have a few questions here. The first one is, "How do I know I am pregnant?" So, one of the best ways to know you're pregnant is to follow your menstrual cycle. If you have missed a period, that would be an excellent time to check a pregnancy test. You may also experience symptoms of pregnancy early on.

These can include fatigue, nausea, breast tenderness, or even some spotting. The next question is, "Can I dye my hair while pregnant?" Yes, that should not be a problem. Some women prefer to avoid dyeing their hair during the first trimester, but in the second and third trimesters, it is considered safe.

The next question: "Do I need a birth plan?" So, birth plans are optional. You can learn a lot about them, either online or through birthing classes. Birth plans are not necessary for a healthy delivery. You need to communicate with your doctor as well as the nurses when you come into

Labor and Delivery about what your wishes are if you have particular requests, such as wanting to have an unmedicated work, meaning with no pain medication. It may be nice to have a birth plan so that we know what you will and will not accept.

Please keep in mind that every labor progresses differently and that you have to be flexible to accommodate your health as well as that of the baby. "How long does nausea last?" For the majority of patients, nausea will end after the first trimester, usually 12 to 13 weeks.

Occasionally, patients can have nausea lasting into the second and even the third trimester. Please discuss this with your doctor, as they may be able to help you with various medications or advice.

"What does it mean when the baby drops?" So, frequently women will feel that a baby, especially one that's already head down, moves further down into the pelvis in the latter stages of the third trimester. In general, this does not portend impending labor, but it can signify that your body is getting ready for the last day when your baby will be born.

"How about if my mucus plug comes out?" So, many times patients will report to their physician that they noticed pieces of their mucus plug, or their entire mucus plug, being a part of their discharge. In general, this does not mean that labor will start right away. Sometimes women can lose their mucus plug even early in the third trimester and still remain pregnant for several weeks afterward.

"What can I do to stimulate labor?" So, say you're already close to your due date or even past, and you want to try some things to help stimulate labor. There's no good evidence for many techniques. However, I often recommend to patients to stay active, to consider nipple stimulation, because when you stimulate your nipples, it releases oxytocin from the brain, which is essentially Pitocin, and can help stimulate contractions.

Intercourse can also help stimulate contractions or help ripen the cervix because the semen has prostaglandins in it. Often, women also try acupuncture to help with labor stimulation. These are all just home remedies you can try. The membrane stripping in the office can also help with ripening your cervix.

"I feel really swollen. Is that normal?" So, during pregnancy, you definitely do have increased volume, and you can definitely experience swelling. If you feel like your swelling has risen significantly very quickly, or you're just feeling uncomfortable, it's worth the discussion with your physician.

Usually, this occurs in the third trimester when you see your doctor every other week or every week, so for that reason, you should have ample opportunity to make sure everything is okay. If you are ever caring, you can always go to Labor and Delivery to be evaluated.

"What can I do for pain during labor?" So, there are many options for women for discomfort that comes with the contractions of labor. So, you can receive medication in the IV, which is usually a narcotic to help take the edge off the discomfort. This is a superb choice for women who are in early labor or who'd prefer to try a natural delivery but need a little something to help them for a brief amount of time.

Usually, this medication's effects are short-lived, and they can affect the baby, so for that reason, we don't recommend them close to the time of delivery. For a more extended, more effective pain control, women have the option of choosing an epidural. The epidural is a medication that goes into the epidural space through your spine.

This is performed by an anesthesiologist who will be working on Labor and Delivery. The epidural works to take away the pain of the contractions, and it will last from the time you have it placed through the time of the delivery of the baby. With the epidural, you will not be able to get up out of bed or go to the bathroom or walk around, so for that reason, usually, you know, we place a Foley catheter so that you don't have to get up to the restroom, and we do help you with your legs as you get ready for pushing and delivery.

Some hospitals will offer walking epidurals as well, so that's something to inquire about when you go in for your delivery. I found out I am pregnant and noticed some bleeding.

What should I do?" So, bleeding in the first trimester is very common, and we usually recommend to patients either to keep an eye on it, if the bleeding persists, we can order blood work to track your beta HCG levels and see if they're rising appropriately.

We can also check a progesterone level to see if your progesterone level is high enough to support a pregnancy. If the bleeding is persistent or heavy, there is a concern for a miscarriage, and an ultrasound may be performed by your physician. If the bleeding stops and your blood values look good, it's

possible, you can just continue the pregnancy and wait until your 8-week visit to make sure everything is okay.

One important thing to know about this also is to know your blood type. If you're Rh-negative, you may need a program to protect future pregnancies.

"How do I pick an obstetrician?" That's a great question. So, you should first figure out which hospital you want to deliver. Once you've decided that, then you should investigate the doctors who practice at that hospital. You will find reviews online, you can look up their credentials, and in general, doctors who practice evidence-based medicine are, you know, much preferred to doctors who are not evidence-based and keeping up with the current literature.

It is essential to also ask your doctor before using them what their plan is if they are sick or out of town at the time when you are about to deliver your baby. You should make sure they have good coverage with people that they trust with your care. So, I want to thank you all for being here and for listening to this webinar about pregnancy.