Answers to Common Questions During Pregnancy

How do I contact people in the office?

If you have questions or concerns and you prefer not to wait until your next visit, please call the office or message us on patient portal. Our office number of (860) 646-1157, is answered 7 days a week, 24 hours a day. During business hours, our practice’s registered nurses Barbara and Carrie will return your call between seeing patients. After office hours, the phone is transferred to an answering service and the on call physician will be contacted with any emergencies. The on call physician will then call you back. If you have an upcoming appointment but have a questions or concern do not hesitate to call the office. You may read our “Pregnancy Roadmap” for any non-emergent questions that might come up in between visits.

Pregnancy Roadmap

The OBGYN Group of Eastern CT is excited to be part of your prenatal care. We understand that, whether this be your first baby or not, you might have questions along the way.

Who will deliver my baby?

We have seven physicians in the practice who deliver babies. We alternate call, and the physician that is on call the day you deliver will be the physician delivering your baby. For this reason, we want to be sure that you meet all the delivering providers during your pregnancy. We do not cross cover with any other groups, and you will never have a stranger deliver your baby.

What’s Ahead During Pregnancy?

Frequency of visits: We routinely see most patients every 4 weeks until 32 weeks, then every 2 weeks from 32 to 36 weeks. Weekly visits occur between 36 weeks and delivery. This may vary for patients with different needs.

We welcome questions at visits, and ask that you write questions down before coming so you don’t forget anything!

An overview of the major visits is below:

Education visit (5-7 weeks): You will meet with our PA, Pamela and review the testing offered in pregnancy, identify potential pregnancy complications, receive education about general pregnancy do’s/don’ts, as well as what to expect from us during the pregnancy. We will also draw pregnancy bloodwork. It is very important that you review your health insurance plan so that you are aware of what is covered, what is not, and your financial obligations. Our billing team will meet with you regarding your benefits.

Establishing pregnancy visit (8-10 weeks): We will obtain a complete history, and perform a health assessment. This will include a measurement of your weight, a urine culture, and a blood pressure check to serve as a baseline for subsequent visits. A manual breast exam, and pelvic exam, will also be performed. Your previous bloodwork will be reviewed with you at this appointment.

12 weeks pregnant: We should be able to hear the baby’s heartbeat with a Doppler, and we will do this at all visits going forward. If you have elected to have Down Syndrome screening, you will be seen at a Maternal Fetal Medicine office for an ultrasound and bloodwork between 12 and 14 weeks.

16 weeks pregnant: If you have elected to have Down Syndrome screening, you will complete this screening at this visit with bloodwork in the office. Individuals with an increased risk for gestational diabetes will undergo initial testing with a glucose test at this visit. The glucose test is a carbohydrate rich drink that you drink in our office. After one hour our phlebotomist will draw your blood. You should eat a fat and protein rich breakfast (ex: bacon and eggs) that morning and avoid all carbohydrates and excessive sugar.

20 weeks pregnant: Most women will receive an ultrasound in the office to screen for any abnormalities (AKA anatomy ultrasound). It is usually possible to determine the gender of the fetus at this ultrasound. High risk individuals will have this ultrasound performed at the Maternal Fetal Medicine office (AKA Level II anatomy ultrasound) in addition to their routine 20 week visit in our office.

24 weeks pregnant: At this visit you will be screened for Gestational Diabetes. You should eat a fat and protein rich breakfast (ex: bacon and eggs) that morning and avoid all carbohydrates. At the time of the test you will be asked to drink a small bottle of carbohydrate-rich drink and a blood test is drawn one hour after you have finished the drink. Along with this screening, we will check your blood count for anemia and other routine bloodwork. If your blood type is Rh negative you will need to get your rhogam injection at the hospital within 3 days of your visit. The Tdap vaccine is optimally timed to be given between 28 and 36 weeks gestation, and can be obtained from your primary care physician or a local pharmacy.

36 weeks pregnant: This is the time when we will test for a bacteria called Group B Strep (GBS) using a cotton swab in the vagina. While it has no symptoms in your pregnancy, this bacterial colonization can cause newborn to become ill within the first few days of life. If your GBS test is positive you will be given antibiotics when you are in labor. Please note that further testing may be indicated at any time during your pregnancy. We can explain why the test is needed, and what to expect before, during, and after the test. The result will be reviewed with you in detail at your next scheduled appointment.

Safe Solutions for you and your Baby!

Although the ideal situation is to abstain from all medication throughout your pregnancy, this may not be realistic for you. Some medications can be safely taken in pregnancy. The following list is provided to make you more comfortable.

Aches – Many preventative measures can be taken to avoid muscle aches, such as; exercise, proper body mechanics, good posture, and frequent position changes. If “prevention” is too late, begin implementing these techniques and try placing a heating pad to the affected area or a warm bath for no longer than twenty minutes at a time. Back support belts designed for pregnancy are available in maternity stores and provide relief for many women. One type of support belt is called Prenatal Cradle. Vulvar varicosities or varicose veins of the vulva can be supported with a V2 Supporter. Two Tylenol extrastrength or the generic equivalent, taken as directed, in combination with

these suggestions may help eliminate your discomfort. You can also try relaxing in a pool, as this is often successful in relieving pressure by creating a type of weightlessness. If these measures are not helpful most women benefit from a consultation with a qualified physical therapist for individual therapy.

Bloating – Intestinal gas and bloating in pregnancy can often be managed by an over the counter remedy containing simethicone, such as Phazyme.

Congestion and runny nose – Saline nasal drops or Breathe-Right strips used as directed may provide relief of sinus symptoms. A humidifier may also help the symptoms. Antihistamines such as Chlortrimeton, Benadryl, Zyrtec and Claritin are not associated with any known problems in pregnant women. For allergies Claritin and Zyrtec (or their generics loratadine and cetirizine) are best. If your symptoms are more from a cold or flu then the older antihistamines Chlortrimeton and Benadryl (chlorpheniramine or diphenhydramine) will relieve symptoms better but are known to cause more sleepiness than loratadine and certrizine. Decongestants in general should be avoided in pregnancy. A recent study showed some rare fetal birth defects associated with the first trimester use of Sudafed or phenylephrine, phenylpropanolamine, and psuedoephedrine. The use of the nasal spray oxymetazoline (Afrin) should be avoided in the first and second trimesters due to concerns about its association with fetal renal collecting system anomalies or kidney problems in the baby. Reference: Am J Epidemiol 2013:178(2):198-208.

Constipation – By increasing the amount of fiber in your diet, increasing your fluid intake, and maintaining an active lifestyle as possible, you will decrease the occurrence of, or at least help in relieving, constipation. If you are without relief, you may take Colace and Dulcolax as directed.

Cough – Robitussin is often helpful in treating a minor cough, if necessary. Depending on the type of cough you have, increasing humidity with a cool mist vaporizer may provide some relief as well as well as taking a hot shower. Increasing fluids can also moisten your throat and thin secretions, which may be helpful as well. Nonmedicated lozenges with glycerin or honey are helpful and safe.

Diarrhea – It is important to prevent dehydration and electrolyte imbalance when suffering from diarrhea by drinking enough water and Gatorade to make the color of your urine clear. A clear liquid diet, including items like jello and popsicles, is recommended. You can slowly return to a regular diet as symptoms disappear and if tolerated well. Imodium AD as directed is safe, however, be aware that constipation can be a side effect.

Fever – Tylenol extra strength as directed. If your temperature is 100.4° F or higher, please call the office.

Hemorrhoids – Preventative measures are to avoid straining when having a bowel movement through preventing constipation, spending the shortest time sitting on the toilet possible, avoiding, lifting heavy objects, and standing in one position for extended periods of time. If prevention is too late, Anusol HC, Tucks, and Dermaplast spray used as directed should provide temporary relief. Tub baths with Epsom’s salt are often soothing.

Indigestion – Avoid foods that make your symptoms worse (often spicy or greasy foods) Eat small frequent meals, and remain upright for at least 1 hour after eating. If you still have symptoms you can try Tums and Carafate. If you continue to have symptoms, call the office, but in general over the counter antacid medications (ex zantac or prilosec) are generally felt to be safe in pregnancy.

Insomnia – Avoid naps during the day if possible. Exercise for at least 30 minutes a day in the late afternoon/evening, and take a warm shower before bed. Don’t consume food or beverages that are high in sugar and caffeine after 5:00 PM. Place a nightlight in the bathroom so you don’t need to turn the full light on when you use the bathroom. If lack of sleep continues to haunt you, Benadryl taken occasionally can help.

Nausea – Eating food high in protein and complex carbohydrates while avoiding the ingestion (and the smell) of spicy or greasy food is a good start to preventing an episode of nausea. Try to eat several small meals a day. Because a too empty or too full stomach can increase the nausea, try to keep your stomach about the same degree of fullness all day. A bedtime snack with meat or milk (protein) will sometimes help you avoid morning nausea. Drink plenty of fluids between meals. Avoid extra stress and extreme fatigue. If nausea is inhibiting your activities of daily living, begin the day with crackers in bed. Proceed with other bland food such as dry toast, Cheerios, low salt pretzels, wheat/bran muffins, or ginger snaps until the nausea has subsided. “Sea bands” are acupressure wristbands worn to prevent motion sickness and effectively reduce nausea in some women. A variety of herbal remedies, often in the form of teas, including peppermint, spearmint, and ginger may reduce or even eliminate nausea. If you continue to have issues with nausea you can take the combination of unisom and vitamin B6 to decrease symptoms. This is taken as ½ of a 25 mg unisom tablet broken in half before bed, and a 10 or 25 mg vitamin b6 tablet every 6 hours as needed for nausea. We can provide prescription medications for women in whom these methods are not helpful. We also are able to give IV fluids to women with severe nausea and vomiting in the office. Hospitalization is required for only a low percentage of pregnant women and is generally limited to those women who are unable to continue to drink liquids. Nausea without vomiting, while miserable, generally does not require hospitalization.

Sore Throat – Any over the counter throat lozenge especially dyclonine (Sucrets Maximum Strength) or Chloraseptic spray taken as directed may be soothing. Tylenol can also help the pain. Treating runny nose and congestion as in the congestion section above will help with sore throat.

Leg Cramps – Calf cramps are very common in pregnancy, generally at night. If you have a cramp, stand up and stretch the calf muscle to help the cramp resolve. Daily stretching and good water intake can decrease the frequency of these cramps. If the cramps remain frequent with these measures you can take an over the counter magnesium supplement to decrease their frequency.

Leg Swelling – most pregnant women get some leg swelling during pregnancy, usually worse after standing for a long time. Compression stocking put on first thing in the morning can decrease leg swelling and also decrease discomfort with varicose veins.

Good Nutrition…it does make a difference!

Remember a 25-35 pound weight gain is ideal during these next nine months for women starting at a normal weight. This weight needs to come from adequate amounts of foods consisting of protein, carbohydrates, calcium, iron, fruits, and vegetables. Protein is essential for an appropriate birth weight in your newborn. By consuming four servings of protein a day, you can meet you and baby’s needs. Be careful to avoid eating fish that is high in mercury (shark, swordfish, king mackerel and tilefish). In order to avoid listeriosis, a bacterial infection potentially harmful to you and your baby, you should not eat pate` or store-made meat salads (chicken salad, tuna salad, etc.) and should only eat hot dogs, luncheon meats, bologna or deli meats if they have been re-heated until steaming hot. Also don’t drink raw or unpasteurized milk or milk products. Don’t eat soft cheeses such as feta, queso blanco, queso fresco, Brie, Camembert, blue-veined cheeses or Panela unless it is specifically labeled “MADE WITH PASTEURIZED MILK.” We recommend you review Food Safety for Pregnant Womenat this link. We also recommend www.fsis.usda.gov for information on food safety.

Five servings of complex carbohydrates a day will provide your baby with the required vitamins (B vitamins in particular) and minerals needed. Whole wheat, rice, oats, rye, soy, corn, barley, potatoes, and legumes are all wonderful sources of complex carbohydrates. Include a variety of these complex carbohydrates in your diet to get the maximum nutritional benefit. Calcium is not only essential for the development of strong bones and teeth, but for the development of your baby’s muscles, nerves, and heart as well. Four servings of calcium a day is crucial in supplying yourself and your baby adequately. Leg cramps in pregnancy are often due to insufficient calcium intake. Because your body is expanding its blood supply while your baby is developing his or her own blood supply, the demand for large amounts of iron is great. Get as much iron from your diet as possible by including lean beef, pork, poultry, liver, green leafy vegetables, legumes, and dried fruits whenever possible. These iron-fortified foods, eaten with Vitamin C rich sources (orange juice, strawberries, cantaloupe, green/red pepper, tomatoes, and broccoli), increase the absorption rate of iron. With this in mind, combine the two daily. Fruits and vegetables contain vitamin A, vitamin E, folic acid, riboflavin, and a host of other vitamins and minerals that are essential in the development of healthy skin, eyes, and bones. By eating three to five servings a day you will be providing your little one with the necessary vitamins and minerals he or she needs to develop appropriately. To satisfy your sweet tooth, enjoy the sweetness of fruit, fruit juice concentrates, or dried fruit and benefit from its nutritional value. Avoid empty, and therefore wasted, calories found in sugar and sugar products. Use this information as motivation to maintain excellent nutrition throughout your pregnancy and in return come as close as you can to guaranteeing your baby excellent health at birth!

Caffeine. Should I or should I not?

Caffeine intacke should be limited to under 200 mg/day. This is equivalent to 1 cup of coffee, 2 cups of tea, or 3 servings of soda. Artificial sweeteners are felt to be safe in pregnancy with the possible exception of Saccharin (sweet ‘n low) Alcohol and Cigarette Smoking.

Many women express their concern about having a couple of drinks before they knew they were pregnant. There is no evidence that a few drinks consumed early in pregnancy will have harmful effects on your developing baby. However, continuing to drink heavily throughout pregnancy could cause a multitude of complications as well as inducing harm to your growing baby. Because of these risks, alcohol consumption is not recommended.

Cigarette smoking has proven to be one of the most common causes of prenatal problems. There is evidence that cigarette smoking during pregnancy directly affects the development of your baby. Small birth weight, early birth, premature detachment of the placenta, and premature rupture of membranes are among the most serious complications. Therefore, cigarette smoking is strongly discouraged. Please ask us about options for help in smoking cessation.

Marijuana in Pregnancy

Marijuana has become legal in recent years for medicinal use in Connecticut and recreational use in Massachusetts, however, it is not recommended in pregnancy. Marijuana use in pregnancy has been shown to increase the risk of poor neurological outcomes in the child. For these reasons we strongly discourage marijuana use during pregnancy, even when prescribed to treat a medical problem.

Labor and Delivery Experience

The goal for each patient is to have a healthy mother and baby. If the baby’s heartbeat is reassuring on monitoring (category 1 strip) and the mother is doing well, we are flexible about particular birthing plans. The emphasis on each labor and delivery experience is on communication. A full explanation will be provided for each management decision we will make together. We encourage you to ask questions and express your concerns. We recognize that childbirth is one of the most important events in a woman’s life and strive to meet your expectations of the experience.

We prefer an intravenous access site for emergencies while admitted in labor. If you are admitted in labor and desire an epidural anesthesia, this may be obtained whenever the laboring patient desires. Hydration with adequate fluid intravenously is required before an epidural can be placed. We do not require a particular cervical examination change before an epidural can be administered. We also have access to IV pain medications as well as nitrous oxide to aid with labor pain relief.

Continuous monitoring is required if the mother is receiving IV medication to strengthen contractions, and if there is any question of the well-being of the baby. Internal monitors are recommended if there is a problem with monitoring the baby on external monitoring.

Cesarean sections are avoided unless the baby is showing signs of intolerance of labor, the baby is breech, or progress in labor is abnormal indicating the baby cannot be delivered vaginally. An episiotomy will not be performed without discussing it with you at the time, unless there is significant fetal distress and time does not allow.

Vaginal birth after cesarean section (VBAC) and vaginal birth after two cesareans (V2BAC) are options offered for appropriate candidates. We require a copy of your cesarean operative note in order to allow an attempted VBAC.

We are doula friendly and appreciate labor support from family and friends as well.

A tubal ligation can be provided at the time of cesarean delivery for patients who are certain they want permanent surgical contraception. Risks and benefits of this procedure need to be discussed in detail in the office.

If you are admitted in labor and desire an epidural anesthesia, this may be obtained whenever the laboring patient desires. Hydration with adequate fluid intravenously is required before an epidural can be placed. We do not require a particular cervical examination change before an epidural can be administered.

Manchester Memorial has a labor tub available for hydrotherapy. We have some providers who are comfortable with ‘water birth’ in the appropriate patient, but we can not guarantee that a ‘water birth’ provider will be available when you are in labor.

Most patients with vaginal deliveries stay in the hospital one to two days after delivery. Patients with cesarean sections stay two to three days after delivery. You will be discharged with pain medication if needed and a plan for follow up and contraception. Postpartum (after delivery) We want to see you back in the office at 6 weeks for a routine checkup after all deliveries. If you have shortness of breath, fever, heavy bleeding, abnormal discharge or problems with breasts or breast feeding, please call our office. It is also important to let us know about postpartum blues or depression. We recommend vaccinations of the baby as recommended by the American Academy of Pediatrics and the CDC, as we feel this is in the best interest of your baby’s health. Breastfeeding is a wonderful experience for most women, but can be one of the most frustrating if the baby does not nurse well. See our breastfeeding FAQ page for more information. For women who choose not to breast feed, engorged breasts can be treated with ice packs, cold cabbage as a pack to the breasts, Tylenol or Motrin, and binding the breasts. Intercourse, douching and tampons are to be avoided for 6 weeks. Vaginal bleeding may continue for several weeks, but is usually gone by 5-6 weeks. Almost all moms have swollen ankles after delivery. This edema gets worse when at home from the hospital, because you are on your feet more. The swelling will go away on it’s own. Keeping your feet above your heart for a portion of each day, and drinking extra fluid can speed the process. If the swelling is associated with shortness of breath and cough or a severe headache you should our offices.

Most first time moms are surprised by how fatigued they are in the baby’s first year of life. You are encouraged to call us if you experience postpartum blues that are not improving with rest and time. This can be a serious problem for some women. It helps to take more time for yourself, to get out of the house and do something you enjoyed before the baby came. Increasing your rest time by simply allowing others to help, is invaluable. You may need to treat yourself to a cleaning service, or send out the laundry. By this point in your care, our office will consider you our friend. Call if we can help you through this time.