Prenatal Care Instructions and Tests
Prenatal Care is a very important part of having a normal healthy baby. Prenatal visits help us diagnose and intervene as needed as early as possible. We encourage you to become active in your care and keep a list of questions or concerns.
Three Trimesters of Pregnancy:
First trimester –
you will have visits with your physician monthly.
Second trimester –
at approximately 28 weeks you will begin biweekly visits.
Third trimester –
At 36 weeks, you will begin weekly visits.
First and Second Trimester:
The first trimester is the time from conception to 12 weeks gestation. On your first appointment, the physician will conduct a physical exam and take a thorough history. We will be discussing nutrition, medical history, and exercise and will answer any questions you may have. Several physical changes occur early in pregnancy. You may experience nausea, vomiting, breast tenderness, or frequent urination. Nausea and vomiting usually fade after the first trimester. Relief measures include eating small frequent meals, avoiding spicy food and, if need be, using Emetrol, which you may buy over the counter.
The fetal heart beat can usually be heard around 12 weeks gestation. We will check the heart rate on each visit. You should start feeling fetal movement around 18-20 weeks gestation. It is commonly described as a “flutter” low in the abdomen.
Most fetal growth occurs during the last three months. During this time decisions will be made regarding anesthesia, bottle or breast feeding, and choosing a pediatrician. We will be happy to assist you in any way we can in making these decisions.
Tests Performed During Pregnancy:
- Blood pressure: Taken at each visit.
- Urine: Checked at each visit to see if your body is producing excess protein or glucose.
- Fundal Height: We measure the height of the uterus to help determine gestational growth.
- Fetal heart tones: The fetal heart beat will be audible after 12 weeks gestation.
- Ultrasound: Ultrasound can be performed after approximately seven weeks gestation. The ideal time is 20 weeks to evaluate organ development.
- Glucola: The glucose test screens for gestational diabetes. It is performed around 28 weeks and takes about one hour. Fasting is required for this test. Please do not eat or drink anything (including gum) or smoke after midnight the night before your test is scheduled.
What to Expect
Oral intake – You will be allowed to have ice chips, hard candy, or popsicles.
IV – An IV is necessary for administering antibiotics, pain medication, an epidural, or fluids for hydration. Keeping moms hydrated is better for the baby. An IV provides a way to give medicine to help stop your bleeding once the baby is born
Bed pans or urinary catheters – Bed pans are only necessary if you are restricted to bed. Urinary catheters are sometimes necessary with an epidural or if the baby’s head is low. A full bladder will prevent the baby’s head from descending into the pelvis.
Activity – During the early or “latent” phase of labor, it may be helpful to be up and moving around. You may take walks with your labor coach, sit in a chair, relax, sleep if you can, or take a warm shower. As labor progresses, walking or sitting may help the baby descend into the pelvis. The nurse will help you by making suggestions about walking or activity.
Monitoring – The baby’s heart rate and your contractions will need to be monitored during labor. It may be done periodically during early labor if all seems well. In most cases the baby will need to be monitored continuously during active labor. This may be done by external belts or internal devices placed through the dilated cervix. The doctor or nurse will explain which is best in your case.
Labor Management – The doctor or nurse will be checking your cervix periodically to evaluate your progress. At some point the doctor may break your water. The doctor may recommend a medication called pitocin to be given by IV to strengthen the contractions. These methods can sometimes help prevent a prolonged labor or a Caesarean section.
Pain relief – Your nurse and labor coach will help you with measures such as positioning and relaxation techniques to relieve discomfort. Pain medication can be given through the IV in small doses to help you relax. An epidural may be placed for pain relief.
Pushing – Positions for pushing include lying down, squatting, or kneeling. Squatting and kneeling may be difficult if you have an epidural for pain relief. Your nurse will help you find the best position for you. She and your labor coach will help you push. This sometimes takes one to three hours. The doctor will evaluate pushing periodically to determine progress.
Episiotomy – An episiotomy is not routine, but may be done to prevent excessive tearing of the vaginal area or to assist in a difficult delivery. A local anesthetic may be needed to numb the vaginal area if the patient does not have an epidural.
Forceps or vacuum – Forceps or vacuum are used only if necessary; for example, if the baby’s heart rate is slow or erratic, the position of the baby’s head makes delivery more difficult, or if you are too tired to push any longer (usually after at least two hours). Your doctor will discuss these measures with you if necessary.
Breast feeding – If there are no complications, you may hold and nurse the baby soon after delivery. It is best to try to nurse the baby within the first hour because they are usually very alert at that time.
Newborn care – After an hour or so, the baby will be taken to the nursery to be admitted to the hospital. This process usually takes two hours. Any concerns or requests you may have can be relayed to the nursery at this time (for example, if you do not want the baby to have a bottle or a pacifier)
Postpartum care – After an hour or two you will be moved to a room on the postpartum unit where you will remain until discharge. After a normal vaginal delivery you may go home after 24 hours, if you desire. In most cases you may stay for 48 hours. (This usually depends on your insurance.) If you are beta strep positive your baby will be required to stay in the hospital for 48 hours to make sure no complications arise.
What information you will need at the Hospital
- Insurance Cards
- Pediatrician Name
- List of known allergies
What to bring to the Hospital
- Music of your choice
- Telephone numbers – to notify family and friends of the new arrival
- Change for the coaches to use for vending machines
- Extra socks
- ChapStick or lip gloss for the mom
- Supportive bra, robe, slippers, gowns, underwear
- Loose fitting outfit to wear home
- Outfit for the baby to wear home
- Outfit for the baby’s first picture
- An appropriate infant car seat for the baby’s ride home
- List of three support people to be in the labor and delivery area