It is so important to connect with a local OB/GYN provider, a doctor or midwife, as soon a feasible after finding out that you are expecting. This helps to increase the odds of a safe pregnancy and delivery, or may help to discover concerns as early as possible so that recommended plans of care and/or visits to specialists may be initiated. Ideally, you would continue with the current office where you go for your annual pelvic exam but if for some reason you don't have one or prefer to change start searching right away. You can check with family and friends for a recommendation and start browsing the local hospital website to connect with someone that way. While there are other options available to you for where you choose to have your baby (some people prefer to deliver at a birthing center or at home under the care of a midwife if they have a low-risk pregnancy) but this site concentrates only on hospital births so we will not be delving into that further here. Keep in mind that certain hospitals are not set up to deliver babies, this is especially common if you have a health system in your area with multiple locations, so be sure to find out which locations offer those services. Likewise, your provider may not elect to deliver at certain hospitals in the area when there are several to choose from, usually due to distance from home and office, so ensure you select a facility and provider with these things in mind.
This is a very exciting time, and you are likely eager to do everything possible to ensure the health of both you and your growing baby. One of the most important ways you can do this is by actively participating in your prenatal care. This means keeping all of your appointments, following the recommended guidelines for tests, and communicating openly with your healthcare provider about any concerns or questions you may have.
Regular prenatal care is crucial for monitoring the health and development of your baby and for identifying and addressing any potential problems early on.
It is recommended that you see your healthcare provider for prenatal check-ups about once a month during the first 28 weeks of pregnancy, and then every two weeks until 36 weeks, and then weekly until delivery. During these appointments, your provider will check your weight, blood pressure, and urine, and will measure the growth of your baby as well as check the baby’s heart rate.
In addition to regular check-ups, there are several recommended tests that you should have during your pregnancy. These tests can help identify any potential health issues for you or your baby, and can help your healthcare provider develop a plan of care that is tailored to your specific needs.
One such test included in your prenatal blood panel is your blood type and Rh factor: This test checks for the presence of a specific protein on the surface of red blood cells called the Rh factor. You may have been told for example that your blood type is O+. That means your blood type is O and your Rh factor is positive, therefore you have a specific protein on your red blood cells. A woman who does not have this protein will be Rh negative, O negative in this example. If a woman is Rh negative and the baby is Rh positive, which we will not usually know until it is born, it is possible that the mother could build up antibodies against this protein in her baby’s blood which could then attack and destroy the baby’s blood cells recognizing them as a foreign intruder. This could affect not only this pregnancy but also future pregnancies for the mother as well. Fortunately, the baby’s blood typically does not mix with the mother’s but it is possible that it could during some invasive testing, trauma, or birth. To prevent the mother’s blood from having this occur we are able to give a product called Rhogam or Rhophylac. This can be given as an injection in the muscle at 28 weeks and again after delivery. The Rhophylac product can also be given through an IV line which patients usually have while in the hospital, so guard that IV if you need this to save yourself from getting another needle stick!
Another test of great importance is the complete blood count (CBC). It is done early in pregnancy and usually repeated later in pregnancy as well. This test measures the levels of various blood components, such as red and white blood cells and platelets. One such abnormality in these levels can indicate anemia (a common condition in pregnancy caused by having a low number of red blood cells or low iron levels), infection, or other conditions that could affect the pregnancy. Your provider will talk with you about ways to increase your iron if you have abnormal results. Typically this involves consuming more foods rich in iron especially with foods or drinks containing vitamin C to increase your body’s absorption of the iron. They may also recommend an iron supplement for certain patients.
An exam commonly repeated (sometimes at each visit) is the urinalysis. This is a urine screen that checks for signs of infection in the bladder or kidneys, signs of diabetes by examining the glucose (sugar) levels, and preeclampsia (a serious problem affecting blood pressure) by checking protein levels. The urine may also be screened for maternal drug use but is dependent on individual office policies. We will discuss this topic further in later sections.
Testing for sexually transmitted infections (some of which are also passed along through exposure to bodily fluids or needle sticks), will also be performed. Syphilis (usually found in the bloodwork under RPR or VDRL) , HIV, Hepatitis B, Herpes (HSV) and other sexually transmitted infections (such as gonorrhea and chlamydia) are also recommended. These infections can be passed from the mother to the baby during delivery and can have serious health consequences if not treated. With proper treatment the risk of transmission to the baby can be significantly reduced. Some of these are easily treated and you will have a follow up test to ensure that the infection is gone (often referred to as a test of cure), while others involve more monitoring and various regimens, sometimes including seeing a provider specializing in infectious disease.
Your immunity to the Rubella virus will also be checked. Rubella is a viral infection that can cause serious birth defects or miscarriage/stillbirth if contracted during pregnancy. Typically patients who have been vaccinated earlier in life with an MMR (Measles, Mumps, and Rubella) vaccine series are still immune, meaning they will not contract the virus if exposed. However, over time our immunity may lessen and we may become nonimmune or equivocal (meaning somewhat but not fully protected). This test is included in the initial blood panel but unfortunately we can't do anything about it while you are still pregnant (other than recommending avoiding anyone with a known infection) as giving the vaccine during pregnancy will likely cause the problems we are trying to prevent since it uses a weakened live virus. We test because we can give you the vaccine soon after delivery to protect you and your future pregnancies. After delivery during your hospital stay is the best time to give it to you because you won’t be getting pregnant in the next few weeks due to avoiding sexual activity.
There is a blood test that can be performed at approximately 10 weeks that is referred to as a noninvasive prenatal test, or NIPT for short, that can tell us many things about your baby. There are many brands of such tests that the office can use, so you may see MaterniT 21 Plus or other such brochures in the waiting area. During pregnancy there is a small amount of fetal dna in your bloodstream and the NIPT analyzes this via a mother's blood draw for numerous genetic disorders (such as Down syndrome, Edward syndrome, and Patau syndrome). This information was previously only available through more invasive testing, so this is a wonderful advancement. If any results come back positive this would require further testing to confirm any suspected diagnosis. Your provider may refer you to a genetic counselor at any point prior to, during, or after your pregnancy based on your health history, risk factors, familial health history, or results found on this or others tests. A fun and sometimes medically useful part of the test is that it can also determine the sex of the baby. Should you wish to be surprised about the sex of your baby at a gender reveal party or at delivery you can ask the provider to not release that information to you and/or to write it on paper they place in a sealed envelope that you bring in to your appointment with you.
Other exams include a one hour glucose tolerance test, abbreviated as gtt, is usually given around 24 weeks of pregnancy. This is a test to measure your blood sugar (glucose) which could indicate if you have diabetes in pregnancy, known as gestational diabetes. This involves drinking a sugar solution and having blood drawn an hour after you start drinking it. The lab will check your blood sugar to see how your body handles the mixture. If it is high a follow up test will be administered another day over 3 hours, a 3 hour gtt. . If those results are high your provider will discuss management of your gestational diabetes with diet control, or possibly also medications including metformin and/or insulin.
Around 36 weeks of pregnancy your provider will likely order a GBS test, which stands for Group Beta Strep, a common bacteria found in the vaginal and GI tracts.. This bacteria is not a sexually transmitted infection and typically poses no harm to the mothers who carry it, but can cause issues with the baby at delivery. Because of this, mothers who test positive are usually given antibiotics via IV during their labor to reduce the risk of transmission to the baby.
Another important test you will have during your pregnancy is the ultrasound. This test uses high-frequency sound waves to create images of your baby in the womb. Usually you will have a preliminary scan at your first appt that may be done transvaginally (with a wand in the vagina) because the baby is so small at that stage and this can produce a more accurate image. They will determine at this time if you have one or more babies, if your baby has a heartbeat, the location of your placenta, and approximately how far along you are. Then you can have a more detailed anatomy scan at around 18-20 weeks. At this time the provider would be looking to see the placenta, and if the baby had any obvious disorders related to the brain, heart, lungs, kidneys, or overall growth and development. They could also determine the sex of the baby if the baby was in a good position to see the genitals, although you may already know this if the blood test had been performed earlier in pregnancy. If everything the provider was looking for was visible on this scan and there are no other issues this may be the last scan prior to delivery. The office usually prints out several pictures for you to keep of the ultrasound but may be able to provide you with a video copy if you bring a disk or flash drive depending on the equipment used so be sure to ask about this before the appointment. Sometimes you may wish to have more people present at the ultrasound than just your partner but I would caution you in doing that, if your office even allows for it. You may be given information that there is a concern and you don’t really need to process that with an audience.
It is important to keep in mind that the recommended tests and appointments may vary depending on your individual health history and risk factors. Your healthcare provider will work with you to develop a plan of care that is tailored to your specific needs.
In addition to attending your appointments and following the recommended guidelines for tests, there are several other things you can do to ensure a healthy pregnancy. These include maintaining a healthy diet and getting regular exercise, avoiding alcohol, tobacco, excessive caffeine, and recreational drugs. If you do use any of these substances please talk to your provider openly about this as they may have ways to help you to safely quit or can refer you to someone who can help you transition to a less dangerous product during the pregnancy. Also use care before consuming any over the counter medication (Yes, even something as seemingly innocent as Motrin or a dietary supplement) before seeing your provider. You will usually be given a list of what you can safely take if needed for a minor ailment. The office will also instruct you on what foods to avoid as some can be harmful to consume during pregnancy. These include soft cheeses, deli meats, and raw eggs, raw sprouts, and raw fish as they may contain a harmful bacteria that could lead to miscarriage. Also avoiding excessive amounts of fish that is high in mercury (like shark steaks or white albacore tuna) is critical for your baby's developing brain and nervous system. Your provider will educate you further on these topics but it is always nice to learn something before hand so that you may be prepared ask questions you have regarding your medical or dietary needs.
I would like to encourage you to consider creating a birth plan.
I know every nurse that has ever worked in OB is cringing right now reading this! "Why?," you ask. It is because every time someone comes in with even the best thought out printed care plan nothing ever seems to go according to this plan. Being too specific or rigid in exactly what you want is a surefire why to ensure Murphy's law comes in to play where everything goes out the window. It is important to know that your birth plan does not need to be a physical document and is even preferred not to be, but can be simply a set of preferences that you keep in your mind. When considering the things you want, think about what is most important to you, such as pain management options, labor positions you may wish to try, who you want in the delivery room with you, and any cultural or religious preferences. For example, when I was having my first baby I had in my mind that I would like to receive an epidural for pain. Working in OB I know this doesn't always work out if, for example, I was too far along when I arrived, or the anesthesiologist was backed up due to emergencies. Had I been too adamant that I was definitely getting an epidural I may not have been prepared mentally for things not going according to plan. The opposite has happened to others in the case where she definitely did not want to receive any medications for pain but ended up with a very long labor and felt like a failure when she asked for medicine. Your plan is only a general guideline of your wishes and may be subject to change based on your pain level, your baby's tolerance to labor, and other factors. We understand that labor and delivery can be unpredictable, and our top priority is always the safety and well-being of both you and your baby. Be sure to discuss your plan with your healthcare provider and ask questions about any concerns or uncertainties you may have.
Remember, your birth plan is simply a fluid set of ideas to help guide your care team in providing the best possible experience for you and your baby. But please keep in mind that unexpected circumstances can arise, and your care team will always prioritize your health and the health of your baby above all else.
Planning how you'll feed your baby is an important decision that you'll need to make before your little one arrives. You have different options to choose from, including breastfeeding, formula feeding, or a combination of both. It's important to know that whichever option you choose, it should be one that you feel comfortable with and works best for both you and your baby.
Breastfeeding provides a host of benefits for your baby, including important nutrients and immune-boosting properties. It's also a great way for you and your baby to bond and helps promote your healing post-delivery. It can also help reduce the risk of certain types of cancer for the mother. If you're considering breastfeeding, talk to your healthcare provider and/or a lactation consultant to learn more about how to prepare and what to expect.
While formula feeding doesn't offer the same immune-boosting benefits as breast milk, it can provide complete nutrition for your baby. Modern infant formula has been developed to closely mimic breast milk, and it can be a great option for moms who are unable or choose not to breastfeed. If you choose to formula feed, make sure to follow the instructions carefully and ask your healthcare provider any questions you may have.
Donated human milk is yet another option that can be considered as well and will be addressed in the lactation section, as will pumping your own breastmilk and feeding it in a bottle.
Whatever your decision, remember that feeding your baby is an individual choice and there's no one-size-fits-all answer. Your providers, lactation consultants, and OB nurses are here to support you and help you make the best decision for you and your baby.
Choosing a pediatric provider for your baby is another important decision you'll need to make prior to delivery. This is a healthcare professional who specializes in the medical care of children, from infancy through adolescence. If you have not yet selected one when you arrive at the hospital there is typically someone called a hospitalist that will care for the baby until discharge. This can be a physician or nurse practitioner that only works in the hospital, not someone that you will continue care with in the community. They are there for families who have not yet made a decision or for those whose providers do not come to that particular hospital to see them.
When choosing a pediatric provider, consider factors such as their experience, qualifications, and reputation. You may want to ask for recommendations from friends, family members, or your own provider. It's also important to find someone whose approach to healthcare aligns with your own values and beliefs.
Once you've found a potential provider, schedule a consultation or interview to get to know them better. Ask questions about their philosophy of care, their approach to handling common childhood illnesses, and any other concerns you may have.
Remember that you'll ideally be working closely with your pediatric provider over the course of your child's life (although you may certainly change at anytime) so it's important to establish care with someone you trust and feel comfortable with.
When preparing to give birth at a hospital, there are a few essential items that expectant mothers should bring along and other items best left at home. Bringing too much can be cumbersome and take up valuable space. It's best to pack light and focus on bringing the essentials to make the hospital stay as comfortable as possible. Hospitals typically provide basic necessities such as towels, washcloths, hospital gowns, pads and underwear. You do not need to bring items like Depends, although some patients prefer to have them, because they do not allow providers to check your bottom easily and may have to be completely removed during assessments which you may find annoying. It doesn't matter to us either way so it is completely up to you. They also usually have items such as soap, a basic shampoo and body wash combination product, toothbrush, and toothpaste, but you may prefer to pack your own for yourself and your partner. You will probably also want to bring hair ties, conditioner, and a lip moisturizer/chapstick to ensure your comfort, and many hospitals do not provide deodorant so you can add that to your list as well. They have hand soaps and hand sanitizer of course, but a small travel bottle of sanitizer may be nice for your bedside table in case you are not up and about right away. Hospitals usually provide no-slip socks that can be worn in the room or around the unit but you would want to put on a new pair before getting back into your bed for infection control and that may be wasteful or not possible due to supply limitations. A pair of slip on shoes like sandals or slides make it very convenient for you to get in and out of bed, just be sure they fit properly so they are not a trip hazard. Other items may include comfortable clothing to wear after delivery such as a loose-fitting nightgown and a comfortable, stretchy outfit, and either a very supportive bra if you choose not to breastfeed or a looser fitting nursing bra if you do. Hospitals typically don't carry nursing pads as they may not be needed in the first day or two post-delivery, but if you are already leaking breastmilk it is very nice to have them. Breast pumps are usually available at the hospital to use during your stay for no additional charge so they prefer you not bring your own in case of accidental damage from being dropped or power surges. Be sure to bring your cell phones with important numbers already programmed in your contact list, and chargers with long cords as the outlets may be far behind you in the wall or on/under your or your partner's bed. Just please use care when plugging in items so they are not a trip hazard for you or staff, and do not keep them in bed with you while you sleep. While it is comforting to bring necessary items, it's also important not to overpack as you may have to move several times during your stay. Please leave all valuables and your medications at home. You cannot take any of your own medications at the hospital (unless you have a specific formulation that they do not have) so its best to leave them but please bring a list of your medications with current doses. Your partner may want to have a small amount of pain reliever, antacids, and any prescription medications packed in advance as well. It is usually very cold in the hospital which you will likely not feel as much due to your hormones but your partner and visitors may be freezing so make sure they bring warm clothing, a cozy blanket if desired, and layers like sweatshirts, etc.
You will also want to pack items for the baby if they are important to you, such as a going-home outfit, an outfit or two with any special blankets or small signs you wish to use for the photographs. Please be aware that the baby may quickly soil the outfit you planned to use so don't put it on too far before the photo session and have the extras as mentioned. The hospital will normally provide baby blankets, long-sleeved t-shirts with built-in mittens, hats, diapers and wipes. Diaper creams are usually not needed in the first few days so are not typically provided by the hospital. Baby lotions are also not necessary to use or bring. You may choose to bring mitts for the baby's hands if you plan to spend a lot of time skin to skin but find the baby is scratching too often and you want to protect the face. Sometimes the mitts are too loose and they are able to remove them quickly, so you may be better off with some thicker athletic type socks to use in the early days instead. A properly installed infant car seat is a must, so please purchase the car seat well in advance and open it and learn how to use it. Many facilities have a special department, with employees known as child advocates that are certified installers and educators who will assist you during a detailed appointment. This is best done in advance but they may be able to accommodate you during your stay, although it is not guaranteed.
It's always a good idea to check with the hospital beforehand to see if they have any specific guidelines or recommendations regarding what to bring. Usually you will need your ID and insurance card, and your partner and other visitors typically need their ID to gain entrance to the facility. You may need to bring your records with you unless this has already been taken care of electronically by your provider. Some hospitals allow you to pre-register to that you don't have to worry about it while you are in labor. If you are planning to travel near the end of your pregnancy please do have a written copy of your records printed by your provider. I can't even begin to count how many patients I have taken care of while they were on vacation! If your office is closed or takes too long to send records you may have to unnecessarily repeat some testing so the hospital team can best care for you.
While your provider has surely already told you when to go to the hospital (usually if your water has broken, you are having bleeding, or your contractions are at least every 5 minutes lasting for a minute each for at least an hour, or you are having any medical issues like severe headache, blurred or disturbed vision, etc.) it is up to you to know the best way to get there. Please be aware of any construction going on in your area that may cause you delay or when rush hour traffic is, and know any alternate routes to save you time. If it is a true medical emergency please call 911, do not have your partner try to drive you for your safety and that of those around you. Also, be aware of the correct entrance to go to at the facility as certain doors may be locked during the evenings and nights, or there may be a separate OB entrance, and knowing this will save you from excessive walking to and from the car multiple times.
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