Labor, Delivery, & Postpartum

 

What is a Prenatal Visit?

A prenatal visit is a routine visit you make to your doctor or midwife while pregnant. You should expect to make several visits to your doctor or midwife throughout the course of your pregnancy.

When Should I Schedule My First Prenatal Visit?

The date of your first visit depends on a number of factors, depending how far along you were when you found out about the pregnancy, your health history, and your doctor's policies. Generally, your best option is to call your OB/GYN as soon as you find out you are pregnant, and they will let you know when to come in.

How Often Will I Have Prenatal Visits?

Most doctors will have you come in every four weeks throughout your first and second trimester. During the third trimester, you will likely come in every two weeks at first, and then every week once you hit 36 weeks. Of course, if you have health concerns which put your pregnancy at greater risk, you may need to come in a little more frequently. Your doctor will let you know.

Because of how frequently you can expect to see your doctor throughout the course of your pregnancy, choosing one you like and feel comfortable with is essential.

What Happens at a Prenatal Visit?

While each visit may differ slightly, here is what you can expect at a prenatal visit: At the first visit, the doctor or nurse will likely take your medical history and your vital signs, including your height, weight and blood pressure. The doctor will listen to baby's heartbeat and feel and measure your abdomen. Occasionally, you will give a urine or blood sample and you'll probably have an ultrasound or two. Toward the end of your pregnancy, your doctor will also check to see how far dilated you are.

Your doctor should also talk to you about any questions or concerns you have and instruct you on how to best care for yourself and your growing baby. Don't be afraid to ask questions, especially if this is your first pregnancy or if something doesn't seem right.

Prenatal visits are routine, so don't be surprised if they are fairly short after the first one. The doctor simply wants to check to make sure everything is looking okay, and if it is, you should be good to go until your next appointment!

Giving birth is a beautiful, natural process, but it can also take quite a toll on your body. Thankfully, there are plenty of tips and products out there designed to make your recovery easier. Here is what nurses and experienced moms everywhere recommend.

What is a First Trimester Screening?

A first trimester screening, performed roughly between 11-13 weeks of pregnancy, is used to detect chromosomal abnormalities such as Down's Syndrome, Edwards' Syndrome and Patau's Syndrome. It involves two parts, a blood test and an ultrasound screening referred to as a ‘Nuchal Scan’ or ‘Nuchal Translucency Screening.’ The screening helps your OB/GYN determine the fetus’ risk of these abnormalities.

How is a Nuchal Scan Performed?

A nuchal scan is done by ultrasound. The ultrasound technician will measure the amount of fluid in the back of the baby's neck. While all babies have some fluid in the back of their necks, the presence of excess fluid in the back of a baby's neck can be a symptom of an abnormality.

When Is a Nuchal Scan Performed?

Nuchal scans are generally performed between 11 and 14 weeks gestation. Tests completed before or after this range are not as accurate.

How Accurate are Nuchal Scans?

Nuchal scans are screening tests - not diagnostic tests. This means that they can be used to assess the risk or likelihood that your baby has an abnormality, but they cannot be used to diagnose a condition. If your nuchal scan does detect an abnormality, you will then have the option to pursue further diagnostic testing.

First trimester combined screenings typically detect Down Syndrome 85 percent of the time. However, they also give a false positive 5 percent of the time, meaning that they indicate an abnormality that doesn't exist.

What Should I Do If My Nuchal Scan Comes Back Positive?

If your nuchal scan indicates that there might be an abnormality, the first thing you need to do is try to relax. Just because the scan says something could be wrong with your baby's chromosomes does not necessarily mean that something is.

At this point, you will likely have the option to pursue diagnostic testing such as chorionic villus sampling or amniocentesis for a better understanding of what is going on. These tests do come with increased risks, however, so you will want to talk to your doctor to find out which course of action is best for you.

What Risks are Associated with Nuchal Scans?

Nuchal scans themselves present no known risks. However, receiving a false positive can lead to undue anxiety, more testing and even terminating a pregnancy needlessly.

Nuchal scans are routine and relatively risk-free, so if your doctor recommends one, do not be alarmed. He or she is likely just checking to be sure.

Prenatal ultrasounds are common part of a new mother’s prenatal testing. Using high­-frequency sound waves, ultrasounds produce images of a fetus and the mother's reproductive organs. These sessions, which are usually performed in a doctor's office, track fetal growth and development and monitor for any ongoing problems.

Standard ultrasounds are two-dimensional. A water-­based gel is applied directly to the mother's abdomen, and a wand, also called a transducer, will be maneuvered around the area. Transvaginal ultrasounds may also be used, in which a smaller transducer is placed inside the vaginal canal.

The images being captured will then be shown on a screen in black­-and­-white. These are used from the very beginning to pregnancy to confirm the gestational age and size of the fetus, monitor the fetal heartbeat, examine the mother's reproductive system, and diagnose any abnormalities. Doctors may also use ultrasounds to guide them as they perform other tests, such as an amniocentesis (an analysis of the amniotic fluid).

Ultrasounds are usually performed as part of screening or medically recommended testing, and should not be performed solely to reveal the sex of the fetus. Doctors also do not recommend ‘souvenir’ ultrasounds, as these might pose as-­yet unknown risks for the fetus.

 

Pain Reduction

Find out if your hospital offers special ice packs to new mothers, and if they don't, make your own. They are bulky, but they will help. Dermoplast pain spray helps immensely too. Line your sanitary napkin with a witch hazel pad to ease the itchiness of any stitches. Recline or lay down rather than sitting straight up. It is normal to feel contraction, similar in pain to menstrual cramps, after birth. These tend to worsen with every successive pregnancy.

For the Bleeding

You will bleed for several weeks after birth. Either wear the underwear the hospital provides or your own underwear you don't care about with a giant pad. Some women opt for adult diapers. Your bleeding should gradually slow and turn from bright red to brown. Call your doctor right away if you soak a pad within an hour, you pass clots larger than a golf ball or your vaginal discharge smells foul.

For Your Breasts

Your milk probably won't come in for a day or two after birth. If your breasts are painfully full, you may pump or feed a little for relief, but be careful not to overdo it as your body produces milk on a supply -and­-demand basis.

It is normal for breastfeeding to hurt at first. Make sure baby is latched on correctly and use Lanolin cream to help with any cracking or bleeding. Alternate which side you feed on and wear nursing pads to catch any leaking, especially at first.

If you are not planning on breastfeeding, wear a compression bra and do not pump. Cold washcloths can help with the pain.

Using the Bathroom

Use a squirt bottle when you urinate for the first few days to relieve the stinging. If you find yourself leaking small amounts of urine throughout the day, doing Kegels can help. If you have hemorrhoids, witch hazel pads can soothe them. If your stools are hard and painful, be sure to drink plenty of water and consume enough fruits and vegetables. Your doctor may also recommend a stool softener. You may find it helpful to take a sitz bath afterwards.

Other

Rest as much as possible, and don't be afraid to ask for help. Do not drive or carry anything over 10 pounds for a week. Realize that mood swings are normal, but if you are worried you have postpartum depression, talk to your doctor right away. Worry about taking care of yourself and your baby before you worry about weight loss.

After about six weeks, you’ll check in with your healthcare provider. This is the time to discuss any symptoms still troubling you and look at your progress so far. All in all, take things at your own pace, and try to enjoy these first precious weeks after your delivery!

Considering the many chemical changes that happen before, during and after childbirth, it really should come as no surprise that many pregnant women and new mothers experience confusing mood swings. While this is normal, there does come a point when the sadness has lasted long enough and been severe enough to cause concern.

What Sets Postpartum Depression Apart?

It is completely normal for new mothers to have mood swings, sadness, irritability, trouble sleeping and anxiety -­ some people call these the “baby blues.” However, when a new mother's symptoms go on to include severe mood swings, withdrawal from friends and family, fatigue, intense anger and a lack of interest in life, something more serious may be the cause: postpartum depression. Postpartum depression can even cause thoughts about hurting yourself or your baby.

Postpartum depression affects 10­-15% of women every year, making it a very common condition. Postpartum depression isn't the mother's fault, but she and her family may suffer if she doesn't receive the treatment she needs.

If you begin to see things that aren’t there or feel confused and paranoid, you may be suffering from a more rare and severe postpartum psychological disorder, and should contact a doctorimmediately.

Causes of Postpartum Depression

No one is 100 percent sure what causes some women to get postpartum depression while others slide into motherhood blissfully. However, doctors think that the condition can be worsened by:

  • Hormonal changes
  • Lack of sleep
  • Anxiety
  • Lifestyle changes while caring for a newborn
  • Genetic predisposition

Women who have a history of depression, who are undergoing a stressful period, who lack a strong support systems, or whose pregnancy was unintended are at an increased risk, though postpartum depression can happen to anyone.

If you think you may be suffering from postpartum depression, you aren't alone, and there is hope. Call your doctor if your symptoms don't lessen within two weeks, if they are getting worse, or if you are having a difficult time doing routine tasks and caring for yourself and your baby. Call your doctor immediately if you are thinking about harming yourself or your baby.

Treatment

Treatments for postpartum depression range the gamut from counseling and talk therapy to medications such as antidepressants. Your doctor may also recommend simple lifestyle changes to improve your symptoms, but, make no mistake, postpartum depression must be treated by a doctor.

Postpartum depression is a serious condition that can last for months or even years if not treated. There is nothing to be embarrassed about. If you think you may be experiencing symptoms such as those listed above, call your OB/GYN today.

While complications could potentially happen in any pregnancy, a high­-risk pregnancy is one in which there is a greater risk of complications. A pregnancy could be considered high-­risk whenever the mother has one or more of the following risk factors:

  • Age: Women who are younger than 18 or older than 35.
  • Medical History: Certain health conditions, or coming from a family with a history of those conditions. These include, but are not limited to, diabetes, anemia, cancer, mental health problems and high blood pressure.
  • Pregnancy History: Women who have had pregnancy complications such as miscarriages, prior C­-sections and early labor.
  • Pregnancy Complications: Women who develop certain pregnancy complications,including gestational diabetes, preeclampsia, too much or too little amniotic fluid, or restricted fetal growth.
  • Number of Babies: While twins are a blessing, they also put a woman at greater risk for complications.
  • Infections: Infections such as HIV, Hepatitus C, Rubella and chickenpox.
  • Lifestyle Choices: Smoking, drinking, or using drugs.

Just because your pregnancy is considered high-risk does not mean that you won't deliver a healthy and happy baby. It simply means that you will need to be even more careful, and that your doctor will want to monitor you a little more closely to make sure that both you and your baby stay healthy.

If your pregnancy is considered high-risk, make sure to see your doctor regularly, eat a healthy, balanced diet, exercise in moderation and avoid risky substances. Be sure to also keep the lines of communication open between you and your doctor. Be truthful about your medical history and any symptoms that you have had or are having. Follow your doctor's advice and don't be afraid to ask questions.

A pregnancy should be a time of excitement. Take care of yourself and your baby and work closely with your doctor, and chances are everything will turn out just fine!