Obstetric care

Preconceptual counseling focuses on planning to have a baby. You’ll meet with an obstetrician to discuss preparing for pregnancy and how to take good care of yourself before and during pregnancy.

You’ll also talk about pregnancy risks based on your health history. Your spouse or partner is welcome to be part of this appointment.

Topics include:

• Any medical conditions you may have that might affect your pregnancy or your health 
• Genetic (inherited) risks and the chances of passing on a genetic disorder to your child
• Screening tests for genetic disorders that can be passed on to your baby
• Risks associated with older parents, such as Down syndrome
• Your pregnancy history to see if you’re at risk for preterm labor and delivery or other concerns

Your first obstetric visit is usually when you’re about 8 weeks pregnant with one of our physician assistants or nurse practitioners. This visit includes an ultrasound and blood draws for prenatal labs.

We'll also talk to you about:

• Your health history 
• How to take care of yourself during pregnancy
• Our clinic and Swedish Medical Center, where you’ll deliver your baby
• Diet and exercise
• Genetic screening tests (to check for inherited risks)
• Warning signs 
• When to see your doctor

You will see your doctor for your next visit around 11 to 12 weeks.

You’ll be scheduled for many office visits during your pregnancy. These allow your doctor to check on your health and the baby’s growth and development. As you get closer to your due date, these visits will happen more often.

The following is a typical schedule of doctor visits during pregnancy:

• Every 4 weeks up to 28 weeks pregnant
• Every 2 weeks from 30  to 36 weeks pregnant
• Once a week from 37 weeks to delivery

Your body’s hormone levels change during early pregnancy, which can cause nausea and vomiting. This is often called morning sickness, but it can happen at any time of day. This usually goes away after about the third month.

To prevent morning sickness, try the following:

• Eat a piece of bread or a few crackers before you get out of bed in the morning (put them close to your bed the night before) or when your stomach is upset.
• Get out of bed slowly. Avoid sudden movements.
• Eat yogurt, cottage cheese, juice or milk before you go to bed or get up. 
• Eat small meals during the day so your stomach doesn’t remain empty for long.
• Eat high-protein foods like eggs, cheese, nuts or meat, as well as fruit and juices. These foods help prevent low blood sugar, which can cause an upset stomach.
• Have soup or other liquids between meals instead of with meals.
• Don’t eat greasy or fried foods because they’re hard to digest.
• Don’t eat spicy, heavily seasoned foods.

If you have morning sickness:

• Sip soda water (carbonated water).
• Get fresh air. This can include taking a walk or sleeping with a window open. When you cook, turn on the exhaust fan or open a window. 
• Take deep breaths.
• Drink spearmint, raspberry or peppermint tea.

If vomiting continues, or if it becomes difficult to keep food or liquids down, call your doctor. Also, don’t take over-the-counter, anti-nausea medications unless your doctor tells you to.

There aren’t many studies about medication use during pregnancy. Because of this, safety information is gathered slowly — usually when drugs are used accidentally during pregnancy, or when a doctor decides a health concern is serious enough to use medication. 

Guidelines:

• Try natural remedies first, such as rest, fluids, a change in diet, ice or heat. (Take care not to overheat yourself.)
• If you must take medication, read the list of active ingredients. All products list them in the fine print. 
• Don’t use products with mixtures of active ingredients, such as Comtrex^® (acetaminophen, dextromethorphan hydrobromide, phenylephrine hydrochloride, and chlorpheniramine maleate kit) or Theraflu^® (diphenhydramine HCl). They usually include ingredients that aren't recommended.
• If you’re sick, call your doctor. Prescription medications like antibiotics can be used if needed. It’s important to treat urinary tract infections to lower the chances of early labor. Significant respiratory and other infections may need antibiotics as well. 
• While homeopathic and natural remedies are great for help with symptoms, some can be harmful in pregnancy and others haven't been studied. Don't hesitate to check with your doctor before trying something.

Given the safety data we do have, the medications listed here seem to be safe to use during pregnancy: 

• Benadryl^® (diphenhydramine)
• Claritin^® (loratadine)
• FiberCon^® (calcium polycarbophil) 
• Gyne-Lotrimin^® (clotrimazole)
• Imodium^® (loperamide)
• Metamucil^®/Benefiber^® (psyllium fiber supplement)
• MiraLAX^® (polyethylene glycol 3350)
• Monistat^® (miconazole nitrate) 
• Mylanta^®, Maalox^® (aluminum hydroxide/magnesium hydroxide/simethicone)
• Pepcid^® (famotidine) 
• Robitussin DM^® (guaifenesin/dextromethorphan)
• Sea Brands
• Sucrets^® throat lozenges (dyclonine)
• Tums^® (calcium carbonate)
• Tylenol^® (acetaminophen)
• Sudafed^® HCl (pseudoephedrine HCl), after first trimester
• Unisom^® (doxylamine) 
• Vitamin B6
• Nasal saline
• Cough drops that don’t contain zinc or echinacea 

Note that we can’t guarantee the safety of any drug taken during pregnancy. If you decide to take medication, please use caution.

Some women who have given birth before by cesarean (also called a C-section, delivering a baby by surgery) want to try a vaginal birth. This is called a trial of labor after cesarean (TOLAC).

Women choose TOLAC for different reasons. Some don’t want to have surgery or a longer recovery period again. Others want to try a vaginal birth. We understand this and offer TOLAC only to certain patients after careful consideration.

We have many safeguards in place to care for women who want a TOLAC delivery. These include:

• Careful patient selection to identify patients with the greatest chances of success 
• Information about the process and potential risks 
• Doctors available 24/7 so we can respond right away when you go into labor
• Ready access to emergency surgical care if needed during delivery

We work closely with each patient to understand as best we can the risks and benefits specific to your situation. We also respect your values, while never losing sight of our number one goal — a safe delivery for you and your baby.

We will talk with you and your partner about:

• The status of your labor 
• How the baby is doing 
• Any questions or concerns we have
• Any other issues that may come up

If you have questions at any time, let us know. It’s part of our commitment to providing the best care we can for you and your baby.

Cord blood is the blood that stays in the umbilical cord after your baby is born and the cord has been cut. Cord blood is a rich source of stem cells, which are used in many medical treatments.

Donating or banking your baby’s cord blood is an important option available to you when you have a baby. Because cord blood stem cells are collected right after delivery, it’s important to think about this before the birth of your child.

There are four choices you can make about your baby’s cord blood:

• The hospital will dispose of it along with the placenta. 
• It will be used for research, for example, at Seattle’s Fred Hutchinson Cancer Research Center.
• It will be given to a public blood bank. Your donation may be made available to any patient who needs a stem cell transplant. There is no cost to you.
• It will be collected and stored for you for a fee.

If you’re expecting a boy, you’ll need to decide if you want to have him circumcised. This involves removing a small piece of skin that covers the head of the penis. Circumcision is done in your doctor’s office. It’s a simple procedure that takes just a few minutes.

Steps include:

• The doctor cleans and numbs the groin area. 
• The foreskin is removed with a special clamp. 
• The penis is wrapped in petroleum jelly and gauze to protect it.
• Healing takes about seven to 10 days. You will receive detailed care instructions.

Many parents have their baby circumcised for personal or religious reasons. There are pros and cons to circumcision and to leaving the foreskin intact. The decision is entirely up to you. 

Our ob/gyns provide postpartum (after birth) care for mothers. The goal is to help you recover and return to normal activities. The postpartum period lasts for six weeks.

Postpartum care begins in the hospital after delivery. On average, women spend 24 to 36 hours in the hospital after a vaginal delivery and 48 to 60 hours after a cesarean. Because all deliveries are different, you may need a longer hospital stay.

At your postpartum exam, your doctor will:

• Check on your physical and emotional recovery
• Screen you for depression 
• Talk about birth control (family planning)
• Talk about exercise and your return to normal activity
  

During the postpartum phase, your strength and energy levels should get better over time. If you don’t feel you’re recovering emotionally the way you should, your doctor can connect you to the Swedish Center for Perinatal Bonding and Support.

Our goal is a safe delivery for you and your baby. You can help by calling us right away if you notice any of the following changes: 

• During pregnancy, if you notice your baby is moving less than what is normal for you, or not moving at all
• If you leak clear fluid that is not urine or fluid that is green, which could mean your water has broken; even if you’re not having contractions, you need to be checked 
• If you have vaginal bleeding like a period
• Severe abdominal (middle of the body) pain or cramping
• If you are contracting painfully and regularly every four to five minutes, the contractions last about a minute, and this pattern has been happening for an hour
• A fever higher than 101 degrees Fahrenheit
• A burning sensation during urination  
• Severe vomiting (throwing up)

Your doctor may change these guidelines if you have gestational diabetes, high blood pressure or if you’ve had a previous cesarean delivery.

Pregnant women who will be 35 or older when they give birth have an increased risk of birth defects. Birth defects can occur because of genetics (traits passed from parent to child) or by chance. 

Genetic screening identifies any abnormalities that may cause birth defects, such as Down syndrome.

There are two types of genetic testing:

1. Screening tests determine your chances of having a baby with genetic birth defects. These tests are noninvasive and pose no risk to mother or child. 
2. Diagnostic tests determine if your child has a specific genetic disorder or birth defect. Because they are more invasive than screening tests, diagnostic tests carry the risk of possible complications.

If results from your screening tests show a possible problem, your doctor will order more diagnostic tests.

First trimester: ultrasound and blood work

First trimester screening is done between weeks 11 and 13 of pregnancy. It includes blood work and an ultrasound. 

Sequential blood work screening is done for low risk pregnancies and cell-free fetal DNA blood work is done for high risk pregnancies. The ultrasound measures the thickness of the back of your baby’s neck. Extra thickness can be a sign of birth defects.

Second trimester: blood work

A second blood test that screens for genetic conditions and spinal defects is always done if you elected to do the sequential screen. A second blood draw to screen for spinal defects can be done if you elected for the cell-free fetal DNA test.

Chorionic villus sampling

Chorionic villus sampling (CVS) is done between weeks 10 and 13 of pregnancy. A sample of tissue is taken from the placenta, an organ that develops during pregnancy. It provides oxygen and nutrients to the baby. The tissue is checked for abnormalities.

Amniocentesis

This test is done between weeks 15 and 22 of pregnancy. It involves taking a sample of amniotic fluid (which surrounds a baby during pregnancy) from the uterus. This fluid provides important information about your baby’s health.

It’s important to be aware of all genetic testing available to you and to talk about them with your doctor.

One of the most important things you can do during pregnancy is eat well. A well-balanced, nutrient-rich diet plays a key role in your baby’s growth and development. 

A healthy diet for pregnant women includes:

• Lots of fruits and vegetables
• Lean protein — about 70 grams of protein daily
• Dairy — about 1500 mg of calcium or three to four servings of dairy daily
• Plenty of water
• Prenatal vitamins

If you have trouble digesting milk products, you can get calcium from other sources, such as broccoli, dark, leafy greens, sardines or a calcium supplement.

During pregnancy, you need to eat about 300 calories more a day to support your baby’s growth. For most women, that means eating about 1,800 to 2,300 calories a day overall.

We recommend eating three small meals and two snacks every day. This helps keep your blood sugar and energy levels consistent. It’s also easier on your digestive system.

We also recommend eating a diet rich in folic acid:

• Folic acid is a B vitamin and can help prevent major brain and spine defects. 
• It’s found in leafy greens, vegetables, fruits and nuts. 
• Many breads and cereals are fortified with folic acid.
• Pregnant women should also take 400 micrograms of folic acid a day.

If you have a family history of defects of the brain, spine or spinal cord, or if you’re taking any medications, your daily dose of folic acid may need to be higher. Talk with your doctor about this at your first OB visit.

The amount of weight you gain in pregnancy depends on your body mass index (BMI). The higher your BMI, the less weight you should gain.

If your BMI is:

• Less than 18.5 (underweight), you should gain 28–40 pounds
• 18.5–24.9 (normal weight), you should gain 25–35 pounds
• 25.0–29.9 (overweight) , you should gain 15–25 pounds
• 30.0 and higher (obese), you should gain 11–20 pounds 

While eating some fish can be part of a healthy diet, pregnant women should not eat shark, swordfish, king mackerel and tilefish. That’s because these fish have higher mercury levels, which can affect brain development.

You can safely eat up to 12 ounces a week of the following fish:

• Salmon
• Canned light tuna
• Shrimp
• Crab
• Cod
• Catfish

Listeriosis is an infection caused by a germ that can hide in many foods. It’s especially dangerous for pregnant women and can cause preterm delivery and other complications.

Because of this, pregnant women shouldn't eat certain foods that can carry this germ, including:

• Unpasteurized dairy
• Prepared meats, like hot dogs and lunch meat unless heated until steaming
• Undercooked foods, including chicken and turkey

You can find information about pregnant women and listeriosis on the CDC website. For suggestions on healthy eating and meal planning, visit Choose My Plate.

Childbirth is one of the most physically stressful challenges a woman will ever face. Staying physically active before and during pregnancy will help you get into the best shape possible.

But because your body will change during pregnancy, you may need to modify your activities. You also need to know when to slow down or to stop exercising and rest.

In addition:

• Wear a good-fitting support bra to protect your breasts.
• Tighten your stomach muscles when standing or sitting.
• Bend at your knees and hips if you need to lift something that’s lower than the level of your waist. Don’t bend forward at the waist with straight knees.
• Check your posture each time you pass a mirror. Good posture puts less strain on your back. 

The best time to begin exercising is when you’re planning to get pregnant. The sooner you start, the better you’ll feel. Many women don’t start until the last three months of pregnancy, when childbirth classes begin. 

Regular exercise during pregnancy leads to better posture, less back pain, more energy and stronger muscles for labor and delivery.

Pelvic muscles

Strengthening the muscles in the lower belly will help you handle childbirth more easily. This will also help prevent urinary problems after delivery, like leaking urine when you cough or sneeze.

Back muscles

Strengthening your back muscles, including exercises to improve your posture, will reduce the strain of pregnancy on your lower back.

The exercise you should do during pregnancy depends on your health and on how active you were before getting pregnant. If you were active before pregnancy, there’s no reason to stop, within reason. But this probably isn’t a good time to take up a new intense sport.

Walking

Walking is good for most pregnant women. If you didn’t exercise before pregnancy, start with walking.

Jogging

If you jog, you can probably continue as long as you feel comfortable. Try not to get overheated, and stop if you feel uncomfortable or unusually tired. Drink plenty of water.

Tennis

If you’re a tennis player, you can keep playing unless you have special problems or feel unusually tired. Also, be aware of your change in balance and how it affects quick movements.

Swimming

If you swim, continue to do so. Swimming is an excellent form of exercise. The water supports your weight while you tone and strengthen many different muscles. Scuba diving is not advised.

Golf

Golf is a good form of recreation. Be sure to adjust your movements because your belly is enlarged. Also, watch your balance.

Snow skiing, water skiing and surfing

These activities can be dangerous because you can hit the ground or water with great force, which could harm your baby. Talk to your doctor before doing these activities.

Climbing and hiking

Climbing and hiking are OK, but don't do exercises that make you short of breath or give you muscle cramps.

Yoga

Yoga exercises can help with your flexibility and strengthen your muscles for labor and delivery.

Kegel exercises

Kegel exercises help strengthen your pelvic muscles and prepare them for childbirth. Your health care provider can tell you how to do these exercises. 

You should stop exercising and call your doctor if you notice unusual symptoms, including:

• Pain
• Bleeding
• Feeling faint
• Irregular heartbeat (skipped or very rapid beats)
• Pain in the belly
• Difficulty walking

If you have any problems, or if you had problems with exercising during previous pregnancies, talk with your doctor.

Regardless of what type of activity or exercise you do, keep the following in mind:

• Warming up and cooling down are important. Start slowly and build up to more demanding exercises. Then taper off gradually.
• Regular exercise at least three times per week is better for you than spurts of exercise followed by long periods of no activity.
• Don’t do too much. Stop if you feel tired, short of breath or dizzy.
• Drink water before, during and after exercise to prevent dehydration. 
• Don’t do sports and exercises that put you in danger of falling or being bumped.
• Be careful of your back. Don’t do positions and exercises that increase the bend in your back. 
• Don’t get overheated. Limit outdoor exercise in hot, humid weather. Also, don’t use hot tubs, whirlpools or saunas.
• Don’t exercise if you have a temperature of 100° F (37.8° C) or more. 
• Avoid jerky, bouncy or high-impact moves that require quick changes in direction. These may cause back, abdominal, pelvic and leg pain. They can also make you lose your balance.