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A pregnant woman should carry on her usual physical activities as long as she does not become overtired or the activity does not cause discomfort. A pregnant woman tires readily, and fatigue should be avoided. Walking, swimming, golf, tennis, and bowling are all examples of healthy exercises for the pregnant woman. She should not undertake new activities during pregnancy or participate in sports with danger of physical injury. An activity which results in breathlessness should be avoided. So long as you can carry on a normal conversation during your physical activity, you are not over-exerting yourself. By then eighth or ninth month, most women find the physical activities become more difficult because of changes in their balance and coordination. Patients should use common sense in deciding on activities and exercises during pregnancy.

It is not unusual to experience dizziness and fainting episodes during pregnancy. These are most common when the patient stands quickly, rises from a lying position to an upright position suddenly, or stands for prolonged periods. This is because of normal changes in the circulation of the legs. It can be prevented by the use of support hose, and by remembering to change positions more slowly. Lying on your left side for an hour in the morning and late afternoon will also help you avoid some of the symptoms noted above.

Nutrition and Weight Gain

A balanced diet is essential during the prenatal period. The proper diet for pregnant woman does not differ radically from that for a normal, healthy, non-pregnant woman. Restrictions on the amount of salt may be suggested by your doctor. Digestion during pregnancy is often slowed. Some women’s appetites increase markedly during pregnancy, resulting in excessive weight gain. The average patient should gain between 20 and 35 pounds. Deviations from this average weight gain may be suggested by your physician for those who start pregnancy markedly overweight or underweight. Weight gain should be progressive throughout pregnancy, not rapid at any stage.


Excessive salt intake often results in the accumulation of fluid in the tissue, which is known as edema. During the last four months of pregnancy, it is often desirable for patients to use less salt. The normal requirements for salt in the diet will still be met since all foods contain some of the necessary elements. Patients who gain excessive weight and retain fluid are prone to develop more complications during pregnancy than those who are more conscientious about their diets. All patients should increase their water intake during pregnancy, up to eight to ten glasses of water a day.

Bowel Habits

Constipation is not uncommon during pregnancy, due to the decreased activity of the intestinal tract. This tendency can be lessened by drinking more water and including fiber in the diet. Some may occasionally need laxative. Simple laxatives such as prune juice or milk or magnesia can be used safely in moderation. Use of a stool softener such as Colace (which can be purchased without prescription), will often decrease the need for laxatives. Excessive gas may be treated by an over the counter medication called Mylicon. If you are taking vitamins and iron, your stools may be dark in color.


Maintaining a neat, fresh, well-groomed appearance contributes to a sense of well-being with the changing figure during pregnancy. Outer clothing should be loose and comfortable. Rolled stockings are garters should be avoided because of the constriction they place on the veins in the legs. Low or medium heels should be worn, since high heels make balance precarious and put undue stress on the lower back.


Changes take place in the skin and sweat glands during pregnancy which may make daily bathing desirable. This is not permitted, but recommended. Tub baths are okay during uncomplicated pregnancy, but your doctor may recommend that showers in the last few weeks of pregnancy. The reason is the danger of serious falls getting in or out of the tub. Excessive bathing during pregnancy, especially in the winter months, can result in extreme drying of the skin and itching, the treatment for this condition is to bathe less often and apply skin moisturizers.


Glandular activity of the cervix increases during pregnancy, which can result in an increase in vaginal discharge. This does not make douching necessary. If a discharge becomes heavy or foul-smelling and irritates the skin, your doctor can prescribe a treatment. Douching should not be utilized unless directly prescribed by your doctor.

Diabetes Mellitus in Pregnancy

Diabetes mellitus is the body’s inability to metabolize sugar properly. One to five persons per thousand in the united States will require treatment for the problem with insulin. The normal changes of pregnancy can impair the metabolism of sugar. When this occurs, it is called gestational diabetes mellitus. It is estimated to occur in one in twenty pregnant women. Diabetes in pregnancy is divided into two groups: diabetes before pregnancy and gestational diabetes. It is important to identify patients with gestational diabetes, so screening of patients is frequently performed. One screen test that is used is called the glucose loading test. The patient is given an unknown amount of glucose by mouth and a blood sugar level is determined one hour later. If the test result is abnormal, a three-hour glucose tolerance test will be recommended. If you have questions regarding this, please discuss them with your doctor.

Dental Care

Care of the teeth remains important during pregnancy. Routine dental treatment and examination is encouraged. It is important that your dentist be aware that you are pregnant, as this may affect medication and management of any dental problems which he may be treating. If you are given any medication be the dentist, please inform your doctor at your next office appointment. If you need to have dental x-rays, be sure to wear a lead shielded apron. If your dentist administers local anesthesia, please avoid Epinephrine.

The Due Date and Quickening

The due date or EDC is an approximation of the end of pregnancy. The date is calculated by counting 40 weeks, or 280 days, from the first day of the last menstrual period. The date is only an approximation and not a date when the patient should definitely expect delivery. Your physician can estimate the probable EDC on the basis of the last menstrual period, the size of the uterus and its growth, ultrasound examinations, when fetal heart o= tones are first heard, and when the patient feels the first definite kicking of the baby. This active movement of the fetus is called quickening and usually occurs between the 18th and 20th week. This movement is not to be confused with the fluttering sensations in the lower abdomen with some patients experience as early as the second month of pregnancy.

Postdated pregnancy

Any pregnancy that extends beyond 42 two weeks from the last menstrual period is considered post dated. Approximately 10 percent of pregnancies will extend past 42 weeks from the last menstrual period, and 3 percent will extend past 43 weeks. For this reason, it is extremely important to be accurate with the dates given in your history to your physician to monitor the appropriate growth of the uterus in the first and second trimesters of pregnancy. Postdated pregnancies sometimes have increased risk factors and special monitoring of the pregnancy may be required in those situations.

Contractions of the Uterus

Contractions of the normal pregnant uterus have been recorded in the first few weeks of pregnancy. These contraction are not the type of contraction which will result in the emptying of the uterus. The uterus is a thick-walled muscle, and to retain the normal tone and health of the muscle tissue, contractions occur normally. Some patients notice these contractions as pregnancy progresses as a slight tightening in the lower abdomen and a hard feeling of the uterus. These contractions are called Braxton-Hicks contractions and become more noticeable as pregnancy progresses, and inpatients who have had previous deliveries. These contractions should not be confused with true labor, which will be discussed later. These toning contraction of the uterus are rarely regular and rarely cause much discomfort.

Pre-term Labor (Less than 37 Weeks)

Approximately 10% of pregnancies end with delivery prior to 37 weeks of gestation. In many situations, premature or pre-term labor is treated with bed-rest, hospitalization, or medications called tocolytic drugs. The patient with a past history of premature labor and delivery has an increased risk of this problem. Regular tightening or pressure in the lower abdomen or back which is not relieved by resting on the left side may indicate pre-term labor. Please report andy persistent pre-term contractions to the doctor without delay.


Expectant mothers may continue to work as long as the work does not cause excessive fatigue and the pregnancy remains uncomplicated. Any occupation that subjects the pregnant woman to severe physical strain should be avoided. Jobs requiring moderate manual labor should be avoided if they involved long hours. When severe physical work is involved, or when jobs require long hours of standing or walking, it is advisable to stop work at least several weeks before the expectant delivery. Your physician can give you a letter stating that you are pregnant, your expected date of confinement, and any limitations in your activity. The usual postpartum recovery time is six week. In as uneventful pregnancy and delivery, most employers recognize this as the routine time of absence from work following delivery.

Travel During Pregnancy

Travel during pregnancy is not considered harmful in the uncomplicated case, but long, tiresome trips should be avoided. Patients who have had repeated miscarriages or premature births should not travel long distances. All long trips should be avoided during the last eight weeks of pregnancy. If travel is necessary, air travel is recommended. Some airlines request a physician’s note after a certain point in pregnancy, so please inquire when buying tickets. If you have questions regarding travel during pregnancy, please consult your physician. If travel is by an automobile, you should not go more than 250 miles per day. Frequent stops and rest should be included. When traveling by automobile, it is suggested that the patient wear her seat belt over the hips, below the enlarging uterus.


Most pregnant patients have had the basic immunizations during the first four months of pregnancy. Smallpox vaccinations should not be received at any time during pregnancy. Some patients may be asked to receive certain immunizations during pregnancy. In certain situations when general immunizations are carried out, as with certain influenza programs, we will advise you regarding recommendations in pregnancy. When your prenatal laboratory studies were obtained, a rubella test was performed. If the test indicated that you are not immune, you should receive an immunization or vaccine after your delivery. when such and immunization is given, you should not get pregnant for 12 weeks. There is no evidence that the vaccinations after delivery can cause any problems to the baby even if you are breast feeding.

Sexual Intercourse

In a healthy, uncomplicated pregnancy, sexual intercourse is not a problem. When there is a history of vaginal bleeding, threatened miscarriage, or a history of premature delivery, it may be recommended that intercourse be restricted.

Smoking, alcoholic beverages and other chemicals

Smoking during pregnancy is not recommended. The long-term dangers of cigarette smoking are well known. Also, the risk of premature delivery is greater in patients who smoke heavily, and smoking can stunt the growth of the infant. It is well known that alcohol intake during pregnancy can cause damage to the infant. Drinking alcohol during pregnancy is therefore not recommended. The use of other chemicals (mood and mind altering drugs) is absolutely not recommended. Exposure to any toxic chemical should be avoided.

Drugs and X-ray during pregnancy

Due to the uncertainty as to the possible side-effects of medications on the developing fetus, no medication should be taken during pregnancy without a clear medical indication. The routine use of drugs such as tranquilizers, sleeping medications, etc., is discouraged. The most important time for the restriction of drugs is during the first few months of pregnancy. For this reason, it is wise to restrict medications after pregnancy is suspected, unless prescribed by a physician who is aware of the possible pregnancy. If you are not certain whether to continue a particular prescription, ask your doctor. If you are given medications by other physicians or dentists, we request that you inform us at your next office visit of the type of medications and the medical condition being treated. It should be stressed that the treatment of medical problems with drugs can be done safely if the physician is aware of the pregnancy. The taking of excessive amounts of vitamins during the pregnancy is to be avoided unless specific approval is given by your physician. X-rays of a non-emergency nature should be avoided during pregnancy. This is especially true of x-rays of the pelvis. as a general rule, any non-emergency x-ray involving the pelvis should only be performed immediately after a menstrual period in women of the reproductive age group. This will help avoid exposure of an early developing pregnancy. The risk of radiation injury during pregnancy from most x-ray exposure is not great, however

Breast Care

The breasts should be supported by a well-fitted, comfortable bra. Tight, constricting bras should be avoided. It is common to notice a discharge from the nipples, which will increase toward the end of the pregnancy. It is important to maintain good hygiene with daily washing of the nipple area with a washcloth, soap and water. No patient should attempt should attempt to breast feed unless well-motivated. The success of breast feeding may depend on the mother’s motivation. We encourage a patient to nurse her newborn if she is so inclined. If the patient does not desire to breast feed for any reason, we would no suggest she try. In situations where the mother is not going to breast feed, simple binding of the breasts following delivery is a safe method for decreasing breast engorgement. The nurses in the hospital will be happy to explain how to bind your breasts. Medication will rarely be prescribed to decrease engorgement. Please ask your physician about this if you have any questions. There are excellent formulas if you choose not to breast feed. Presbyterian Hospital offers classes for women interested in breast feeding. Please ask your physician or the nurses in the office for information regarding these special classes. Remember to continue your self breast examinations on a monthly basis during pregnancy. If you are concerned that you have detected an abnormality, bring this to your physician’s attention.

For the patient who decides not to breast feed her infant, binding of the breasts is probably the safest method to suppress breast engorgement. Occasionally, medication can be administered at the time of delivery to help suppress breast engorgement. Occasionally a patient will have breast engorgement following this attempt at suppression. These patients should realize that when engorgement does occur, it will usually subside within 72 hours. Patients who are breast feeding will be allowed to nurse their babies at the discretion of their pediatrician. True engorgement of the breast occurs between 48 and 72 hours after delivery, but in this interim period, colostrum, which is gold-colored secretion from the breast, supplies all the nutrition that the new nursing infant needs. The nursing staff from the nursery and your pediatrician will most helpful in answering your questions regarding your breast feeding, If the nipple area becomes tender, certain local care can lessen the discomfort. If you develop pain and redness with swelling in a breast after you leave the hospital, please notify your physician immediately.

Remember that any medication which you take while breast feeding has a potential of crossing through the milk to the baby. For this reason, you should inform any physician of dentist that you are breast feeding prior to the prescribing of any medication.

Some patients who are not breast feeding and who received medication in the hospital to prevent engorgement of their breasts will still experience a delayed engorgement after they return home. Unfortunately, there is not medication or injection available at this time to reverse the situation. If the patient develops such engorgement, or if they initially began to breast feed and then stop, they may relieve such breast discomfort by the following suggestions, realizing that approximately 72 hours later they will feel better:

1. Do not express milk from the breast

2. Wear a well-supporting bra at all times. Bind the breasts as instructed.

3. Decrease fluid intake for 48 to 72 hours.

4. Apply ice to the breasts as needed

5. Take hot showers for temporary relief

6. Take two aspirin every four hours as needed for relief of pain

Excessive Nausea and Vomiting

Nausea during early pregnancy is very common. Vomiting may occur with this nausea, but usually both symptoms are not distressing enough to require more than understanding, alterations of diet, or occasionally, medications. Most patients will have little, if any nausea and vomiting after the fourth month. Occasionally patients will have an excessive amount of nausea and vomiting which may require hospitalization. Eating dry crackers in the morning before other foods or liquids will often help. Drinking no fluid with meals and taking vitamin B6 100mg, three to four times a day may also be useful. This can be purchased over the counter in your local pharmacy. It is our feeling that if you do not need to take medications in early pregnancy, they should be avoided.


The term “heartburn” means a sensation of burning pain beneath the breastbone. This symptom has nothing to do with the heart, but is related to the stomach contents going back into the lower esophagus (the tube that leads to the stomach). This symptom is common in pregnancy and is treated effectively in most cases with antacids. Liquid antacids such as Mylanta can be bought without prescription. Under no circumstance should patients take sodium bicarbonate or other medications containing large amounts of sodium. This can result in fluid retention as pregnancy progresses.


Hemorrhoids are protruding, dilated veins around the opening of the rectum. They are a result of increased pressure on these veins and a weakness in their walls. Hemorrhoids are common in pregnancy. Hemorrhoids may become painful if there is excessive swelling, or if a blood clot forms within the vein itself. The discomfort from hemorrhoids (itching, burning, and pain) can be relieved by filling the bathtub with approximately four inches of moderately warm water and sitting in this water for 20 minutes three of four times a day (Sitz baths). Maintaining good bowel habits and a soft consistency to the stool will also help. Colace, a stool softener, or Metamucil, a bulk former, can be purchased at your pharmacy. Occasionally hemorrhoids may bleed slightly , especially with the passage of a hard stool. If you have excessive discomfort from hemorrhoids, please notify your physician at your next visit, or sooner if the problem becomes acute. Over-the-counter suppositories, ointments and creams also are frequently helpful, and are safe.

Vaginal Discharge

All women experience some discharge from the vagina. As previously noted, pregnant women will have an increase in this discharge, which is a result of the activity of the glands of the cervix (the opening of the womb). Occasionally, this discharge may become annoying. Irritation from the discharge on the outside of the vagina is a result of the skin remaining moist. Evaporation can be improved by wearing white cotton undergarments and loose fitting clothing to provide air circulation. Occasionally the discharge may be associated with an infection. Persistent, unusual discomfort or odor should be brought to your doctor’s attention.


Backache, a common complaint, is a result of an increasing strain on the back as pregnancy progresses. As the uterus grows, the patient’s posture changes to compensate. This often results in a dull, aching discomfort in the lower back. The discomfort can be worsened by prolonged periods of activity. The wearing of high heels should be avoided. The best treatment for persistent low backache is rest, the wearing of proper garments, and prenatal exercises. Bothersome backaches may be temporarily relieved by lying on a hard surface (such as the floor) with the legs elevated, or by local heat.


Headache early in the pregnancy is a frequent complaint. In the majority of patients with headaches in the first five months of pregnancy, no abnormality can be demonstrated as the cause. by the middle of pregnancy, these headaches mostly decrease in severity and disappear. You may take Tylenol as needed. Persistent headaches in the latter part of the pregnancy may be a sign of a complication and should be reported. This will be discussed further in the next section.

Varicose Veins

As mentioned earlier under the section on hemorrhoids, the veins in the pregnant patient are subjected to increasing pressure due to the growth of the uterus. Some patients have congenital weakness of the walls of the leg veins and are prone to develop dilation of these veins with the stress of pregnancy. Varicose veins are dilated blood vessels which appear on the legs, usually after the fifth month. Adequate support hose, especially the leotard type for maternity patients, are of great help in protecting the veins and decreasing the symptoms and complications connected with varicose veins. Standing or lifting for prolonged periods contributes to the problem. Lying flat with legs elevated in a pillow offers temporary relief. Scheduled rest periods for an hour in the late morning and an hour in the late afternoon, lying on your left side, will give added relief to the discomfort of varicose veins.

Leg Cramps

Some patients will experience cramping sensations in the muscles of the legs, especially in the calf (charley horse). These cramps most often appear at night. They may be related to the extra weight which the legs support, as well as the interference with blood flow in the leg, due to the pressure of the enlarged uterus. These cramps can be helped in some cases by increasing the rest periods during the days and by gentle massage of the feet and calves. In some patients, these nocturnal cramps can be helped by placing a rolled blanket under the covers to rest the feet against while sleeping. Five or six tablets of the antacid Tums for several days may also be helpful, as might the addition of more calcium to the diet, If you experience persistent or severe leg cramps, please consult your physician at your next appointment.

Numbness of the hands

Pregnant women often develop numbness in their fingers due to pressure of the nerves in the wrist. The medical term for this problem is called carpel tunnel syndrome. Most patients will find that these symptoms will disappear within several months following delivery. If the situation becomes severe, please bring it to your physician’s attention.

Colds, Flu, Diarrhea, and Other Acute illnesses during Pregnancyt

Pregnant patients are susceptible to any medical problems that the non-pregnant patient may experience. Upper Respiratory infections, gastroenteritis, flu, and other illnesses occur as frequently in pregnant women as in non-pregnant women. The physician who treats the patient should know that she is pregnant so the proper choice of medications can be made. There is no specific treatment for the common cold, either in the pregnant or non-pregnant patient. Bed rest, fluids, the us of Tylenol, a mild antihistamine such as Chlor-Trimeton (Coricidin), Robitussin and nose drops (1/4% Neo-Synephrine) are probably safe. The patient should not take any cold symptom medication unless absolutely necessary. The use of a cold mist humidifier will relieve symptoms safely. It is advised that you run the humidifier in your bedroom.

Minor diarrhea and vomiting or gastroenteritis can be treated in the pregnant patient and non-pregnant patient very conservatively, Kaopectate for diarrhea is recommended, but the most benefit can be obtained by the following simple regimen: Once symptoms have appeared, do not eat or drink anything for six hours, take in only liquids you can see through and which do not bubble. If that is well tolerated, you may add for the next six hours bland food such as dry toast and crackers. If after 18 hours, your symptoms have improved significantly, you may slowly return to your regular diet. It is important to avoid milk and milk products (butter), as they are difficult to digest, especially after recovering from an intestinal upset. The majority of these minor illnesses during pregnancy have not been shown to have adverse effects on the baby.

One disease that is extremely rare in pregnancy is acute toxoplasmosis. This disease is caused by a protozoan which lives in the intestinal tract of cats, and in raw meats. Exposure to cat fecal material may be the source of transmission of the disease. When a pregnant woman develops an acute toxoplasmosis in early pregnancy, sever defects to developing fetus may occur. It should be emphasized that this is an extremely rare disease, and avoidance of contact with cat fecal matter (litter boxes, etc.) should be stressed during the course of your pregnancy. Proper cooking of meat will prevent infection from the source of raw meat.

Herpes Infection and other viral infections

The herpes virus (HSV), the hepatitis virus, the German measles virus, chicken pox, and more recently, the AIDS virus are identified. Testing for some of these viruses in pregnancy with either blood tests or cultures may be indicated. If you have an infection with any of these viruses, please discuss this with your physician. Unfortunately, there is no treatment for most of these infections. The best rule to follow is to avoid contact with any person known to be infected. Under some special circumstances, patients who have active infections with the herpes virus at the time of labor may need to consider a Cesarean section. Your physician will be happy to discuss this area of your care with you at your visit.

The Rh factor

The Rh factor refers to the presence of material on the red blood cells of an individual. If a person has a substance he is called Rh positive; it not, he is Rh negative. When a pregnant patient is Rh negative and her baby is Rh positive, there is a possibility of Rh disease in the baby when it is born. Since only 15% of the population is Rh negative, only a few patients have any concern regarding this. When an Rh negative patient delivers an Rh positive infant, it is possible in most cases to prevent any further Rh problems with medication called Rhogam. This is administered to all Rh negative patients at 28-30 weeks of pregnancy and then after delivery if the baby is Rh positive. During preparation, Rhogam is sterilized against all known infectious agents. If you have further questions about the Rh factor, more information is available in the office for you to read and discuss with your doctor.

Toxemia in Pregnancy

Toxemia is a disease which only pregnant women develop. It usually appears after the sixth month and involves an increase in blood pressure, protein in the urine and fluid retention, with swelling of the hands, face and feet, and rapid weight gain. Women who do not receive prenatal care have a higher chance of toxemia in pregnancy. Although we know that good prenatal care can prevent most cases of this disease, the exact cause of the problem is unknown.

Emotional Factors of Pregnancy

Many changes take place in the women during the nine months of pregnancy. It is best to avoid great emotional upheavals and to continue a normal, tranquil home environment and steady pace. Every member of the household can help with this. A little extra effort and kindness, understanding, and consideration on the part of everyone can do much to make a pregnancy a happy one. Many patients begin pregnancy troubled with fears and superstitions, The best way to eliminate fear is with understanding and knowledge. If you have any questions about the emotional aspect of your pregnancy, please fell free to ask your physician.

Postpartum tubal ligation

Today many couples are concerned about adequate contraception. Those who have decided that their families are complete often seek surgery to prevent future pregnancies. An operation is available after delivery to provide permanent contraception. This is called tubal ligation., and can be performed within the first 36 hours after delivery or at the time of Cesarean section. The procedure itself is relatively simple at this time. It is designed to be permanent, but no 100% guarantee of permanency can be made with any sterilization. The failure rate for sterilization in the female are approximately 4 in 1000. Any patient who wishes for more information regarding such permanent contraception is urged to seek advice from her physician during pregnancy. The doctor can tell her about risks and anticipated results. Patients who receive financial help from any government funds must sign papers requesting this procedure 30 days in advance of the surgery. Your doctor will be happy to give you more information and answer any questions you may have about this surgery.

Choice of Pediatrician

Following delivery of the baby, its care in the hospital nursery will be under the management of the pediatrician or family practitioner. Many patients do not have a pediatrician prior to their pregnancy. If you need help in selecting a pediatrician, please consult with your doctor or nurse. If you have questions about the care of the newborn, you should meet with your pediatrician during pregnancy.

Round Ligament Pain

The uterus is supported with several cord-like structures called ligaments. Two of these ligaments, called round ligaments, support from the front of the uterus to the lower abdomen. A round ligament is located on both the right and left side of the uterus. As the uterus grow in pregnancy, stretching and occasional discomfort from pulling on these ligaments can be felt by the patient. This is perceived as discomfort in the lower abdomen, radiating into the groin. The more pregnancies the patient has had the more likely she will experience discomfort of this type. Such discomfort can be precipitated by walking or even rolling over in bed. It is suggested that when you experience this type of discomfort, rest ad lying on the side on which you are experiencing constant pain not relieved by the above, other conditions may be present and you should bring this to your physician’s attention.

Spotting early in pregnancy and miscarriage

It is know that one out of every five to eight pregnancies will end in miscarriage, and that many women who have a late menstrual period and then experience a heavy flow may have had an early miscarriage. Therefore, we see that miscarriage is a very common event in human pregnancies. Spotting in early pregnancy occurs in at least one out of every five women. This may be related to normal changes within the uterus or may be a threatened miscarriage. When spotting occurs, we suggest that a patient avoid intercourse or the use of tampons. Bleeding as heavy as the heaviest day of a menstrual cycle or bleeding with severe cramping may be signs of a miscarriage. No treatment for this is available. In the majority of women in whom spontaneous abortion (miscarriage) occurs, it is the result of some problem in development of the early pregnancy which can no be corrected. Spotting alone is not necessarily a sign that miscarriage will happen but should be treated as a potential warning. we suggest that when you have spotting, you avoid allowing anything to enter the vagina, and rest–although other changes in your activity are not required. If heavy bleeding or severe cramping occurs, or you notice the passage of tissue with the bleeding, please save any tissue and consult with your physician immediately.

When to notify your doctor-

The majority of pregnancies are uneventful, normal situations. Occasionally unusual events take place and should be reported immediately to your physician In case you doctor in unavailable at the time you have a problem, one of the associates in the office will be happy to help you. If any of the following signs or symptoms appear, you should call your doctor immediately. The problem may be solved by a telephone call or may necessitate a visit to the office or to the hospital. The following and other unusual signs or symptoms should be reported at once:

1. Vaginal bleeding as heavy as a menstrual period

2. Swelling of the face, hands, or arms

3. Prolonged, sever, or frequent headaches

4. Dimness or blurring of vision

5. Persistent vomiting or associated abdominal pain

6. Persistent burning with urination

7. Chills or fever

8. Leakage of fluid from the vagina

9. Any excessive, rapid weight gain

10. Regular uterine contractions

11. Marked decrease in fetal movements

Emergency Medical Care

If any serious difficulties occur between office visits, please call the office night or day. If a sudden emergency arises and a telephone is not available, you may go directly to the emergency room at Presbyterian Hospital. The emergency room physician will evaluate the situation and call your doctor or his/her associate regarding any obstetrical problem.

What is Labor?

The onset of labor is difficult to outline and sometime confusing to the patient. As mentioned previously, the uterus has contractions throughout the pregnancy, and these are not to be confused with labor. Labor is a progressive change of the cervix with thinning and dilation. Labor usually starts with irregular contractions which feel like dull ache in the lower abdomen and back. This resembles menstrual cramps to many women. The contraction will gradually become more regular and more frequent. When the contraction are regular and last longer than 45 seconds each, and have done this for an hour, please call the doctor. If this is your first baby, contractions every 5 minutes is probably close enough. If you have had pervious deliveries, regular contractions every 8 to 10 minutes for an hour should indicate probable labor. If the bag of waters should break, patients are to contact the physician immediately. Please note the color of the fluid and report this to your physician when you call. Many times, if leakage of amniotic fluid can be proven, the patient may be admitted to the hospital whether she is in labor or not. Rupture of the bag of waters usually results in a sudden gush of clear fluid from the vagina, followed by a constant water discharge. When you have concern whether the contractions you feel are labor pains or if you have rupture of the bag of waters, please call your doctor for advice. Occasionally labor is preceded by the so-called bloody show. This is a think, often dark, bloody discharge from the vagina and represents bleeding and passage of mucus from the cervix. This is of no significance unless bleeding is heavier than a menstrual period.

Admission Procedure

It is anticipated that all patients will have completed the pre-admission forms for Presbyterian Hospital before the onset of labor. This helps efficiency when the patient is admitted. When your physician advises admission to the hospital, report directly tot he Admission Office or the Emergency Room. It is best to have a member of your family come with you to help with the paperwork. You may get more information about admission procedures by visiting the Admission Office and the Business Office of Presbyterian Hospital before the end of your pregnancy.

What to bring to the hospital

Most necessary items will be provided by the hospital. It is best to leave valuables at home to avoid the threat of loss or theft.

The labor and delivery rooms and LDR

When the pregnant patient is admitted to the hospital in labor she it taken to a labor room or LDR. LDR (Labor, Delivery, and Recovery) is a concept for the low risk patient where labor, vaginal delivery and immediate postpartum recovery are accomplished in the same room. Following admission to the labor area the patient is evaluated by the nursing staff. A baseline electronic fetal tracing will be made to evaluate the contractions and the baby’s response to them. The nurse will report the patient’s status tot he physician. The physician may order intravenous fluids during labor, and an enema may be given. The length of labor is variable, but averages fourteen hours for first delivery and somewhat less for later deliveries. Labor is divided into three stages, the first stage being the time required for the cervix to completely dilate, the second from complete dilation until the birth of the infant, and the third from the delivery of the infant until the delivery of the placenta. When a patient is in labor her support person of choice is encouraged to stay with her. During the second stage of labor, the patient will be under close supervision of the nursing staff and physician. The physician may not be in the hospital during the entire labor, as we rely on the nursing staff to inform us of the progress in labor.

Support person in the delivery room

When the patient wishes, her husband, or another support person, may share the birth of the baby. The hospital will ask her and her support person to sign a permit for this privilege. it must be understood that admission to the delivery room or LDR is at the discretion of the patient, her physician and the obstetrical nurse. In situations where general anesthesia is given or some medical complication is present, this privilege can no be granted. In most situations, support persons will be permitted to be in attendance at the time of a cesarean section, but this must be with agreement of the anesthesiologist, the pediatrician, and the obstetrical nursing staff, and the obstetrician. If you are planning to have your husband or other support person present during schedule cesarean section, please discuss this with your obstetrician early in your pregnancy.

Medications during labor

Various medications may be used during labor to ease the normal discomfort from contractions. These medications can help the patient with relaxation. It is impossible to remove all of the discomfort of labor with medications. Meperidine (Demerol), butorphanol (Stadol), and other medications have been shown to be effective and safe when used in small doses. If you have questions about medications,please ask your physician during office visits.

Anesthesia for Delivery

The use of anesthetic for delivery is a medical decision and not one of pure choice. If a patient has a preference for a certain type of anesthesia, this will be followed as closely as medical indications allow. In certain medical emergencies, an anesthetic other than that preferred by the patient may be necessary. For this reason, we request that the patient discuss any concern she has about the various types of anesthesia with the physician before the end of pregnancy. The following is a brief summary of the types of anesthesia used in modern obstetrics. a special class about anesthesia is available for you at the hospital, and we urge you to attend even if you do not anticipate needing any anesthesia.

Pudendal block, or local anesthesia: This type of anesthesia is given by the obstetrician at the time of delivery to provide pain relief just at the opening of the vagina. It is not designed to relieve discomfort of uterine contractions or the pressure associate with delivery.

Saddle block (low spinal): This provides anesthesia to the area of the body that would touch the saddle if the patient were riding a horse. It is given just before delivery of the infant, and is not useful for relief of labor pain, but provides excellent relief for the pain of delivery. It is very safe, but has largely been replaced by epidural anesthesia in recent years.

General anesthesia (gas): This type of anesthesia involves the patient’s breathing an anesthetic gas which results in her going to sleep. Most obstetricians do not prefer to use this type of anesthesia except in special situations. A certain amount of the gas will cross the placenta and enter the baby’s system, possibly depressing the baby. Also, this type of anesthesia often causes nausea and vomiting while asleep and can increase the risk to the mother. In some medical situations, general anesthesia is the safest and best for delivery. If your physician feels this is best for you, he or she will discuss with you the medical reasons behind the decision.

Epidural anesthesia: This type of anesthesia may be given during labor and relieves much of the pain of contractions. It’s also a good anesthesia for delivery. The area of anesthesia is similar to the saddle block, but the medication is place outside the spinal canal in the lower back. It has little effect on the infant, and it can be given during labor. It has become one of the most common anesthetics in obstetrics.

Preparation for childbirth

The LaMaze method is a personal preparation approach to the management of labor and delivery. By utilizing certain breathing techniques, it seems to minimize the discomfort of labor. The goal of this technique is to approach childbirth as a natural physiologic phenomenon and to deliver the child without the use of any drugs or anesthesia. LaMaze classes are usually available in Albuquerque. Patients planning to use the LaMaze method are encouraged to discuss it with us, so we can assist in giving a clear understanding of its advantages and limitations.

Breech presentation

Approximately 95% of infants will descend to the birth canal with the head first. Five percent will enter with the infant’s buttocks or feet first. This is termed breech presentation. There are difficult ways of dealing with a breech presentation, depending upon the particular circumstances. Cesarean section delivery may be recommended in some cases. Vaginal delivery is also an acceptable method of delivery if certain criteria are present. If a breech presentation is noted near the end of pregnancy, an attempt to turn the infant to head-first position can be considered. This is called an external cephalic version. Since there are so many circumstances to consider in a breech presentation, you should discuss it fully with your physician should it be diagnosed in your situation.

Cesarean Section Delivery

Sometime delivery through the vaginal canal is impossible or medically unsafe. In such situations, delivery through an abdominal incisions and incision into the uterus is the safest mode of birth. This operation is called a cesarean section. This operation is called a cesarean section. The incision into the abdominal wall can either be vertical (up and down) or transverse (crosswise). The type of abdominal incision has no relation to the incision to the uterus. Most incisions in the uterus are transverse. If a patient has a Cesarean section delivery it is important for her to know what type of incision was made in the uterus. It is impossible to predict prior to a patient’s arrival in labor whether a condition will arise that will necessitate this type of delivery. There are many reasons for performing cesarean sections. If a medical conditions arises in your case that would irritate the advisability of a cesarean section, your physician will discuss it with you in detail. Cesarean section delivery is a relatively safe operation which has saved many infants and their mothers from the dangers of difficult or unsafe vaginal deliveries.

Vaginal Birth after Cesarean Section (VBAC)

It is accepted procedure today for women who have had a previous Cesarean section to attempt a subsequent vaginal birth. There is a concern about a potential rupture of the surgical car on the uterus but the incidence is very rare. A trial of labor after previous Cesarean section delivery is appropriate when certain criteria are met. During the patient’s prenatal care, it is important to discuss this option fully. Your physician will be happy to present to you both the benefits and the risks of this plan.


Episiotomy is the small incision made at the opening of the birth canal at the time of the vaginal delivery. The reasons for an episiotomy are many, but the most important is that it reduces the danger of a serious tear or laceration of this area and prevents delay in the delivery of the baby due to the rigidity of these tissues. The other long-range value of episiotomy is that is may help to prevent abnormal stretching and relaxation of this anatomical area reducing the possible need for surgical repair later in life. The episiotomy is repaired with suture material which is absorbed and does not have to be removed. The episiotomy is commonly referred to as the patient’s “stitches” and is usually healed within the first seven to ten days after delivery. Some women are able to accomplish delivery without and episiotomy or tear. This is more likely in women who have had previous vaginal deliveries.


The term forceps delivery arouses an unnecessary fear in some patients. Forceps, a type of surgical instrument, have been utilized by obstetricians with increased frequency since the 1700’s. For the past fifty years, the use of forceps in the hands of trained physicians has been proven to be safe and effective in what otherwise would have been potentially unsafe situation for the baby. Forceps are designed to protect and cradle the infant’s head as it make its exit from the birth canal and to control the delivery. They are not used with all patients, as many patients are able to deliver the infant without any assistance from the attending physician. Forceps are more commonly used in women having their first baby or in women who have chosen epidural anesthesia. slight markings may occur in front of the baby’s ears when forceps have been applied to assist in delivery. These marks will fade and usually be undetectable within the first 48 to 72 hours. It has been shown that the use of forceps shortens the second stage of labor, preventing undue, constant pressure of the baby’s head as it makes its descent through the birth canal to the opening of the vagina, resulting in a marked reduction in injuries to the baby. If you have questions regarding the use of forceps, or concerning the possibility for the need of forceps in the delivery of your infant, please bring them to your physician’s attention.

Recovery Room

Following delivery in a routine delivery room, the patient is taken to the postpartum recovery room adjacent to the labor and delivery area. If the patient delivers in an LDR, her recovery will take place in that room in most situations. During the stay in the recovery room, the patient will be checked frequently for any abnormal vaginal bleeding or changes in her blood pressure and pulse. Following her recovery, the patient will be taken to her postpartum room. In most situations, the newborn infant will be returned to the mother for visitation in the recovery room prior to her transfer to the postpartum bed. If delivery occurs in an LDR, the infant will remain with her for most of her recovery in that room. Infants delivered in an LDR may be transferred for medical reasons to the newborn nursery.


If the patient desires her male infant to be circumcised, this will be performed by her pediatrician during the patient’s hospitalization. If you have questions regarding circumcision, or want advice on it advisability, you should discuss this with your pediatrician either prior to admission to the hospital, or during your pediatrician’s first visit.

The Postpartum Visit- Visitors

Following delivery, the patient will remain on the postpartum floor until her discharge. Discharge usually come 12 to 24 hours after vaginal delivery, or two to three days after Cesarean section delivery. Visiting hours depend on the hospital rules, but in general, visiting hours for the new father are open during the day. Other visitors may visit at set hours.

Release of Medical Information

Occasionally friends and neighbors will inquire regarding you, your baby or events taking place in the hospital. Release of this type of information by your physician or by the hospital staff is not permitted, as it is considered privileged information among you, your doctor, and the hospital. In this way, the patient is protected from the disclosure of information to unauthorized people. If you desire information to be released to any specific individual, please notify the nurses while you are in the hospital. Please ask your friends and relatives to obtain information from your family instead of calling the hospital during your stay.

Care of the episiotomy or stitches

There will be some discomfort in the area of the episiotomy immediately after delivery. To relieve this discomfort, ice packs may be placed on the stitch area at first. During your hospitalization, Sitz baths, which are nothing more than sitting in a tub of warm water, may be used. The nursing personnel will help you and instruct you in keeping the stitch area clean and as comfortable as possible. You will also be instructed in the use of a surgigator, which will also aid in relieving discomfort from this small incision. Pain medication is available as needed.

After-birth plans

Following delivery, the uterus will return to its normal size. The contractions that the uterus undergoes, especially in the first ten days after delivery, are occasionally uncomfortable for the patient. These are called “after pains” and are more common the more babies the patient has delivered. Medication is available at your bedside in the hospital if such discomfort is annoying. The remainder of the medication will be sent home with you at the time of your discharge. At home, the use of tylenol, 1 to 2 tablets every four to six hours, should be adequate for relief of this discomfort.

Postpartum Exercises

Instruction sheets regarding postpartum exercises are available. These exercises will help you regain the proper tone and strength in your muscles, which have been altered during pregnancy. We encourage the continuation of these exercises during the postpartum period at home. The only exercise that should be avoided in the initial postpartum period is any knee-chest exercise. Women’s wellness program offers a full postpartum exercise program for those who wish it.

General Information

You will find that you tire easily and require more rest when you return home. It is important that you plan your activities to allow enough time for proper rest and time with your new infant. Vaginal bleeding with persist for 3 to 6 weeks following your discharge from the hospital. This bleeding, called lochial discharge, is related to the return of the uterus to its normal size and physiological activity. This bleeding may at times be bright red in color, but during the first three weeks should not be heavier than a normal menstrual period. The return of normal menstrual periods is quite variable. Most patients will have a menstrual period with 6 to 12 months following delivery. Breast feeding may further delay the return of the menstrual cycle. Continuing with exercise is permitted and encouraged. You should return to your normal activities as you feel physically and mentally able. Driving an automobile is permitted when you are physically able. If your stitch area is uncomfortable, it is suggested that you continue with Sitz baths, filling the tub with four to five inches of warm water and sitting there for 15 to 20 minutes, three to four times a day.

Daily showers or tub baths are also permitted. There is no danger in washing your hair. If you are constipated, you may take a laxative without any danger. If you are breast feeding, some of this medication may pass through the breast milk and affect the newborn infant’s bowel habits, but this is not dangerous.

Postpartum Follow-Up Office Visits

All postpartum patients are seen at three to six weeks following their discharge from the hospital. It is suggested that following your release from the hospital you call our office to make an appointment to see your physician in four weeks, unless he or she instructs you differently. Postpartum examinations enable your physician to make sure that the changes of pregnancy have reverted to normal. A pelvic examination will be performed at this follow-up visit, and pap smear will be obtained if indicated.

Minor diarrhea and vomiting or gastroenteritis can be treated in the pregnant patient and non-pregnant patient very conservatively, Kaopectate for diarrhea is recommended, but the most benefit can be obtained by the following simple regimen: Once symptoms have appeared, do not eat or drink anything for six hours, take in only liquids you can see through and which do not bubble. If that is well tolerated, you may add for the next six hours bland food such as dry toast and crackers. If after 18 hours, your symptoms have improved significantly, you may slowly return to your regular diet. It is important to avoid milk and milk products (butter), as they are difficult to digest, especially after recovering from an intestinal upset. The majority of these minor illnesses during pregnancy have not been shown to have adverse effects on the baby.

One disease that is extremely rare in pregnancy is acute toxoplasmosis. This disease is caused by a protozoan which lives in the intestinal tract of cats, and in raw meats. Exposure to cat fecal material may be the source of transmission of the disease. When a pregnant woman develops an acute toxoplasmosis in early pregnancy, sever defects to developing fetus may occur. It should be emphasized that this is an extremely rare disease, and avoidance of contact with cat fecal matter (litter boxes, etc.) should be stressed during the course of your pregnancy. Proper cooking of meat will prevent infection from the source of raw meat.


Most patients have a normal postpartum convalescence. Occasionally some problems might develop which should receive immediate medical attention. If you note the onset of bleeding heavier than a menstrual period within the first three weeks following your discharge from the hospital, please inform our office. Frequently, bleeding will become heavier following nursing of the baby, but this should not persist. If you develop severe abdominal or pelvic pain or severe pain in the area of your episiotomy, this also should be reported at once. Occasionally, fever or chills will appear, which are indicative of an infection. Infections of the kidneys and bladder and/or the reproductive organs can occur following delivery and require medical attention. If you have concerns or problems regarding your recovery, please bring them to our attention.

Advice to Expectant fathers

A happy, cheerful home environment will foster a feeling of security and contentment which your wife needs more than ever during pregnancy. Help her avoid worry about her condition or its symptoms. Help her conserve her strength by relieving her as much as possible of heavy work. During pregnancy it is normal for a woman to be more tense and to experience emotional upsets. Encouragement and understanding by the husband during these difficult periods are extremely important. Find amusement and relaxations which you and your wife can enjoy together. Walks, spectator sports, short automobile rides, and social visits are enjoyable and excellent diversions for both of you. The regular medical check up of the expectant mother is a most important factor in her care. Between visits, her husband is often the stabilizing emotional factor. As you are well aware, pregnancy is an exciting and at times difficult experience for both expectant father and mother. The father’s role in pregnancy should be an active rather than a passive one, and much depends on how well you meet this challenging situation. If you have questions not answered by this book or by your wife’s office visits, bring them to our attention. You are welcome to come to the office appointments with your wife, but if you wish to discuss some pregnancy matter, we ask that you schedule a special appointment.

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