Care for pregnant patients
This is a general outline of the care which we at the Wesley Women’s Care Clinic will seek to help you carry out during the course of your pregnancy.
Today, pregnancy and delivery can be made very safe for the mother and baby by paying attention to several details. Our goal for your pregnancy is a healthy mother and a healthy baby. This is accomplished by careful cooperation on your part, and constant care and watchfulness on our part.
Sometimes, in spite of all the best efforts, unexpected problems arise. Statistics show that 30% of all pregnancies result in spontaneous miscarriage and 23% of all pregnancies result in delivery by Caesarean section (c-section) for various reasons. Caesarean sections are done if a vaginal delivery would be detrimental to the health of the mother or infant.
Prenatal care during your pregnancy
For your health and the health of your baby, prenatal care should be started early in your pregnancy. Even though pregnancy is a normal body process, pregnancy produces many changes in your body, so early and regular care can often prevent or minimize problems for you or your baby.
Your first prenatal visit
This will take longer than other visits because several things will be done including:
- Medical History: You will be asked to answer questions about your previous pregnancies, including any miscarriages, age when you started your periods, menstrual cycle, past health problems including hospitalization and surgeries, allergies, medications you take and family health problems.
- Complete Physical Examination: You will have a complete physical examination, including a pelvic examination with a Pap smear and cultures for sexually transmitted diseases. This will help make sure you will be healthy during your pregnancy, and enable us to be aware early in your pregnancy of any expected problems. We will listen to the baby’s heartbeat, if you are far enough along in your pregnancy.
- Laboratory Tests: A small amount of blood will be taken from the vein in your arm. A number of tests will be done, including your blood type and Rh factor. Your health care provider will review the lab results with you at your next visit.
- Prenatal Vitamins: You will be given prescriptions of prenatal vitamins.
Please have the prescription filled and take as directed. When you run out,
take your bottle back to the pharmacy and they will refill them for you; or if you lose your prescription, call the office.
If you have problems taking your vitamins, do not stop taking them, call the office. Other ways of taking them can be suggested to you, or another type can be prescribed if necessary.
If you do not have the money to have the prescriptions filled, tell the office staff. Often, we can help you obtain your prescriptions until you are able to get them from your pharmacy.
- Childbirth Education Classes: You will be given information about the
Wesley Family Life Education Classes including special Lamaze classes for patients of Wesley Women’s Care Clinic. Childbirth, infant care, andparenting are topics of these classes.
At the time of your labor and delivery, you may have a support person in the birthing room. Cameras are allowed so you can take picture of your new baby and your family. It is a good idea to write a plan of birth on paper. Discuss this with your health care provider. Every attempt will be made to make your labor and delivery as you want it.
Tell your health care provider about any type of problems you may have, physical, financial or personal. They may be able to help you or suggest someone you can consult for help.
Ask questions about your pregnancy. There is no such thing as a stupid question. We want to help with your concerns.
Prenatal visits after the first visit.
- Monthly until 28-32 weeks (7 months)
- Every 2 weeks until 36 weeks (9 months)
- Weekly until delivery
- More often if necessary
The nursing staff will check your weight, urine and blood pressure at each visit. Your uterus (fundal height) will be measured each visit. And the fetal heart tones (baby’s heart beat) will be evaluated. Any time problems are noticed or suspected; we will discuss changes in your plan of care with you.
Between 24-28 weeks (6-7 months), we will need to do a test to check for gestational diabetes and anemia during pregnancy. If you blood sugar is too high, we will treat you for your gestational diabetes or, we will refer you to a specialist. If you are anemic, we will ask you to take more iron. The anemia test will then be repeated in about 4 weeks to make sure the hemoglobin is increasing. Also, if you have Rh-negative blood, you will receive a RhoGam injection to protect your baby against Rh disease, a serious complication in women who are Rh negative.
If you have any other special health problems, laboratory studies may be done and followed up appropriately.
Superstition and pregnancy
There are many interesting and fun stories and books about superstition and pregnancy. There are probably more superstitions and “old wives tales” about pregnancy than any other area of health care.
Even with all the advanced scientific knowledge and practices of pregnancy, there are still areas that are not completely understood. Since it is only in recent generations that women have received care from health professionals during pregnancy, it is little wonder that many of the beliefs, although false, have had such wide acceptance for so long and are often sill believed today.
A superstition that we often hear about is that stretching the arms high above the head during pregnancy results in strangulation of the baby by the umbilical cord. Knots in the cord can occur at times, but not because of anything the mother did. There are many myths about how to tell the sex of the baby. Some of these myths are as follows:
“Girls come from the right ovary and boys from the left side.”
“If you douche with an acidic solution you will have a girl.”
“If you douche with an alkaline solution you will have a boy.”
“If the baby’s heart beats fast, it is a girl; if it is slow, you will have a boy.”
The baby’s normal heart beat ranges from about 120 to 160 beats per minute. Like our heartbeats, the beat changes slightly with activity, sleep and the physical and mental state of the mother.
Nutrition And Weight Gain During Pregnancy
A weight gain of 25 to 35 pounds during pregnancy is recommended. It is important to see a gradual weight gain throughout the pregnancy. If you have problems with your weight, you may need special nutritional counseling. The amount of weight gain during pregnancy is as follows:
|Nutrient stores for milk production||7 pounds|
|Full term baby||7-7 ½ pounds|
|Placenta (afterbirth)||1-1 ½ pounds|
|Amniotic and Body Fluids||3-5 pounds|
|Enlargement of Uterus||2 pounds|
|Enlarged Breasts||5 pounds|
|Total Weight Gain||25-35 pounds|
Pregnancy and diet
You need more food while you are pregnant. When breast-feeding you need even more food. It is important to eat a balanced diet of foods from the food pyramid. A copy of the food Pyramid can be obtained on many of the cereal boxes sold at your local grocery store.
Protein comes from animal and vegetable sources. Protein builds muscle and tissue for you and your baby. Protein foods provide B vitamins for energy, and iron to help form red blood cells and carry oxygen to your body tissues.
Each day you need to eat four 2-3 ounce servings of protein foods. A 3-ounce serving of meat is the same size as a deck of cards. If you do not eat much meat, agood way to get extra protein is to drink “Instant Breakfast” with milk 2 or 3 times a day.
|Animal Protein||Vegetable Protein|
Poultry- Chicken, Turkey or Duck
|Dried Peas and Beans
Canned Beans- kidney, lima,
garbanzo, red, pinto or navy
Nuts, Sunflower Seeds
Milk and milk products
Milk and milk products are the best food sources for calcium. Calcium is needed for your baby to form strong bones and teeth. Milk also contains vitamins A and D, and also several B vitamins. Each day you need four servings (five, if breast feeding) from this food group. Some sources are:
- Cheese / Cottage Cheese (1 serving = 1 cup of milk)
- Custard/ Puddings
- Ice Cream/ Ice Milk
- Milk / Buttermilk
Breads and cereals
Breads and cereals contain B vitamins and iron. Many are also enriched with other important nutrients and are a source of fiber. Fiber is important because it helps prevent constipation. You need six to eleven servings each day, some sources include:
- Breads (1 slice)
- Cereals, Granola (1 ounce)
- Macaroni, Noodle, Pasta, Rice (1/2 cup)
- Wheat Germ
- Pancakes / Waffles
Dark green vegetables
Dark green vegetables are needed for vitamin A and folacin. Vitamin A is needed for bone and tooth formation in your baby. It also aids in eyesight and resisting infection. Folacin is needed to form red blood cells and other body cells. It is best to eat these foods raw, because cooking destroys folacin. You need one to two servings each day. Some sources include:
- Asparagus (1 serving = 1 cup)
Fruits and vegetables
Fruits and vegetables add vitamins and minerals to your diet. They also provide fiber, which is important for normal bowel movements.
Vitamin C is needed by the body to help hold body cells together, strengthen blood vessels, and aid in healing wounds. You need one to two servings (1 serving = ½ cup) per day, some sources include:
|Green and Red Peppers||Tangerine|
|Turnip and Mustard Greens|
Other fruits and vegetables
Other fruits and vegetables add vitamins, minerals and fiber to your diet. You need three servings (1 serving = ½ cup) per day. Orange and yellow fruits and vegetables are rich in vitamin A. Some of these foods include:
|Beans, green and wax||Apricot|
Liquids are very important, especially water. Drink at least six 8-ounce (1 cup) glasses each day while pregnant. While breast-feeding you need eight 8-ounce glasses of liquids per day. Besides water, you can drink milk, cocoa, fruit juices and soups.
Fats and oils
Fats and oils are needed each day to provide fatty acids and vitamin E, and for energy and healthy skin. You need no more than 3 tablespoons (1-ounce) each day. These foods include margarine, oil, mayonnaise, salad dressing, and fatty cheeses. Fats are naturally included in meats and are already added to many foods we eat everyday.
It is recommended that you have a minimum of eight hours sleep every night with one hour of rest in the afternoon. When you are pregnant, you may notice that you tire more easily. No matter what your lifestyle, when you are pregnant you need at least the full eight hours of sleep/rest.
Rest periods, a time you really relax, even if it is for a short period of time, will help conserve your energy. If you are working and unable to lie down during the day, rest by sitting down with your feet up for a few minutes at lunch and break time.
During your pregnancy you may find that you are perspiring more than usual. Bathing every day will refresh, stimulate and relax you. Either a shower or a tub bath is fine. It is important to move slowly when getting in and out of the tub so you do not lose your balance and fall. Make sure the shower and tub have non-slip grippers to prevent slipping. Take your shower or bath when someone else is present in your home to help you if needed.
It is important to wear loose comfortable clothing during your pregnancy. Cotton underwear is more absorbable and will be more comfortable. Do not wear garters or anything constricting to the legs. Low heeled or flat shoes with good support are best to prevent backache.
Breast care during pregnancy
Wear a good fitting, supportive bra as soon as you notice that your breasts are enlarging. This will help prevent muscle strain on your back and neck area. If your breasts are uncomfortable, you may want to wear your bra at night also. During your pregnancy you may notice fluid draining from your nipples. This is a normal part of your pregnancy as your body prepares for breastfeeding. If the fluid dries on your nipples, gently wash it off with water.
If you are planning to breast feed, no special preparation is necessary for your breasts. However, if your nipples are inverted (turned in), talk to your health care provider about this.
See your dentist early in your pregnancy. Good dental care is important because healthy teeth are needed to enable you to chew your food. Brush and floss your teeth in the morning and before going to bed at night. If you have any dental problems, such as cavities, you should see your dentist for care. Tell your dentist that you are pregnant so he can take special care of you.
If you need a lot of dental work done, tell your health care provider. There may be some special instruction for you and your dentist.
Douching during pregnancy
Do not douche during your pregnancy unless recommended by your health care provider. Douching is not needed when you are pregnant and may cause serious problems during your pregnancy.
Bathing or washing yourself with a wash cloth and mild soap, washing from front to back, is adequate for general cleanliness, if done daily.
Vaginal discharge may increase during pregnancy. You may notice even more discharge as you get near your due date. Good cleanliness is important. Since the discharge is part of normal process of pregnancy, medication is usually not necessary. If you have itching, burning, foul odor, or irritation, tell your health care provider. You can be examined to determine if you need medication.
Care of bowels
Some pregnant women have problems with constipation during pregnancy. This is due to changes in your digestive system. Things you can do to relieve constipation include:
- Drink 6-8 glasses of water each day
- Eat fruits and vegetables. Raw vegetables such as carrots and celery will add fiber to your diet
- Exercising every day keeps your body toned
- Prune juice helps some women who are constipated
- Mild laxatives or stool softeners may be needed. Ask your health care provider which would be best for you.
The amount of exercise you do will be decided by what you have been used to doing before becoming pregnant. Drink several glasses of water before starting each exercise session. It is important not to become overly fatigued or exhausted. If you start having contractions or cramping, you need to stop exercising and rest. Walking 3-4 times a week is recommended because it uses the muscles of your entire body and strengthens some muscles you will use during labor. Drink water before, during and after exercise to replace what is lost during exercise. Do not exercise in hot, humid conditions or when feeling ill.
Always do a 5-10 minute warm of stretching exercise, keeping your heart rate under 140 beats per minute. The intense portion of exercise should not last more than 15-20 minutes. A cool down period of 5-10 minutes, keeping the heart rate at less than 100 beats per minute, should be done.
Avoid high impact exercise (jumping or rapid changes in direction), exercises that stretch the adductor muscles of the legs (putting soles of feet together and pushing down or bouncing legs), exercises that require uncomfortable positions or change the normal curvature of your spine.
After 20 weeks of pregnancy, do not lie on your back for more than a few minutes at a time.
Stop exercising if you are bleeding, having contractions, become dizzy, get short of breath, or have pain.
Exercises that are not safe for you during pregnancy include snow or water skiing, surfing, diving, scuba diving, ice or roller-skating, sprinting, or sports done at high altitudes. These activities can be serious risk to you or your baby.
If you are used to participating in sports which require additional exercises, check with your health care provider to find out which activities you can safely participate.
Exercises You Can Do While Pregnant
Exercises you can do during your pregnancy will help prepare your body for the work of labor. You may exercise with the approval of your health care provider.
Please remember these points before beginning your exercise program.
- You may start out slowly with the type and amount of exercises you do and gradually work up to move.
- When you are changing positions, do it slowly to avoid losing your balance and falling.
- You may continue exercising as long as you feel comfortable. When your pregnancy gets to an advanced state, it will be more difficult and then you may need to stop or decrease exercises.
Working during pregnancy
Check with your health care provider to see if your type of work is suitable for you during your pregnancy. Do not work for more than 8 hours a day or 48 hours per week. Take two 10 minute breaks and one meal break for every 8 hours worked.
If you stand most of the day at your job, sit or lie down during your breaks and put your feet up. Drink something and empty your bladder during your break. If you sit in one position for long periods, get up and walk around whenever possible. You should not lift over 25 pounds while you are pregnant.
Check with your health care provider if your job involves strenuous physical activity, extreme temperatures, noxious fumes, or activity requiring good balance. These activities may be harmful to you or your baby.
You may work until you go into labor as long as you are feeling good and not having any other complications that prevent working. This is a decision that you and your health care provider should make together.
Ssexual activity during pregnancy
You may continue sexual activity during pregnancy as long as it is not uncomfortable for you. You may need to try different positions until you find one that is comfortable for you, such as with the woman on top, or in a side lying position. When sexualactivity becomes uncomfortable you should stop.
Sexual activity may cause uterine contractions to occur. This is not a problem Unless you are at risk for a preterm labor. Do not have sexual intercourse if you are having any vaginal bleeding or if you believe your membranes (bag of waters) have ruptured. Contact the Wesley Women’s Care Clinic immediately!
Your feeling about having sex may vary while you are pregnant. Some women enjoy sex more often during pregnancy while others want less sex. You may even feel that you do not want to be near your male partner. This is usually temporary and you will soon feel different.
Sometimes the desire for sex decreases when about 7-8 months pregnant. It is often difficult to participate comfortably. You and your partner may need to try various positions to find one that is comfortable for you.
Safe sex / HIV / STDs
Anyone who is sexually active is at risk for being exposed to HIV, the virus that causes AIDS, and other sexually transmitted diseases (STDs). AIDS is not a male disease anymore. Women of childbearing age are at high risk for exposure to HIV. HIV infections are the fifth leading cause of death in the USA for women of childbearing age. The HIV virus is spread through sexual contact and sharing of contaminated needles and syringes. The virus can also be passed from an infected mother to the fetus during pregnancy, at birth, shortly after birth and through breast milk.
What are the risk factors?
- Having more than three sexual partners in a lifetime.
- Not using condoms each time you have sex.
- Not knowing your partner(s) well.
- Having sex with a bisexual man or a man who uses IV drugs.
- Using IV drugs yourself.
- Having anal or oral sex.
- Having another STD.
- Having a blood transfusion between 1977 – 1985.
How to practice safe sex.
- Do more cuddling, dry kissing, body massage or talking about your fantasies.
- Always use a latex condom. Cary one with you to be prepared in case he isn’t.
- Have only one partner. Get to know your partner well before deciding to have sex.
- Do not use illegal drugs.
- If you think you have a STD, see your health care provider right away.
Hepatitis B is a viral infection that is passed sexually or through body fluids. There is also risk for becoming a chronic carrier. If you get Hepatitis B, you can pass it to your baby. All pregnant women are tested for Hepatitis B at their first visit. If you are positive for Hepatitis B, tell the baby’s health care provider so the baby can receive the treatment at birth. The complications can lead to liver disease, which is a life threatening condition. If you are at risk for Hepatitis B, ask about the vaccine, which is safe to receive during pregnancy.
Cats, toxoplasmosis, and pregnancy
Toxoplasmosis is an infection that you may get if you handle cat litter or eat undercooked or raw meat. The cats get the infection from eating mice and birds. The germ is passed through their stools. You may get the infection and not even know it because the symptoms are usually so mild. Our recommendations are not to handle cat litter, or if you must, wear gloves and thoroughly wash your hands afterwards. Also, it is important to cook your meat until it is done.
Drugs and medications during pregnancy
During your pregnancy, do not take any drugs without consulting the Women’s Care Clinic. Many drugs pass through your placenta and can have a harmful effect on your baby. If you are taking drugs or medications, tell your health care provider. We can advise you about continuing prescribed medications during you pregnancy.
If you have a problem with DRUG ABUSE, tell us. We can get you help for this problem. Using cocaine, marijuana, alcohol, speed or other illegal drugs during pregnancy will affect your baby in a harmful way. There are special programs to help pregnant women with drug abuse during pregnancy. It is best not to take any medication during pregnancy, unless recommended by your health care provider.
Over the counter drugs that are safe to use during pregnancy include:
- Acetaminophen (Tylenol or Datril) for pain
- Sudafed or Actifed (or the generic equivalent) for colds
- Robitussin PE or DM (or the generic equivalent) for cough and congestion
- Benadryl (or the generic equivalent) for allergies or hayfever
Smoking during pregnancy
Many years of study and research have shown that smoking while pregnant will cause harmful effects to your baby. Some infants born to mothers who smoke while pregnant weight less than normal. Often these babies are born too early (premature). There is also an increased risk of bleeding problems, miscarriage, low birth weight, and premature rupture of bag of waters in women who smoke.
If you do smoke, quit now! If you cannot quit “cold turkey,” then cut down on the number of cigarettes you smoke each day. Instead of smoking a whole cigarette, smoking a half a cigarette. Change to a brand that is low in tar and nicotine. Instead of lighting up a cigarette, chew a piece of gum or hard candy. It also helps to keep your hands busy with handwork such as cross-stitch or knitting or any hobby you like to do. Go for a walk instead of lighting up a cigarette. Just think, after the baby arrives you will be too busy to smoke.
Smoking is also harmful to children who grow up in a smoke filled environment. They receive the smoke second hand. These children have more respiratory infections and asthma than children who are not around smoke.
Ask your health care provider for information about stop smoking classes.
Remember, if you can quit or decrease smoking, it will benefit you and your baby!
Alcohol use during pregnancy
When a pregnant woman drinks, the alcohol quickly enters the blood stream, and passes the placenta to reach the baby. Alcohol is high in calories, but does not have any food value. We strongly recommend that you do not drink any alcoholic beverages while you are pregnant.
The Surgeon General of the United States has advised pregnant women not to drink alcoholic beverages. Drinking alcohol while pregnant has serious effects on the baby and can cause a serious conditions called Fetal Alcohol Syndrome. Alcohol places your baby at higher risk of growth problems. Infants of alcoholic mothers will also have the same withdrawal symptoms as the mother. Many are born with malformations of the heart, head, face and extremities. Some of the mentally retarded and have learning disabilities.
Please be honest with us. Talk to your health care provider about your drinking or other drug use. Help is available. There are several programs for women who are pregnant or have small children. Remember you and your baby will benefit.
Emotions and pregnancy
Women react differently toward their pregnancies. A woman may be very happy to be pregnant, or just trying to make the best of the situation. You and the father of your baby may find that both of you are looking forward to having the baby and are closer than ever before. However, this may not be true for everyone.
Even if you hare happy about being pregnant, you will find that there are times you are “blue.” This is normal. As you become bigger and have more trouble moving about, you may wonder if it is worth it all. You may find yourself worrying about the time when the baby will be born. These are things that concern most women during their pregnancy, but please remember to discuss your concerns with your healthcare provider.
During pregnancy, emotions change very quickly. You may find yourself happy and a few minutes later you feel like crying. You suddenly become irritable, then immediately change back into high spirits. This is true with most pregnant women and varies with each pregnancy.
It is helpful to talk with your partner, friends, and/or relatives if possible. Your physician and other members of the healthcare team want to answer questions that concern you.
Plan to attend parenting classes for expectant mothers and fathers. The class may be helpful in answering questions regarding the pregnancy and the arrival of your new baby. Ask us for information about parenting classes.
Recreation is just as important now as before you were pregnant. You also need to do relaxing activities. Set aside a time for a nap each day or just spend time relaxing doing something enjoyable such as reading.
If you become depressed and have trouble doing your normal daily activities or have difficulty sleeping because of a problem, talk to your health care provider. We can refer you to our social worker or counselor for help.
Travel and pregnancy
It is always fun to take a trip! The best time to travel during pregnancy is during the second trimester (13-26 weeks) when the risk of complications is least and you are feeling good. If you are at high risk for preterm labor, bleeding conditions, or other complications of pregnancy, please check with your health care provider before taking a trip. During your last month of pregnancy, we do not recommend traveling more than 1 to 1 ½ hours from Wichita.
The general guidelines for travel during pregnancy are as follows:
- Take a rest stop every 2 hours if you are traveling by car or bus. Get out and walk around. Drink plenty of liquids. Take healthy snacks with you to eat to help reduce the nausea. Go to the bathroom every 2 hours.
- If you will be gone for several weeks or longer, take a copy of your prenatal records with you and get the name of an obstetrician in the place you are visiting, in case you have any problems.
- If you are flying, check with the airlines about their regulations concerning flying during pregnancy. Do not fly in an unpressurized plane above 7000 to 9000 feet. Pressure changes may decrease the oxygen supply to you and your baby. Try to get a seat in the front part of the cabin for a more solid ride. Do not take medication for motion sickness without checking with your health care provider first. Drink plenty of fluids to keep your body well hydrated.
- If you are traveling to a foreign country, please check with your health care provider for special recommendations.
Should I wear a seatbelt while I’m pregnant?
Yes! You should wear a shoulder and lap belt while traveling in a motor vehicle. Positions the belt so the lap portion is below your stomach, across the upper thighs. The shoulder belt should be between your breasts. If there is only a lap belt, you should use it. Studies have shown that it is safer for the mother and baby when a seat belt is worn.