Obstetrics

Thank you for choosing Southern OB/GYN to assist you through your pregnancy. Good prenatal care is important for the health of both mother and baby. We strive to provide care keeping that in mind. Your initial Obstetric visit allows us the opportunity to answer concerns and to individualize your care. Our office staff will help answer any insurance and financial questions you may have.

Southern OB/GYN provides comprehensive care, from routine checkups to high risk pregnancies.

Obstetrical pre-natal visits are scheduled on a monthly or weekly basis, depending on how far along you are in the pregnancy.

If you require an urgent or unexpected visit when your physician is unavailable, we will ensure your medical needs are taken care of immediately with one of our trusted team members onsite.

While every pregnancy is different, the following are some general guidelines and tests which you can anticipate over the course of your care.

Weeks 4-10

Please contact our office when you discover that you are pregnant.  You will be scheduled to meet with our prenatal nurse educator for a consultation. During this visit, your gynecologic and medical history will be reviewed extensively and you will have the opportunity to ask questions.

For week-by-week information about your pregnancy including fetal development, you may want to visit the Pregnancy Calendar provided by About.com as a helpful online resource.

We encourage your first visit to be by at least 8 weeks. Please note that your first visit (prenatal workup) will be the busiest and generally includes:

• General orientation to the practice
• Physician examination (pap smear if due)
• Assigning a due date
• Discussing prenatal vitamins
• Discussing any concerns
• Routine prenatal blood work

You will have an ultrasound to establish the due date and viability of your pregnancy.  You will also have routine laboratory studies drawn and meet with our financial counselor.

Normal symptoms include fatigue, breast tenderness and nausea. While spotting and occasional cramps are not unusual, persistent cramping or bleeding should be reported.

Weeks 11-12

Your next visit will be with one of the OB physicians during which a complete physical and pelvic exam will be performed.  Your physician will also provide counseling specific to you and answer any questions you may have. The first trimester screen will be offered to you between 11-14 weeks.  This test involves blood work from you and an ultrasound to measure the thickness of the baby’s neck.  This is an optional screen for Down syndrome, Trisomy 13 and Trisomy 18.

Weeks 13-19

Normal symptoms include some uterine ligament stretching and typically, an ending of nausea and fatigue as you enter your second trimester. Typically, most women begin to feel some fetal movement between 16 and 20 weeks.

We check for fetal heart tones at every visit from 12 weeks.

At 16 weeks, you will have the opportunity to have your blood drawn for the AFP or Quad Screen.  The AFP only is an optional test which screens for spina bifida.  The Quad Screen screens for Down syndrome, Trisomy 18 and Spina Bifida.

At approximately 18 weeks you will have another ultrasound of your baby. This ultrasound is used to ensure that there are no major problems with your baby’s growth and anatomy.  If you wish to know the gender of your baby, we can usually tell you at this time.  Further ultrasounds may be indicated later in the pregnancy should any complications arise.

Weeks 20-30

Normal symptoms include uterine round ligament stretching and occasional tightening of the uterus (Braxton-hick contractions).

During this time, we will measure uterine growth at every visit and listen to the fetal heart beat.

At approximately 28 weeks, you will take the screening blood test for Diabetes in pregnancy. We usually schedule this visit in the morning.  You will have a fasting blood glucose level drawn, a sugary drink administered, and another blood level drawn an hour later.  If this screening test is positive, we then administer a more accurate and more involved 3 hour Glucose tolerance test another day.

For women who are Rh- (Ex: A ‘negative’ blood type like A-, B-, O- and AB-), you will receive your first Rhogam injection (to decrease the chance of building up antibodies against future pregnancies) at 28 weeks; the second injection will be administered after delivery.

Also 28 to 36 weeks is typically the best time to view your baby using the latest 3D 4D Ultrasound technology.

Weeks 31-36

As you enter your third trimester, we will give you registration information for your hospital. You can sign up for classes, obtain more information on epidurals, childbirth and breast feeding.  During this time, we typically see our patients more frequently, every 2-4 weeks.

Normal symptoms during this time include uterine cramping (braxton-hicks contractions), back pain, and heartburn.  If you have more than six contractions per hour that are persisting and increasing despite rest and fluids, please notify us.

Weeks 37-40

We increase your visits to weekly, and discuss delivery management plans.  You’ll have weekly cervical checks for dilation, effacement and baby’s positioning. Repeat Cesarean sections are typically scheduled at approximately 39 weeks.

Normal symptoms include lower abdominal pressure, contractions and fatigue. As your cervix thins, you may have some vaginal spotting.  If you have any vaginal bleeding, a sudden gush of fluid (possible rupture of the membranes), or your baby is not moving, call us.  Labor varies from person to person.  If you have contractions increasing in frequency to every 5 minutes apart, lasting longer each time, with increasing intensity for at least 1 – 2 hours, then please call us.

Typically around 35-37 weeks, we will do a Group B streptococcus Culture.  This a vaginal culture to screen for fairly common vaginal bacteria that can cause serious infections in newborns (ex: pneumonia).  If positive, we will treat with I.V. antibiotics during labor.

Weeks 40+

It is fairly common for patients to go past their due date.  We will increase antenatal surveillance by performing tests (non-stress tests, biophysical profiles by ultrasound) to evaluate fetal well being.  We will further discuss labor and delivery management plans, including possible induction.

Pregnancy can be unpredictable and the above guidelines can change depending upon your particular situation. The professional staff and doctors at Southern OB/GYN Specialists are available to answer any questions you may have.

For more information on local childbirth classes, please visit the East Georgia Regional Hospital website.

Sometimes couples have been trying to conceive for over a year without any luck. If this is true for you, the chances are high that one or both of you are infertile. Infertility affects 10 to 15% of reproductive-aged couples. As women get older, the chance of infertility increases.

We can provide you with an infertility evaluation and pre-pregnancy counseling and discuss several medical treatments with you so that you may have the chance to conceive your own child. Advancements in fertility treatments have increased the possibilities for infertile couples to conceive.

What is assisted vaginal delivery?

Assisted vaginal delivery is vaginal delivery of a baby performed with the help of forceps or a vacuum device. It sometimes is called operative vaginal delivery.

How common is assisted vaginal delivery?

Today, assisted vaginal delivery is done in about 3% of vaginal deliveries in the United States.

What are the types of assisted vaginal delivery?

There are two types of assisted vaginal delivery: 1) forceps-assisted delivery and 2) vacuum-assisted delivery. The type of delivery that is done depends on many factors, including your obstetrician’s experience and your individual situation.

Why might assisted vaginal delivery be done?

Some of the reasons why an assisted vaginal delivery may be done include the following:

• There are concerns about the baby’s heart rate pattern during labor.
• You have pushed for a long time, but the baby’s head has stopped moving down the birth canal.
• You are very tired from a long labor.
• A medical condition (such as heart disease) limits your ability to push safely and effectively.

For more information on assisted deliveries, click here.

What is cesarean birth?

Cesarean birth is the delivery of a baby through incisions made in the mother’s abdomen and uterus.

What are the reasons for cesarean birth?

The following situations are some of the reasons why a cesarean birth is performed:

• Multiple pregnancy—If a woman is pregnant with twins, a cesarean birth may be necessary if the babies are being born too early, are not in good positions in the uterus, or if there are other problems. The likelihood of having a cesarean birth increases with the number of babies a woman is carrying.
• Failure of labor to progress—Contractions may not open the cervix enough for the baby to move into the vagina.
• Concern for the baby—For instance, the umbilical cord may become pinched or compressed or fetal monitoring may detect an abnormal heart rate.
• Problems with the placenta
• A large baby
• Breech presentation
• Maternal infections, such as human immunodeficiency virus or herpes
• Maternal medical conditions, such as diabetes or high blood pressure

Is a cesarean birth necessary if I have had a previous cesarean birth?

Women who have had a cesarean birth before may be able to give birth vaginally. The decision depends on the type of incision used in the previous cesarean delivery, the number of previous cesarean deliveries, whether you have any conditions that make a vaginal delivery risky, and the type of hospital in which you have your baby, as well as other factors. Talk to your health care provider about your options.

Can I request cesarean birth?

Some women may request a cesarean birth even if a vaginal delivery is an option. This decision should be weighed carefully and discussed with your health care provider. As with any surgery, there are risks and complications to consider. Your hospital stay may be longer than with vaginal birth. Also, the more cesarean births a woman has, the greater her risk for some medical problems and problems with future pregnancies. This may not be a good option for women who want to have more children.

For more information about having a c-section, please click here.

What is a vaginal birth after cesarean delivery (VBAC)?

If you have had a previous cesarean delivery, you have two choices about how to give birth again:

• You can have a scheduled cesarean delivery
• You can give birth vaginally. This is called a vaginal birth after cesarean delivery (VBAC).

What is a trial of labor after cesarean delivery (TOLAC)?

A trial of labor after cesarean delivery (TOLAC) is the attempt to have a vaginal birth after cesarean delivery.

What are the some of the benefits of a TOLAC?

Compared with a planned cesarean delivery, a successful TOLAC is associated with the following benefits:

• No abdominal surgery
• Shorter recovery period
• Lower risk of infection
• Less blood loss

If you want to have more children, VBAC may help you avoid problems linked to multiple cesarean deliveries. These problems include hysterectomy, bowel or bladder injury, and certain problems with the placenta.

What are the risks of a TOLAC?

With TOLAC, the risk of most concern is the possible rupture of the cesarean scar on the uterus or the uterus itself. Although a rupture of the uterus is rare, it is very serious and may harm both you and your baby. If you are at high risk of rupture of the uterus, TOLAC should not be tried.

Why is the type of uterine incision used in my previous cesarean delivery important?

Some types of uterine incisions are more likely to cause rupture of the uterus than others. Low transverse (side to side) incisions carry the least chance of rupture. Women who have had one or two previous cesarean deliveries with this type of

incision can try TOLAC. High vertical (up and down) incisions carry the most chance of rupture. Women who have this type of incision should not try TOLAC.

For more information on VBAC and TOLAC, please click here.

An ultrasound is performed to visualize and determine both your health and the health of your baby. We may order an ultrasound for several reasons, including the following:

• Establish the presence of a living embryo or fetus
• Estimate the age of your pregnancy
• Evaluate the position of the fetus
• Determine if there are multiple pregnancies

We have acquired advanced ultrasound technology that displays clinical images of the human body, allowing us to see 4D images.

Widely recognized for its clinical use in obstetrics and gynecology, 4D Ultrasound with real-time motion is a new, powerful tool that can aid our physicians in studying the following:

• Baby’s motion and behavior
• Baby’s surface anatomy
• Problems related to a woman’s uterus and ovaries

4D Ultrasound technology is revolutionary and we are thrilled to offer this tool to our patients.

Antenetal fetal testing are procedures, or tests,  performed during pregnancy to detect health problems in the growing fetus; establish characteristics such as fetal age, sex, or weight; or diagnose any material conditions that may affect fetal development.

What is gestational diabetes?

Gestational diabetes is diabetes mellitus that develops in women for the first time during pregnancy. Some women found to have gestational diabetes actually may have had mild diabetes before pregnancy that was not diagnosed.

What causes gestational diabetes?

Gestational diabetes is caused by a change in the way a woman’s body responds to insulin during pregnancy. Insulin is a hormone. It moves glucose out of the blood and into the body’s cells where it can be turned into energy. During pregnancy, a woman’s cells naturally become slightly more resistant to insulin’s effects. This change is designed to increase the mother’s blood glucose level to make more nutrients available to the baby. The mother’s body makes more insulin to keep the blood glucose level normal. In a small number of women, even this increase is not enough to keep their blood glucose levels in the normal range. As a result, they develop gestational diabetes.

For more information about gestational diabetes, please click here.

What is preterm labor?

Preterm labor is defined as regular contractions of the uterus resulting in changes in the cervix that start before 37 weeks of pregnancy. Changes in the cervix include effacement (the cervix thins out) and dilation (the cervix opens so that the fetus can enter the birth canal).

What are the signs and symptoms of preterm labor and what should I do if I have any of them?

Call us right away if you notice any of these signs or symptoms:

• Change in type of vaginal discharge (watery, mucus, or bloody)
• Increase in amount of discharge
• Pelvic or lower abdominal pressure
• Constant low, dull backache
• Mild abdominal cramps, with or without diarrhea
• Regular or frequent contractions or uterine tightening, often painless
• Ruptured membranes (your water breaks with a gush or a trickle of fluid)

How is preterm labor diagnosed?

Preterm labor can be diagnosed only when changes in the cervix are found. Your obstetrician or other health care professional may perform a pelvic exam to see if your cervix has started to change. You may need to be examined several times over a period of a few hours. Your contractions also may be monitored.

Your obstetrician or other health care professional may do certain tests to determine whether you need to be hospitalized or if you need immediate specialized care. A transvaginal ultrasound exam may be done to measure the length of your cervix. The level of a protein called fetal fibronectin in the vaginal discharge may be measured. The presence of this protein is linked to preterm birth.

For more information on preterm labor and preterm birth, please click here.

What can I do about nausea?

Nausea and vomiting in early pregnancy is not always limited to “morning” sickness. Eat small, frequent meals starting first thing in the morning. Avoid greasy and spicy foods. Make sure you are taking in plenty of fluids. Try sucking on peppermint or sour hard candy. Consider sipping on a carbonated drink. “Sea Bands” motion-sickness wrist pressure bands are available at drug stores and may be helpful. You may also try Vitamin B6 supplements, 100mg/day. Prescription medications may be recommended in some cases. Please contact the office if you are unable to keep down food and liquids for more than 12 hours.

What medications can I take for…?

Listed below are medications that you can safely use for minor symptoms and discomforts of pregnancy. In general, it is recommended that any unnecessary medications be avoided, especially in the first 12 weeks of pregnancy. Medications for chronic medical problems such as diabetes, high blood pressure, thyroid disease, and seizure disorders should be continued until you can talk to your physician about them.

Pain/Headaches/Fever
Acetaminophen (Tylenol)
Do not use: aspirin, ibuprofen, or naproxen
Cold symptoms
Robitussin regular or DM for cough
Pseudoephedrine (sudafed), saline nasal spray, humidifier for congestion
Salt water gargles, Cepacol lozenges for sore throat
Allergy symptoms
Benadryl, Claritin, Zyrtec
Heartburn/Indigestion
Tums, Mylanta, Pepcid or Zantac
Do not use: Pepto-Bismol
Constipation
Colace, fiber supplements (Metamucil, Benefiber, Citrucel, Fibercon)
Increase water intake and natural fiber in your diet
Hemorrhoids
Avoid constipation
Preparation H, Tucks pads
Yeast infection
Monistat 7
Diarrhea
Imodium

If any symptoms that you are treating over the counter seem to be worsening instead of improving, contact the office for advice.

Can I exercise?

Exercise in pregnancy is healthy and may help you to feel better and stronger. Most moderate intensity exercise routines can be safely continued in pregnancy. Recommended activities include walking, swimming, stationary bicycle, low impact aerobics, yoga, and free weights. Avoid activities requiring extended time flat on your back or standing still in one position. You may find that your balance is not as good during pregnancy. Drink plenty of fluids during your workouts, and discontinue any activity which causes abdominal pain, cramping, or back strain. Your physician will counsel you if any obstetrical/health reason arises requiring you to modify your routine.

What should I be eating?

A healthy balanced diet is very important during your pregnancy. The key to good nutrition is including a wide variety of foods including proteins, carbohydrates, fats, and minerals.

Things to avoid include raw or undercooked meat, alcohol, predatory fish (shark, swordfish, king mackerel, and tile fish), unpasteurized milk and soft cheeses. Reheat deli meats until they are steaming hot. Limit consumption of fish from local rivers, lakes or ponds to no more than one 6 oz serving per week. Limit other fresh or canned ocean fish (salmon, tuna, flounder) or seafood (shrimp, oysters, clams) to no more than 12 oz per week.
Make sure to wash all fruits and vegetables thoroughly. It is also recommended that you take a daily prenatal vitamin containing at least 1mg of folic acid to reduce the risk of birth defects and to ensure you are getting the extra nutrients that you need.

How do I know if my baby is moving enough?

Every baby has periods of sleep and of activity through the day. You may start to feel occasional fetal movements starting around 17-21 weeks. By 24-26 weeks, you should feel several active periods of movement everyday. If you feel at some time (after 26 weeks) that your baby is not moving adequately, perform a kick count. To do this, lie on your left side away from any distractions. Count all of the movements that you feel. When you get to 5, you may stop. If you do not feel at least 5 movements in an hour, call the office right away.

What is the AFP/Quad Screen?

This is an optional blood test offered to low risk patients in the 16th-17th week of pregnancy to assess the risk of chromosome abnormalities (such as Down’s syndrome) and birth defects (such as spina bifida). This screen cannot diagnose these problems or completely rule them out. It can only indicate an increased or reduced risk. Additional testing would be offered should your test results return abnormal.

What tests do I need if I’m over 35 years old?

We know that due to physical changes in the body, the risk of certain pregnancy complications increases as the pregnant mother ages. These include risks of chromosome abnormalities such as Down’s syndrome. All women who will be 35 or older at delivery are offered prenatal testing. These tests are always optional. The risk for carrying a pregnancy affected by a chromosome problem is 1/132 at 35yo and increases to 1/40 by age 40. Options for definitive diagnosis include second trimester amniocentesis (extraction of a small amount of amniotic fluid through the mother’s abdomen) and chorionic villus sampling (CVS) in which the placenta is sampled between 10-14 weeks. Both tests carry a small miscarriage risk. Noninvasive testing is also available which can provide some additional risk information. A first trimester ultrasound measurement of the fetal nuchal skin fold combined with a blood test can identify up to 90% of Down’s syndrome cases. Some women over 35 prefer to have no specialized testing.

When is it necessary to have a cesarean section?

A cesarean delivery may be indicated for many different reasons including the position of the baby, inability of the baby to fit through the pelvis, abnormalities of the placenta, and fetal stress with labor. Women may also elect to have a repeat cesarean section if they have undergone a cesarean delivery in the past.

Is vaginal birth after cesarean (VBAC) right for me?

In most cases, when a woman has had a cesarean section in the past, she will be given the option to consider a repeat cesarean section versus an attempted vaginal delivery with her next pregnancy. Vaginal birth after cesarean carries special risks, the most serious of which is the risk of rupture of the uterus, seen in 1/100 VBAC attempts. When uterine rupture occurs, the mother and her baby may suffer significant complications. The advantages of VBAC when successful include more rapid recovery and shorter hospitalization. Your physicians will discuss these issues in detail with you in order to help you come to the best decision for you.

What are the risks of smoking in pregnancy?

Cigarette smoking in pregnancy has been associated with increased risk of miscarriage, preterm delivery, low birth weight, placental abruption, and perinatal mortality. Following delivery, an increase in cases of respiratory and ear infections and of sudden infant death syndrome is observed in the infants of parents who smoke. Your doctors strongly encourage you to stop smoking and to ask for help if you need it.

What if I develop gestational diabetes?

All patients will be screened for diabetes of pregnancy in the second trimester. If results are elevated, a second confirmatory test will be ordered. Gestational diabetes affects 2-5% of pregnancies. Management includes consultation with an endocrinologist or a high-risk obstetric specialist, home blood sugar monitoring, and dietary changes to control blood glucose levels. Good control is necessary to promote normal growth of the baby and healthy development. Occasionally insulin is required to maintain desired blood sugar levels. If this is the case, you would be counseled regarding additional monitoring of the baby and any special considerations for delivery.

Is swelling normal?

Swollen feet can be very common, especially late in pregnancy and in the warm weather months. This can be a sign of toxemia/preeclampsia, so if your blood pressure has been high or your swelling is associated with headaches, blurry vision, or nausea, you should contact the office. Most swelling is not related to toxemia. Limiting salt intake and drinking 8-10 glasses per day of water may help. Elevate your feet when you are able and consider using support panty hose.

Can I paint?

You may paint while you are pregnant. Make sure you use water-based paint only and work in a well-ventilated area. Limit painting to only 2 hours at a time and avoid sleeping in a recently painted room until the fumes are gone.

Can I travel?

If you are experiencing a normal pregnancy without complications, you may travel by car or air up until the 36th week. We recommend that you stretch your legs while traveling at least every 2 hours and increase your fluid intake to avoid dehydration.

What if my baby is breech?

Your baby may change position frequently. By approximately 36 weeks, the majority of babies have settled into the head-down position. About 3% of healthy babies at term will present with the feet or bottom in the lowest part of the uterus–considered breech. Because of potential serious risks, a vaginal delivery is not recommended if the baby remains breech. If the situation is appropriate, you may elect to undergo a version procedure to attempt to turn the baby and increase the chances that you will have a vaginal delivery. The physician uses pressure on the mother’s abdomen to roll the baby into a head-down position. If the procedure is not successful or if you decide against a version attempt, then a cesarean delivery would be scheduled.

How will I know when I am in labor?

You may have intermittent contractions through much of the pregnancy. These are called Braxton-Hicks contractions and they may or may not be painful. Labor occurs when the uterus tightens with contractions regularly every few minutes with increasing intensity. Other signs that labor may be approaching include a bloody or thick mucous discharge, increasing pelvic pressure, or loose stools. Your water may break during your labor or before it even starts. Or the physician may break the water to help encourage labor in the hospital. Call the office/answering service when your contractions are strong and regular, about every 5 minutes, for about one hour. You should also call if you believe your water is broken, if you have a large amount of vaginal bleeding, or if your baby is not moving.

How long could I go past my due date?

A full term delivery may occur as early as 37 weeks or as late as 42 weeks (2 weeks past the due date). Allowing a pregnancy to continue beyond 42 weeks may increase the risks of harm to the baby and is not recommended. If you remain pregnant significantly past your due date, you will be assessed to see if the cervix is “ready.” Special tests may be done to make sure the baby remains healthy. Induction of labor would then be scheduled for between 41-42 weeks in most cases.

Congratulations on the birth of your new baby! This is an exciting and challenging time. Following delivery, you may find that you are experiencing many physical and emotional changes. We are providing this guide to help you better understand what to expect.

Postpartum 6-Week Appointment

It is requested that you schedule a postpartum check with your delivering physician for 6 weeks after your baby’s birth. If you have concerns before this visit, you may contact the office for assistance.

Vaginal Bleeding

Also known as lochia, vaginal bleeding will continue for 3-6 weeks following delivery, gradually slowing and becoming a thick yellow discharge before stopping altogether. Nothing should be placed in the vagina during this time – no tampons, sex, or douching. Call the office if your bleeding seems excessively heavy, requiring pad changes more than once an hour or with large clots.

Perineal Care

It is common to feel soreness in the area around the vagina after delivery, especially if stitches were required to repair an episiotomy or tear. Any stitches placed will dissolve. Keep the area clean. Cold packs or topical anesthetic spray such as “Dermoplast” may be used for comfort. Sitz baths may also be used 2 to 3 times per day initially to promote healing. To do a sitz bath, sit in a tub with a few inches of plain warm water for 10-15 minutes.

Pain Relief

Medication will be prescribed for you for pain relief upon discharge from the hospital. Additional medications for anemia, constipation or other discomforts may be recommended as well. For safety information regarding breastfeeding with any other medications, contact your pediatrician or our office.

Post Cesarean Section Care

You may shower and clean the area around your incision with soap and water. Otherwise it should be kept dry. You may remove any remaining surgical tapes one week after you leave the hospital. It is recommended that you do not drive for 2 weeks after surgery and avoid heavy lifting for 4 weeks. Call the office if you notice fever, increased pain, redness around the incision, or significant incisional drainage.

Activity/Diet

It is normal to experience fatigue, even exhaustion, in the weeks that follow your baby’s arrival. Rest when you can and listen to what your body is telling you. You may resume a light exercise routine of walking within 4 weeks of your delivery. Avoid abdominal exercises until after your 6 week check up. Be careful not to skip meals and to continue to drink 8 to 10 glasses of water per day. We recommend that you continue taking prenatal vitamins at least until your 6 week visit and as long as you nurse your baby.

Constipation/Hemorrhoids

Try increasing your fluid intake as well as your intake of fresh fruits and vegetables. Stool softeners such as Colace and fiber supplements (Metamucil, Benefiber, etc) may be used according to package directions. For hemorrhoids, try Preparation H, Anusol cream, or chilled Tucks pads.

Postpartum Blues and Depression

Motherhood can be overwhelming. New feelings of increased responsibility, frustration, anxiety, and sometimes loneliness or disappointment are common following delivery. Sleep deprivation may contribute to these feelings, and you may find yourself experiencing the “Baby Blues.” However, if these symptoms last for more than 2 weeks, seem severe, or cause you to be unable to take care of yourself or the baby, depression may be present. Depression can become very serious and may require medical treatment. Talk with family and friends about how you are feeling and call your physician with any concerns.