Obstetrics

Preconception Care

A preconception care checkup is advised if you are planning to become pregnant. The checkup reviews your diet and lifestyle, medical and family history, medications, and past pregnancies. This enables you to take steps that increase the chances of having a healthy pregnancy and a healthy baby. Health and nutrition can impact your baby’s growth and development during the first 8 weeks of pregnancy when most of your baby’s major organs and body systems begin to form.

More information at:
https://www.acog.org/womens-health/faqs/good-health-before-pregnancy-prepregnancy-care

Nutrition During Pregnancy

Eating a healthy, well-balanced diet is the most important thing you can do for your baby. Include foods from all food groups in appropriate amounts for proper nutrition. This ensures essential nutrients (carbohydrates, fats, protein, vitamins, minerals and water) are supplied to the body for optimal health. Proper nutrition is essential for normal organ development and functioning, reproduction growth and maintenance, resistance to infection and disease, and bodily damage or injury repair. While pregnancy is a normal condition, it is stressful, so nutritional needs are increased to meet the needs of the pregnancy.

The World Health Organization recommends pregnant women eat at least 75 grams of protein daily, obtained from a variety of whole foods. While MyPlate (USDA guidelines) offers a well-balanced plan, pregnant women need more protein and calories. Include daily:

• • 2 – 3 servings of meat, fish, nuts or legumes, and tofu
  • 2 – 3 servings of dairy (milk, eggs, yogurt, cheese)
  • 3 servings of vegetables (predominantly green)
  • 3 servings of fruit
  • 3 servings of whole grain breads, cereals, or other complex carbohydrates
  • At least 8 glasses of water

For information about specific foods and nutrients during pregnancy, visit:  http://www.acog.org/Patients/FAQs/Nutrition-During-Pregnancy

Exercise in Pregnancy

The extra weight you carry will make your body work harder during pregnancy. Exercising at least 30 minutes on most, or ideally every, day benefits your health during pregnancy by:

• • Reducing backaches, constipation, bloating, and swelling
  • Preventing or treating gestational diabetes
  • Increasing energy
  • Improving mood
  • Improving posture
  • Promoting muscle tone, strength, and endurance
  • Helping you sleep better

Regular activity keeps you fit during pregnancy and may improve coping ability with labor.

Hormones produced during pregnancy cause ligaments that support your joints to relax, making the joints more mobile and at risk of injury. The extra weight in the front of your body shifts your center of gravity and places stress on joints and muscles, especially those in the pelvis and lower back. You may feel less stable, experience back pain, and be more likely to lose your balance and fall, especially later in your pregnancy.

Certain sports are safe during pregnancy, even for beginners. Walking, swimming, and cycling are beneficial. Yoga and aerobics can also be done, typically with slight modifications for your expanding abdomen. If you were a runner before pregnancy, you can often keep running during pregnancy, although you may have to modify your routine.

What Forms of Exercise Should Be Avoided?

Avoid activities with a high risk of falling, e.g., gymnastics, water skiing, horseback riding. Some racquet sports increase the risk of falling because of shifting balance. Other sports to avoid include:

• • Downhill snow skiing — Shifting balance increases risk of injuries and falls, and there is a risk of altitude sickness from breathing air containing less oxygen.
  • Contact sports, e.g., hockey, basketball and soccer
  • Scuba diving — Puts your baby at risk of decompression sickness, a serious illness resulting from changes in pressure surrounding the body.

More information at:
http://www.acog.org/Patients/FAQs/Exercise-During-Pregnancy

Medication Use During Pregnancy

Many over-the-counter and prescription medications are safe to take during pregnancy OTC SAFE MEDICATIONS.  However, some are not. Prior to pregnancy, discuss your medications with your provider to determine if any should be changed or discontinued. If you discover you are pregnant and are taking medication, make an appointment with your provider immediately to discuss – in some cases, abrupt discontinuation can be harmful. Some safe medications are not recommended for breast-feeding mothers. Be sure to discuss medications with your provider about necessary changes post-delivery.

All pregnant women (unless specifically instructed by a provider) should take a daily prenatal vitamin. There are many over-the-counter and prescription options. It is an individual choice that should be determined by tolerability and affordability. Prenatal vitamins typically contain more folic acid, iron, and supplemental DHA vs. traditional multivitamins. Prenatal vitamins should be continued during breast-feeding and sometimes beyond, e.g., a future pregnancy, alternative multivitamin.

The FDA urges pregnant women to not take any herbal products before talking to their health care provider. Vitamins and herbal supplements do not undergo the same FDA scrutiny as prescription drugs. The quality and strength of a supplement can vary between batches and manufacturers. Reliable information about the safety and efficacy of the product may be hard to find, which makes researching them challenging. Although herbs are natural, not all herbs are safe to take during pregnancy. The FDA suggests women consult a trained herbalist if they wish to take herbs during pregnancy. Some herbal products may contain agents that are contraindicated. They may contain substances that cause miscarriage, premature birth, uterine contractions, or injury to the fetus.

These herbs are considered Likely Unsafe or Unsafe when used orally during pregnancy:

• • Saw Palmetto — has hormonal activity
  • Goldenseal — may cross the placenta
  • Dong Quai — uterine stimulant and relaxant effects
  • Ephedra
  • Yohimbe
  • Pay D’ Arco — in large doses
  • Passion Flower
  • Black Cohosh
  • Blue Cohosh — uterine stimulant and can induce labor
  • Roman Chamomile
  • Pennyroyal — either orally or topically

These herbs have been rated Likely Safe or Possibly Safe for use during pregnancy:

• • Red Raspberry Leaf — Rich in iron, used to increase milk production, decrease nausea, and ease labor pains. Tea helps promote uterine health. There is some debate whether this should be used throughout pregnancy or only in the second and third trimester.
  • Peppermint Leaf — Helps relieve nausea/morning sickness and flatulence.
  • Ginger Root — Helps relieve nausea and vomiting.
  • Slippery Elm Bark — (when inner bark is used in foods) Helps relieve nausea, heartburn, and vaginal irritations.
  • Oats & Oat Straw — Rich in calcium and magnesium. Helps relieve anxiety, restlessness and irritated skin.

Additional Herb Information HERE

More information at:
https://nccih.nih.gov/health or http://www.herbmed.org/

Food Guidelines

FDA AND EPA GUIDELINES
Fish and shellfish contain high-quality protein and other essential nutrients, are low in saturated fat, and contain omega-3 fatty acids. A well-balanced diet that includes a variety of fish and shellfish can contribute to heart health and children’s proper growth and development.

However, nearly all fish and shellfish contain traces of mercury. For most people, the risk from mercury by eating fish and shellfish is not a health concern. Yet, some fish and shellfish contain higher levels of mercury that may harm an unborn baby or young child’s developing nervous system. The risks from mercury in fish and shellfish depend on the amount eaten and the levels of mercury in the fish and shellfish. Women who may become pregnant, pregnant women, nursing mothers, and young children are advised to avoid some types of fish and eat fish and shellfish that are lower in mercury.

Do not eat fish containing high levels of mercury:

• • Shark
  • Swordfish
  • King Mackerel
  • Tilefish

Eat 2 meals a week of a variety of fish and shellfish that are lower in mercury, such as:

• • Shrimp
  • Canned light tuna
  • Salmon
  • Pollock
  • Catfish

Check local advisories about the safety of fish caught by family and friends in your area. If no advice is available, limit intake to 6 ounces per week of fish from local waters, and do not consume any other fish during that week.

Frequently Asked Questions About Fish
Q: I’m a woman who could have children but I’m not pregnant. Or, I’m trying to get pregnant, but I’ve not yet conceived. Why should I be concerned about methylmercury?
A: If you regularly eat fish high in methylmercury, it can accumulate in your blood stream. Methylmercury releases from the body naturally, but it may take over a year for levels to drop. This may be present in a woman before she becomes pregnant.

Q: Is there methylmercury in all fish and shellfish?
A: Nearly all fish and shellfish contain traces of methylmercury. Larger fish that have lived longer have the highest levels. Large fish such as swordfish, shark, king mackerel, or tilefish pose the greatest risk. Other types of fish and shellfish may be eaten in the amounts recommended by FDA and EPA.

Q: What about fish sticks and fast food sandwiches?
A: Fish sticks and fast-food sandwiches are commonly made from fish low in mercury.

Q: The advice about canned tuna is in the advisory, but what’s the advice about tuna steaks?
A: Because tuna steak generally contains higher levels of mercury than canned light tuna, you may eat up to 6 ounces of tuna steak weekly as one of your two servings.

Q: What if I eat more than the recommended amount of fish and shellfish in a week?
A: One week’s consumption of fish does not greatly impact the level of methylmercury in the body. If you eat a lot of fish one week, cut back for the next week or two.

VBAC

WHCG supports vaginal birth after cesarean section if desired and when appropriate. If you are interested, please discuss this with your provider. We will review the circumstances and risk factors to provide our best prediction for likelihood of success. In most incidences, this option is available to women who have had only one cesarean section.

We will need to review your dictated operative note from your prior delivery. Please bring a copy or the name and address of the hospital where your cesarean section was performed. As our office is adjacent to Overland Park Regional, we prefer to do these deliveries at OPR to be more available.

When to Call Your Doctor

Call us if you experience any of the following before 37 weeks:

• • Persistent vomiting
  • Six or more contractions in one hour
  • Leaking of fluid or sudden gush from vagina
  • Vaginal spotting or bleeding
  • Unusual or severe discomfort
  • Fever greater than 100.6 degrees C, especially if associated with abdominal pain
  • Rhythmic back pain or pelvic pressure, low dull backache, menstrual-like cramps, abdominal or pelvic cramping
  • Noticeable decrease in fetal movement, less than 4 movements per hour or less than 10 movements in 2 hours (28 weeks or beyond)
  • Swelling of hands, face, legs, or feet
  • Painful urination

 

Call us if you experience any of the following 37 weeks or beyond:

• • Regular, painful contractions, every 3 to 5 minutes apart (1st time mothers). If this is not your first child, call when your contractions are 5 minutes apart, lasting 60 seconds. If you have a history of very rapid labors, discuss this with your provider.
  • Leaking of fluid, regardless of the presence or absence of contractions
  • Any significant amount of vaginal bleeding. A small amount of mucous, bloody show is normal. (call us if bleeding is like a menstrual cycle or heavier or wearing a maxi pad is required)
  • Fever greater than 100.6 degrees, especially if associated with abdominal pain
  • A noticeable decrease in fetal movement. It is a wives tale that decreased fetal movement is normal right before the onset of labor.  The baby can be more difficult to feel as you get closer to your due date. Make sure you are in a quiet place, free of distractions when trying to assess the amount of movement.
  • Visual disturbances: Dizziness, double vision, spots before eyes
  • Severe headache
  • Swelling of hands, face, legs, and feet
  • Painful urination

 

Call us if you experience any of the following post-partum:

• • Fever greater than 100.6 degrees, especially if associated with abdominal pain or increased bleeding or breast pain
  • Bleeding that consistently gets heavier instead of lighter
  • Worsening abdominal or episiotomy site pain
  • Foul smelling vaginal discharge
  • Unusual pain or redness of breast(s)
  • Pain or difficulty breast-feeding

More information at:
http://www.whcg.org/services/gynecology