Pregnancy

Scheduling regular appointments with your healthcare provider throughout your pregnancy is important to give your baby a healthy start. As you prepare for motherhood, together we’ll review your personal health history, goals, and birth plan and help you make informed decisions to ensure the best prenatal care and a safe, healthy delivery. 

Genetic Testing

We are pleased to offer preconception and prenatal genetic testing as well as screening for hereditary cancer syndromes. Your healthcare provider will make recommendations for testing after review of your individual risk factors (such as age, ethnicity, and family history).
Please click here for some frequently asked questions about genetic testing

Obstetric Testing

Most of the routine testing you will need during your pregnancy can be done in our office. Check with your insurance carrier to make sure they cover these types of services.

• Labs: At your first visit, a panel of blood is drawn for routine testing including blood count, blood type, HIV status, Rubella, RPR, and Glucose. These results will be reviewed with you (and printed on a card for you to carry with you during your pregnancy) at your following appointment unless they are abnormal. No other labs are routinely done until 24 weeks with your gestational diabetes screen. 
• Ultrasound: At your first visit an ultrasound will be done with the physician to confirm your due date. The next routine ultrasound performed during pregnancy is done at 20 weeks. This is an anatomy screen to ensure that the baby is developing normally. If you'd like to find out the sex of your baby, this is the best time!
• Gestational diabetes: Click here for detailed information about diabetes testing.
• Rhogam: Patients with an Rh negative blood type (determined by labs done at the first visit) need an injection at 28 weeks to prevent any complications.
• GBBS: Click here for detailed information about GBBS screening
• Non-Stress Test (NST): Fetal monitoring done as necessary for a variety of different reasons

Postpartum Blues and Depression

Postpartum blues refers to a passing condition characterized by mood swings, irritability, anxiety, decreased concentration, insomnia, tearfulness, and crying spells. Symptoms occur in over 50% of patients, and generally develop within 2 to 3 days of delivery. Symptoms peak on the 5th postpartum day and should resolve within 2 weeks. Support and reassurance along with adequate sleep/rest usually leads to improvement. If your symptoms are not improving and are continuing after 2 weeks postpartum, please call our office.
Postpartum Depression
Postpartum depression occurs in approximately 10% of women. It generally appears within the first month postpartum and does not resolve within 2 weeks. However, postpartum depression can present up to several months postpartum. Women with a prior history of depression are especially at risk.

• Depressed mood most of the day, or
• Markedly diminished interest/pleasure in almost all activities nearly every day. Also, one might experience:
• Extreme trouble sleeping (even when your infant sleeps)
• Profound lack of energy where you may not be able to get out of bed for hours
• Significant anxiety (often with panic attacks)
• Intense irritability and anger
• Feelings of guilt
• A sense of being overwhelmed or unable to care for the baby
• Feelings of inadequacy, and of being a failure as a mother.
• Not bonding to the baby which further exacerbates feelings of shame and guilt and leads women to suffer in silence.

Many women will have some of the above symptoms occasionally after giving birth. However, it is the woman that has multiple symptoms that are not resolving who should call our office for an evaluation.

Treatment involves a multidisciplinary approach towards possible biological, psychological, and social aspects of the disease. Medication and counseling are common treatment modalities.

Natural Childbirth

Natural childbirth is also known as “unmedicated” childbirth. As physicians, we are here to support our patients’ decisions whether or not they would like to have pain medication during their labor and delivery.
Ultimately, our goal is a healthy mother and a healthy baby!  To reach that goal, there are certain things that we feel are necessary when a patient is in labor.
All our patients must have IV access (a “hep-lock” is sufficient), they must have continuous fetal monitoring, they cannot labor or deliver in a tub and they must have pitocin through an IV after the baby is born.
Labor is a painful experience for most people but with the right preparation, the pain can be managed without medication.  We recommend that any patient interested in an unmedicated delivery begin the process of educating herself and her husband/partner as early as 20 weeks.
The hospital has comfort measure classes as does Bloom Yoga , MotherMe and Birthways.

Twin/Triplet Pregnancy

The moment you find out you are pregnant can be the most exciting of your life-and when you find out you are having twins or triplets that excitement is multiplied! All the providers here at NSW are very comfortable taking care of these higher risk pregnancies.
We work in tandem with the maternal fetal medicine and neonatal specialists at Prentice providing you with the highest standard of care. Women who are pregnant with twins and triplets can more frequently develop diabetes, preeclampsia, preterm rupture of membranes and preterm labor so you will have more frequent office visits, more ultrasounds and potentially need to have hospital monitoring.

Breastfeeding

Experts agree that breastfeeding is valuable for both infant’s health and mother’s health. If you are having difficulty breastfeeding or have general questions, please call the office during business hours.
The following are some common problems women have while breastfeeding:
Mastitis is an infection of the breast that should be treated immediately with antibiotics. The following are signs of mastitis:

• A discrete area of redness on the breast
• Fever >100.4
• Chills and body aches
• Call the office right away for antibiotics
• Continue to breastfeed
• Plugged ducts occur if there is poor drainage from one or more milk ducts.
• Very tender area of the breast
• No fever
• Warm compress, massage and ice are best to relieve the clog
• Continue to breastfeed
• Sore nipples often occur if the infant has a poor latch.
• Red, painful, scabbed nipples
• No fever
• Can use lanolin to soothe
• Call a lactation consultant to observe latch

Fetal Movement

Feeling the baby move is one of the most exciting parts of pregnancy. Although every pregnancy is different, most women feel movement between 18 and 24 weeks.   While formal "kick counts" are not necessary to perform every day, you should pay attention to how your baby moves throughout the day so you know what is normal for your baby.
Here are some general guidelines for movement based on gestational age.
Between 24-32 weeks: 10 movements throughout the day: any kick, roll, push, turn, or shrug counts!
32 weeks - delivery: You should notice a minimum of 3 active periods throughout the entire day:  babies do not move all day, but you should not go more than 3-4 waking hours without noticing some activity. Once you have gone to sleep for the night, do not worry about movement.
If your baby's movements change drastically or you are feeling less movement or you are concerned about the baby in any way:
-Lay down in a quiet place
-Eat or drink something cold or sweet
-Count for 2 hours
-If there are less than 10 movements call the office 312-775-1100

Vaginal Birth After Cesarean

Women who have had a prior c-section have the option of a undergoing vaginal birth after c-section (VBAC) or an elective repeat c-section.  A successful vaginal birth carries a lower risk to the woman than does a repeat c-section.  Women undergoing a vaginal delivery will generally have an easier recovery with fewer problems after delivery and a shorter hospital stay than those who have a c-section.
However, there are certain individuals who are more likely to be successful for a VBAC than others.  If your prior cesarean section had been performed for a fetal issue (I.e. baby was breech, heart rate was worrisome, etc.), the likelihood of a successful VBAC approaches 85%.  If your prior cesarean section was done for a maternal reason (i.e. stopped dilating, baby didn’t fit through the pelvis), the likelihood of a successful VBAC is only around 50%.
There are risks associated with undergoing a VBAC.  The most serious risk is that of uterine rupture.  In most cases, cesarean sections are performed with a low uterine incision.  If that was the case, the risk of uterine rupture is around 1-3%.  However, if your cesarean section was not performed with a low uterine incision, the risk of rupture can be upwards of 10% and a VBAC is not medically recommended.
In cases where the uterus ruptures, an emergency c-section is needed.  If the uterus ruptures, there is a risk that the baby can be seriously injured or even die.  Another risk is for those women who end up needing a c-section after a trial of labor, there is a higher risk of infection, bleeding, and injury to organs inside the abdomen than for those women who elected to have a repeat c-section.  Recovery is also typically more difficult.
For those women who would like to attempt a VBAC, we do have certain best practice measures that need to be followed to ensure safety.  All patients must have IV access.  All patients should have an epidural catheter placed as well.  This is to ensure that if an emergency cesarean needed to be performed, anesthesia is readily available that allows you to be awake during the procedure.
All patients must have continuous fetal monitoring of the baby as well.  The fetal heart tracing is the first place where signs of fetal distress can be noted which may indicate the beginning of a uterine rupture and allows for earlier intervention.
The best situation for a successful VBAC is if you enter into active labor spontaneously with a  clear change in the cervical exam.  If you are not in labor and break your water, our medical recommendation is to proceed with a repeat cesarean section because of the increased risk of induction.  If you do not go into labor by your due date or slightly after, we also recommend a repeat cesarean to avoid the risks of an induction.

External Cephalic Version (for Breech Babies)

Before birth, most babies are in the head down position, ready for labor. Some babies have their feet or buttocks in the birth canal instead-this presentation is called breech. At 28 weeks about a quarter of all babies are breech, but by full-term less than 5% are breech. Vaginal deliveries are not recommended for babies in the breech position.
 
At 36 weeks we will confirm that the baby’s head is down either by ultrasound. If the baby is breech, there are a few options. One is to wait and see if the baby turns on its own and if it does not the baby is born by planned cesarean section. Another option is to perform an “external cephalic version”. This procedure is done in the hospital and is an attempt to turn the baby head down by placing our hands on the abdomen and lifting/pushing the baby into position. We will help you make the decision that is best for you and your baby.

Circumcision

Circumcision (surgical removal of the foreskin) is an aesthetic or religious procedure that we are happy to perform for our patients. There is no medical evidence for or against circumcision-it is a completely elective procedure. Risks include bleeding, infection, local organ damage and the need for possible revision for aesthetic reasons-these occur very rarely.
Typically, the circumcision is performed before the infant is discharged home. One parent will sign a consent form prior to the circumcision and then the infant is taken to the nursery. We always use a local numbing medicine similar to novocaine and try to keep the infant as comfortable as possible with “sweetees” and a pacifier. The whole procedure takes 10-15 minutes.
Following circumcision, it is important to keep the area as clean as possible. Gently clean with soap and warm water —do not use diaper wipes. You should also place Vaseline or Aquaphor on a gauze pad over the tip of the penis for 3 to 5 days to alleviate any potential discomfort caused by friction against the diaper.
It usually takes between 7 to 10 days for a penis to heal. Initially the tip may appear slightly swollen and red and you may notice a small amount of blood on the diaper. You may also notice a slight yellow discharge or crust after a couple of day.
Although this is normal, certain other problems are not. If your baby has any of the following symptoms, let your pediatrician know right away; they could mean infection or some other problem:

• persistent bleeding or more than quarter-sized spot of blood on his diaper
• fever
• swelling
• crusty, fluid-filled sores
• trouble urinating

Here you’ll find our guidelines to ensure a safe and healthy journey for mother and baby.  

Dietary Advice

Maintaining a healthy diet during your pregnancy is key to both your and the baby’s health.  Although taking a prenatal vitamin is important, your body utilizes vitamins and minerals best when they are absorbed through food.  In general, you should increase the protein portion in your diet, aiming for a percentage of protein/carbohydrates/fats of 40%/40%/20%.  Remember, the key to a good diet in pregnancy is moderation; there are very few foods you need to avoid, but pay attention to the amount consumed not only for health risks like food borne illnesses or toxins, but also to avoid unnecessary calories.

Average Weight Gain:  Unless otherwise advised by your physician, the average person will be expected to gain approximately 25-35 pounds for her pregnancy.  Most women gain about 7-10 lbs in the first 20 weeks.  From that point onward, you should expect to gain approximately 0.5-1.0 pounds per week.

Excess maternal weight gain – over 40 pounds – has been linked to increased risks of cesarean section, childhood obesity, and maternal obesity after delivery.  If you are underweight or overweight at the start of your pregnancy, your physician will give you specific instructions regarding weight gain, and we have nutritionists that can consult with you if you are concerned about your weight.

Prenatal Vitamins/Supplements:  These are important to make sure any gaps in nutrition are covered and to decrease the risk of certain birth defects such as spina bifida. Most prenatal vitamins contain the recommended daily allowance of Folic Acid (400 mcg), as well as B vitamins and iron.

A pregnant woman should make sure to take at least 1200 mg of calcium per day (2-3 servings) yet most prenatal vitamins do not contain this much.  If you feel that your diet is lacking in calcium, over the counter supplements of calcium, such as Caltrate, will suffice.  DHA supplements have been associated with improved neurological development, and should be taken in conjunction with your prenatal vitamin once you are pregnant.

Seafood:  In most cases it is safe and recommended to eat fish through your pregnancy to maximize Omega-3 fatty acids, mono-unsaturated fats, and protein.  You should try to have 2-3 servings per week of fish and seafoods that are low in mercury.  Most freshwater fishes are safe to eat (unless a local advisory has been posted), and most white, flaky fishes (tilapia, cod) are also low in mercury content.

We recommend cooked fish as much as possible to decrease the risk of any food borne illnesses; however “sushi grade” fish that has been appropriately frozen has been shown to be low in parasites and can be eaten safely.  In general, large, oily fish (fish that eat other fish) should be avoided because they have higher mercury content in their flesh.

This includes swordfish, mahi mahi, tuna steaks, mackerel, tilefish, and sardines.  Canned light tuna can be ingested safely, however, albacore tuna, with its higher mercury content, should be avoided.  Salmon is a very healthy fish rich in omega-3 fatty acids and can be consumed at least once a week. Please refer to this chart if you have more questions about fish consumption during your pregnancy and while breastfeeding.

Food Restrictions During Pregnancy

FOOD/ADDITIVE	WHERE IT IS FOUND
Alcohol	Beverages
Caffeine	Beverages, some foods
Fish with high mercury content	Large fish (swordfish, mackerel, etc.)
Unpasteurized foods	Cheeses (camembert, brie, moldy or raw cheeses) Some juices
Raw eggs	Caesar salad dressing, raw cookie dough

Exercise

Pregnancy is an ideal time for lifestyle modifications, including increasing physical activity.  Exercise has been shown to improve or maintain fitness and also improves positive outcomes during labor.  The American College of Obstetrics and Gynecology guidelines recommend that, in the absence of any complications, pregnant women should exercise at a moderate level at least 30 minutes per day on most days.

If you are new to exercise, you should start slowly and build up your training.  You do not need to check your heart rate, just make sure you can carry on a conversation.  Always drink plenty of water while you exercise.  Exercise should be performed in a normal-temperature (no “hot” rooms) environment to prevent dehydration.

You may want to avoid activities where there is a higher risk of abdominal trauma or falling, such as volleyball, skiing, basketball, and baseball.  As pregnancy progresses, many women feel a change in balance as well; exercise should be modified at this point as needed.

Resistance training, such as weightlifting, yoga, or pilates, is also recommended. Make sure to tell your trainer or instructor that you are pregnant so that he/she can make modifications in the second and third trimester.  The general rule of thumb is not to extend the body past the 90-degree point and keep yoga/pilates positions in the “open phase” rather than the “twisted phase.”

In the second and third trimesters, lying flat on your back should also be avoided in both weightlifting and yoga/pilates due to the risks of a drop in blood pressure.  Modifications can be made to perform the same activity on your side or in the sitting position.  Core work is safe during pregnancy and can help strengthen your back.

Sexual Activity:  In the absence of any pregnancy complications, there is no evidence that discourages sexual intercourse throughout pregnancy.  Most studies have shown no risk of preterm labor or delivery unless a sexually transmitted disease is acquired.  You do not need a condom at any point in your pregnancy unless you are concerned about the transmission of sexually transmitted diseases.

Travel

In most circumstances, travel is safe during pregnancy. Please consider postponing any non-essential travel during the Coronavirus pandemic. Click here for information about Zika.

Our recommendation is that any domestic airline travel should end by the start of your 36th week, and any international airline travel should end by the start of your 32nd week.  We recommend getting travel insurance just in case you need to cancel your trip at the last minute. After 36 weeks you should not be further than a 2-3 hour car ride from Chicago. By your 37th week, your partner may also want to stop traveling to make sure he/she is available if you go into labor.

Air Travel: Most airlines will allow you to fly until 36 weeks of pregnancy, and commercial airline travel is generally safe.  Fetal heart rate and development are not affected during air travel.  Studies on flight attendants have shown no increased risk of preterm labor.  All airline passengers, but particularly pregnant ones, should maintain adequate hydration, and we recommend taking a bottle of water with you onto the flight so you are not dependent on service to begin your hydration. All pregnant women should periodically move and flex their legs to decrease swelling and improve blood circulation to prevent the development of blood clots in the legs.  If you are greater than 24 weeks gestation, you may find compression stockings, found in any pharmacy, helpful to decrease swelling and improve circulation as well.  A small amount of spotting may be noted with frequent fliers as a response to pressure changes, but this is not harmful to the pregnancy as long as it resolves within 24 hours and is no more than spotting.

Travel to High Altitudes:  In general, travel to altitudes up to 5000 feet above sea level is well tolerated and needs no additional care or planning.  Travel to high altitudes greater than 5000 feet, and particularly above 8000 feet, may be more difficult.  The pregnant body will gradually acclimate to higher altitudes over a period of 48 hours, but during the first 48 hours increased shortness of breath, dehydration, preterm contractions, and vaginal spotting may be noted.  If you know your travel schedule ahead of time, it is ideal to start an iron supplementation once a day.  Make sure you stay well hydrated.  If you are able to, try to schedule your first 24 hours at a slightly lower elevation so that the body has time to adjust.  Finally, do not plan on any major physical activities, i.e. hiking, for your first 48 hours to give your body time to adjust.

Car Travel:  Pregnant women should continue to wear a three point seat belt during their pregnancy.  The lap belt is placed across the hips and below the uterus; the shoulder belt goes between the breasts and alongside to the uterus.  There has been no evidence that has shown that it is unsafe for an airbag to deploy in the case of an accident.  However, if you are in a car accident, and particularly if the airbag does deploy, you should call us immediately as we may want to assess both you and the baby.  It is safe to continue to drive until you deliver unless any activity restrictions have been placed on you.

Vaccinations

Maternal immunization protects both the mother and fetus from the dangers of certain infections. It can also provide the infant protection against infections acquired after birth until his/her immune system is fully functioning.  Most vaccines are safe in pregnancy as long as they do not contain a live virus.  The following are the vaccines that are recommended by the CDC for every pregnant woman as well as any individual who will be spending extended periods of time around the baby. Our office offers the Influenza and TDaP vaccines.

Influenza (flu vaccine): There is a tenfold increased risk of hospitalization for a pregnant woman who contracts influenza during her pregnancy and a fourfold increased risk of death.  It is a safe vaccine and also imparts influenza immunity to the baby if you are breastfeeding.  This vaccine is recommended between September and March and can be given in any of the three trimesters.

Some people should not be vaccinated. Contraindications include severe allergy to eggs (vaccine influenza is grown in hens’ eggs), or any other vaccine component (i.e., thimerosal, a mercury-containing organic compound widely used as a preservative in many biological and pharmaceutical products, including certain vaccines and contact lens solutions), and having a moderate or severe illness with fever at time of vaccination (not including minor illness). Note that if your immune system is compromised by illness at the time of vaccination your body may not be able to respond as it should to build up antibodies for protection against the flu.

The most common side effect of the flu shot is soreness at the injection site, which can last up to two days but does not usually affect an individual’s ability to perform normal daily activities. Some people, usually children and others who have not been exposed to the influenza viruses before, may notice “mild” flu-like symptoms, such as fever, malaise, and muscle weakness, after receiving a flu shot. Symptoms usually start six to 12 hours after vaccination and can last up to two days. Less common side effects include allergic reactions and Guillain-Barré Syndrome (GBS). Life-threatening allergic reactions, which usually occur immediately, are very rare but can be possible in individuals allergic to any vaccine component. The risk is estimated to be very low at one to two cases per million vaccinated, which is much less than the risk of getting the flu.

TDaP (Tetanus, Diphtheria and Pertussis) Vaccine:  The CDC is now recommending this vaccine for all pregnant women during each pregnancy regardless of the timing of the last booster. Rising rates of whooping cough and diphtheria, especially in the Midwest, have resulted in increase in hospitalizations and death for infants in the first two months of life.  This vaccine is administered in the third trimester, typically around 28 weeks of pregnancy, to maximize the advantage of the vaccine to both the mother and the baby.

What are the side effects?

• Pain, redness or swelling, mild fever of at least 100.4°F, headache, fatigue, nausea, vomiting, diarrhea, stomach ache
• Chills, body aches, sore joints, rash (rare)
• A severe allergic reaction could occur after any vaccine. They are estimated to occur less than once in a million doses

Other vaccines safe in pregnancy:  Hepatitis A and B, Yellow Fever (only if traveling to a very high risk area), Typhoid (the inactive type), Tuberculosis

Vaccines to avoid in pregnancy:  Measles/Mumps/Rubella (MMR), Varicella (chicken pox), HPV, Zoster

Medications

Many prescription medications (including some antibiotics and anti-depressants) are considered safe in pregnancy. Please consult with your prescribing doctor if you have questions about starting or continuing a specific medication. We are happy to review any questions you have about medications during your preconception and pregnancy consult visits as well.

As a rule, you may safely take any over the counter medication that does not contain ibuprofen or aspirin. Here are a few of the common over the counter medications you may need during the pregnancy.

Cold medications: Robitussin, Sudafed, Benadryl, Tylenol Cold (or Sinus), Dayquil/Nyquil

Allergy: Benadryl, Sudafed, Zyrtec, Claritin

Constipation: Colace, Metamucil, Miralax, Milk of Magnesia, Fibercon, *do NOT use suppositories or enemas unless prescribed by us

Hemorrhoids: Preparation H, Cortaid

Heartburn/reflux: Tums, Pepcid, Prilosec OTC, Zantac

Insomnia: Unisom, Tylenol PM