Obstetrics

Congratulations on your pregnancy! Pregnancy is a very special time in a woman’s life, and we are very pleased to share this incredible time with you and your family. Our goal is to help you have the best pregnancy possible, and to safely deliver a healthy infant.

For more information, please select the various topics below. We hope this will answer some initial questions you may have had about pregnancy, or our office. As always, never hesitate to ask us about any questions or concerns you may have. We look forward to sharing this special time with you and your family.

General Information

How do I contact you?

If you need to talk to us, you can always reach us, or someone who can help by calling our office at 281-364-9898.

If you call during office hours, you will usually be able to speak to a nurse, or can leave a message to speak with one of us. If you have an emergency after hours, or on the weekends, our number is answered by an answering service who will page the doctor on call. Please allow about 20 minutes for us to call you back. If you have not been called back in this length of time, please call again.

If you are bleeding, contracting, or believe you are in labor, please go directly to labor and delivery at the hospital. This saves time and they will then call us after you have been evaluated.

How often will I be seen during my pregnancy?

Normally your visits will be scheduled every four weeks from now until 30 weeks, every two weeks from 30-36 weeks, and then weekly until delivery. If you have any pregnancy complications or have twins, then you may be seen more frequently.

Where will I deliver my baby?

We deliver our patients at Memorial Hermann Hospital - The Woodlands. It is an outstanding facility with exceptional nursing and anesthesia care for you and your infant.

Who will deliver my baby?

We recognize what a special time the birth of your baby is and appreciate sharing this moment with you. We make every effort to be at your delivery. If we should not be available when you are in labor due to illness, vacation, family, or other commitments, one of our associates will be. They are all superbly trained physicians, as well as warm, compassionate individuals, with whom we are confident that you will receive the highest quality of care.

Testing

What routine tests will I have done?

At your first visit, blood is drawn and tested for your blood type and Rh factor, blood count (to check for anemia), rubella (to check for exposure to German Measles), as well as tests for syphilis, hepatitis B, and HIV. You may also need a pap smear and tests for gonorrhea and Chiamydia at this time.

When you are 24 to 28 weeks into your pregnancy, your blood count for anemia will be rechecked, and you will be screened for gestational diabetes with the one-hour glucola test. If your Rh factor is negative, then you will receive a shot of Rhogam at 28 weeks as well.

In addition, when you are 36 weeks, we do a vaginal culture to look for Group B Strep. Group B Strep is a bacteria that many women carry in the vagina. It is usually asymptomatic and does not cause any problems, but can cause an infection in a baby. If this test is positive, you will be treated with antibiotics during labor.

Are there any optional tests I should consider?

There are several optional tests that are offered during pregnancy. These tests can give information about a woman's risk of having a baby with certain birth defects.

Testing for these issues may be right for some people and not right for others based on many factors. These factors include your risk of having an affected baby, your personal plans and needs, and your spiritual and religious beliefs. We will discuss these tests with your during your prenatal visits, but the decision to be tested or not is a personal decision between you and your partner and many couples choose not to be tested for birth defects.

In addition to the tests discussed below, there may be additional elective tests that we discuss with you based on your personal history, family history, or ethnic background. The following discussion is not meant to be comprehensive, but is an overview of some of the standard elective tests offered to all pregnant women.

Cystic Fibrosis Carrier Screening
At your first prenatal visit one of the tests we routinely offer is carrier screening for cystic fibrosis. Cystic fibrosis is a genetic disorder that causes lifelong serious illness resulting in problems with breathing and digestion. The purpose of carrier screening is to see if a couple is at increased risk for having a child with this disease. You could be a carrier of cystic fibrosis even if nobody in your family has cystic fibrosis, and even if you already have children without cystic fibrosis.

The carrier rate is 1 in 29 for people of European Caucasian background, 1 in 46 for Hispanic people, 1 in 65 for African Americans, and 1 in 90 for Asian Americans. Screening involves a blood test that looks for mutations in the cystic fibrosis gene. The test does not pick up every possible mutation, but detects the majority of mutations. If your blood test shows that you are a carrier, then your partner's blood is tested. If he is also a carier, then the baby has a 25 % chance of being born with cystic fibrosis. If you are both carriers, we would then discuss options for testing the baby during your pregnancy including CVS or amniocentesis

Testing for Chromosomal Problems
While there are many potential chromosomal problems, one of the most common chromosomal birth defects is Down syndrome. This happens when an individual is born with too many chromosomes, specifically an extra chromosome 21. It occurs in approximately 1 in 800 births in the general population, but increases in frequency with increasing maternal age. For example, a 20 year-old has a risk of 1 in 1,667, and a 35 year-old woman has a risk of 1 in 378. But, because most babies are born to younger women, 80% of cases of Down syndrome are born to women under 35 years old who have no risk factors.

There are several ways to test for Down syndrome:
1. Amniocentesis or Chorionic Villus Sampling (CVS)
  In addition to looking for Down syndrome, these tests will look for other chromosomal problems that involve extra or missing chromosomes. These are both invasive tests and therefore have a chance of miscarriage when performed. These tests are the only way to determine with certainly that the chromosome count is normal for your baby.
  
  Amniocentesis is done at 15 to 19 weeks. A needle is placed with ultrasound guidance through the abdomen, into the amniotic sac, and a small amount of fluid is withdrawn. The cells in the fluid are grown and then examined for chromosomal abnormalities. The risk of miscarriage from an amniocentesis is approximately 1 in 300.
  
  Chorionic Villus Sampling (CVS) is performed at 10-12 weeks. A needle is placed with ultrasound guidance through the abdomen or cervix, and a biopsy of the placenta is performed. This is done in the medical center by specialized physicians. The miscarriage rate is approximately 1 in 200.
2. Quad Screen or Alpha-fetoprotein (AFP4)
  The quad screen test is a blood test done on you at 15 to 20 weeks. The results will compare your risk of having a baby with Down syndrome with the risk of an average 35 year old woman. If your risk returns as greater than that of a 35 year old woman, then amniocentesis will be offered.
  
  The quad screen is not perfect and it only picks up approximately 80% of cases of Down syndrome. This means that even if the test comes back normal (showing your risk is less than that of a 35 year-old woman), then there is still a chance that the baby may have Down syndrome. In addition, if it comes back abnormal (showing your risk is greater than that of a 35 year-old woman), the majority of the time the baby is fine and will not have Down syndrome. In fact, only about 1 - 2% of patients with an abnormal quad screen will actually have a baby with Down syndrome.
  
  Spina Bifida is another common birth defect that the AFP test looks for. This is a type of defect where the fetus's brain and/or spinal cord don't form as they should. It occurs in about 1-2 in 1,000 births. About 90% of babies with Spina Bifida are born to parents who have no known personal or family history of the disease. The AFP screening test can detect approximately 90% of cases of Spina Bifida.
3. First Trimester Screening and Nuchal Translucency Testing
  First trimester screening consists of blood work done on you, and an ultrasound that looks at the amount of fluid accumulation behind the neck of the baby, called the nuchal translucency (NT). These tests are performed between 11 weeks and 13 weeks 6 days. As with the AFP4 testing, this result will compare your risk of having a baby with Down syndrome with that of a 35 year-old woman. If your risk returns as greater than that of a 35 year-old woman, then amniocentesis or CVS will be offered.
  
  First trimester screening testing is also not perfect, but it picks up approximately 90% of cases of Down syndrome. As with the AFP4 test, if your first trimester screening result is normal, there is still a chance the baby may have Down syndrome. And if it is abnormal, the majority of time the baby is fine and will not have Down syndrome.
  
  If you do this test, then we would also perform the AFP test at 15 weeks to determine your risk for Spina Bifida.

How often will I have ultrasounds?

At your first visit an ultrasound is normally done to confirm gestational age and make sure the heartbeat is present. At 18-20 weeks, an ultrasound is done to make sure the baby's anatomy is developing as it should. If you want to know the sex, we can usually see at that time. We can schedule an ultrasound any time after you are 15 weeks to see the sex of the baby. This is not covered by insurance and there is a charge of 75.00.

In our office, we offer 4D ultrasound as well. This allows you to have an amazing view of the baby growing inside of you and is a wonderful picture and video keepsake. Usually the best pictures of the baby's face are obtainable at 26-32 weeks. This service is not standard or medically necessary and so is not covered by insurance companies. Please refer to the flyer in your information packet about this service, or ask us during any of your prenatal visits.

Weight

How much weight should I gain?

We recommend a weight gain of 25 to 35 pounds during your pregnancy for most women. If you were significantly overweight or underweight prior to your pregnancy, we may modify this recommendation and discuss specific guidelines for your situation.

In the first three months, you are likely to gain 2-4 pounds. You will then gain an average of 3-4 pounds each month during the rest of pregnancy. The weight gain is not all fat, but is mainly from retaining water and from the weight of the growing baby.

Gaining an appropriate amount of weight is an important part of a healthy pregnancy, but remember you do not have to "eat for two!"

Diet

Should I change my diet during my pregnancy?

It is important to eat a healthy, well-balanced diet incorporating all the food groups. There are several things that you should eliminate or pay special attention to during pregnancy and they are as follows:

Alcohol
We do not know what a safe amount of alcohol is during pregnancy. The amount of alcohol consumption it takes to cause fetal alcohol syndrome in an infant is unknown. Therefore, we recommend that you abstain from alcohol during your pregnancy.
Caffeine
You should limit your caffeine consumption to approximately one serving per day.
Fish
Because of mercury contamination in certain fish that may harm a baby's brain or nervous system, you should avoid shark, swordfish, king mackerel, and tilefish during your pregnancy. You can safely eat 12 ounces a week of other fish such as tuna, shellfish, canned fish, smaller ocean fish, or farm-raised fish. We recommend that you avoid sushi or raw/rare fish during your pregnancy.
Meats
You should avoid raw or undercooked meat and poultry to prevent listeriosis. Listeriosis is an illness caused by bacteria in certain foods. In women, it often causes no symptoms or mild flu-like symptoms, but it can cause serious problems in a fetus including miscarriage or stillbirth. To prevent listeriosis from meat products, make sure all meat is thoroughly cooked and avoid prepared meats such as hot dogs or deli meats unless they are reheated and steaming hot. As always, take care when preparing foods and handling raw meats.
Cheeses
Avoid soft cheeses like Brie, blue, or feta cheese and any unpasturized cheeses. Soft or unpasturized cheeses can cause listeriosis. Pasteurized or hard cheeses are fine to eat.
Fruits and Vegetables
To prevent listeriosis, make sure to wash all fruits and vegetables before eating them.

Do I need extra vitamins?

You may need extra nutrients including iron, folic acid, and calcium. Most often a prenatal vitamin may be all that you need. We would also recommend taking a DHA supplement during your pregnancy. Some prenatal vitamins contain this already, otherwise you can take a supplement. We will discuss your individual needs during your prenatal visits. Please do not take any vitamins or supplements without speaking to us first.

Precautions

Can I exercise?

Unless you are having pregnancy complications or are advised otherwise by us, most women can exercise throughout their pregnancy. The things that women often find the most comfortable to do are swimming, cycling on a stationary bike, walking, pregnancy yoga classes, or low-impact aerobics classes designed specifically for pregnancy. You should refrain from downhill skiing, contact sports, scuba diving, high impact aerobics, weight lifting, horseback riding, and most racquet sports. After 20 weeks, do not attempt any activities that require you to lie flat on your back. Your weight could press on the major blood supply to the uterus. During any form of exercise, you should check your pulse rate and try to keep it below 140 beats per minute. Do not push yourself physically - if you are uncomfortable or tired, you should stop and rest. Always make sure you wear appropriate clothing and drink plenty of fluids.

What about sex?

You may continue to have intercourse until labor begins as long as it is comfortable and enjoyable for you. If there is a medical reason to abstain, we will discuss this with you.

What about work?

You may continue to work outside the home or continue with your usual household activities until you go into labor as long as there is no medical reason to restrict your activities.

What about travel?

As long as everything is going well, you may travel outside of the Houston area until you are 34 weeks pregnant, or 6 weeks before your due date. If you are traveling outside of the continental United States, we would like you to be back by 32 weeks, or 8 weeks before your due date. If you travel, take a bottle of water with you so you stay well hydrated during your trip. If you fly, get up and walk around at least once an hour to promote circulation in your legs.

Can I go to the dentist?

Yes - just be sure to let him or her know that you are pregnant. You may have your teeth cleaned, have fillings placed, or have root canals done during your pregnancy as long as your dentist would only use local anesthesia and no nitrous oxide. It is normal to have an increased amount of bleeding due to the increased blood volume in your circulation. If your dentist has any questions, please feel free to have him or her contact us.

Can I care for my cat?

If you have a cat, you can continue to care for it as usual, just have someone else clean the litter box. If this is not possible, then make sure to thoroughly clean your hands afterwards. They can transmit an infection called toxoplasmosis through their feces that can be harmful to a developing fetus.

Can I take a bath?

Yes, but you should keep the temperature below 100 degrees. You do not want your core baby temperature to go above 100 degrees because this can affect the baby's development. Because of the elevated temperatures, you should avoid hot tubs and saunas during pregnancy.

Medications

What medications can I take?

The following are a list of treatments or over-the-counter medications for certain problems during pregnancy. Please avoid taking any herbal supplements or other over the counter medications without speaking with us first. If your symptoms persist, worsen, or you develop a fever of 101.4 or higher, please contact us in the office.

Constipation
Increase intake of fiber with things like all-bran cereals, beans, fruits, raisins, and prunes. You can also supplement your fiber intake with Metamucil or Konsyl.

Make sure you are drinking plenty of fluids. You may also try Milk of Magnesia, Surfak, or Colace.

Diarrhea
Start with clear liquids like 7-up, Sprite, Ginger Ale, and then advance to bananas, rice, applesauce, and toast. You may also take Imodium AD - start with 1/2 the suggested dose on the label. Once the diarrhea has stopped, resume the bland diet and avoid all dairy products for 2-3 days.

Headaches
Tylenol, regular or extra strength, is fine to take. Do not take Advil, Motrin, Aleve, or any Ibuprofen based product.

Head Cold/Sinus/Cough
Tylenol Cold and Sinus, Sudafed, Benadryl, Drixoral, Robitussin, or Triaminic (match symptoms on label).

Hemorrhoids
Try Tucks pads, Anusol, or Preparation H Ointment or Suppositories.

Indigestion or Gas
Tums or Simethicone are fine, but avoid Pepto-Bismol.

Leg Cramps
Sometimes this may be due to a lack of calcium or potassium. You can take 600 mg twice a day of calcium, and I or 2 bananas a day

Minor Sore Throat
Chloraseptic spray, throat lozenges, or gargle with warm salt water

Minor Swelling
Reduce salt intake and elevate feet as often as possible.

Morning Sickness or Nausea
Start with vitamin B6 50 mg tablet 3 times a day, ginger root 1 gram a day, or ginger tea. Discontinue your prenatal vitamin until nausea resolves and eat small frequent meals. If this does not help, then try Emetrol - follow directions on the label for dosing.

Cord Blood

What about cord blood collection?

We highly recommend doing cord blood collection. This is your one chance to collect these potentially life- saving stem cells. There are two main companies, CBR (Cord Blood Registry) and Viacord. We will discuss this with you during your visits, and please feel free to ask us any questions. There is a fee of 125.00 for the physician to collect the cord blood in addition to the amount the cord blood bank requires.

Childbirth Classes

Are there any childbirth classes I should take?

There are a number of classes offered through the hospital including classes about pregnancy, Lamaze, cesarean delivery, fitness, breastfeeding, CPR and first aid, baby care, infant massage, and sibling classes. There is detailed information about these classes and others included in the folder from the hospital.

You can also contact the perinatal education office at Memorial Hermann Hospital at 281-222-CARE or visit the website at www.memorialhermann.org/ for further information or to register for any of these courses.