LeConte Women’s Healthcare Associates wants you to have the best pregnancy experience possible. Read the information below to help prepare you for all stages of pregnancy.
Tests Performed During Pregnancy
- Blood pressure: taken at each visit
- Urine: checked at each visit to see if your body is producing excess protein or glucose and make sure there is not an early bladder infection
- Fundal height: we’ll measure the uterus with a tape measure at each visit to make sure the pregnancy is growing properly.
- Fetal heart tones: we should be able to hear the baby’s heartbeat around 12 weeks of gestation
- Ultrasound: ultrasound can be performed after approximately seven to nine weeks gestation to determine the due date and check on baby’s wellbeing. The ideal time is 18 to 20 weeks to evaluate organ development. We can often determine the baby’s gender at this 18-20 week ultrasound.
- Glucola or gestational diabetes testing: the glucose test screens for gestational diabetes. It’s performed around 25 weeks and takes about one hour. Make sure you have NOTHING to eat or drink other than water for at least ONE HOUR BEFORE your appointment. This includes no gum, candy, mints or smoking.
- Group B strep: we’ll test this around 35 weeks gestation (also known as GBS or Beta Strep). The test is simple and quick and involves a Q-tip just inside the vagina and near the rectum and only takes about two seconds to perform. (Nothing to dread!) This is a very common bacteria and is not sexually transmitted. It poses no immediate threat to the unborn baby. But if the test is positive then you’ll receive an antibiotic through your IV while you are in labor. If the bacteria is not there then one less thing to worry about!
What to Expect
During Labor
- Enema: an enema is available if necessary or if you request it, but it is not required
- Shave or “prep”: you will not have to be shaved or “prepped” unless a caesarean section is performed
- Eating in labor: you’re allowed to have ice chips, hard candy, or popsicles
- IV: an IV is necessary for administering antibiotics, pain medication, an epidural, or fluids for hydration. Keeping moms hydrated is better for the baby. An IV provides a way to give medicine to help stop your bleeding once the baby is born.
- Bedpans or urinary catheters: bed pans are only necessary if you are restricted to bed. Urinary catheters are sometimes necessary with an epidural or if the baby’s head is low. A full bladder will prevent the baby’s head from descending into the pelvis.
- Activity: during the early or “latent” phase of labor, it may be helpful to be up and moving around. You may take walks with your labor coach, sit in a chair, relax, sleep if you can, or take a warm shower. As labor progresses, walking or sitting may help the baby descend into the pelvis. The nurse will help you by making suggestions about walking or activity. If medication is needed to help your labor progress, if you have an epidural, or if continuous monitoring of your baby is required then you will need to remain in the bed.
- Monitoring: the baby’s heart rate and your contractions will need to be monitored during labor. It may be done periodically during early labor if all seems well. In most cases the baby will need to be monitored continuously during active labor. This may be done by external belts or internal devices placed through the dilated cervix. The doctor or nurse will explain which is best in your case.
- Labor management: the doctor or nurse will be checking your cervix periodically to evaluate your progress. At some point the doctor may break your water. This is not a painful procedure because the membrane around the baby does not have nerves. The doctor may recommend a medication called pitocin, a naturally occurring hormone in pregnant women, to be given by IV to strengthen the contractions. These methods can sometimes help prevent a prolonged labor or a Caesarean section.
- Pain relief: your nurse and labor coach will help you with measures such as positioning and relaxation techniques to relieve discomfort. Pain medication can be given through the IV in small doses to help you relax. An epidural is often a great choice. An epidural does NOT slow the progress of labor.
Delivery
- Pushing: positions for pushing include lying down, squatting, or kneeling. Squatting and kneeling may be difficult if you have an epidural for pain relief. Your nurse will help you find the best position for you. She and your labor coach will help you push. This sometimes takes one to three hours. The doctor will evaluate pushing periodically to determine progress.
- Episiotomy: an episiotomy is not routine, but may be done to prevent excessive tearing of the vaginal area or to assist in a difficult delivery. A local anesthetic may be needed to numb the vaginal area if the patient does not have an epidural.
- Forceps or vacuum: forceps or vacuum are used only if absolutely necessary for the health and safety of both you and your baby. The doctor will discuss these measures if it becomes necessary.
After Delivery
- Breast feeding: if there are no complications, you may hold and nurse the baby soon after delivery. It is best to try to nurse the baby within the first hour because they are usually very alert at that time.
- Postpartum care: under most circumstances with a vaginal delivery you will deliver your baby in the same room you came to when you were admitted to the hospital. You will also remain in this same room for the remainder of your hospital stay. If you have a C-section you may be transferred to a different room on the same floor
- Nursery or “rooming in”: most new moms will keep the child in the room with them during the majority of their stay. The nursery is utilized if mom needs a break or if the baby needs special attention.
Optional Testing
Optional Fetal Abnormality Tests Available
There are several optional tests available to all pregnant women. While there are no prenatal therapies or cures for fetal abnormalities, parents can use early diagnosis to prepare for the birth of the baby. Screening tests are noninvasive and can determine if there is a high or low risk for certain abnormalities. Diagnostic tests are invasive and can determine if a certain abnormality is present or not. Testing is not perfect and is only available for certain abnormalities. Fetal abnormality testing is not required but is an option that may be chosen by the patient in consultation with her care providers. These tests are not for the purpose of deciding whether or not to keep the pregnancy but to provide information that may guide you and your doctor in following the pregnancy as it progresses.
Non-Invasive Screening Tests
- Cystic Fibrosis Carrier Status: Cystic Fibrosis is an inherited genetic disease that is characterized by severe respiratory and digestive problems. The test for cystic fibrosis is a Maternal Blood Test that evaluates whether the mother is a carrier of the disease. If this test is positive we then screen the father’s blood for the gene mutation. If both are positive, the parents may opt to have an amniocentesis to determine if the baby has cystic fibrosis. Of course your pediatrician can proceed with testing after delivery if needed.
- First Trimester Screening + Second Trimester AFP: This screening pairs an Ultrasound to evaluate specific measurements of the baby with Maternal Blood Tests done at the same time. This determines if the baby is at high or low risk for specific chromosomal abnormalities. This screen can detect 90% of Down’s Syndrome cases and 97% of Trisomy 13 or 18. This test has a 5% False Positive Rate. If this screening shows that the risk of abnormalities is high, you may opt to have an invasive test to confirm the diagnosis. Patients may also opt to have blood drawn again in the second trimester to screen for spina bifida. This screen can detect 98% of open neural tube defects. There is a 6% False Positive Rate. If this screening test shows that the risk is high, you may opt to have an invasive test to confirm the diagnosis.
- Second Trimester Screening: This Maternal Blood Test that determines if the baby is at high or low risk for specific chromosomal abnormalities or open neural tube defects/spina bifida. This screen can detect 80% of Down’s Syndrome cases, 70% of Trisomy 13 or 18, and 98% of spina bifida. There is a 6 % False Positive Rate. If this screening test shows that the risk is high, you may opt to have an amniocentesis (drawing amniotic fluid from around the baby) to confirm the diagnosis.
Invasive Diagnostic Tests
- Chorionic Villus Sampling: This diagnostic test is an ultrasound guided needle aspiration of cells from the placenta, and it can detect 99% of chromosomal defects as well as some other inherited disorders. The risk of complications, including fetal injury and miscarriage, is approximately 1/100. This test is only performed by the doctors at the Perinatal Center or UT High Risk Obstetrics.
- Amniocentesis: This diagnostic test is an ultrasound-guided needle aspiration of fluid from around the fetus, and it can detect 99% of chromosomal defects and open neural tube defects as well as some other inherited disorders. The risk of complications-including infection, bleeding, fetal injury, rupture of membranes, and miscarriage-is approximately 1/300.
Genetic Counseling
This is a consultation between a patient and an expert in the field of inheritable diseases. The visit involves evaluation of the patient’s family history and discussion of testing options available. This service is widely available; however, it is commonly utilized in patients who are at high risk for fetal abnormalities.
Discomforts of Pregnancy
- Breast tenderness: Wear a good, well fitting support bra. You can take Tylenol.
- Heartburn: Tums, Maalox, Mylanta are safe to use. Zantac, Tagamet, or Pepcid are also fine to use during pregnancy.
- Nausea: Unisom Nighttime Sleep Aid or Emetrol over the counter liquid. Take 1 tsp when nausea first occurs, then follow bottle instructions. Using Vitamin B6 50mg twice daily and Unisom at night can be a good combination.
- Crackers, toast, soup, or broth
- Maalox or Mylanta
- Eat regular, small meals every two to three hours
- Try peppermint or cinnamon candy
- It is possible that your nausea may be related to your prenatal vitamins, so changing the time of day you take them may relieve the problem.
- Vomiting: clear liquid diet (i.e. popsicles, Jell-O, Ginger ale, Sprite, Gatorade). Gradually add soup and broth, then advance to regular foods. If vomiting resumes, stay on clear liquids. If vomiting continues, especially for more than 24 hours, and fever arises, call your doctor (865) 524-3208 .
- Nasal congestion: increase fluid intake, vaporize at home. Normal saline nasal drops two to three times a day. Tylenol Cold & Sinus, Claritin, or Benadryl are okay to use.
- Headache: Regular Strength Tylenol or Extra Strength Tylenol. If headache continues and is associated with blurred vision, swelling of the hands, face, or feet, call your doctor.
- Nosebleed: Pin the nose and hold for five to ten minutes. Ice to back of neck. Frequent use of a saline nasal spray may be helpful. Also applying a thin layer of Vaseline to the inside of each nostril may help (almost like Chap stick to the inside of your nose.) Nosebleeds occur more often in pregnancy due to increased blood volume.
- Diarrhea: Imodium and Kaopectate are okay to use during pregnancy.
- Dizziness: Gradually stand from sitting or lying position. Eat regular meals. Do not skip meals. Drink plenty of fluids. Avoid hot showers. If more than twice a week, notify your doctor.
- Colds or sinus problems: Increase fluid intake. You may use Tylenol Cold & Sinus, Benadryl, Sudafed, Tylenol PM or Chlor-Trimeton (as directed on package) for nasal drainage not accompanied by fever. Robitussin or Vicks Formula 44 may be used for cough. Vaporize at home. Normal saline drops to both nasal passages two to three times a day. If you develop a fever, colored nasal drainage, or persistent cough (productive or non-productive) call your doctor.
- Sore throat: Gargle with warm salt water two to three times a day. Tylenol as directed on package. For sore throats, Cepacol or Chloraseptic Spray or Lozenges are okay.
- Constipation: Increase fluid intake. Increase dietary fiber (i.e. fruits, vegetables, and bran). Miralax and Citracel are good brands to use for fiber supplementation as they may produce less gas. Stool softeners such as Colace/docusate sodium. Milk of Magnesia. Enemas and glycerin suppositories are also safe.
When to Call the Doctor
- Contractions may begin 15-20 minutes apart and last 30-45 seconds. Usually, you will not need to go to the hospital when your contractions begin.
- It is time to call the doctor when your contractions are 5 minutes apart, last at least 60 seconds and you have to breathe through the contractions.
- The contractions should be five minutes apart for about 2 hours.
- If you think your water has broken (a sudden gush of fluid or constant trickling down your leg) you should call the doctor.
- Call the doctor if you experience bleeding more than spotting or decreased fetal movement, or have questions regarding symptoms you are experiencing.
- We have an answering service relaying calls to the physicians. If for some reason you do not receive a call back from a physician in 30 minutes, please call the exchange again–there are some situations when the pages may not be answered immediately such as when the physician is in surgery or a delivery.
- False labor – It may be difficult to tell the difference between false and true labor. Be prepared for the possibility of being sent back home if you are having false labor.
Early Labor at Home
- Activity: try to rest in order to conserve your energy. However, some patients find walking helpful.
- Eating (while at home): You may drink liquids or eat soup or jell-o, but avoid eating a heavy meal to prevent nausea and vomiting when labor progresses.
Where To Go
When you arrive at Covenant Health LeConte there are two places you may check in. If it is a regular weekday and between the hours of 6:30 a.m. and 6 p.m., you may check in at the registration desk at the main entrance at the front of the hospital. If it is a weekend or after hours you need to check in through the Emergency Department where they will sign you in and then send you on up to the Birthing Center.
Admission to the Hospital
- You will be evaluated by a nurse in the triage area and she will contact the doctor. Your cervix will be examined and the baby will be monitored.
- If you are in labor you will be admitted to a room. You may be sent home if you are in false or early labor. (It is best to avoid admission until active labor begins.)
- Sometimes patients may be observed for an hour or so and then re-examined to see if the cervix has changed. You may be allowed to get up and walk during this time.
Prenatal Classes
Attending a prenatal class is a great way to become acquainted with our Dolly Parton Family Birthing Unit at Covenant Health LeConte and some of our staff. This half-day class covers many different aspects of the labor process, vaginal delivery, Cesarean section, epidurals, and after care for you and your newborn. Classes are usually recommended in the last 4-6 weeks of your pregnancy. Early sign-up is recommended. You can enroll by visiting the birthing unit on the second floor of Covenant Health LeConte or by calling 865-446-8210 for more information.
