Frequently Asked Questions

Obstetrical FAQs    pdfdownload/print for later viewing

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Unless you are having complications, your first OB visit should be around 8 weeks gestation. However, if you are unsure of your last menstrual period or have a history of miscarriage, we would like to see you for a "confirmation of pregnancy" visit sooner than 8 weeks. Please call the office to schedule your initial visit once you have missed a period or have a positive home pregnancy test.

Your initial visit will take about 1-1 1/2 hours. You can expect to see your baby for the first time on ultrasound and will get to listen to his / her heartbeat. After that, you will meet with one of our certified nurse midwives. She will review your health history as well as basic procedures you can expect throughout your pregnancy. Once you are finished talking with her, you will head to our in office lab where you will have some basic blood work drawn.

You can expect to be seen every four weeks until you are 32 weeks gestation. You will then be seen every two weeks from 32-36 weeks. Weekly visits will start at 36 weeks and continue until delivery.

At your initial OB visit, you will receive a pap smear, vaginal culture, and have some basic blood work drawn. Also at that visit, the midwife will discuss two optional tests that you can have done, one being the First Trimester Screening that is done through our local perinatologist's office. The First Trimester Screening is an early test for genetic abnormalities and birth defects. The second test she will discuss with you is for Cystic Fibrosis, which is a genetic disease that affects the lungs and digestive system. Since both of these tests are optional and are considered screening tools for genetic abnormalities, not all insurances will cover them. We recommend contacting your insurance to discuss your coverage if you are interested in having them done.

Between 15-20 weeks you will be offered a Quad Marker Screening. The Quad Marker is a blood test that determines if a women is at a higher or lower risk for carrying a baby with a birth defect or chromosomal abnormality. Since this is considered a genetic screening, we recommend contacting your insurance to discuss your coverage if you are planning to have this done.

You will have a 1 hour glucose tolerance test and CBC between 24-28 weeks. The glucose tolerance test is done to screen for gestational diabetes and the CBC (Complete Blood Count) is done to evaluate the three major types of cells in the blood: red blood cells, white blood cells, and platelets.

If you are Rh negative, you will receive an injection called Rhogam at 28 weeks. This can be done at any of our local hospitals.

Around 36 weeks you will be tested for a bacteria called Group Beta Strep and will also have another CBC drawn. Group Beta Strep (GBS) is a type of bacteria that is found in 10-30% of pregnant women and is one of the many bacteria that live in the body and usually doesn't cause any harm. However, GBS can be passed to the baby during labor and delivery. If this happens, the illness can cause serious health problems and can even be life threatening.

Your Physician or Midwife will discuss each of these tests in more detail and will be able to answer any questions you may have during your appointments.

If you test positive, you will be treated with antibiotics during labor to help prevent the spread of infection to the baby.

You will have a total of 3 sonograms throughout your pregnancy. The first sonogram will be done at your initial ob visit. This sonogram is done to confirm your due date and to make sure the pregnancy is progressing appropriately. Your second sonogram, the "Anatomy Sonogram", is done around 20 weeks. Around 37 weeks you will have an "Estimated Fetal Weight Sonogram" to determine the baby's size and position. Some insurance companies will only cover a certain number of sonograms during pregnancy. Because of this, we recommend contacting your insurance to find out what your coverage entails.

All of our doctors and midwives can deliver at OSF, Methodist, and Proctor hospitals.

Our practice does not support home births because of the risks associated with them. If you are planning a home birth, we cannot assume the care of you and your baby throughout your prenatal course.

Yes, our midwives will continue to manage your labor and delivery even if you have an epidural.

We recommend a healthy, well balanced diet that contains proteins, carbohydrates, vegetables, fruits, dairy, vitamins, minerals, fats, and oils. On average, you only need 300 extra calories per day to fuel your baby's growth and keep your body healthy. This is the equivalent of a glass of skim milk and half a sandwich. Eating healthy snacks between meals is a good way to get the extra calories and added nutrients that you need.

How much weight you should gain during pregnancy depends on how much you weighed before getting pregnant. Women of a normal weight prior to pregnancy should gain 25-35 pounds. Women who are underweight should gain 28-40 pounds, and women who are overweight should gain 15-20 pounds.

Some foods should be avoided in pregnancy. Most of these foods should be avoided because of their potential for contamination with a bacteria called Listeria, which can lead to miscarriage, pre-term birth, and / or flu-like symptoms. You should avoid unpasteurized dairy products, raw or undercooked eggs (eggs should be cooked until both the white and yolk are solid), liver and liver products, swordfish, marlin, shark, and raw or undercooked meat, fish, and poultry.

Seafood can be a great source of protein, iron, and omega-3 fatty acids which are crucial nutrients for your baby's growth and development. You can safely eat up to 12 ounces per week of shrimp, canned light tuna, salmon, catfish, pollock, tilapia, whitefish, haddock, calamari, and scallops. However, some types of seafood, particularly large, predatory fish such as shark, swordfish, king mackerel, and tilefish, can contain high levels of mercury and should be avoided.

Yes, but try not to drink more than one per day. If given a choice, use products that contain Aspartame or Sucralose (Splenda).

In moderation, caffeine is safe to consume while you are pregnant. We recommend limiting your caffeine intake to 1-2 cups of coffee, tea, or other caffeinated beverages per day.

No amount of alcohol is safe during pregnancy. This is to prevent Fetal Alcohol Syndrome.

If you had a drink or two before you realized you were pregnant, don't panic. It's not likely to have caused your baby any harm. The most important thing from here on out is to focus on staying as healthy has you can and to abstain from any further alcohol intake for the rest of your pregnancy.

Like all things in pregnancy, moderation is key. Most commercially available herbal teas are safe to drink. Raspberry leaf tea is the foundation of almost all pregnancy teas as it helps promote uterine health during pregnancy. Chamomile is a great for reducing stress, promoting relaxation, and aiding in digestion and restful sleep. Peppermint tea helps to relieve flatulence and intestinal cramps, while Fresh Ginger tea is commonly used to relieve nausea associated with pregnancy. When choosing an herbal tea, it's best to avoid anything that contains "nutritional supplements" such as St. John's wort or ginseng.

Folic Acid is a naturally occurring B vitamin that helps the baby's neural tube develop properly. The neural tube is a part of the baby that will develop into the brain and spinal cord. If the neural tube does not close properly, the baby can be born with a serious birth defect called a neural tube defect. You can help prevent this birth defect from occurring by taking 600-1,000 micrograms of Folic Acid daily during your pregnancy. Most prenatal vitamins contain the necessary amount of folic acid, and an additional supplement is usually not necessary. It's recommended that women take a multivitamin with at least 400 micrograms of folic acid three months prior to getting pregnant.

In general, it's better if you can get your nutrients through food. But chances are you're not eating enough of the right fish to give you a significant dose of omega-3's, especially when you have to avoid fish high in mercury, which is the case during pregnancy. Because of this, supplements are an easy way to get a good dose of omega-3's. Most experts recommend pregnant women consume 200-300 milligrams of DHA daily to help promote your baby's brain and eye development. When choosing a DHA supplement, try to find a brand that contains some EPA as well. If you have a history of bleeding or clotting disorders, you should not take an omega-3 supplement.

Due to hormonal changes during the first three months of pregnancy, nausea and vomiting can be very common. These symptoms are typically worse when the stomach is empty, so try eating a few crackers in the morning before getting out of bed. We also recommend eating small frequent bland meals (at least every 1 1/2 - 2 hours) throughout the day to keep something in your stomach and to stabilize your blood sugar. Dehydration can also make symptoms more pronounced, so make sure you are drinking plenty of fluids, such as water, ginger tea, ginger ale, or lemonade. You can also try taking vitamin B6 25mg in the morning and in the evening, and a 1/2 tablet of Unisom in the morning and in the evening. Some other remedies include: lemon drops, mints, ginger chews, preggie pops, and motion sickness bands.

First, try taking it at night before bed. If this doesn't help, you can take two Flintstones Vitamins daily in place of your prenatal vitamin.

The flu shot can be safely given during any trimester of pregnancy and is highly recommended by our physicians and nurse midwives for all pregnant and breastfeeding mothers. For more information regarding the importance of getting a flu shot during pregnancy, please click on the following link: http://www.cdc.gov/flu/protect/vaccine/pregnant.htm

As long as your pregnancy remains uncomplicated, it is safe to travel until 34 weeks gestation. After 34 weeks, we don't recommend that you travel further than one hour away. While traveling, you should get up and move around for at least 10 minutes every 1-2 hours. This is to promote adequate blood flow through your body and prevent blood clots from forming. Make sure to mention any upcoming travel plans at your next visit, as the doctor or midwife may recommend taking a copy of your prenatal record with you.

Yes, we recommend that you continue with routine dental visits during your pregnancy. Make sure the dentist is aware of the pregnancy and that your abdomen and thyroid are covered during any x-rays that may need to be done. If it is necessary to have dental work done while pregnant, you can have local anesthesia, but no nitrous oxide should be used. Some dentist require written guidelines for treatment from our office. If your dentist requires this type of note, please call our office with their fax number and we will be happy to send it to them.

Whether or not you get stretch marks primarily depends on your genetic makeup and how rapidly you gain weight. The best defense against stretch marks is to drink plenty of water and eat a diet rich in fruits, vegetables, vitamins, and minerals in order to keep your skin healthy and well hydrated. Creams and lotions cannot change your genes, but they can help with the itching and burning that accompanies your rapidly growing abdomen.

Toxoplasmosis is an infection caused by the parasite toxoplasmagondii, which can threaten the health of an unborn baby. The most common ways to become infected with toxoplasmosis are by handling cat feces, eating undercooked or raw meat, or by eating uncooked foods that have come into contact with contaminated meats. In order to prevent toxoplasmosis, make sure you thoroughly cook all meat (meat should not look pink and juices should be clear), wash all fruits and vegetables before eating, use hot soapy water to wash any surface that has come into contact with raw meats, and avoid changing cat litter. If changing cat litter is unavoidable, wear gloves and wash your hands with hot soapy water when finished.

After your 1st trimester, it is safe to color and / or perm your hair. However, due to the hormonal changes that are going on in your body, you hair may not react to the color or perm like it did before the pregnancy.

Most first time moms will start feeling their baby move around 16-20 weeks. If this isn't your first pregnancy, you may feel movement earlier than 16 weeks. Most women describe the initial sensations of movement as being like popcorn popping or like butterflies in their stomach. By 28 weeks you'll be able to discern a pattern to your baby's movements and you'll know if he or she isn't moving as much as normal. You should call the office ASAP if you notice a decrease in your baby's movements.

Round ligament pain is very normal in pregnancy. It's a sharp pain on either side of the lower abdomen that can occur with movement such as getting up from a chair, urinating, or turning from side to side in bed. Thought sharp, the pain goes away quickly. Try supporting your abdomen when standing up or turning in bed to prevent the ligaments from being over stretched.

As long as your pregnancy remains uncomplicated, it is safe to continue having intercourse. If you've had any spotting, bleeding, or problems with pre-term labor, you should abstain from intercourse until your doctor or midwife advises otherwise. You should not have intercourse once your water has broken.

The mucus plug is a small amount of thickened mucus that seals your cervical canal and prevents bacteria from entering the uterus. As your cervix begins to ripen and dilate, the mucus plug is expelled. It may be clear, slightly pink or blood tinged in color, and may be stringy or sticky in consistency. Some women may not even notice the loss of their mucus plug because of the increased discharge already associated with pregnancy. Passing your mucus plug is a sign that your body is preparing for labor, but does not mean labor is imminent. Labor could be hours, days, and even weeks away as the cervix gradually opens over time.

There are many great reasons to continue an exercise program after becoming pregnant. Exercise will help you to sleep better, reduce pregnancy discomforts, help prepare your body for childbirth, reduce stress levels, lift your spirits, and will help to get your body back in shape after delivery. Low impact or prenatal aerobic exercise classes, as well as walking and swimming are recommended. When working out, always remember to drink plenty of water and never lie flat on your back during any exercises.

We do not recommend using a Jacuzzi or hot tub during pregnancy. This is because they can elevate your body temperature to a level that is unsafe for both you and the baby. A good rule of thumb is anything over 100 degrees Fahrenheit is too hot to be in while pregnant.

Latex paints that do not contain solvents such as ethylene glycol ethers and biocides are safe to be around during pregnancy. If you are painting indoors, make sure the area is well ventilated. You should avoid all oil based paints and varnishing products.

Consuming 1,000-1,500mg of Calcium daily, along with a potassium rich snack such as a banana or glass of orange juice before bed should keep cramps at bay. You can also try gentle calf stretches before getting into bed to help loosen your muscles.

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Gynecology FAQs    pdfdownload/print for later viewing

Our Providers follow the ACOG (The American Congress of Obstetricians and Gynecologists) recommendations when deciding at what age to perform a pap smear. Currently the recommendations are to have your first pap smear at the age of 21 regardless of whether you have been or are sexually active.

The majority of women will need a yearly gyn exam and pap smear, especially if you are taking birth control pills, sexually active with more than one partner, or having any gyn problems. Pap smears may be recommended more frequently if they are abnormal. If you are postmenopausal and have a normal pap history, your doctor or midwife may recommend spacing out your pap smears to every two years. However, you will still need a yearly gyn visit with a breast and pelvic exam.

If your pap smear comes back abnormal, one of our nurses will contact you by phone to inform you of the results and will discuss your doctor or midwife's recommendations for follow-up. Follow-up may be as simple as a repeat pap smear in 4-6 months, or may involve an in office procedure called a colposcopy.

Colposcopy is done when a pap smear shows abnormal changes in the cells of the cervix. It's a way of looking at the cervix through a special magnifying device called a colposcope, which allows the doctor to identify problems that can not be seen by the eye alone. If your doctor sees any abnormal areas during the procedure, a biopsy of the area may be taken and sent to the lab for further evaluation.

We recommend screening for all women who have been sexually active with more than one partner. However, screening is not a routine part of your yearly exam. If you are unsure if you need screening, please discuss your concerns with your doctor or midwife at your appointment. Contact our office at any time if you are worried you may have been exposed or are showing symptoms of an STD.

HPV is a very common virus that affects approximately 75% of all sexually active people at some time in their lives. HPV is primarily spread through sexual contact, but can also be spread by skin-to-skin contact. There are two types of HPV, high risk and low risk. High risk HPV causes abnormal cells on the cervix, which can lead to cervical cancer. Low risk HPV can cause genital warts, and has not been linked to cancer. There is no medical cure for HPV, however, women can minimize their risks of becoming infected by limiting their number of sexual partners and using condoms.

Gardasil is a vaccine that can be given to girls and young women, ages 9-26, to protect against four of the most common types of HPV. Gardasil works by triggering a woman's immune system to fight off these viruses in the event that she is exposed, and is most effective if given before a woman becomes sexually active. The vaccine is given in three separate doses over a six month period. Gardasil is not a treatment for HPV and does not protect against all types of HPV, therefore, women who are vaccinated should still have regular pap smears to screen for cervical cancer.

Yes, even though a woman has been diagnosed with HPV we still recommend getting the vaccine in order to prevent future infection of a different type of the virus.

No two women are alike, and because of this, there are many methods of birth control available depending on your interests and lifestyle. The most common form of birth control is the birth control pill, which is taken at the same time everyday. Newer more convenient methods include Nuvaring, a flexible 2" ring that is inserted monthly into the vaginal like a tampon, and the Ortho Evra Patch, which is worn like a band aid and changed weekly. Another option is the Mirena IUD, which is a small device that's inserted into the uterus, lasts for up to 5 years, and helps to reduce heavy periods. Depo Provera, another popular method, is a contraceptive injection that's given every 12 weeks. If you are interested in starting birth control, contact our office for an appointment to discuss which option is best for you.

Irregular bleeding can be normal for the 1st three months after starting a new birth control pill. Once you start your 4th pack of pills, your body should be completely adjusted to the hormones and you shouldn't have any further problems. It's also normal to have some spotting or irregular bleeding if you miss a pill, take a pill more than a few hours late, or are using an antibiotic.

If you miss one of your pills, take your missed pill the following day, along with that day's pill. For some women, taking 2 pills at the same time can cause nausea, which is due to the increased amount of estrogen. To prevent this from happening, you can take one pill in the morning and one pill in the evening. Missing a pill will decrease it's effectiveness, so you should use another form of birth control, such as a condom, until you start your next pack. You may also have some irregular bleeding or spotting, which should resolve after your next period.

Yes, you can skip your period while on birth control pills. Contact our office for further recommendation on how to do this safely.

When birth control is taken correctly, it is not uncommon for women to have very light to non-existent periods. This is nothing to be concerned about because the pill protects the uterus from abnormal cells. Missing periods when you are not on the pill can be a sign of pregnancy, a hormonal imbalance, perimenopause, or menopause. If you miss three consecutive periods and are not pregnant, you should contact our office.

Abnormal uterine bleeding is one of the most common reasons women see their doctors. It can occur at any age and can have many different causes. It can be defined as bleeding after intercourse, bleeding between periods, bleeding that lasts longer than 10 days, bleeding that is heavy enough to saturate a super pad or tampon sooner than every hour, or bleeding after menopause. Menstrual cycles that are longer than 35 days or shorter than 21 days are also abnormal.

Abnormal bleeding can have many causes. Your doctor or midwife will start by checking for problems that are most common in your age group. Many causes are not serious and are easy to treat, while others can be more challenging. Some common causes of abnormal bleeding include pregnancy, miscarriage, ectopic pregnancy, problems with birth control, hormonal imbalances, infections, uterine fibroids or polyps, clotting disorders, thyroid disorders, diabetes, and certain types of cancers, such as uterine, cervical or vaginal cancer.

We recommend any over the counter products that contain Ibuprofen (Motrin) or Naproxen (Aleve) for the relief of menstrual cramping. For best relief, start taking Motrin or Aleve at regular intervals the day before your period starts. Soaking in a warm bath or applying a heating pack to your abdomen can also be very effective. Some research has shown that increasing your daily calcium intake to 1500mg can improve menstrual cramping as well. If you continue to have severe cramping after trying the above recommendations, call our office for an appointment to discuss other treatment options with your provider.

Urinary leakage is also know as urinary incontinence and is a common problem for many women. Incontinence can present itself in several different forms, such as stress incontinence, which occurs when a woman coughs, sneezes, laughs, or during exercise. Urge incontinence, otherwise know as overactive bladder, is when a woman suddenly has an urge to urinate and leaks urine before she can get to the bathroom. Mixed incontinence is when a woman has symptoms of both stress and urge incontinence. Often times women are too embarrassed to discuss their symptoms, however, with a proper diagnosis, urinary incontinence can most often be treated. Most of the treatments you can do at home revolve around lifestyle changes, such as avoiding caffeine, which acts as a diuretic, losing weight, avoiding constipation, limiting the amount of water you drink in the evening, and smoking cessation. Please contact our office for an appointment if you are having any problems with your bladder. Sometimes urinary leakage can be caused by something as simple as a bladder infection, which can be easily diagnosed and treated.

Most women should begin having yearly screening mammograms at age 40. However, if you have any risk factors, such as a family history of breast cancer, your doctor or midwife may recommend having a baseline mammogram done earlier than age 40. Most insurance companies will cover a one time screening mammogram between the ages of 35-40 if risk factors are present. We recommend contacting your insurance company regarding coverage before your appointment, especially if you are over the age of 35.

Osteopenia refers to bone mineral density (BMD) that is lower than normal, but not low enough to be classified as Osteoporosis. Bone mineral density is a measurement of the minerals in the bones, which indicate how dense and strong they are. Having Osteopenia puts you at a greater risk for developing Osteoporosis.

Osteoporosis occurs when more of your bone is lost than formed, which causes your bones to become thin and brittle. There are two types of bone, compact bone and spongy bone. Compact bone looks solid and hard and is found on the outer part of the bones, while spongy bone is filled with holes (just like a sponge) and is found on the inside of the bones. With osteoporosis, the bones remain the same size, but the outside walls of the compact bone become thinner and the holes in the spongy bone become larger. The combination of these two changes drastically weakens the bone and puts you at a greater risk for fractures.

A bone density scan is a safe, painless test that determines whether or not you have osteopenia or osteoporosis. It also measures your rate of bone loss and your risk of a future fracture. The most accurate test available is called a DEXA scan. During this scan, you will be asked to lie down for 3-10 minutes while an arm like device (an imager) scans your body.

Most women should begin having DEXA scans at age 50. However, there are some instances when women would need tested earlier than age 50, such as long term use of certain medications like prednisone or depo provera, history of a spinal fracture, or a history of certain thyroid disorders. If you are unsure if you should begin having routing DEXA scans, please discuss your concerns with your doctor or midwife at your next visit. Since DEXA scans are considered a screening tool for osteoporosis, some insurances may not cover it or may only cover it if done at a specific facility. We recommend checking with your insurance regarding your coverage before your appointment.

DEXA scans should be done every 2 years unless otherwise specified by your doctor or midwife.

Prevention is extremely important because it is difficult to grow new bone after it is lost. Therefore, the focus of prevention should be on building and keeping as much bone as you can. This can be done by performing weight bearing-exercises and choosing foods that are rich in Calcium and Vitamin D. Low-impact or step aerobics, brisk walking, and tennis are all great examples of weight-bearing exercises. Good sources of Calcium are dairy products, such as milk and yogurt, leafy green vegetables, nuts, seafood, and juices and cereals that are fortified with Calcium. Women ages 51 years and older should consume 1,200mg of Calcium per day. Women that are postmenopausal and are not using hormone replacement therapy, along with all women over the age of 65 should take 1,500mg of Calcium per day.

Perimenopause refers to the years leading up to menopause, and can last for a period of up to 10 years. On average, perimenopause begins in the mid-40's and it's during this time that the ovaries begin to produce less estrogen and you may start to experience hot flashes - the most common symptom of perimenopause. You may also begin noticing other changes, such as trouble sleeping, night sweats, irregular bleeding or spotting may occur, periods may be heavier or longer than normal some months, and may be shorter and lighter in other months, the number of days between periods may increase or decrease, and you may even start to skip periods. Some women may also experience a decreased libido, begin having mood swings or become more irritable than normal, experience memory lapses, or have trouble concentrating.

Menopause refers to the period in a woman's life when the ovaries completely stop functioning and menstruation stops. If you have not had a period for 12 consecutive months, you are most likely in menopause.

Approximately 75-85% of perimenopausal women experience hot flashes. A hot flash is a sudden feeling of heat that spreads through the upper body and face. Your face may redden like a blush and you may break out in a sweat. They can last for a few seconds to several minutes, and at times, even longer. Some women experience a few hot flashes a month, while others will experience several per day.

Try to pinpoint what triggers your hot flashes and avoid them if you can. For example, some women find that hot drinks like coffee and tea, alcoholic beverages, or spicy foods precipitate hot flashes. Try dressing in layers so you can remove a pieces of clothing when you feel a hot flash coming on. Keep your office and home thermostat low and keep a fan handy. Studies have shown that women who exercise regularly experience fewer and less intense hot flashes. If you have tried the recommendations listed above without improvement, call our office to schedule an appointment with your doctor or midwife to discuss hormones or other therapies he or she can prescribe.

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