Prenatal Care

There are a lot of misconceptions about prenatal care. Women’s Health Associates is here to change that. A cornerstone of our treatment philosophy is the patient education that takes place during your first prenatal visit. We’re here to cut through the clutter and provide peace of mind knowing that the information you receive is coming from a trusted and qualified source to help you during your first trimester. A healthy baby needs top-notch care from the moment of conception. We hope you find the basic information in these pages valuable as you prepare for your prenatal appointments.

Wellness

Nutrition

Maintaining proper nutrition in pregnancy is vital to both mother and baby’s wellbeing. Proper nutrition includes not only a good diet but vitamins and supplements as well. They do not replace proper nutrients obtained from food but help to boost the good nutrients from the food. It is important to eat a well-balanced diet of protein, fat, and carbs combined with the proper exercise routine for optimal health.

Read more about prenatal nutrition

Lifestyle Changes

Illegal Substances

The use of illegal drugs is strongly discouraged in pregnancy. Please talk to your doctor if you are using illegal drugs and want to quit. There are resources for quitting.

Alcohol During Pregnancy

When you’re pregnant, your baby drinks what you drink. Alcohol goes into your bloodstream and crosses the placenta. Some unborn babies whose mothers drink alcohol have mental retardation, behavior and learning problems, and problems growing. These problems are serious and can be long-term.

There is no known safe amount of alcohol (even wine, wine coolers, and beer) when you’re pregnant, and there is no safe time to drink if you’re pregnant. Every pregnancy is different. Even if you had a healthy baby before when you were drinking, the baby you’re carrying now could be harmed by alcohol. Talk to your physician if you have questions about drinking during pregnancy or call Tel-Link (Missouri’s information and referral telephone line for maternal, child and family health services) at (800) 835-5465 for more information.

Smoking During Pregnancy

When you smoke, so does your baby. Cigarettes contain poisons such as nicotine, lead, arsenic and carbon monoxide. These poisons get into the placenta, which is the tissue that connects you to your baby and sends oxygen and nutrients and eliminates wastes. Smoking tobacco or marijuana products during pregnancy can cause low-birth weight, preterm labor, and infant death. It can cause serious complications such as preeclampsia and abruption. Second-hand smoke CAN cause problems for your baby. There can be long term health risks for your baby. Smoking during pregnancy can cause your baby to have more colds, lung problems, learning disabilities, and physical growth problems. After the baby is born, the baby may get more colds, coughs, and middle-ear infections.

Contact the Missouri Tobacco Quitline at (800) 784-8669 or visit www.quitnow.net/Missouri for free telephone counseling to help you quit. It is easy. You’ll learn why it’s tough to quit and techniques to help you quit successfully. Another helpful website is http://health.mo.gov/living/wellness/tobacco/atod. Make a difference in your health and the health of your baby. Call the Quitline today.

Medications safe in pregnancy

Heartburn
Pepcid, Zantac
Tums, Rolaids
Prilosec, Nexium, Zegrid

Colds/Allergies
Limit Sudafed
Tylenol
All cough drops
Robitussin (not DM) for cough
Benadryl
Zyrtec, Claritin
Saline Nasal Sprays
Mucinex

Back Ache
Tylenol
Aspercreme
Thermacare
Icy Hot

Constipation
Colace
Milk of Magnesia
Miralax
Senna

Sleep Aids
Unisom
Melatonin
Tylenol PM

Vaccinations
Injectable Flu vaccine
Whooping cough (tdap)
Tetanus
RSV (seasonally)
COVID-19

Alternative Care/Medicine

Alternative care is combining traditional prenatal care with eastern medicine in order to achieve the right balance in pregnancy. This can include spa care, massage, acupuncture, and chiropractic care. All are considered safe in pregnancy if used appropriately. Please refer to each section for specific details.

Spa Care

When you are pregnant it is important to pamper yourself. It is safe to go to a spa and have a pedicure, manicure, facial massage, or hair removal. Studies have been done on pregnant women who underwent these services and there is no harm to the baby. So ENJOY!!

Acupuncture

Acupuncture is a tradition that goes back more than 2000 years. It is a complement to Western medicine techniques and has many uses in pregnancy. Acupuncture can reduce stress, reduce first trimester morning sickness, reduce hip and low back pain, move the baby out of the breech position in the third trimester, help with mild to moderate anxiety and depression, and it can possibly start and reduce the length of labor.

Acupuncture may also help with improving fertility. Studies show that acupuncture can increase the chances that In Vitro Fertilization will result in a live birth by 10 to 15 percent or more, for example.

If you are considering having acupuncture in pregnancy, please make sure you ask questions to make sure they are certified to work with pregnant women. Always inform your doctor if you have had any procedure done in pregnancy.

Chiropractic Care

Chiropractics can control symptoms of nausea in the first trimester, reduce the time of labor and delivery, relieve back neck or joint pain, realign pelvis after delivery, and can possibly help change breech position to head down.

Speak with your doctor if you are receiving care from any other provider. Make sure you find a certified chiropractor who works with pregnant women. If you are experiencing pain, bleeding, or contractions contact your doctor and abstain from further treatment until you are seen.

Massage Therapy

Massage therapy in pregnancy has been shown to improve maternal health, labor outcomes, and newborn health because it reduces stress and anxiety in pregnancy. It decreases cortisol and norepinephrine which are two stress hormones released in the body. There are many massage techniques available but Swedish Massage tends to be the most beneficial.

Message therapy can reduce stress, relieve nerve pain (especially pelvic pain), relieve sciatic nerve pain, improve circulation, and reduce swelling in hands and feet.

Make sure the massage center has a certified person who can perform prenatal massage, and tell them you are pregnant as most places will not perform a massage until after the first trimester. Stay hydrated before and after massages. DO NOT get a massage if you have high blood pressure, are on bed rest, or are having preterm labor issues.

The safest time to have a massage is after the first trimester. After the baby, you should wait until you have your postpartum visit to make sure you have healed appropriately.

Exercise

Exercise is important part of maintaining good health in pregnancy. The most important thing is to listen to your body. If you are not feeling well, bleeding, or having pain, discontinue the exercise. The guidelines below will help you make some good choices for you and your baby.

Under 20 weeks

You can continue the exercises you are currently doing as long as you are not experiencing pain or bleeding. Women may experience nausea in the first trimester and limit your desire to workout. Make sure you stay hydrated.

20-30 weeks

At this time the uterus reaches the belly button and is no longer protected behind the pelvic bones. It is important to only do exercises where you will not get hit in the belly or fall on your belly. Some suggestions include yoga, pilates, water aerobics, walking, and easy step aerobics. Always stay hydrated!

After 30 weeks until Delivery

Exercise may lead to mild contractions. You do not have to stop exercising unless you are having preterm labor, bleeding, or it is too uncomfortable for you.

---

What to Expect

Pregnancy can be unpredictable, and the below guidelines can change depending upon your particular situation. Our professional staff is available to answer any questions you may have.

First 14 Weeks

Your first visit will be with one of the OB physicians during which a complete physical and pelvic exam will be performed. You may have an ultrasound to establish the due date or check for viability. Your physician will also provide counseling specific to you and answer any questions you may have. You will have routine blood work done that determines you blood type, check for anemia and potential infections. You may have genetic testing done if you desire after discussing it with your provider.

You will return for visits approximately every 4 weeks during the remainder of the first and second trimesters. Most of these will be brief visits during which we will measure your blood pressure, weight, and uterine growth. We will also listen to your baby’s heartbeat and check your urine each time.

16-24 Weeks

At approximately 20 weeks you will have another ultrasound of your baby. This ultrasound is used to assess the growth, development and anatomy of the baby and to check for any possible major birth defects. If you wish to know the gender of your baby, we can usually tell you at this time. Further ultrasounds may be indicated later in the pregnancy should any complications arise.

24-36 Weeks

Between 24-28 weeks, you will be screened for gestational diabetes. A “glucose” beverage will be given to you to drink when you arrive at the office. Your blood sugar will be tested one hour later. You are not required to fast leading up to the test. You should plan for this visit to take about one hour.

Appointments will be scheduled at 2 week intervals from 28 to 36 weeks to follow your blood pressure, weight, urine, and baby’s growth. Also 28 to 32 weeks is typically the best time to view your baby using the latest 3D 4D Ultrasound technology – available in our office.

You and your partner are encouraged to participate in a birthing class if this is your first baby or if you feel you might benefit from a refresher course. You will also be able to tour the birth center. Sign up early, as these classes can sometimes fill up. Ideally, you should plan to attend these classes around 32-36 weeks.

36 Weeks – Delivery

Between 35-37 weeks, you will be tested for Group B streptococcus (GBS). This test involves a pelvic examination during which a culture is obtained from the vaginal and rectal areas. GBS is fairly commonly found in pregnant women, and has been associated with potentially severe infections in newborns who are exposed during delivery. If your culture is positive for GBS, you will receive intravenous antibiotics during your labor to reduce the risk of transmission to your baby.

You will be seen weekly from 36 weeks until your delivery to follow you for signs of labor or any complications. You may have your cervix checked during any of these visits if you wish.

---

Labor and Delivery

Before Labor

Your cervical Exam

In the last weeks of pregnancy, your doctor may check your cervix each week. Checking your cervix tells your doctor if you are progressing. The cervical exam is composed of three things:
dilation (how open is your cervix)
effacement (how thin is your cervix)
station (where is the head in relation to your pelvic spines)

What to bring to the hospital

You should bring what you need for your personal comfort including cosmetics and comfortable clothes for you and your partner. As far as the baby, Boone Hospital provides diapers, wipes and a baby hat. If you want to bring some outfits for pictures then you are welcome to do so. You do not need a car seat until the day you leave the hospital.

Labor Process

The Labor Process can be scary for most patients. The most important things is to stay positive and open-minded. Your provider will also review your preferences for labor management with you in the last weeks of your pregnancy. The wonderful staff at Boone Hospital is there to provide a memorable and beautiful experience for you and your family.

Options for Pain

Epidural Anesthesia

An epidural is a local anesthetic that is placed in the space surrounding the spinal cord. It provides pain relief from the waist down. You will feel pressure but not pain.

What are the benefits?
continuous pain medication
no affect to baby
can relax and this can help with cervical dilation

What are the risks?
can lower your blood pressure that requires position changes
less than 1% chance of spinal headache
may take longer to push as you are comfortable

IV Narcotics

Narcotics can be given through IV route for labor pain. Typically they last between 1-2 hours. You can get them up until you are ready to push. It takes the edge off of pain but does not completely get rid of pain.

What are benefits?
fast onset
no additional needle sticks

What are risks?
can cause nausea, vomiting, lower blood pressure

What is the APGAR score?

The APGAR score is a score assigned to all newborns at birth. Is based upon several categories worth 2 points each. A perfect score is 10.
skin color
heart rate
body tone
breathing
reflexes

---

After Delivery

The postpartum, or postnatal, period is the 6-8 weeks following the birth of your baby. The World Health Organization describes this period as being the most critical, yet most neglected, phase of pregnancy. Clearly, it is important to visit your doctor regularly to ensure that there are no postnatal complications for either the mother or the baby. During this postnatal phase, your hormone levels and uterus size will return to pre-pregnancy conditions. Some women develop mood symptoms or postpartum depression during this time. You will be screened at your postpartum visit. Many women also begin pelvic floor therapy after their postpartum period to help restore normal pelvic anatomy. Ask you provider for more information.

---

FAQs

We understand that pregnancy can be a time of excitement as well as apprehension. Each pregnancy is different and we hope to help you have the most positive experience that you can. There are many questions and concerns that are common to pregnancy and we have provided information on some of these topics here. Of course, we are always available to answer your questions in the office.

What can I do while pregnant?

These are the most common activities asked about by our patients. If you have other concerns or questions, don’t hesitate to ask us about it.

Yes you can:

Go to concerts/ sporting events- Loud noises will not harm your baby. Although, you should be aware of how active you may be during the event.

Dye your hair- There has never been a case report of a baby born with a birth defect due to the mother coloring her hair.

Exercise- Exercise is not only allowed but encouraged during your pregnancy. For more information check out our Prenatal Wellness Page.

Travel- You can travel on an airplane until you are 36 weeks along in your pregnancy. If you are going to travel by car make sure to take frequent breaks to move your legs and prevent blood clots.

Paint a room- You can paint a room as long as you use good ventilation. Make sure you have open doors, fans, windows in order to make sure you avoid excess fumes.

Go to a waterpark/ amusement park- You can go to a park, but you cannot go on rides as it may cause bleeding, cramping, or even labor. Please be aware of the signs posted in the park.

What medications can I take while pregnant?

Heartburn
Pepcid, Zantac
Tums, Rolaids
Prilosec, Nexium, Zegrid

Colds/Allergies
Limit Sudafed (not to be used in the first trimester)
Tylenol
All cough drops
Robitussin (not DM) for cough
Benadryl
Zyrtec, Claritin
Saline Nasal Sprays
Mucinex

Back Ache
Tylenol
Aspercreme
Thermacare
Icy Hot

Constipation
Colace
Milk of Magnesia
Miralax
Senna

Sleep Aids
Unisom
Melatonin
Tylenol PM

Vaccinations
Injectable Flu vaccine
Whooping cough (tdap)
Tetanus
RSV (seasonally)
COVID-19

When will I feel the baby move?

Usually women feel the baby move about 19-20 weeks. If you don’t, don’t panic as it can take up to 24 weeks to feel movement. At 28 weeks, we suggest kick counts. A baby should move 10 times/2 hour time frame when it usually the most active. Always pay attention to the movements when your baby is usually the most active.