Frequently Asked Questions

ALCOHOL

Don’t drink alcoholic beverages. It is a known fact that alcohol in excess can cause damage to your unborn child. As time goes by, more and more drugs are found to exert harmful effects on the fetus during the pregnancy. Remember that alcohol is a drug and that any product that contains alcohol is a drug.  Studies have not established any safe amount of alcohol use in pregnancy, therefore, we recommend you do not drink alcohol during your pregnancy.

BATHING

It is okay to take tub baths or showers in pregnancy, whichever you prefer. Water generally does not enter the vagina during these activities, so chance of infection is minimal. Your balance may be more difficult to maintain toward the end of your pregnancy, so be careful while getting in and out of your bathtub and make sure it has a nonslip surface on the bottom.  Hot tubs and saunas are not recommended during pregnancy.

BOWELS

Your regular bowel habits may become disturbed during your pregnancy. Hemorrhoids appear more frequently. These changes probably result from relaxation of the muscle cells in the bowel and pressure on the surface of the bowel wall from the expanding uterus containing the growing baby. Stool softening laxatives usually provide relief without danger to you or your baby. But don’t take a laxative, enema, or any drug without consulting your doctor first. Avoid enemas. Some dietary changes can safely prevent constipation: increased quantities of bran, fresh and dried fruits, vegetables, water, and other fluids help. 

BREASTS AND SKIN

Breasts enlarge during pregnancy because of hormonal changes. The nipple area becomes darker. Other parts of the skin may become discolored-the neck, face, and a line down the middle or lower part of the abdomen. These changes are temporary and normally disappear after delivery. Use a moistening lotion or cocoa butter around the abdomen and breast to guard against stretch marks as much as possible. Use sunscreen on skin areas exposed to the sun. 

CAFFEINE

Consumption of caffeine in low to moderate amounts (less than 3 cups a day-preferably one cup/day is recommended) is not associated with significant risks during pregnancy. Heavy caffeine use can result in potential problems such as low birth weight, caffeine withdrawal symptoms in the newborn and fetal loss. Heavy caffeine drinkers need to reduce their caffeine use while pregnant. Other sources of caffeine besides coffee to be alert to are teas, colas, chocolate and some nonprescription drugs.

CLOTHING AND SHOES

Maternity clothes are available in a wide range of prices and styles. In addition, some regular clothing with a loose fit can be worn during and after a pregnancy. Outer clothing should be practical and non-constrictive. Because a pregnant woman may feel the cold less and perspire more, cotton and natural fibers may be more comfortable than synthetic fabrics. Borrow maternity clothing from a family member or friend. Keeping up your appearance can help boost your spirits.

Wear maternity pantyhose or special support hose. Regular pantyhose may constrict blood flow. Wear maternity bras that are well-fitting and give good support.

Shoes should be low or medium heeled and as comfortable as possible with nonskid soles. Swollen feet are common during pregnancy due to normal fluid retention. There may be extra fat in the feet if weight gain is excessive. The shoe size may increase, and sometimes become a permanent change.

DOUCHING

Don’t douche.  Douching is never advised and can upset the ecological balance of the vagina which can predispose you to vaginal infections.

EMOTIONS

You may experience more emotional ups and downs than usual. This is very common during pregnancy. Urge those close to you to understand and to be supportive.

EMPLOYMENT

You may safely continue working throughout your pregnancy for as long as you remain comfortable at your job and avoid severe physical strain. 

Some jobs that involve more physical exertion may need evaluation by the doctor. There are no set guidelines regarding work during pregnancy as expectant mothers have differences in levels of capability, pre-pregnancy conditioning, exercise tolerance and physique. 

EXERCISE

Continue to enjoy fitness and recreational activities as you did before pregnancy if your doctor has given you the go ahead. Some activities need to be moderated if they are physically strenuous. Pregnancy is not the time to try a new sport or physical activity. Exercise classes designed for pregnant women are helpful. Avoid activities such as horseback riding, skydiving, motorcycle-racing, ice-skating, bicycling, fast running, water or snow skiing and others that carry undue risks of trauma/injury/falling.  You should not lift anything greater than 30lbs.  This is due to the increased risk of back/muscle strain, as well as increasing your risk for falling if going up/down the stairs.  Thirty minutes of brisk walking is encouraged.

COSMETICS AND HAIR CARE PRODUCTS

There is no specific evidence that cosmetics and other personal care products (soaps, lotions, and deodorants) affect pregnancy outcomes, therefore, there is no need to limit their use unless advised differently by the doctor.   It is safe to get your nails painted in pregnancy (no acrylics).  

Hair care products such as dyes, straighteners (relaxers), and permanent wave solutions have been studied in pregnant women and have not shown any specific risks. Exposure to these products should not pose a risk to the fetus. During pregnancy hair may react differently to a tint or permanent so it might be best to wait until after delivery. Hair care products such as sprays and shampoos carry no evidence that they do or don’t cause any adverse outcomes for a pregnancy. Most women continue to use their pre-pregnancy hair products and experience no problems (make sure to be in a well ventilated room).

INSECTICIDES

Avoid the use of or contact with pesticides for the yard, pets or the home (including pesticide strips and flea collars). Little information is available about the risks of exposure during pregnancy to these products, so it is best to keep them out of your household. 

MEDICATIONS

Avoid taking any drugs without checking with the medications in the pregnancy list or the doctor first. This includes all prescription drugs, nonprescription drugs, vitamins, herbs, laxatives, cold remedies, simple pain remedies, and others. For the sake of your unborn child as well as for your own welfare avoid completely marijuana, cocaine, alcohol, narcotics, tranquilizers, sleeping pills, or any other mind-altering drugs. The safest course to follow during pregnancy is to take nothing except nutritious food and beverages.  Illegal drug use can cause damage to the baby’s forming organs in the first trimester and it can affect the brain and overall growth causing premature birth or even fetal death later in pregnancy.  After birth, the baby can be born addicted to drugs and the drugs can pass through breast milk.  We are here to help you and your baby, if you are using drugs please let your provider know.  We might ask you for a urine sample to test for drugs periodically during your pregnancy.  If positive, you are affecting your child with drugs.

PAINTS

Avoiding painting and inhaling toxic fumes in confined areas (use only in a well ventilated room). Medical studies on paint exposure and fetal harm are inconclusive. Oil-based paints and paint thinners contain different solvents that should be avoided, especially in the first trimester of pregnancy.

CLEANING PRODUCTS

It is important to wear rubber gloves when using strong soaps or caustic products. It is also imperative to have good ventilation in the area that you will be cleaning.

REST PERIODS

Include rest periods in your routine, several times a day for short periods. Lay on one side or the other (preferably the left side) during these rest periods, rather than flat on your back.  This is because blood flow through the placenta may be decreased if you lie on your back (if you use blankets electric blankets are not recommended). 

SEAT BELT USE

The use of seatbelts is recommended to decrease maternal and fetal trauma in the event of a motor vehicle accident. Use a diagonal shoulder strap and a lap belt. The diagonal strap should pass over the shoulder and across the chest between the breasts. The lap strap should lie across the upper thighs. The straps should be above and below the “bump” of the pregnancy, not over it.

Motor vehicle accidents happen all of the time and they “don’t always happen to someone else”.  Some pregnancy women fear that the seatbelt will cause more harm to their baby or pregnancy outcome, but the American College of Obstetrics and Gynecology’s research has found no increase in the chance of injury to mom or baby despite the severity of the collision.  Fetal injury is closely related to the mother’s injuries and a mother suffers fewer injuries when she is wearing a seatbelt.  Please call our office if you are involved in a motor vehicle accident while pregnant, even if it is a minor “fender-bender”.

SEXUAL INTERCOURSE

Enjoy sexual intercourse as usual, as long as it is not uncomfortable. There may be restrictions on sexual intercourse in the cases of pregnancy-related complications (e.g., placenta previa, preterm labor).

SMOKING

Avoid smoking.  There is no doubt that smoking is injurious not only to you but also (even more so) to your unborn child. So don’t smoke! If you are a smoker and need help in stopping, speak to the doctor about methods, support groups, and so on.

TEETH

Pregnancy puts an extra strain on dental health. Be particularly careful about brushing and flossing during your pregnancy. Continue with routine dental examinations.  Preventative and restorative procedures should be provided when necessary. Local anesthetics used for dental procedures are considered safe. If dental x-rays (or other kinds of x-rays) become necessary, make sure that your abdomen is shielded by a standard lead apron.  Our office does have a dental letter than we can provide to you at your request if you require more than a routine check-up. 

TRAVEL

If possible, plan your trip for the second trimester of pregnancy. The risk of miscarriage is greatest during the first trimester, and, in the third trimester, early labor could begin.

Travel does not adversely affect pregnancy. Avoid sitting still for prolonged periods of time.  Get up and walk often (every 1-2hours). Empty your bladder frequently so as to avoid increased risk of bladder infections caused by retained urine. Don’t take any anti-nausea travel medications without your provider’s approval. Carry a record of your medical history with you. 

Avoid travel if you have a threatened miscarriage or a history of miscarriage. Avoid travel to areas at high altitudes or areas where certain vaccinations (that may be hazardous during pregnancy) would be necessary.

Airlines often will not allow you to fly late in pregnancy (usually, the last month) without a letter stating your doctor’s approval.

COMPUTERS

Medical studies to date have not demonstrated a convincing association between the use of these devices and an increased rate of miscarriage, low birth weight or birth defects.

Sitting for long periods in front of a computer does cause other symptoms, which can compound the normal discomforts of pregnancy. These include back, neck, wrist, arm, and eye strain; dizziness and headaches. Be sure to take frequent breaks from the sitting position and do stretching or relaxation exercises. Use an adjustable height chair with good back support and have the keyboard and a monitor at a comfortable height.

DIABETES MELLITIS

Diabetes Mellitus (DM) affects how your body uses/breaks down blood glucose (blood sugar).  If you are diabetic prior to getting pregnant, we will work with you and your endocrinologist to keep your diabetes under control, as pregnancy can cause fluctuations in your blood sugars.  If you do not have diabetes, but you have any risk factors for DM (>35yo, elevated body mass index >25, certain ethnicities, etc) your nurse/MD will review these with you and may suggest a HgbA1C. This is a ratio of what your blood sugars have been over the past three months. If this is elevated, dietary counseling and blood glucose checks may be recommended.  If your HgbA1C is normal, routine gestational diabetic screening is done at 26wks.  We will provide further information about gestational diabetes later on in your pregnancy.

TANNING BOOTHS AND SUN EXPOSURE

Your skin is more sensitive because of the hormones present during pregnancy.  We advise an SPF 15 to 30 sunscreen during sun exposures.  Tanning booths are NOT recommended.

Headache

Tylenol (acetaminophen), Peppermint Tea, Rest

Pregnancy Anemia 

Ferrous Gluconate, Ferrous Sulfate, Slow FE

Heartburn

Tums, Rolaids, Maalox, Mylanta, Zantac

Constipation

Water, water, water!

Increase fiber (high fiber cereals-6gms/serving), Citrucel, Fibercon, Colace, and if all else fails Milk of Magnesia, Miralax, Surfak (docusate sodium), Fleets Enema-avoid these in 3rd trimester if you have had premature labor.

Nausea/vomiting

Peppermint, Ginger (250mg 4 x day), Wristbands, Vitamin B6 3 x day, and Unisom QHS(every night). Sour/salty foods, small and frequent meals. Emetrol 15-30 ml every 8 hours may take w/Unisom.

Insomnia

Warm Milk, Benadryl (25-50mg), Unisom

Nasal Congestion

Breathe Right Nasal Strips, Neil Med Sinus Rinses, Normal Saline Nasal Spray, Vicks Vapor Rub, Humidified Air. Tylenol Cold

Fever (>100.5)

Tylenol

Sore Throat/Cold

Gargle with warm salt water or use Cepacol lozenges, lemon tea w/ honey. Robitussin, Sudafed 

Cough

Over the counter cough drops, Vaporizer, Humidifier (you can put lavender oil in humidifier)

Diarrhea

Imodium AD. Kaopectate

Hemorrhoids

Tucks medicated pads, Nupercainel, Prep H, Hydrocortizone cream

**If you are ill and the above suggestions don’t work and it is affecting your pregnancy, please call the office (see list below).  Otherwise, if you are having an unrelated pregnancy illness, please seek care with your primary care physician (ear infection, upper respiratory infection, stomach bug, etc.).

Always call the office if you >>>>>

• Have any vaginal bleeding (except after a vaginal exam)

• Rupture of membranes-leaking or gush of fluid from the vagina

• Sudden puffiness or swelling of the hands, feet, or face

• Severe or persistent headaches unrelieved by Tylenol

• Dizziness

• Abdominal pain

• Persistent nausea or vomiting

• Oral temperatures over 100.4 degrees F even after taking tylenol

• Disturbances of vision (spots, flashes, or blind spots)

• Have decreased fetal movement after 28wks

• Have persistent back pain

• Have signs of preterm labor (persistent cramping or contractions-greater than 4 in one hour not relieved by rest and increased fluids)

• Urinary Tract Infection symptoms-burning sensation or painful urination

• Irritating vaginal discharge (some discharge is normal during pregnancy-non irritation, no odor, no itching)

Nausea and vomiting in pregnancy is extremely common.  Approximately 70-85% of pregnant women experience some form of this condition.  However, in only a small portion of women is the condition so serious to warrant hospital admission or other aggressive measures (hyperemesis gravidarum).  The symptoms usually resolve spontaneously by the end of the first trimester, although a few women have nausea throughout their pregnancies.  There are many conservation and over-the-counter approaches to help you get through these symptoms.

The following is a list of some suggestions.  Please feel free to contact our office if you have any questions or if the nausea is not improving.  If there is any concern of dehydration or weight loss, you should be seen by your obstetrician.  Keep in mind that all nausea and vomiting is not always pregnancy-related.  Other medical conditions can also present with nausea and vomiting.

•        Starting a multivitamin or prenatal vitamin as early as possible, even prior to conception if possible, can help ease the symptoms.

•         Eat small frequent meals.  High carbohydrate meals tend to be better tolerated.  Also increase your protein intake.

•         Eat a cracker before getting out of bed in the morning to fill the stomach.

•         Avoid fatty foods, spicy foods, iron supplementation, and strong odors. 

•         Pyridoxine (Vitamin B6) 10mg up to 4 times a day.

•         Doxylamine (Unisom) 12.5mg up to 25mg at bed time

•         Ginger (Ginger Ale, or Ginger tablets 250mg four times a day)

•         Sea Bands (wrist bands normally worn for seasickness)

•         Dimenhydrinate (Dramamine) 50mg every four hours as needed

There are also some prescription options that can be discussed with your obstetrician, including pills, suppositories, and injections.  Occasionally, patients need intravenous hydration or even intravenous nutrition if the symptoms are severe.

Often expectant mothers are hesitant to treat nausea and vomiting due to concerns with taking medication in pregnancy. A drug-free option for treating nausea and vomiting in pregnancy is called Prima Bella. This device looks and is worn like a watch and when activated emits gentle pulses which are transmitted through the median nerve on the underside of the wrist and travel to the emetic center in the brain. These gentle pulses regulate the nausea signaling process between the brain and stomach (via the vagus nerve), restoring normal stomach rhythm, and providing relief of nausea and vomiting. For more information on the product please visit www.PrimaBellaRx.com .

If you are suffering from nausea and vomiting during pregnancy please contact your provider to further discuss your options.

Pregnancy is no time to diet. Every woman is different, depending on body type and weight before conception, but most women who deliver healthy babies gain about 25 to 35 pounds during pregnancy.

Women who do not gain enough weight have an increased risk for delivering babies with low birth weight (less than 2500gm, or 5.52 pounds). The National Institute of Health considers low birth weight a major public health problem in the United States. Low birth weight is a major cause of infant mortality, as well as many childhood developmental, physical, and psychological problems.

Gaining too much weight can also be a problem. It can make pregnancy an unpleasant experience, causing backache, leg pain, varicose veins, and fatigue. It may lead to hypertension and diabetes. Excess weight may also be difficult to lose after delivery. Excessive weight gain may also cause problems for the baby. Technically, an overweight baby is one who weighs more than 4500gm, or 9.9 lbs. Large babies make vaginal deliveries difficult, increasing risk for cesarean section.

Every woman’s body is different, and determining how much weight a woman should gain is an estimate. Recommended weight gain is based on a woman’s body mass index (BMI) at the beginning of the pregnancy. Body mass index measures the height to weight ratio and is calculated by dividing weight (in kilograms) by the square of the height (in meters).  The following chart shows the recommended weight gain for 40weeks of pregnancy based on a woman’s BMI:

Pre-pregnancy  BMI    Weight gain

Underweight <18.5 28-40

Normal    18.5-24.9  25-35

Overweight    25-29.9 15-25

Obese                >30        11-20

Morbid Obese  >40        11-15

**If you have twins, please add 10lbs to your total weight gain for 40weeks of pregnancy.

Pregnant women should consult a physician or midwife if they have questions about how much weight they can expect to gain on a week-to-week basis during pregnancy. Generally, little weight is gained during the first trimester (3 or 4 lbs.). The most weight (about 12 to 14 lbs.) is gained during the second trimester.  In the third trimester, a woman should expect to gain about 8 to 10 lbs.

WHAT IS IT?

Gestational Diabetes is a type of diabetes occurring only in pregnant women. Gestational diabetes mellitus (GDM) occurs in 2 to 5% of all pregnancies. The percentage is higher in some population groups, such as Native Americans, Hispanic, Alaskan Native, Asians and Black Women.

WHAT CAUSES IT?

Your body isn’t able to use the sugar (glucose) in your blood as well as it should, so the level of sugar in your blood becomes higher than normal.  All the causes of gestational diabetes are unknown.  Some women with gestational diabetes are overweight before getting pregnant or have a family history of diabetes.  

HOW DO YOU KNOW IF YOU HAVE IT?

The diagnosis is based on glucose testing done between 26 and 28 weeks during your pregnancy. The test involves consuming a sugar drink (glucola), then having your blood drawn to determine the levels of glucose in your blood. Further instructions for this test have been included in this packet.

WHAT IS THE TREATMENT?

Treatment includes diet changes and moderate exercise. You will learn how to monitor your glucose levels on a daily basis in order to keep your glucose levels under control. If you are unable to control your levels with diet and exercise, injections of insulin may be necessary.

HOW WILL IT AFFECT YOUR PREGNANCY?

The risk of problems during pregnancy is greatest when diabetes is not well controlled. Some of these problems may increase the chance of a cesarean birth. This is why you need good blood sugar control during pregnancy. 

You should be aware of the problems that may arise if glucose levels are not monitored: 

• Birth defects—such as heart defects, kidney problems, and spinal defects—occur more often in babies of women whose diabetes was not well controlled.

• Macrosomia (very large baby) occurs when the mother's blood sugar level is high. This allows too much sugar to go to the fetus. It can cause the fetus to grow too large. A large baby can make delivery difficult. For instance, there may be problems delivering the baby's shoulders. 

• Preeclampsia is high blood pressure during pregnancy. This can pose problems for the mother and the baby. It may require the baby to be delivered early. A woman with a mild form of preeclampsia may need to stay in the hospital so that she and her fetus can be monitored. Severe preeclampsia can lead to seizures. 

• Polyhydramnios occurs when there is too much amniotic fluid in the sac that surrounds the fetus. This can cause some women discomfort. It may result in preterm labor (labor before 37 weeks) and delivery. 

• Urinary tract infections can occur without symptoms. If the infection is not treated, it may spread from the bladder to the kidneys. This can harm the woman and her fetus. 

• Respiratory distress syndrome can make it harder for the baby to breathe after birth. The risk of this condition is greater in babies of mothers with diabetes. 

*Further information will be provided to you about gestational diabetes if you are diagnosed with this during your pregnancy, as well as a nutritional consult.

Group B strep is a microorganism that is found in the genital tract or rectum of 15-40% of all pregnant women. This is not an infection that you catch.  It is not a sexually transmitted disease, nor does it generally cause you any problems.   However, newborn infants can become seriously ill if they become infected while traveling through the vagina during birth. Therefore, we will obtain a culture using a special q-tip swabbing your vagina and anus around your 36th week of pregnancy. If you are colonized with GBS you will be given ampicillin (clindamycin or erythromycin if allergic) in labor or if your water breaks before the onset of labor.  If you have a penicillin allergy, we will perform certain sensitivity tests on the culture to determine what antibiotic will be appropriate to treat you with if the culture comes back positive.  This in essence is a prophylaxis or preventative measure to avoid having your infant become ill after birth.

If this culture comes back positive, we will let you know at your next scheduled OB appointment (we will not call you).  There is not treatment recommended until you break your water or go into labor.  The hospital will have this on your prenatal summary.  If your culture is positive and you break your water at home, you will need to call our office immediately, as we will want to get you admitted to the hospital sooner than later to get these antibiotics started.  Treatment will be given through your IV until delivery.  The goal is to receive at least one dose of the antibiotic four hours prior to delivering.  Due to the unpredictability of baby’s arrival, this sometimes does not happen.  DON’T worry, it does not mean your baby will definitely become ill.  The pediatrician will just want to watch your baby more closely to make sure that he/she does not develop any symptoms (increased HR, fever, respiratory distress, etc).  Also, if your GBS culture is positive, you will not be eligible for the short stay program.  You will be required to stay for a minimum of 48hrs from the time of delivery, as this is the typical time that symptoms would arise.  If you have any further questions, please speak with your provider at your next OB appointment.

Non-medication options:

• Walking/moving
• Tub/shower
• Birthing ball
• Pressure points
• Essential oils

There are 2 types of pain-relieving medications—analgesics and anesthetics. 

Analgesia is the relief of pain without total loss of feeling or muscle movement. Analgesics do not always stop pain completely, but they do lessen it. Anesthesia is blockage of all feeling, including pain. Some forms of anesthesia, such as general anesthesia, cause you to lose consciousness. Other forms, such as regional anesthesia, remove all feeling of pain from parts of the body while you stay conscious. In most cases, analgesia is offered to women in labor or after surgery or delivery, whereas anesthesia is used during a surgical procedure such as cesarean delivery. 

Systemic Analgesics 

Systemic analgesics are often given as injections into a muscle or vein. They lessen pain but will not cause you to lose consciousness. They act on the whole nervous system rather than a specific area. Sometimes other drugs are given with analgesics to relieve the tension or nausea that may be caused by these types of pain relief (ex. Demerol, Stadol).  

Regional Analgesia 

Regional analgesia tends to be the most effective method of pain relief during labor and causes few side effects. Epidural analgesia, spinal blocks, and combined spinal–epidural blocks are all types of regional analgesia that are used to decrease labor pain.  

• Epidural Analgesia:  Epidural analgesia, sometimes called an epidural block, causes some loss of feeling in the lower areas of your body, yet you remain awake and alert. An epidural block may be given soon after your contractions start, or later as your labor progresses. An epidural block with more or stronger medications (anesthetics, not analgesics) can be used for a cesarean delivery or if vaginal birth requires the help of forceps or vacuum extraction. Your doctors will work with you to determine the proper time to give the epidural. 

An epidural block is given in the lower back into a small area (the epidural space) below the spinal cord. You will be asked to sit or lie on your side with your back curved outward and to stay this way until the procedure is completed. 

Before the block is performed, your skin will be cleaned and local anesthesia will be used to numb an area of your lower back. After the epidural needle is placed, a small tube (catheter) is usually inserted through it, and the needle is withdrawn. Small doses of the medication can then be given through the tube to reduce the discomfort of labor.

• Spinal Block: A spinal block—like an epidural block—is an injection in the lower back. It brings good relief from pain and starts working fast, but it lasts only an hour or two.  The spinal block uses a much smaller dose of the drug, and it is injected into the sac of spinal fluid below the level of the spinal cord. Once this drug is injected, pain relief occurs right away. 

A spinal block usually is given only once during labor, so it is best suited for pain relief during delivery. A spinal block with a much stronger medication (anesthetic, not analgesic) is often used for a cesarean delivery. It also can be used in a vaginal birth if the baby needs to be helped out of the birth canal with forceps or by vacuum extraction. 

• Combined Spinal–Epidural Block: A combined spinal–epidural block has the benefits of both types of pain relief. The spinal part helps provide pain relief right away. Drugs given through the epidural provide pain relief throughout labor. This type of pain relief is injected into the spinal fluid and into the space below the spinal cord. Some women may be able to walk around after the block is in place. For this reason this method sometimes is called the "walking epidural." In some cases, other methods, such as an epidural or a spinal block, also can be used to allow a woman to walk during labor. 

Finally... Many women worry that receiving pain relief during labor will somehow make the experience less "natural." The fact is, no two labors are the same, and no two women have the same amount of pain. Some women need little or no pain relief, and others find that pain relief gives them better control over their labor and delivery. 

Talk with your doctor about your options. In some cases, he or she may arrange for you to meet with an anesthesiologist before your labor and delivery. Be prepared to be flexible. Don't be afraid to ask for pain relief if you need it. 

It’s probably the real thing if:

• The contractions intensify rather than ease up with activity and aren’t relieved by a change in position or rest.
• Pain begins in the lower back and spreads to the lower abdomen; it may also radiate to the legs.  You may even have diarrhea.
• Contractions become progressively more frequent and painful, last longer and become more regular.  
• Bloody show is present and is pink to bloody.
• Membranes rupture.  You will feel a warm gush or steady trickle.  Small amounts of discharge are normal at the end of pregnancy.

You should call the office if:

• Your water breaks, please note the time, amount, color, and odor. Please call right away if you have been told you are positive for group B strep vaginal infection or if the fluid has an odor or is not clear.
• Your contractions are about 5 minutes apart, lasting 60 seconds long for about 2 hours.
• Your first labor was very fast; call as soon as you are having regular, painful contractions.  Please make sure to remind the physician about your prior labor.
• If you are experiencing pelvic or rectal pressure with the contractions.

Other warning signs:

• If you have not felt the baby move in several hours, have something sweet to drink, lay on your left side, put your hands on your stomach, and feel for movement.  There should be at least 10 movements in an hour.  Call if the baby is not moving.
• If you are bleeding like a period.
• If you have a bad headache that is not relieved by rest and Tylenol, visual disturbances, persistent nausea, worsening edema, or unusual abdominal pain.
• If you have contractions that will not relax.

Contact Information:

24 hours a day, call 315-478-1158.   If the office is closed your call will be forwarded to an operator who will take your message and a physician will call right back.

Deciding whether to have your newborn son circumcised may be difficult. You will need to consider both the benefits and risks of circumcision. Other factors, such as your culture, religion and personal preference may also affect your decision. Circumcision is an elective procedure; it is your choice whether to have the procedure performed.

The decision about whether to have your son circumcised should be made before your baby is born. If you have questions or concerns, talk with your obstetrician or pediatrician about them during your pregnancy so you have enough time to make an informed decision. We perfrom circumcisions in our office, typically within 1 week of his birth.

WHAT IS CIRCUMCISION?

During circumcision, the layer of skin (foreskin) that covers the tip of the penis is removed. Circumcision is usually done in our office approximately one week after delivery. The procedure takes only about 5 to 10 minutes. A local anesthetic (numbing medicine) may be given to your baby so he feels less pain during the circumcision. Pain medication may be used after the procedure to help ease the pain (please consult your pediatrician).

BENEFITS OF CIRCUMCISION

Studies have shown that circumcision does offer some benefit in preventing urinary tract infections in infants. There is evidence that circumcision may also lower the risk of sexually transmitted diseases. Other studies have shown that circumcision may help reduce the chance of cervical cancer in female sexual partners. There is also evidence that circumcision may help prevent cancer of the penis, a rare condition in uncircumcised men. It is also much easier to do a circumcision in the newborn period than later.

RISKS OF CIRCUMCISION

Like any surgical procedure, circumcision has some risks. However, complications are rare. Complications that can occur are bleeding, infection, injury to the penis or urethra (the tube that carries urine from the bladder out of the body), or scarring.

CARE AFTER CIRCUMCISION

You may notice redness and swelling of the penis after the procedure. There may be a small amount of yellowish discharge or coating around the end of the penis. You may also notice a small amount of blood on the baby’s diaper. To protect the area from irritation and infection, there may be a gauze dressing with petroleum jelly (Vaseline or clear A&D) over the end of the penis. This should be replaced at each diaper change for one day. Then Vaseline or clear A&D ointment can be applied to the penis for the next couple of days.

If a plastic ring is used instead, no Vaseline or A&D is necessary.  It should drop off in 5-10 days as the penis heals. You should gently wash the area with soap and water each day. The penis should heal in 7-10 days. 

IF YOU CHOOSE NOT TO CIRCUMCISE

The outside of the penis should be washed with soap and water. The foreskin does not fully retract for several years. Do not attempt to pull back the foreskin. No special washing is needed until the foreskin fully retracts. Once the foreskin can be retracted, your son should be taught to clean under the foreskin by gently retracting it, rinsing the end of the penis and the inside fold of the foreskin with soap and warm water, gently drying, then pulling the foreskin back over the end of the penis.

WHEN TO CALL THE DOCTOR (The baby’s Pediatrician)

• If the circumcision site starts to bleed

• If your son does NOT have a wet diaper within 8-12 hours after circumcision

• If the redness and swelling around the tip of the penis does not go away or gets worse after 3-5 days

• If the yellowish discharge or coating around the tip of the penis lasts longer than 7 days

• If the plastic bell device was used and it does not fall off within 12 days.

Below are pediatric offices in different parts of Syracuse.  There are many other pediatricians in the area, so feel free to use our suggestions or one of your own.  You should decide on a doctor for your baby by your early third trimester.  Many offices will schedule a prenatal appointment to meet with you prior to delivery.  

Brighton Hill Pediatrics, R.L.L.P  

151 Intrepid Lane

Syracuse, NY 13205

(315) 469-8191

www.brightonhillpediatrics.com

University Pediatrics

1200 East Genesee Street, Suite 209

Syracuse, NY  13210

(315) 471-4196

www.universitypediatrics.com

Pediatric Associates, LLP

601 North Way

Camillus, NY  13031-1498  

(315) 487-1541 

OR  

8086 Oswego Road

Liverpool, NY  13090

(315) 652-1070

www.pediatricassociatesny.com

Upstate Pediatrics  

Belgium Meadows, 3448 Route 31

Baldwinsville, NY  13027

(315) 622-6595

www.upstate.edu

Wee Care Pediatrics

6251 State Route 31 

Cicero, NY  13039

(315) 699-9595

www.weecarekids.com

Child Health Care Associates  

6700 Kirkville Road #A  

East Syracuse, NY  13057

(315) 463-2013

OR

8138 Oswego Road

Liverpool, NY  13088  

(315) 652-8800

www.childhealthcareassoc.com

Lyndon Pediatric Associates

6851 East Genesee Street

Fayetteville, NY  13066

(315) 446-4580 

Eastside Pediatric Group  

5900 North Burdick Street #215  

East Syracuse, NY  13057  

(315) 656-8750

Summerwood Pediatrics

4811 Buckley Road

Liverpool, NY  13088

(315) 457-9966

OR

5700 West Genesee Street, #128

Camillus, NY  13031  

(315) 488-2868

Dr. Chantell Dalpe:  doxy.me/drdalpe

Dr. Sara Quinn:  doxy.me/drsquinn

Dr. Carly Hornis:  doxy.me/drhornis

Annemarie Dixe NP:  doxy.me/adixenp

Nicole Snyder CNM:  doxy.me/NSnyderCNM

Pregnant and breastfeeding women were not included in the studies for the currently available vaccines and so we do not know much about the vaccine in these women unfortunately. That being said there are a small number of other mRNA vaccines that appear to be safe after being given to pregnant women. At this time, the official position of ACOG and SMFM (high risk pregnancy) is that the vaccine should not be withheld from pregnant or breastfeeding women. But you should asses your risk of COVID exposure and sickness versus the risk of the vaccine.

If you are pregnant and test positive for COVID please ensure that you are well hydrated and rest as much as possible. Please review the medications that are safe in pregnancy to treat your symptoms.

If you are experiencing shortness of breath, chest pain, severe nausea/vomiting, fever not controlled with tylenol, vaginal bleeding or decreased fetal movement, call the office to inform your physician(s). You will then be asked to go to the hospital for further evaluation.

COVID is a viral illness and will run its course. Make sure to treat your symptoms as they arise and follow state guidelines for isolation. You and your baby will now be protected through natural immunity. Please call the office with any other questions or concerns.