Info About Your Pregnancy

Office Visits and Tests 

As your due date approaches, how will you know when it's time to call the doctor, grab your bag and head to the hospital? Not so fast! There's still so much to discuss! 

As you get closer to delivering, there will be a few changes you will notice. First, your office visits will become more frequent. The visits will be scheduled every two weeks from 28 weeks until 36 weeks, when they will become weekly until your labor begins and you deliver. Although we have calculated your due date, your delivery may be different than that date. 

We also will be performing one or more additional diagnostic tests during this time. Typically, between the 35th and 36th week of pregnancy, a Group B Strep test is performed to check for the presence of this common bacteria. If your test result is positive, we will treat you with an antibiotic during the labor process to make sure you don't pass Group B to your baby during delivery. Your doctor also may request additional tests.

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Birthing Classes

Although not necessary, many women and families find it helpful to enroll in Birthing Classes. Not only do these classes help prepare you for the actual birth by teaching proven techniques for delivery, they also familiarize you and your family with the hospital and its procedures.

Chester County Hospital offers a comprehensive Childbirth Education Program intended to meet the needs of first-time parents or experienced ones. They offer a wide variety of classes to help prepare the entire family in welcoming the newborn. The curriculum has been carefully designed to assist parents in obtaining the tools they will need for pregnancy, labor, birth, postpartum, breastfeeding, newborn care, parenting and sibling adjustment. Classes are taught by experienced maternal/infant nurse educators who have a special certification in childbirth education.

For more information or if you are interested in enrolling in the Birthing Classes at Chester County Hospital; please visit visit our Wellness page or call 610-738-2300.

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What to Pack

It's always a good idea to have a suitcase packed and ready to take to the hospital, just in case. We recommend that you have your bag ready when you are around 34 weeks pregnant.  

What you pack is a personal choice, it can range from the general items like toothbrush, toothpaste and make-up to personal items like your favorite pillow, photos of your loved ones or some soothing music. 

Here are some resources to help you on your way:  

• Parents.com 
• WhattoExpect.com 
• BabyCenter.com 

Please keep in mind that Chester County Hospital does everything in their power to protect your items during your stay, but to be cautious, please leave behind items of value that may be misplaced during your stay.

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Labor and Pre-labor 

Premature Labor

Premature labor, also called preterm labor, is labor that starts before the completion of 36 weeks of pregnancy, or more than 3 weeks before your due date. Premature labor can often be stopped if you identify it early. Premature labor is related to 70% of infant deaths due to low birth weight. A low birth weight is defined as an infant weighing less than 5 lbs, 8oz or less at birth. 

Warning Signs 

• Uterine Contractions -- If you feel like your uterus tightening or the baby balling up for four times or more in one hour. 
• Menstrual-like Cramps -- Cramps like those you may have during your period may come and go, or be constant. 
• Abdominal Cramps -- These feel like stomach cramps with or without diarrhea. 
• Low Backache -- This is a backache near your tailbone that comes and goes or is there constantly. 
• Pelvic Pressure -- This feels like the baby is pushing down in your vagina. 
• Change in Vaginal Discharge -- There may be a sudden change in your discharge. It may increase, or become more mucousy, watery or slightly bloody. 

What to Do

If you have one or more of these warning signs, you could be in premature labor. You should: 

• Lie down 
• Drink 2-3 glasses of water 
• If the symptoms do not resolve in 1 hour, call your doctor immediately. Also call your doctor if you have any vaginal bleeding that is more than a light day of menstrual period or if you experience a sudden gush of fluid from your vagina. 

Causes of Premature Labor 

Experts do not really know the actual causes of premature labor, but some things that may put women at risk include: 

• Previous premature labor or delivery of a premature baby 
• Twin or triplet pregnancy 
• Medical problems, such as high blood pressure, diabetes, kidney or lung disease 
• Abnormality of the uterus or cervix 
• Abnormality of the placenta 
• Women under 17 years 
• DES exposure

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Preparing for Labor

Things to Watch for:  

• Some swelling of the legs and feet is normal. Excessive swelling in the hands and face are not, and you should call our office immediately if you experience this. In addition, if you experience unusual headaches, you should call the office. 
• Sharp abdominal pain with bleeding or bright red bleeding is not normal and you must call the office immediately. 
• You may sense that your baby's movements have subdued somewhat, however, what is happening is that as the baby grows, there is less room for him or her to move. Be aware of the overall patterns of movements as you progress. Please call the office if you have concerns about these patterns. 
• A gush of fluid from the vagina or continuous leaking should be evaluated. If you experience either, please call the office. 
• The onset of labor - If you experience contractions that are regular and are no more than 5 minutes apart, please call the office. 

When you finally do go into labor, you may feel generalized pain from time to time. This is normal. If you are uncomfortable at times, you may do any of the following:  

• Sit in a warm bath. 
• Have someone give you a lower back massage. 
• Using common household items such as a tennis ball or a rolling pin can be effective. 
• Use ice, a heating pad, or a combination of both on your lower back. 
• Consume water, juice or even a Popsicle as a way of maintaining fluids. 

By the time you go into labor, you will likely feel frequent contractions (sometimes referred to as Braxton-Hicks contractions). These are normal and are an indication that your body is preparing for actual labor. While the onset of labor is different for each woman, one or more of the following may occur as you begin to go into labor: 

• You may begin to suffer persistent back pain. 
• Many times the pain will be accompanied by a feeling similar to premenstrual cramps. 
• The appearance of a mucous discharge. It might be slightly blood-tinged. This plug blocks the cervix and its passing indicates that labor could be imminent. Even if it's several days away, this indicates that things are moving in the right direction. 
• You also may begin to suffer from diarrhea.

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Is it Really Time? 

We recommend that patients call us when any or all of the following occur: 

• Your water breaks, or if you are unsure if your water has broken. 
• You are having contractions 5 minutes apart, or less, for more than 1 hour. Labor contractions generally last more than 60 seconds from start to end. 
• You can't carry on normal conversation during the contraction. 
• You are experiencing heavy vaginal bleeding. 
• You notice a significant change in fetal movement patterns. 

These are all signs of active labor and you should call our office and plan to proceed to the hospital immediately. But always call us if you have concerns not listed above.

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Hospital Procedures

When you arrive at the Hospital, if it is during the day you will enter through the main entrance. During the night time hours you should enter through the Emergency Room entrance. Proceed to the second floor Maternity Unit and pick up the phone at the door of the unit - a nurse will let you in and provide further direction. 

The admission staff at the hospital will ensure that you are properly processed and admitted in a timely manner. If you are not pre-registered, please contact our office to identify the documents you will need upon admission to the hospital.  

At the Hospital 

Once you are admitted, and probably before your doctor sees you at the hospital, several things will occur:  

• You will be taken to a Labor and Delivery Room. 
• You will be placed on a fetal monitor so that your contractions and your baby's heart rate can be monitored. 
• A member of the hospital's labor and delivery team will do a vaginal exam to determine your dilation and effacement. 
• There are various forms of anesthesia or analgesics that may be offered to treat your labor pain. If you have elected to have an epidural, the labor and delivery nurse will coordinate with your physician (or the delivering OB) and the anesthesiologist to administer the epidural at the appropriate time. This may occur before you are seen by your physician, but not without the consent of your physician

Please call if you have:

• Blood or fluid coming from your vagina
• Sudden or extreme swelling of your face or fingers
• Headaches that are severe or won't go away with Tylenol
• Severe nausea and vomiting that won't go away. "Severe" means vomiting numerous times during the day and being unable to keep any food or liquid in your stomach.
• Dizziness
• Dim or blurry vision
• Pain or cramps in your lower abdomen
• Chills or fever greater than 100.4° F
• Pain, burning or urgency when you urinate. Urgency is when you feel as though you need to urinate, but are unable to do so, or can urinate only a little when you reach the bathroom.
• Decreased fetal movement after you have begun to feel the baby move on a daily basis. Decreased movement is any change that you notice in the amount of the baby's activity. Generally we expect that after 28 weeks you should feel 10 movements in two hour's time one daily, but this varies from baby to baby.
• Contractions your 37th week of pregnancy that occur every 15 minutes or more than 4 times in an hour and do not stop with rest or hydration. During a contraction you will feel your uterus painfully tighten and harden. Some women may feel contractions in their lower abdomen, back or around their whole abdomen.
• After 37 weeks of pregnancy: contractions that occur every 5 minutes, lasting 1 minute long for more than 1 hour.

This portion is provided to you as a guide and should not replace seeking medical attention if you have questions or concerns.

ALCOHOL
Don't drink any alcoholic beverages. It is a known fact that alcohol in excess can cause damage to your unborn child. Remember that alcohol is a drug and that any product that contains alcohol is a drug. There is NO safe amount of alcohol.

BATHING
Take tub baths or showers, 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.

BOWELS
Your regular bowel habits may become disturbed during your pregnancy. You may experience constipation more frequently or have hemorrhoids develop. These changes happen due to the relaxation of the muscle cells in the bowel and pressure on the surface of the bowel wall from the expanding uterus containing your growing baby. Some dietary changes can safely prevent constipation: increased quantities of fiber or bran, fresh and dried fruits, vegetables and increased water intake. Stool softeners usually provides relief without danger to you or your baby. You should avoid enemas unless absolutely necessary. But don't take a laxative, enema, or any drug without consulting the doctor first.

BREASTS & 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 around the abdomen and breasts 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 is not associated with significant risks during pregnancy. Heavy caffeine use can result in potential problems such as low birth-weight. Heavy caffeine drinkers should reduce their caffeine use while pregnant. Other sources of caffeine besides coffee to be alert to are teas, sodas, chocolate and some nonprescription drugs.

CLOTHING & 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. Wear maternity bras that are well-fitting and give good support. Some women begin to wear nursing bras during pregnancy. 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. The overall shoe size may increase due t swelling, weight gain and pregnancy changes.

COSMETICS & HAIR CARE PRODUCTS
There is no specific evidence that cosmetics and other personal care products (soaps, lotions, and deodorants) affect pregnancy outcomes. Hair care products such as dyes, strengtheners, and permanent wave solutions have been studied in pregnant women and have not shown to have any specific risks. Exposure to these products should not pose a risk to the fetus. However, many women wait until they are past the first trimester to use these products.

DOUCHING
Don't douche.

EMPLOYMENT
You may safely continue working throughout your pregnancy. Some jobs that involve physical exertion may need evaluating by the doctor to provide work limitations at later stages of your pregnancy. 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. Your pregnancy is not considered a disability.

EXERCISE
Continue to enjoy fitness and recreational activities as you did before pregnancy if your doctor has given the go ahead. Some activities may 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, fast running, water-skiing and others that carry undue risks.

MISC SUBSTANCES/TESTS
The following substances seem to be safe throughout pregnancy:

• Artificial sweeteners
• Sunscreen
• Dental x-rays with abdominal shielding

PAINTS
Most paints contain low VOCs (volatile organic compounds) and are safe for use in pregnancy. Avoid painting in confined spaces and ensure your are in a well-ventilated area. Oil-based paints and paint thinners contain different solvents that should be avoided, especially in the first trimester of pregnancy. Any removal of paint with suspected to contain lead should be avoided.

REST
Include rest periods in your routine, several times a day for short periods. Lie on one side or the other during these rest periods, rather than flat on your back, because blood flow through the placenta may be decreased if you lie on your back.

SEAT BELT USE
The use of seat belts 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 pregnancy, not over it.

SEXUAL INTERCOURSE
Enjoy sexual intercourse as usual, as long as it is not uncomfortable. There may be restrictions on sexual intercourse in cases of pregnancy-related complications (e.g., placenta previa, preterm labor). These activities may lead to cramping or contractions.

SMOKING
There can now be 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. Routine dental examinations, preventive 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.

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 for many hours without getting up and moving around. Empty your bladder frequently so as to avoid an increased risk of bladder infections caused by retained urine. Don't take any anti-nausea travel medications without the doctor'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.
• If you have any doubt or question about these or any other recommendations, please don't hessitate to call our office and speak with a nurse.

What is the Right Amount?

As a pregnant or nursing mom, your body becomes a productive machine, using what you eat as energy, thus the better the energy, the more efficient the machine works. Getting the best possible nutrition through what you eat each day (and taking your prenatal vitamins!) should be a priority for you. What you eat feeds your baby, so choose healthy foods.

You may need about 300 extra calories each day.

Be sure to include the following:

• 3 servings of milk or dairy products
• 4 servings of vegetables
• 3 servings of fruit
• 9 servings of bread, cereals, rice, or pasta
• 2 to 3 servings of meat, fish, poultry, dried beans, eggs or nuts
• At least 6 to 8 glasses of water

Drink Your Water

Did you know your body is 98% water? Did you know that the amniotic fluid is 99% water? It's a pretty important substance and not one to be ignored. If you don't think you're drinking enough water, drink more.

The general rule is "drink to thirst." In other words, if you're thirsty, drink. Even if you're not thirsty, you should drink between 8 to 10 cups of liquid each day (anywhere from 64-96 oz.), but err on the side of more! The main source of you liquid intake should be from water. Keep in mind that other liquids like fruit juice, Gatorade, iced tea and non-caffeinated beverages may contain extra calories that your body may not need. You may need more if you exercise and lose water through sweating.

Food Safety

Foodborne illness is a serious health risk for pregnant women and their unborn babies. In the following link, you will find accurate, easy-to-understand information about foodborne illness:

• FDA - Food Safety for Moms to Be >>

Exercise

Unless you have problems in your pregnancy, you can probably continue with whatever exercise you did prior to pregnancy. Walking, prenatal yoga and swimming are great choices. If you didn't exercise before pregnancy, start slowly. It is best to avoid any extreme sports that could cause you to fall.

Only your doctor can provide you with personalized advice as to the importance of exercise during your individual pregnancy. But experts agree that prenatal exercise can be beneficial for both mom and baby.

Women Who Exercise During Pregnancy Have:

• Less nausea
• Less tiredness
• Fewer backaches
• Fewer leg cramps
• Fewer swollen ankles
• More strength and flexibility
• More energy
• Better posture and circulation
• More stamina for labor and childbirth
• Less stress

Women Who Exercise After Giving Birth:

• Add strength and muscle tone
• Have more energy to keep up with a new baby
• Return to pre-pregnancy shape faster than those who do not exercise

Weight Gain

How much should I gain during pregnancy? Women who start the pregnancy at a healthy body weight should generally gain about 25 to 30 pounds. Depending on your initial weight, your provider may recommend gaining less or more.

DO NOT TAKE ANY MEDICATIONS DURING THE FIRST THREE MONTHS OF YOUR PREGNANCY WITHOUT YOUR DOCTOR'S PERMISSION!!! 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, tobacco, 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.

The first trimester is when the organs and body systems of your baby are forming. It is imperative that you do not ingest anything that may interfere with the process. There are many over-the-counter medications that you can safely take during pregnancy when used according to package recommendations:

• Fever, Muscle Aches, & Backaches: Tylenol or Extra Strength Tylenol; local application of heat/cold packs (not directly to abdomen)
• Headaches: Tylenol or Extra Strength Tylenol, Excedrin Tension Headache (aspirin free Excedrin)
• Allergies: Claritin, Zyrtec, Allegra, Benadryl, of Chlor-Trimeton (no decongestant versions, ie – no Claritin-D)
• Congestion, Runny Nose, & Colds: Multi-symptom cold products containing – Tylenol, dextromethorphan, and/or gauifenesin, Benadryl, Vicks products, saline nasal spray, breathe right nasal strips, and all antihistamines listed for allergy symptoms
• Coughs: Guaifenisen (mucinex or robitussin products) or dextromethorphan
• Sore Throat: Chloraceptic Spray or Lozenges, active ingredient menthol, benzocaine lozenges; warm salt water gargle
• Diarrhea: bland diet and plenty of fluids; BRAT diet (bananas, rice, applesauce, toast); immodium only after speaking with your doctor
• Heartburn: Tums, Pepcid, Prilosec, Maalox, Mylanta
• Gas: Simethicone preparations (Mylicon, Gas-X)
• Constipation: Fiber supplements - Metamucil, Citrucel, Fibercon; Stool softener – Colace
• Nausea: Ginger capsule – 350mg 3 times daily, Unisom (doxylamine succinate) sleep tabs – 25mg with Vitamin B6 (pyroxidine) 50mg 1-2 times daily
• Hemorrhoids: Preparation H cream or suppositories, Tucks (witch hazel pads)
• Yeast Infection: Vaginal or topical monistat (miconazole), clotrimazole
• Sleeplessness/Insomnia: Diphenhydramine (Benadryl), Unisom sleep
• Sinus Infection/Ear Infection/Persistent Sore Throat, Etc.: If you are suffering from a persistent sore throat, or think you may have a sinus or ear infection, we suggest that you see your family doctor. Antibiotics such as penicillin, cephalosporin, erythromycin, Bactrim, Macrodantin, and Zithromax are considered safe in pregnancy. If antibiotics are required to treat the infection and your family doctor is uncertain about the safety of a particular antibiotic in pregnancy, they may call our office. Many antibiotics are safe to take in pregnancy, though we prefer not to prescribe them unless medically necessary.

 

DO NOT USE ASPIRIN OR IBUPROFEN (Advil or Motrin) UNLESS SPECIFICALLY DIRECTED BY YOUR PROVIDER!

 

Morning Sickness, as the nausea many women feel during the first trimester is often called, can sometimes last even longer, possibly past the first trimester. It also does not always happen in the morning but at any point during the day or all day.

Changing your eating habits can help keep morning sickness at bay:

• Eat six to eight meals a day, instead of three larger meals
• Avoid hunger and overeating; both can increase nausea
• Eat foods that are high in protein and carbohydrates. Eat plain, starchy foods, like toast, crackers, Melba toast, rice, noodles, dry cereal, etc. They are digested easily and less likely to cause nausea.
• Drink plenty of fluids between and with meals. Concentrate your nutrients in them if you are not tolerating solids well. Drink milk shakes, pureed soups, fruit sorbets, sherbet, and cottage cheese or yogurt with fruit.
• Avoid fat, fried, spicy or rich foods. Eat very bland, simple foods.
• Avoid the sight and smell of foods that make you queasy. Some women cannot tolerate food preparation in early pregnancy.
• Ginger can help decrease nausea. You can try ginger ale, ginger tea, ginger candies or fresh ginger.
• Your prenatal vitamin is insurance for adequate nutrition. It is especially important if your daily intake is decreased related to nausea. Take your vitamin at the time of day when it will most likely stay down. Adequate nutrition is especially important to your baby during early pregnancy, as the organs are forming.
• Physical and mental fatigue also may contribute to nausea. Listen to your body and get extra rest as needed.
• Brush your teeth or use mouthwash after vomiting to decrease nausea.
• If you are unable to keep anything down for 24 hours, be sure to call the office, because this will not correct itself and may be cause for concern.

If you have more questions about diet, nutrition and morning sickness, ask your doctor on your next visit.

• Do not smoke -- Smoking raises your risk for miscarriage, premature birth, low birth weight and many other problems.
• Do not use drugs -- Cocaine, heroin and marijuana increase your risk of miscarriage, premature birth and birth defects. And your baby could be born addicted to the drug you have been using.
• Do not drink alcohol -- Drinking alcohol during pregnancy is the major cause of preventable birth defects, including mental slowness.
• Do not clean your cat's litter box, or eat raw or undercooked red meat --You could get toxoplasmosis, a disease that can cause birth defects.
• Do not sit in the sauna or hot tub -- This raises your risk of miscarriage and vaginal infections.