I am an OB/GYN :: This is What EVERY Woman Should Know About Pregnancy and Delivery

As an OB/GYN and high-risk pregnancy specialist, I get called, texted and emailed nearly daily by friends, friends of friends, coworkers and family members with questions about various issues surrounding pregnancy and delivery. I make it a policy to answer truthfully and directly and always make sure whoever is asking the question is prepared for the answer. As a physician and now mother, this is what I think every women should know, but may not think to ask.

I am an OB/GYN:: This is What EVERY Woman Should Know About Pregnancy and Delivery | Houston Moms Blog
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You will be offered screening for Down Syndrome ::

You will be offered prenatal screening during your pregnancy to assess your risk for having a baby with Down Syndrome and other genetic abnormalities. This testing is offered to ALL pregnant women early in pregnancy, but is especially important for women pregnant later in life. You can choose whether or not you want to be tested. It is important that you discuss with your OB/GYN which test is best for you since there are many forms of testing now available.

Factors that play a role in determining which prenatal testing is best for you include your age, a history of a genetic/chromosomal disorder or birth defect in a previous child or close family member, or the presence of abnormalities on an ultrasound in the current pregnancy. The role of prenatal screening is not solely to screen for the risk of your baby having a genetic/chromosomal abnormality; an increased risk for placental abnormalities and birth defects not associated with a genetic cause can also be detected.

Your OB/GYN will choose the best due date for you ::

There are guidelines your OB/GYN will use to determine the best due date for your pregnancy. Your due date is most accurately determined by your last menstrual period and an early ultrasound done in the first trimester. It is very common for women who are absolutely certain of their last menstrual period to actually be one or two weeks off. As a result, establishing early prenatal care with an early ultrasound is ideal.

On subsequent ultrasounds, you may be told a different ‘due date’ according to the measurements of your baby, but your original due date should not change. This is because babies grow at various rates and may not always measure exactly according to the originally established due date, especially later in pregnancy. The earliest determined due date in your pregnancy is the most accurate and should remain the same throughout your pregnancy regardless of the growth curve of you baby.

Pain and discomfort in pregnancy is normal ::

The discomforts of pregnancy can start with abdominal or menstrual-like cramping early in the first trimester as the uterus starts to grow. In addition, there is discomfort as the enlarged uterus places tension on the round ligaments, which are ligaments on either side of the uterus that attach it to the abdominal wall. This is most pronounced in the in the second trimester. You may experience a “pulling” sensation on either side of the abdomen that worsens with movement or walking.

The hormones of pregnancy also cause relaxation of the ligaments of the pelvic bones to allow room for the growing baby, which can cause pain your hips, lower abdomen and lower back. Finally, you may experience pain with fetal movements, stretching abdominal skin, sciatica, and pressure in the vaginal area as the baby grows. Keeping an open dialogue with your OB/GYN about what you are feeling is ideal. If you are concerned, it is always best to call your OB/GYN.

You will pee a lot, but you may also experience constipation and reflux :: 

In pregnancy, the blood flow to and function of your kidneys increases and more pressure is placed on your bladder as the baby grows, which means many trips to the bathroom throughout the day and especially at night. We always advise women to drink lots of water, which adds to the frequent urination you will experience. However, the hormones of pregnancy do the opposite to your stomach and intestines by decreasing their activity and transition of food through your gastrointestinal system, which can cause constipation and reflux. If you are taking iron supplements for any reason, this may make constipation worse. The hormones of pregnancy also cause relaxation of the valve that separates your stomach from your esophagus, which can cause reflux or heartburn. If you are experiencing reflux or constipation, let your OB/GYN know so treatment can be initiated if necessary.

During labor and delivery, you will see a lot of blood and other bodily fluids ::

As the cervix dilates with progressing labor, a thick mucousy discharge and some bleeding will occur due to the breakage of small blood vessels in the cervix. When your cervix is examined by your OB/GYN, you may have a little more bleeding. In addition, when your water breaks, you may experience a continual leakage of amniotic fluid for the remainder of your labor. Having a big gush like you see on TV does not always happen. Because of the bloody, mucousy discharge and leakage of amniotic fluid, your nurse will change your hospital pads and clean you many times during the course of your labor.

When you are pushing, you may pee or have a bowel movement. Don’t worry or be embarrassed; this is completely normal and expected by the doctors and nurses. We see this all the time. Finally, once your baby is delivered, there is a significant amount of sudden bleeding, especially after the placenta is delivered. This often surprises many women and any family member who happens to be present for the delivery. Fortunately, the natural reaction of the uterus to contract after delivery of your baby and placenta limits the bleeding, and it is typically quickly controlled.

If a laceration occurs in your vaginal area with delivery, you should ask questions ::

Lacerations/tears of your vaginal area do not only occur if an episiotomy {an intentional cut made by the OB/GYN to facilitate delivery of the baby} is done by your OB/GYN. Small and large tears can occur just with pushing and then delivery of your baby. Tears can occur in all the different parts of your female anatomy and in areas you never even knew existed! You may have tears of your cervix, vaginal vault, labia, area surrounding your urethra, and, most commonly, the area between your vaginal and rectal openings-the perineum. If your OB/GYN tells you that he/she is going to need to repair a tear, it is important for you to ask exactly where the tear{s} occurred.

You may feel stitches when cleaning yourself after going to the bathroom, and you may see or feel stitches coming out a few weeks after delivery. You will also need to know exactly how to keep the area clean in order to avoid infection or wound breakdown. If you have increased pain in those areas after going home, you will need to notify your OB/GYN; the pain should get better over time, not worse.  If you find that you are experiencing a different or worsening pain a week or two after delivery, let your OB/GYN know immediately. Finally, if you have a significant tear that involves your rectum, this may have an impact on how you deliver your next baby.

If you had swelling before delivery, the swelling will likely get worse AFTER delivery ::

With a normal pregnancy, your overall blood volume increases in order to support the growing pregnancy and allow you to tolerate the normal blood loss that occurs with delivery. Swelling of your legs and even vaginal area is common as you get closer to your due date. This is oftentimes more severe, and occurs earlier, with each subsequent pregnancy. Swelling occurs because the blood flow circulating back from your lower extremities to your heart is hindered by the growing uterus as your pregnancy progresses. As a result, excess fluid accumulates in your lower body and extremities.

After delivery, this extra blood volume is diverted away from your uterus {which is now empty} and goes back into your blood vessels. The swelling of your legs may get worse immediately after you deliver and may take several days to get better. As long as the swelling is even in both legs and you have no pain in your calves, there is no need to worry. However, if the swelling is uneven or you have pain in your calves, let your OB/GYN know immediately.

What are some things YOU wish you knew about pregnancy and delivery? 

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Shannon C
Shannon M. Clark, MD is a Professor in Maternal-Fetal Medicine at UTMB-Galveston, TX where she is an educator, researcher and clinician. As an ACOG media expert, she contributes to multiple websites, news outlets and magazines regarding pregnancy-related topics. More recently, she has taken a special interest in fertility, pregnancy and motherhood after age 35, which according to age alone, is considered a high-risk pregnancy. She was inspired not only by the experiences of friends and patients, but also by her own personal experience of trying to start a family at the age of 40. Because of her personal and medical knowledge of the fertility and medical concerns surrounding pregnancy after age 35, she started Babies After 35 -a site dedicated to fertility, pregnancy and motherhood after age 35. Sharing her medical expertise and personal experiences, she has written for Huffington Post, Mind Body Green, The Washington Post and Glamour. Dr. Clark became a mother at age 42 to twins Remy Vaughn and Sydney Renée {September 2016} via IVF. She is a full-time working mother with a passion for world travel, writing, amateur photography and her first baby, a pit bull named Cru, who crossed the rainbow bridge 4/17/2018.


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