About Our Pregnancy Services

Pregnancy length is measured from the first day of your last menstrual period. There are 40 weeks in an average pregnancy, with the assumption that you conceived about 2 weeks after your period started. In many cases, your due date is calculated based on your last period. However, your due date may be adjusted based on the first trimester ultrasound.

We also talk about “trimesters” of the pregnancy. The first trimester includes conception up to 13 weeks, the second 13-26 weeks, and the third is 26 weeks until delivery.

Obstetric ultrasound has been extensively studied and found to be safe for mom and baby. The current recommendations are to limit the use of ultrasound to that which is medically useful or necessary. In our office, we typically do ultrasounds at the following points: initial visit to confirm viability, a detailed ultrasound around 20 weeks to assess baby’s anatomy, and an ultrasound for growth and fetal well-being at about 34 weeks. Other ultrasounds may be done based on medical necessity.

We need an average of only 300 extra calories daily during pregnancy. Many women think they need to “eat for two”, but this would only lead to excess weight gain. For most women, the recommended weight gain is 1 pound per month for the first 3 months, then one pound per week through the rest of the pregnancy. Small frequent meals can help with nausea, heartburn, and feelings of low blood sugar. Eat what sounds good to you, but do your best to make good food choices.

Fish consumption is limited in pregnancy due to the potential for mercury accumulation in the fish. The FDA recommends avoiding fish such as shark, tilefish, swordfish, and king mackerel. Shellfish, shrimp, and smaller fish (snapper, catfish, salmon, and tilapia) are lower in mercury, and up to 12 ounces a week is recommended. Canned tuna is low in mercury and can be included in the 12 ounces per week recommendation. If you would like more information on fish in pregnancy, please visit the EPA's website. Unpasteurized cheeses (ex: brie, feta, queso fresco) and deli meats can carry Listeria, a bacterium that can cause miscarriage and fetal infection.

While this is very uncommon in the US, it is wise to avoid regular intake of these products. Listeria is killed by high temperatures, so deli meats heated in the microwave until steaming are safe. Raw fish and meats can carry parasites and other microbes that could cause potential harm to the mother and fetus. While these infections are extremely rare, it is wise to avoid raw meat and fish for this reason. There is no safe limit of alcohol in pregnancy. Complete avoidance is the best policy. Caffeine is safe in small quantities (1-2 caffeinated beverages daily).

Continuing regular activity during pregnancy is great for you and your baby. If you have an uncomplicated pregnancy, you can continue your regular exercise routine with a few modifications. When doing cardiovascular exercise, it is best to keep your heart rate under 140 beats per minute.  The best guide for this is, while exercising, you should be able to have a conversation with the person next to you without being out of breath.  By keeping to this recommendation, you will have good blood flow to the uterus and your large muscle groups. If you are working out with weights, modify any exercises that require you to be flat on your back or flat on your stomach after 12 weeks of pregnancy. Abdominal exercises should be avoided during pregnancy.

In some cases, complications such as bleeding, preterm labor, or high blood pressure will prevent you from being able to exercise, but for most women, regular exercise is a great way to prevent excessive weight gain, reduce stress, and keep the physical strength necessary to deliver and care for a new baby.

Sexual intercourse is safe in pregnancy unless you have complications such as bleeding, preterm contractions, or a low-lying placenta. While sex may make you have mild contractions, it will not make an otherwise healthy pregnant woman go into premature labor. Unless we tell you otherwise, continue your normal sexual practices if you want to.

Hair color, including highlights, is safe during pregnancy. The portion of hair that is outside of the scalp is dead tissue and does not absorb anything into the bloodstream.  If you normally have your hair colored, we recommend waiting until after the first trimester to have it done.

Inhaling paint fumes is not good for anyone, pregnant or not. While normal, casual exposure to paint does not cause birth defects, use good judgment if you are painting and make sure the room is well ventilated.

Exposure to very high temperatures (>103F) for long periods of time in baths, hot tubs, or saunas can increase the risk of spina bifida during the first two months of pregnancy. Normal temperature baths (98-101F) are safe and can be very relaxing. If you are concerned, put a thermometer in your bathtub.

If you have an uncomplicated pregnancy it is safe to travel until you are likely to go into labor. We generally recommend staying close to home after 36 weeks, and not leaving the country in the third trimester (26-28 weeks) unless absolutely necessary. Flying is safe in pregnancy, but may increase your risk for blood clots, so wear support hose on long flights and move about the cabin at least once per hour. With long road trips, make frequent rest stops to stretch your legs and maintain circulation.

Outdoor cats can be exposed to Toxoplasmosis and can pass this parasite to humans through the feces. One could acquire it by changing the litter box of an infected cat. If your cat goes outside, have someone else change the litter box when you are pregnant, or wear gloves and wash your hands well. If your cat lives inside and only eats processed cat food, he/she cannot get the disease. Cuddling with your cat is safe and will not expose you to the disease. Dogs are not affected. Toxoplasmosis can be harmful to a developing fetus, but is very rarely seen in the US.

Folic acid is a B vitamin that has been shown to reduce the risk of neural tube defects (ex: spina bifida). It is recommended to have 1 mg (1000 micrograms) during the month prior to pregnancy and for the first two months after conception to reduce this risk. More folic acid may be recommended if you have a personal or family history of spina bifida, including a prior affected child. A prenatal vitamin is a general multivitamin with 800-1000 micrograms of folic acid, as well as calcium and iron. Most women continue their vitamins throughout the pregnancy to help reduce anemia and make up for any imperfections in their diet.

After 12 weeks of pregnancy, the baby begins to make bone and will draw the necessary calcium from your bones. To prevent bone loss, 1000-1500 mg of calcium is recommended. This recommendation equates to 4-5 servings of milk, yogurt or dairy each day.  Since this may be difficult to consume, a calcium supplement may be needed to make up the difference. There are a variety of supplements available to meet this need.  Please let us know if you need any recommendations. Essential Fatty Acids may help fetal eye and brain development, improve maternal skin, hair and nails, and are also passed into the breast milk. Many prenatal vitamins include these fatty acids and they are found in fish.

When we lie on our back, the large blood vessels that run close to the spine can be compressed by the pregnant uterus.  In the third trimester, this can decrease blood flow to the baby. At the same time, blood flow to your head can be decreased and you may feel dizzy and lightheaded. While there is no evidence that lying on your back sometimes is harmful, blood flow to the baby will be maximized if you tilt your abdomen to the left or right.

Testing your baby for disease prior to birth is a personal choice. Depending on your age, family history and race, you may be at higher risk of having a baby with a certain disease. Caucasians are more likely than people of other races to carry the gene for cystic fibrosis, for example. African Americans are more likely to carry the gene for sickle cell disease, and people of European Jewish ancestry are more likely to carry the gene for Tay Sach’s disease. Blood tests can be done to see if you carry the gene for these diseases, to help establish whether the baby may be affected.

Down’s Syndrome occurs when there is an extra copy of chromosome 21. While it can happen to anyone, the chance increases as the mother gets older. At age 35, the risk of having a baby with Down’s Syndrome or other chromosomal abnormalities is about 1/200, and at age 40 is about 1/50. Women who are age 35 or older may choose to have an amniocentesis (fluid withdrawn from the amniotic sac and tested for number of chromosomes) to have a definite diagnosis. Other non-invasive tests are also available, but are not 100% accurate. There are multiple methods for screening in the first and second trimesters. Women of any age may choose to do these non-invasive tests. Some patients choose not to do any testing because the results would not change their feelings or choices about the pregnancy. If you have any questions, please let us know.  We want you to make an informed decision regarding all prenatal testing.

Routine dental work is safe during pregnancy and we recommend you keep up with your normal dental health routine. Most dentists will require a note from us saying that the visit is safe, and we can give you documentation to take with you if needed. If you need extensive dental work, we can discuss the best options for medications with your dentist.

Our providers deliver at the Woman’s Hospital of Texas. Women’s Hospital of Texas has state of the art labor and delivery units. Anesthesia and neonatology services are available 24 hours a day, and all rooms are large and private with private bathrooms. Neonatal intensive care is available in both hospitals, and both encourage “rooming in” so that you are not separated from your baby.  Lactation consultation services are available to assist you with breastfeeding after delivery.

Woman’s Hospital – You can register online by visiting www.womanshospital.com and clicking on “Account Management” and “Online Hospital Preregistration”. If you would like to schedule a tour or class, the schedule can be found on the website under “Patient Education” and “Classes and Tours”.

Most people deliver close to their due date. About 10% of women deliver before 37 weeks. It is more common to go past your due date in your first pregnancy than in subsequent pregnancies. While it is sometimes safe to go as long as 2 weeks over the due date, we generally recommend induction at 41 weeks.  If you have had a preterm (<37 weeks) delivery before, you are more likely to have another preterm delivery.  If you are planning a cesarean section, we generally will schedule it at 39 weeks.

The goal for our providers is to cover all their own deliveries as long as they are in town. They take weekend call for each other with rotating weekends. Even if they are not on-call during the weekend, they do their best to attend to those deliveries if they are available.

After an uncomplicated vaginal delivery, you can expect to stay 24-48 hours. Most c-section patients are seen in the office 1-2 weeks after delivery and 3-6 weeks after a vaginal delivery.

You will need a pediatrician who has privileges at the Women’s Hospital of Texas. He/She will see the baby before discharge. If you do not have a pediatrician, we are happy to recommend some excellent physicians for you to consider. Some patients like to meet with the doctor prior to delivery, or you may be comfortable meeting them in the hospital. After discharge, the first visit with the pediatrician is usually at 2 weeks of life, and you can make this appointment as soon as the baby is born.

If this is your first baby, you may want to take a childbirth class. While this is not required, it may help you to be more comfortable regarding what to expect during labor and delivery. Most people take a class in the last 2-3 months of pregnancy. There are a variety of options for these classes, and you can schedule them with the hospital or other locations.

This is a personal choice. Epidurals are a safe and effective means of controlling the pain associated with childbirth. Complications from an epidural are extremely rare and often easily corrected. You do not have to make any arrangements for an epidural prior to your delivery day. Anesthesiologists are available 24 hours a day to help you whenever you request their services.

Blood from your baby’s umbilical cord contains stem cells, which may be collected and stored after the baby’s birth. Stem cells have numerous current and possible future medical uses that warrant consideration. There are a variety of places available for cord blood and tissue collection and storage. We can offer additional information if you are interested.

If you have a true emergency that cannot wait until the office opens (if you are in labor, for example), our office number will prompt you to connect to an operator who will page the doctor on call. Reasons to call:

• bleeding that is more than spotting (especially in first and second trimester)
• persistent cramping
• any severe pain
• fever > 101F
• vomiting that is preventing fluid intake for more than 24 hours
• leaking of fluid
• decreased or absent fetal movement
• regular, painful contractions

If you think you are in labor, and you are more than 36 weeks, call when your contractions are 5-10 minutes apart or less for at least an hour. If you are worried or not sure if you are in labor, it is always best to call. If you feel you need to go to the hospital at any time, please call us first so that the doctor on call can advise you and let the hospital know you are coming.