Delivery Information
Childbirth Education and Hospital Tours
Sign up for a birthing class early in your pregnancy as you may not be able to take it at the time or place of your choice if you wait until the third trimester to register. Los Olivos birthing classes are designed to help both new and experienced parents prepare for childbirth. With adequate knowledge and preparation, expectant parents are encouraged to take an active role towards a healthy and fulfilling pregnancy and childbirth. A cesarean section class is also available. Classes are taught by experienced registered nurses certified in childbirth education. The instructors are committed to providing the most current pertinent and practical birth information. Dates and information about classes is available at www.lowmg.com/office/classes.html
Register for Los Olivos classes at 356-0431 extension 209, or by email: CBEclass@lowmg.com. Good Samaritan Hospital offers childbirth education classes, breast-feeding classes, infant CPR and sibling classes. Register by calling 559-BABY. Tours of Good Samaritan Hospital labor and delivery and the mother and baby suites are included with the birthing classes or can be arranged separately by calling 559-BABY.
Anesthesia Information
GSH offers a free informational monthly meeting to discuss pain control options during labor and delivery. The discussion is led by an anesthesiologist (pain relief MD) and covers many topics including epidurals and narcotics. The meeting is the first Tuesday of every month at 7:00 pm in the Good Samaritan Hospital auditorium. Call 559-BABY for more information. An anesthesiologist is available on the labor and delivery unit for your safety at all times. This service is provided by physicians in Group Anesthesia Services. More information about the group is available at www.groupanesthesia.com.
Hospital Registration
Los Olivos Women’s Medical Group delivers babies at Good Samaritan Hospital. You will be provided with a hospital registration form during the third trimester of your pregnancy or you can download it from the Los Olivos website or at https://prereg.app.medcity.net After completing the form, FAX it to Good Samaritan Hospital admissions at (408) 559-2675. They will need a copy of your insurance card and driver’s license with the form. The completed form can also be dropped at the admissions desk located in the lobby of the Good Samaritan Hospital.
Cesarean Section Scheduling
Cesarean sections are typically scheduled in the week before your due date to avoid going into labor and to be certain the baby’s lungs are mature. A cesarean section in a high risk pregnancy may be scheduled earlier if necessary. Once you and your physician agree on a date, please contact Celeste, so that the surgery can be scheduled. Her phone number is (408) 358-4835 and email is celestec@lowmg.comelcome to Los Olivos Women’s Medical Group.
We are pleased that you have chosen our office for your obstetric care. Our approach toward your care is to educate you and work together with you to make your pregnancy a wonderful and memorable experience. The following information is designed to help you with your pregnancy. You will be given a copy of the guide at your first obstetric visit with your physician.
Labor Information
Birth plans
Many first time expectant couples attend prenatal classes. After you complete your classes, please ask your physician any questions that arise. The philosophy of the physicians at Los Olivos is one of nonintervention. Many patients choose natural child birth, and your physician and the labor and delivery staff are supportive. Keep an open mind to additional options should they be needed. Pain medications and anesthesia are usually available if requested. Shaves, enemas, intravenous fluids, internal monitoring, and episiotomies are not performed routinely. Intervention is kept to a minimum. Our goal is to keep you and the baby healthy and to provide a positive experience. A written birth plan is not necessary.
Signs of labor
Contractions – during the last weeks of pregnancy, you may experience uterine contractions. Braxton-Hicks contractions serve as warm-up exercises for the uterine muscle. Labor contractions are more regular in timing and stronger in intensity, frequency and duration. Labor contractions do not go away when you lie down or rest.
Rupture of membranes – Either a gush of fluid or a slow leaking of fluid may occur when the amniotic sac ruptures. This occurs before labor begins about 15% of the time. The fluid is usually clear and odorless.
Bloody show – A small amount of bleeding is commonly seen after an exam in the office or just before the onset of labor. This may or may not contain the mucus plug. Unfortunately, neither the passage of blood nor the mucus plug will predict when labor will begin. It is not necessary to call the doctor if you have bloody show or lose your mucus plug.
False Labor (Braxton-Hicks)
These contractions often are irregular and do not become closer together. They may stop when you walk, rest, or change position. Often felt low in the abdomen, these contractions are usually weak and do not become stronger in intensity. Resting usually makes them stop.
Preterm labor
Preterm labor occurs at less than 37 weeks. Many patients have occasional irregular contractions, also known as Braxton-Hicks that may be painful. If you have more than 5 contractions in an hour, stop all activities, drink extra fluids and stay in bed. If you continue to have more than 5 contractions in an hour before 37 weeks, call your obstetrician.
Fullterm labor
Your baby is considered mature after 37 weeks. It is normal to have bloody show and mucus during early labor and after office visits if your cervix has been checked. This is due to the cervix softening or stretching.
Call Your Doctor
When in doubt, call. The guidelines offered here are guidelines, not rules. Please call if you have any one of the following:
1. When contractions are 5 minutes apart, from the start of one contraction to the start of the next, and when contractions are 45 seconds to one minute in length, and have been so for at least one hour. If you can talk through the contraction, it is probably too early to call.
2. If your water breaks.
3. If you have heavy bleeding.
4. If your baby is not moving normally.
5. If the baby is known to be other than head down (breech or transverse) and labor begins or the water breaks.
6. If you are scheduled for a cesarean section and labor begins.
7. If this is not your first labor and your cervix is dilated when checked in the office, call when you know you are truly in labor. Your second delivery may be much faster than your first delivery.
If this is your first baby, and your pregnancy has been uncomplicated, you may want to stay home as long as possible. When labor begins, try resting. Start timing contractions when they become very painful and difficult to speak through. You may try walking, taking a warm bath, or watching a movie to keep yourself distracted until it is time to call your doctor.
If you have had a prior vaginal delivery, your labor may be more rapid than your first experience. Call when your contractions are regular or painful. If you have had very rapid labors or are dilated before labor, your doctor may tell you to call at a time earlier than suggested above.
During the day, you may call the office (356-0431). Press "0" for the operator. If you are calling after hours, call the exchange (554-2872). They will contact the doctor on call for Los Olivos. When the doctor calls you back, please communicate anything unusual about your pregnancy such as diabetes, history of herpes, positive group B strep culture, high blood pressure, breech presentation or previous cesarean section. If the doctor on call is delivering a baby or is in surgery, there may be a slight delay in returning your call. If you feel the delay is too long, please contact the exchange a second time. Call labor and delivery directly at Good Samaritan Hospital (559-2327), or go directly to labor and delivery if there is still no return call.
At Good Samaritan Hospital
Orders are called to the hospital after the doctor speaks with you. These orders include recommendations for walking, using the shower or spa, diet, monitoring and pain medications or epidural. The nurses at the hospital will evaluate your labor and communicate with the doctors throughout your labor. Your baby will be monitored when you first arrive, and later in labor when you are no longer able to walk. Shaves, enemas, intravenous fluids, internal monitoring, and episiotomies are not performed routinely. Intervention is kept to a minimum. Our goal is to keep you and the baby healthy and to provide a positive experience.
When you are admitted to the hospital, you will be assigned a room and a nurse. If you know that you want pain medication or if you are a GBS carrier, an IV may be started. Your blood pressure, the contractions and the baby’s heart rate will be monitored. Your cervix will be checked to assess dilation, effacement and the baby’s head position.
The baby’s heart rate and electronic pattern will be evaluated with an external fetal monitor. A small monitor is held in place by a thin elastic band and records the baby’s heart rate to determine the baby’s well being. A second monitor shows the frequency and length of the uterine contractions.
After you are in strong labor and no longer wish to walk or sit in the room, you can rest in the labor bed. You may be positioned on your side, sitting up or lying down depending on what is most comfortable to you and what position the baby tolerates best. No food is allowed during labor due to an increased risk of nausea and vomiting. You will be offered ice chips and clear liquids instead.
What should I bring to the hospital?
You may wish to bring your pillow, slippers, camera, music, nightgown or pajama, nursing bras, robe, toilet articles, computer or iPod, baby outfit and infant car safety seat. If you know that your baby is going to be small, make sure the car seat is the appropriate size.
How long does labor last?
Labor begins with uterine contractions and the opening of the cervix. The uterus tightens and relaxes at regular intervals, causing the abdomen to feel hard, then soft. These contractions make the cervix thin (efface) and dilate. Labor is considered active when the cervix is dilated to 4 centimeters. On average, a first labor lasts 12-20 hours. Second and subsequent labors are much faster.
What can I have for pain relief?
Natural childbirth uses relaxation, meditation and breathing techniques. If you want additional pain relief, medications are available. Narcotic pain relievers are given through an IV. Demerol and Fentanyl are the most commonly used intravenous narcotics. An epidural is a regional anesthetic that blocks pain below the waist for the duration of labor. A spinal anesthetic is usually used for a cesarean section if an epidural is not already in place.
Stages of Labor
Labor consists of regular contractions that occur closer together as time goes on and continue despite movement or rest. They increase in strength and severity with time. Contractions are usually felt in the lower back and radiate to the front of your abdomen. Blood-tinged mucous (bloody "show") is caused by cervical mucus, which passes out of the vagina as the cervix dilates. It does not mean that labor will start soon, only that the cervix is beginning to soften and dilate in preparation for labor.
Labor begins when the cervix starts to dilate and ends when the baby is born. Labor is divided into several phases, beginning with the latent phase. Latent phase is of variable duration and can last many hours or even days. The latent phase of labor ends and active phase begins when the cervix is 4 centimeters dilated. In a low risk pregnancy, it is best to stay at home during this phase. The active phase of labor usually progresses rapidly at about one centimeter per hour in first labors and much more rapidly with subsequent labors.
The second stage of labor begins when the cervix is fully dilated and it is time to push the baby out. Once the cervix is fully dilated, you will often feel extreme pelvic pressure. “Pushing” involves bearing down during each contraction until the baby is born. This stage may last for generally 1-3 hours and ends with the birth of the baby. Rest between contractions so as not to exhaust yourself. Once your baby's head is delivered, the airways are cleared by suction. The baby is delivered and usually placed on the mother’s abdomen. The cord is clamped by the physician and is then cut by a family member. The baby stays with the mother until additional baby assessment is needed.
After delivery, the placenta is delivered and the vagina is repaired if stitches are needed. This is the third stage of labor. Pitocin is generally given to help the uterus contract and control bleeding.
Vaginal Delivery
Most deliveries are spontaneous without intervention. If your doctor finds it necessary to induce you, the indication will be explained. Most interventions are used to prevent a worse outcome. Interventions are not used unless they are considered both safe and necessary. Risks and benefits of interventions as well as alternatives will be discussed. Forceps and vacuum are used to prevent a cesarean section; an episiotomy is used to prevent lacerations.
The following are brief explanations of possible procedures:
Episiotomy: A small incision on the perineum used to open the vagina and allow delivery of the head or to facilitate delivery in the event of fetal distress. It is used to prevent lacerations and tears into the rectum, clitoris and vagina. Most physicians will cut an episiotomy only if necessary. K-Y jelly and massage are often used during the second stage of labor to stretch the vagina and allow a smaller tear or episiotomy. Local or epidural anesthesia is given before the episiotomy to avoid discomfort.
Forceps: These instruments look like large spoons. They are inserted in the vagina and gently placed on baby's head to facilitate delivery in the event of fetal distress or a very long second stage.
Vacuum: A soft plastic cup that is placed on the baby's head. Suction is used to hold the cup in place so that the infant can be delivered during a contraction with the mother pushing. It is frequently used when the baby’s head is not in the correct position for a vaginal delivery.
Cesarean Delivery
Reasons for a cesarean section include an abnormal position of the fetus (breech), a medical complication of the pregnancy (pre-eclampsia, active herpes, heart disease), a previous cesarean section, a large baby, a fetal heart rate abnormality signaling distress or a baby that is “stuck” (cephalo-pelvic disproportion or CPD). Cesarean sections are either scheduled (planned or elective) or unplanned (emergency or after laboring). If a cesarean section is required, the reason will be discussed with you in detail. Your partner may stay with you throughout the procedure.
If you have been laboring and have an epidural already, this will be used for your delivery. If you do not have an epidural, a spinal is the usual anesthetic. Your anesthesiologist will discuss this with you. Once you are comfortable with your anesthetic, your lower abdomen is shaved, a catheter is placed in your bladder and your abdomen is washed with sterile soap. Drapes are placed to maintain a sterile environment. Your physician will start the procedure after you are ready and comfortable.
After delivery, the baby will be examined by a pediatric nurse and a neonatologist in a room next to the operating room. Amniotic fluid is suctioned from the baby’s mouth and nose and the baby will be returned to you in the operating room. Your partner can stay with the baby during the brief time that the baby is out of the operating room. After the procedure, you will be in the recovery room with your family until your anesthesia wears off. This usually takes about two hours. Your baby is usually weighed in the recovery room after your surgery. The baby remains with you during the entire hospitalization unless you request the nurses to watch the baby in the nursery.
The IV and bladder catheter will remain in place for the first 12 – 24 hours. Once you are tolerating liquids, the IV can be discontinued. The nurses will ask you to stand during the first day and then start walking soon after. You may eat regular food when you are hungry. The hospital has a “room service” menu that you may order from 7:00 am to 7:00 pm. We encourage you to start oral pain medication as early as possible. Ibuprofen is also given to increase the effectiveness of the narcotic (Tylenol #3, Vicodin, Percocet) and decrease the discomfort from uterine contractions after delivery.
If you are scheduled for a planned cesarean section, you should arrive at the hospital two hours before your surgery time. Bypass the hospital’s admitting desk and go directly to Labor and Delivery. If you arrive at the hospital before 6:00 am, you must enter through the emergency room. It is not necessary to stop in the ER.
If you have not preregistered, please do so at least one day before your surgery. Obtain a preregistration form in admitting, at www.lowmg.com or on the Good Samaritan Hospital website:www.goodsamsj.org/reginfo.asp.
For a scheduled cesarean section, do NOT have anything to eat or drink (including water) after midnight the night before surgery or 8 hours prior to surgery. You will meet the anesthesiologist the morning of surgery. A spinal is normally given for a scheduled cesarean section. If you have questions regarding anesthetic services, please contact Group Anesthesia Services at 354-2114 or www.groupanesthesia.com.
Labor Induction
Labor can be initiated by your physician for medical reasons or electively. Induction can be initiated with a cervical ripening agent (misoprostel or cervidil), by breaking the amniotic sac or with pitocin. If your doctor recommends induction, the indication and the process will be discussed in detail. Generally an induction is “scheduled” at the hospital for a specific day and time. Orders are faxed to the hospital by your physician. Call labor and delivery (559-2327) one hour before your scheduled induction time to see if you can go in as scheduled. If the hospital is busy due to already laboring patients, the labor and delivery nurses will ask you to arrive at a later time.
Reasons for induction include postdates (usually one week past your due date), a history of complications in labor, premature rupture of membrane (water breaking early), high-risk pregnancy (diabetes or hypertension), low amniotic fluid, macrosomia (big baby) or elective (after 39 weeks).
Length of Stay at Good Samaritan Hospital
Your insurance will allow you to stay in the hospital for 48 hours after a vaginal delivery and 96 hours (4 days) after a cesarean section. If you are feeling good, the baby is doing well and you have help at home, you may request an earlier discharge from the hospital. To be discharged after a cesarean section, you must be tolerating a normal diet, taking oral medications and walking. It is not necessary to have a bowel movement before discharge.
Postpartum Instructions
Appointments
If you have had a cesarean section, schedule an appointment 2 to 3 weeks after surgery. Your doctor will advise you if you need additional appointments. If you have had a vaginal delivery, schedule an appointment 6 weeks after delivery, unless otherwise instructed by physician. Be prepared to discuss birth control options at your postpartum appointment.
Activity
Rest as much as possible. During your first weeks at home, restrict your activities to caring for the baby. You will heal faster and be at less risk for depression. Take frequent naps. Limit your visitors. You may begin light exercise when you feel like it. Do not push yourself. Walking is better for you than running or lifting weights the first six weeks after birth. After six weeks, you may slowly build back up to your normal exercise routine.
If you had a cesarean section, walking up and down stairs will not harm you. You probably should not carry anything heavier than the baby for the first week or two. Use common sense – if it hurts, don’t continue with that activity.
You may drive when you feel comfortable and have stopped taking pain medications. Wait two weeks or more if you have had a cesarean section. Sitz baths, showers, and baths are safe after vaginal delivery. Do not use a Jacuzzi until the vaginal discharge stops or bathe after a cesarean section until the incision is healed (usually 5-7 days).
Intercourse is permissible after the vaginal discharge and bleeding stop, usually at three to four weeks. If you have had vaginal stitches, you should wait six weeks. Condoms should be used with a water-soluble lubricant such as K-Y jelly or Astroglide.
Vaginal Delivery
After delivery, you will experience bleeding and a discharge for 4 to 6 weeks. It may last longer. The discharge is called lochia. It may be any color, and often has an odor. This continues until the uterus has healed. If you had a vaginal tear or episiotomy, your vaginal area may be swollen or sore. Urination may cause external stinging and should resolve after several days. Taking sitz baths or a warm bath 2 to 3 times a day will help with the discomfort and promote healing. You may use Tucks on stitches or hemorrhoids for comfort. These may be bought without a prescription. The stitches will dissolve by themselves, and do not need to be removed. Do not worry if you see a stitch or knot fall off.
Cesarean Section
Cesarean section incisions have many layers that heal at the same time. There are strong stitches below the skin. Glue and steri-strips should be removed one to two weeks after cesarean section, if they have not already fallen off. It is not necessary to cover your incision while showering. Use a blow dryer to keep the incision dry if your skin folds over the incision. Your incision may ooze slightly as the skin heals. Call the office for an appointment if your incision opens, has a large amount of discharge or bleeding, or if it becomes red or painful.
Diet, Bowel and Bladder Care
You may return to your regular diet at home. If you are breast-feeding and took prenatal vitamins during your pregnancy, continue them while nursing. Increase your diet by 500 calories, and drink 8 to 10 glasses of water each day. Consume more fruits and vegetables.
After delivery, you may become constipated. Fiber supplements and stool softeners (Colace) are available without a prescription. Citrucel, Benefiber, and Fibercon are effective fiber supplements. Drinking water is very important for the stool softeners to work. If you become constipated, with no bowel movement for a few days, you may need a laxative such as Ducolax or Senakot. If still no bowel movement, Miralax or a Fleets enema may be effective.
To prevent a bladder infection, drink plenty of water and urinate frequently. If you develop burning or pain with urination, call the office.
Postpartum Medications
You may also continue to use the same medications used during your pregnancy. If you have any questions about medication, call your doctor.
Ibuprofen and Naprosyn are nonprescription pain relievers that reduce cramping, bleeding and discomfort. The usual dose of Ibuprofen (Advil, Nuprin, Motrin) is 600 mg every 6 hours, not to exceed 2400 mg in 24 hours and Naprosyn (Aleve) is 220 mg, 2 initially, then 1 every 6-8 hours, not to exceed 1100 mg in 24 hours. Tylenol is also useful for pain relief and can be taken with Ibuprofen and Naprosyn as they work differently.
Percocet, Vicodin, or Tylenol #3 are narcotics that may be prescribed by your physician if you have had a cesarean section. Narcotics may cause drowsiness, fatigue, nausea and constipation in the mother. They can be used while breast-feeding. Ibuprofen and Naprosyn work synergistically with the narcotic so that you need less of it. You may use Ibuprofen 2400 mg/24 hours or Naprosyn 1100 mg/day. Continue the anti-inflammatory medication after you stop taking the narcotic to continue with pain relief.
Breast Care and Breastfeeding
If you are breast-feeding your milk should come in within 3 to 5 days after delivery. Breast-feeding on demand will help reduce engorgement and increase the milk supply. Use warm water, without soap, to keep your breasts clean. Soap may dry and crack your nipples. If your nipples crack, expose them to air for 15 minutes after breast-feeding. Lanolin ointment may be applied after this. Most babies eat about eight times each day. Try to nurse your baby for at least 15 minutes on one breast and for about 10 minutes on the other breast. It is normal to have more bleeding and/or cramping when breastfeeding. This is a hormonal response to the breast stimulation.
If you have difficulty nursing, contact Women and Children's services at GSH (559-2229), Nursing Mother's Council (272-1448), Nursing Mother's Resource (377-5350), or Mother's Milk Bank (998-4550). Pump rentals may also be arranged for at the above numbers. Breast milk can be stored in a sterile container in the refrigerator for up to 72 hours or in a standard freezer for 1-2 weeks.
Mastitis (breast infection) pdf
You may be developing mastitis if you have a high fever associated with a painful, red breast. Other signs of a breast infection include increased pulse rate, chills, malaise, headaches and an area on the breast that is red, tender and hard. Treatment involves antibiotics, rest, frequent breastfeeding or pumping, and analgesics for pain and fever. Please call if you suspect mastitis.
If you are not nursing the baby wear a tight fitting bra to reduce engorgement. Cold compresses may help, and consider Tylenol or Ibuprofen for the discomfort. There is no medication approved by the Food and Drug Administration to prevent engorgement.
Medication use while nursing
Safety of commonly used medications while nursing can be accessed at the UCSD guide or contact your pediatrician.
Symptoms to Report
1. Excessive bleeding, soaking a pad in one hour with bright red blood, or passing large clots (call immediately).
2. Chills or fever over 100.4 degrees.
3. Severe pain.
4. Persistent headache, changes in vision, rapid swelling of face, feet, hands or overall body.
5. Increased pain, redness, swelling odor or discharge from episiotomy site or cesarean incision.
6. Depression lasting more than 2-4 weeks.
7. Breast infection - fever in association with red, painful breast.
8. Bladder infection - frequency, urgency, or pain with urination.
Common Postpartum Discomforts PDF
Bleeding
You may stop bleeding and then restart bright red bleeding several times during the first six weeks after delivery. Called "lochia," bleeding and discharge can occur in 3 stages. The first stage is red, lasting for about 3 days. The second is watery-pink, lasting for 1-3 weeks, and the third is yellowish-white, lasting another 3-6 weeks. Change sanitary pads frequently. Passing clots is also common during the postpartum period. Clots can be bright red, dark red, small or large and are frequently associated with severe cramping. Ibuprofen helps with the pain. Call for excessive bleeding, soaking one pad per hour with bright red blood or continuing to pass large clots.
Cesarean Incision
Your scar may pucker and be tender for 2-3 months as it heals. It is common to feel numbness up to the umbilicus for 6 months. The edges of the incision may be more swollen than the center because of knots used to close the layers located at the sides of the incision. It is normal for the pain to be worse on one side than the other. The top of the incision frequently hangs over the lower edge during the healing process until the lymphatic system begins to function normally. Call the office if the incision becomes red, more inflamed, more tender, or begins to leak fluid. Please remove steri-strips or glue from the incision one week after delivery. They are easiest to remove after a shower or bath.
Constipation
Hormonal changes, dehydration, breast-feeding and inactivity cause constipation. Try increasing the fiber in your diet, drinking more water, and using stool softeners.
Cramping
These are due to the uterus contracting as it returns to normal size. These may be increased with breastfeeding. We recommend changing your position often, emptying your bladder often, using a heating pad, and taking ibuprofen to help with the contractions.
Depression and Emotional Changes
It is normal to feel overwhelmed, exhausted and sleep deprived. The lifestyle changes, exhaustion, and fluctuating hormones frequently cause anxiety and feelings of helplessness. After delivery, your body will undergo many changes. The demands of a new baby and inadequate sleep may lead to feelings of depression. For most women, these feelings may only last 4-7 days. Resting, maintaining a good diet, and planning time for you away from baby are important. Ask for help from your family and friends. If depression persists longer, or seems more severe, schedule an appointment with your doctor. Good Samaritan Hospital has an excellent support group (559-2508).
Episiotomy
Use ice packs the first 1-2 days and Ibuprofen as needed for swelling and discomfort. Taking a warm bath, using a sitz bath, a spray bottle, or a rubber ring may also help. As you heal, you may notice the stitches beginning to pull and itch. Swelling decreases so the stitches begin to loosen. The body absorbs sutures used in repairing an episiotomy over the next 6 weeks.
Hair Loss
Thinning hair is normal postpartum, with the most noticeable change 5-6 months after delivery.
Hemorrhoids
Keep your stools soft by using a stool softener. Try Preparation H, Anusol creams, and using a spray bottle after bowel movements. Do not over wipe. Consider Tucks pads and baby wipes.
Hormonal Changes
It is common after delivery to experience hot flashes, night sweats, mood swings and vaginal dryness similar to what women experience in early menopause. Your estrogen level drops with delivery and is reduced until you finish nursing and your regular menses resumes. If the symptoms are troublesome, you can discuss estrogen replacement with your physician. A small dose of oral or transdermal (patch) estrogen will reduce the vasomotor symptoms of hot flashes and night sweats. If vaginal dryness is the only symptom, vaginal estrogen cream can be prescribed.
Hot Flashes
Hot flashes occur frequently when nursing. The body treats nursing like menopause with all the same symptoms due to lack of estrogen. Hot flashes, depression, and vaginal dryness all increase during breast-feeding. Starting a combination oral contraceptive pill or using an estrogen patch usually helps decrease the symptoms. If you are nursing, the estrogen in the pill may decrease milk supply. Vaginal estrogen does not affect nursing.
Leg Swelling
It is normal for your legs to swell after the delivery. There are large fluid shifts after delivery. This usually resolves by your 6-week postpartum check.
Sex
If you had a cesarean section or a vaginal delivery without an episiotomy, you may attempt intercourse four weeks after delivery. If you had a vaginal delivery with an episiotomy or laceration, wait until after your postpartum visit. You may need to use lubrication (Astroglide or K-Y Jelly), especially if you are breastfeeding.
Engorged Breasts
Try using ice packs and wearing a sports bra or nursing bra all the time. If you are nursing, your body should regulate the engorgement within the first few weeks. Nursing is supply and demand. If you are not breastfeeding, avoid stimulation of the breasts.
Urinary Leakage
Urinary stress incontinence is caused by decreased perineal muscle tone and lack of estrogen. Do Kegel exercises to reverse the process. Using estrogen vaginally (prescription) can also help restore the tissue if dryness is an issue.
Vaginal Dryness
Breast-feeding causes vaginal dryness. Lubrication may help the symptoms. It can be treated with prescription estrogen products that are placed vaginally.
Pediatricians at Good Samaritan Hospital PDF
Please let your obstetrician know which pediatrician you have chosen for your baby. The pediatrician is the physician who will discuss baby care with you and take care of your child. If you wish to have your son circumcised, the pediatrician performs this.
Appendix
Glossary of Pregnancy Terms PDF
Abdominal Wall Defects (AWD) – Developmental defects involving the intestines and other organs that form outside the body.
Anencephaly – Anencephaly refers to an incomplete development of the brain that usually results in death.
Amniocentesis – A small amount of amniotic fluid is removed by a needle and is sent to test for chromosomal abnormalities such as Down syndrome and Trisomy 18. Amniotic fluid also screens for neural tube defects such as spina bifida.
Chorionic Villus Sampling (CVS) – This test may be offered at 10-14 weeks of pregnancy. A small number of cells are taken from the placenta and are diagnostic for
Down syndrome and Trisomy 18. The advantage over amniocentesis is that it is performed earlier in pregnancy. On the negative side, CVS does not detect neural tube defects.
Detailed or Level II Ultrasound – A specialized ultrasound that includes basic information as well as detailed anatomical information about the fetus in the second trimester. It is recommended for women who will be 35 years or older at delivery, Screen Positive with the Full Integrated or Serum Integrated Screen or who have other high-risk indications. A Level II ultrasound is always performed with an amniocentesis and is performed at a Prenatal Diagnosis Center.
Diagnostic Test – CVS and amniocentesis are invasive tests that obtain amniotic fluid or placental tissue to grow chromosomes from the fetus. The test can tell if the fetus actually has a specific birth defect. Screening tests estimate the risk of certain birth defects.
Down Syndrome – Down syndrome is a chromosome abnormality that causes mental retardation and certain types of birth defects. It is due to an extra copy of chromosome 21, so that, three copies (trisomy) versus the normal two copies of this particular chromosome are present. Down syndrome affects approximately one in every 800 newborns. The chance of having a pregnancy affected with Down syndrome increases with increased maternal age. Women age 35 years and older are more likely to have a child affected with Down syndrome.
First Trimester Testing or Preliminary Risk Assessment – A blood test is drawn between 10 weeks and 13 weeks and 6 days of pregnancy and combined with a nuchal translucency (NT). A positive test results in referral to a Prenatal Diagnosis Center. Another option is having the second blood test at 15-20 weeks to complete the Full Integrated Screen.
Full Integrated Screen – This combines the First Trimester Screening (blood test and NT) with a second trimester blood test to detect 90 out of 100 with Down syndrome, 81 out of 100 with Trisomy 18, 97 out of 100 with anencephaly, 80 out of 100 with open spina bifida, 85 out of 100 with abdominal wall defects and 60 out of 100 with SLOS.
Genetic Counseling – A genetic counselor reviews test results and family medical history. The counselor explains diagnostic tests, which may be offered.
Neural Tube Defects (NTD) – During the first 5 weeks of fetal development, the neural tube develops into the brain and spinal cord. Abnormalities in development may cause spina bifida or anencephaly.
Nuchal Translucency (NT) – An ultrasound preformed between 11 weeks 2 days and 14 weeks by a perinatologist to measure the back of the fetus’ neck. This measurement helps screen for Down syndrome and Trisomy 18. It is used in conjunction with two blood tests to complete the California Full Integrated Screening. Check with your insurance company to determine your benefits.
Prenatal Diagnosis Center – A center that offers genetic counseling, diagnostic testing and detailed ultrasound for screen positive results. Obstetrix Medical Group (408) 371-7111 is the local diagnosis center.
Prenatal Screening Program – The California screening program offers Serum Integrated Screening. With a Screen Positive result, the California Prenatal Screening Program includes referral to a Prenatal Diagnosis Center for the same fee.
Prenatal Screening Test – Screening tests offer risk assessment to determine whether further diagnostic tests should be done. These tests cannot detect 100% of birth defects.
Quad Marker Screen – One blood specimen drawn between 15 and 20 weeks of pregnancy that gives a risk assessment for detection of 80 out of 100 Down syndrome, 67 out of 100 Trisomy 18, 97 out of 100 anencephaly, 80 out of 100 open spina bifida, 85 out of 100 abdominal wall defects and 60 out of 100 SLOS.
Rh Incompatibility – This is due to the mother having Rh negative antibody in the blood and the father of the baby having Rh positive antibody in his blood. If the baby has Rh positive blood type from the father, it can cause the mother to produce an antibody response against the baby. This is prevented by the mother receiving Rhogam after amniocentesis, at 28 weeks and again after delivery.
Rhogam – Rhogam is a shot given to Rh-negative mothers to prevent Rhesus disease in the newborn. IgG antibody (Rhogam) binds to fetal cells in the maternal circulation to prevent the mother from producing antibodies that could harm subsequent pregnancies.
Risk Assessment – An estimate of certain birth defects obtained with the Prenatal Screening Program.
Serum Integrated Screen – Two blood specimens drawn (first and second trimester) to detect 85 out of 100 with Down syndrome, 79 out of 100 with Trisomy 18, 97 out of 100 with anencephaly, 80 out of 100 with open spina bifida, 85 out of 100 with abdominal wall defects and 60 out of 100 with SLOS.
Screen Negative – The screening result shows that the screen for abnormality is unlikely. California reports risk of 1 in 100 or less to be negative. This does not guarantee that there are no birth defects.
Screen Positive – If the test shows a “positive” of 1 in 200 chance of having a baby with Down syndrome, the program authorizes follow-up services at a Prenatal Diagnosis Center which includes genetic counseling, a detailed ultrasound, CVS and amniocentesis. Obstetrix Medical Group offers genetic counseling and diagnostic testing (CVS or amniocentesis) to anyone who screens less than 1 in 1000 chance of Down syndrome or Trisomy 18. A positive screen does not always mean that there is a birth defect. Most women will have normal follow-up diagnostic tests.
SLOS or Smith-Lemli-Opitz Syndrome – A very rare metabolic defect in which babies cannot make cholesterol normally and results in mental retardation and physical defects. Screen positive results for SLOS can also indicate increased chances of other congenital abnormalities and fetal demise.
Spina Bifida – When there is an opening in the spine, it is called spina bifida and can cause paralysis in the lower extremities as well as loss of bowel and bladder function.
Trisomy 18 – Trisomy 18 is a fatal chromosome abnormality that causes multiple birth defects and profound mental retardation. Few Trisomy 18 infants survive into childhood. Trisomy 18 results when the fetus has three, instead of the normal two, copies of chromosome 18. Like Down syndrome, the chance of an increased risk for fetal abnormality is determined by the test and then genetic counseling, ultrasound examination, and when needed, amniocentesis will aid in the diagnosis. Having a pregnancy affected with Trisomy 18 increases with increased maternal age.
Ultrasound – A device known as a transducer is used to direct high frequency sound waves to visualize the developing baby. The sound waves create an image of the baby’s features and can determine growth and development of the baby.
Carrier Testing for Genetic Diseases PDF
The purpose of genetic screening tests is to determine the carrier status of common genetic abnormalities. These common inherited diseases can occur even without a family history. The tests do not detect all carriers of the diseases. If you screen positive as a carrier for any of the conditions, it is recommended that your partner be tested. If your partner is also a carrier, genetic counseling and further diagnostic testing is recommended. If you have already been screened, it is not necessary to test again. These tests are optional.
Cystic Fibrosis PDF
What is Cystic Fibrosis?
Cystic fibrosis (CF) is one of the most common genetic disorders in the Caucasian population, affecting approximately 1 in 3,000 people. The most common problems are chronic lung infection and poor absorption of nutrients due to the accumulation of thick mucus in the lungs and pancreas of patients with CF. While much progress has been made in the understanding and treatment of the disease, there is no cure. Symptoms of the disease range from mild to severe. Typical lifespan of an affected person is 37 years, though some may live longer.
What causes Cystic Fibrosis?
CF is an autosomal recessive disorder. If both parents are carriers, there is a 1 in 4 (25%) chance to have a child with cystic fibrosis. For an individual to be affected with CF, he or she must inherit one copy of the mutated CF gene from each parent. Individuals having one copy of the mutated gene and one copy of the normal gene are known as carriers. Carriers do not have any symptoms of the disorder. The CF carrier frequency differs among different ethnic groups. The frequency is approximately 1 in 25-30 in individuals of Northern European or Ashkenazi Jewish ancestry, 1 in 50 in Hispanics, 1 in 65 in African Americans and 1 in 50 in Asians.
How can Cystic Fibrosis be detected?
A DNA blood test for some of the mutations causing CF is available. The test can be performed on blood specimens or amniotic fluid to detect carriers or affected individuals. Since there are over 900 different mutations within the CF gene, this test cannot detect all the mutations. The detection rate varies among different ethnic groups, with 97% for Ashkenazi Jews, 90% for Caucasians, 68% for Hispanics, 45% for African Americans and 30% for Asians. If you are a carrier of CF and your partner has a negative test and no family history of CF, the chance that your baby will have CF is less than 1%.
Who should be tested for Cystic Fibrosis?
Because it is becoming increasingly difficult to assign a single ethnicity, it is reasonable to offer cystic fibrosis carrier screening to all pregnant patients, provided that women are aware of their carrier risk and of the test limitations. CF carrier testing is strongly recommended for individuals with a family history of CF, spouses of CF carriers and pregnant couples who are of Northern European or Ashkenazi Jewish ancestry. Prenatal diagnosis is recommended when both parents have been found to be carriers, there is a family history of CF and one parent is found to be a carrier, a previous child has been diagnosed with CF or certain ultrasound abnormalities are seen in the fetus.
Thalassemia PDF
Thalassemia includes several different types of anemia. Alpha and beta thalassemias are named for the part of the oxygen carrying protein that is lacking in the hemoglobin of the red blood cells. Thalassemia occurs most frequently in people of Italian, Greek, Middle Eastern, Asian and African descent. The disease can cause the child to have frequent infections and an enlarged spleen, liver and heart. A hemoglobin electrophoresis to diagnose thalassemia is indicated if the MCV value on the routine blood count (CBC) is less than 80.
Ashkenazi Jewish Genetic Screening PDF
What is an Ashkenazi Jewish Disease?
Ashkenazi is the term used to describe Jewish individuals who have ancestors from Eastern Europe. Roughly 90% of the six million Jewish individuals in the United States are of Ashkenazi descent. Similar to most ethnic populations, the Ashkenazi Jewish population has a higher prevalence of certain genetic disorders. Individuals of Jewish descent should be screened for Tay-Sachs disease, Canavan disease and Gaucher’s disease.
What is Tay-Sachs Disease?
Tay-Sachs disease is a fatal genetic disorder that occurs more frequently in the Ashkenazi (Eastern European) Jewish population. Approximately 1 in 27 Ashkenazi Jewish individuals are carriers of this disease. A baby with Tay-Sachs disease appears normal at birth, but after six months of age, the child progressively develops mental retardation followed by paralysis, blindness, and seizures. Death usually occurs by the age of five. Tay-Sachs disease is caused by a deficiency of an enzyme called Hexominodase-A. As a result of this deficiency, there is an accumulation of certain substances which damage the nervous system.
What is Canavan Disease?
Canavan disease is a progressive disorder in which the brain and nervous system degenerate. Symptoms of Canavan disease include brain damage, mental retardation, feeding difficulties, blindness, and a large head. There is no treatment, and death usually occurs in the first decade of life.
What is Gaucher’s Disease?
Gaucher’s Disease is an inborn error of metabolism that results from a specific malfunction in one of the body’s individual chemical processes. Although there are at least 34 mutations known to cause Gaucher’s Disease, there are 4 genetic mutations, which account for 95% of the Gaucher Disease in the Ashkenazi Jewish population. The carrier rate is 1 in 14 Jewish people of Eastern European ancestry and 1 in 100 of the general population.
How are these diseases inherited?
All three diseases are inherited in an autosomal recessive pattern. For an individual to be affected, he or she must inherit one copy of the abnormal (mutated) gene from each parent. Individuals having one copy of the particular disease-causing gene and one copy of the normal gene are known as carriers. Carriers usually do not have any symptoms of the disorder. If both parents carry the same mutated gene, their child has a 25% chance of having the disease. If only one parent carries the disease gene, their child is not at risk for having that disease but has a 50% chance of being a carrier. If both parents are carriers, the couple should undergo prenatal genetic counseling.
Fragile X Syndrome PDF
What is Fragile X Syndrome?
It is the most common form of inherited mental retardation and accounts for approximately 40% of cases with X-linked mental retardation. Clinical characteristics include mild learning disabilities to severe mental retardation. Approximately one-third of all children diagnosed with fragile X syndrome also have autism and hyperactivity. Almost all males with full mutations have developmental delay or mental retardation. Approximately 50% of females with a full mutation have IQs in the borderline or mentally retarded range; of the remaining 50%, half have learning disabilities.
Who should be tested?
It is recommended that any person with unexplained mental retardation, developmental delay or autism be tested. The American College of Medical Genetics also recommended carrier testing on the basis of a family history of unexplained mental retardation.
How common is Fragile X Syndrome?
The incidence is 1 in 4,000 males and 1 in 8,000 females. The carrier frequency is 1 in 260 and occurs in all ethnic backgrounds. If the test shows that you are a carrier of fragile X, your partner does not need testing because this disease is inherited only through the woman. If a mother is a carrier, there is a 50% chance to have a child with fragile X syndrome. Therefore, the next step is for you to consider diagnostic testing by amniocentesis or chorionic villi sampling (CVS) to determine if your baby is affected.
Where can I find out more information?
For more information see: www.fragilex.org/ or http://www.cdc.gov/genomics/hugenet/factsheets/FS_FragileX.htm
Spinal Muscular Atrophy (SMA) PDF
What is Spinal Muscular Atrophy (SMA)?
SMA is an autosomal recessive condition that causes progressive degeneration of the lower motor neurons, muscle weakness and, in the most common type, respiratory failure by age two. Muscles responsible for crawling, walking, swallowing and head and neck control are the most severely affected. It is variable in severity and age of onset and does not affect intelligence. There is no cure or treatment.
What is the carrier frequency?
The frequency varies by ethnicity and ranges from 1 in 35 to 1 in 117 in the United States. The incidence is 1 in 6,000 to 10,000
What is the carrier detection rate?
Caucasian: 95%, Ashkenazi Jewish: 90%, African American: 71%, Hispanic: 91%, Asian: 93%.
Sickle Cell Disease PDF
What is Sickle Cell Anemia?
Sickle cell anemia is an inherited disorder that affects hemoglobin, a protein that enables red blood cells to carry oxygen to all parts of the body. The disorder produces abnormal hemoglobin, which causes the red blood cells to become crescent or sickle shaped. Normal red blood cells are round and move through blood vessels in the body to deliver oxygen. Sickle red blood cells become hard, sticky and have difficulty passing through the small blood vessels. When these hard, pointed red cells go through capillaries, they clog the flow and break apart. This causes pain, damage and anemia.
What is Sickle Cell Trait?
Sickle cell trait is seen in a person who carries one sickle hemoglobin producing gene inherited from their parents and one normal hemoglobin gene. Normal hemoglobin is called type A. Sickle hemoglobin is called hemoglobin AS on the hemoglobin electrophoresis. This combination of one normal and one abnormal gene will NOT cause sickle cell disease.
How do you get Sickle Cell Anemia or Trait?
You inherit the abnormal hemoglobin from your parents, who may be carriers with sickle cell trait or parents with sickle cell disease. You cannot catch it. You are born with the sickle cell hemoglobin and it is present for life. If you inherit only one sickle gene, you have sickle cell trait. If you inherit two sickle cell genes you have sickle cell disease.
How common is Sickle Cell Anemia?
It is most common in people whose ancestors come from sub-Saharan Africa, Spanish-speaking regions of Central and South America, Saudi Arabia, India and the Mediterranean. The disease occurs in approximately 1 in every 500 African American births and 1 in every 1,200 Hispanic-American births. One in 12 African Americans carries the sickle cell trait.
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