Congratulations,
Now What?
Dr. Nizar Olabi D.O., F.A.C.O.G
Timeline of Your Pregnancy
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1st Trimester
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2nd Trimester
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Weeks 1-13
Expect to visit your obstetrician every month during
this period
Weeks 14-27
Expect to visit your obstetrician every month during
this period as well
3rd Trimester
Weeks 28-40
 Beginning in the 7th month, your obstetrician will
see you every two weeks
 After weeks 35-36, your obstetrician will see you
every week until delivery!
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Making Healthy Choices
Ideally,prenatal vitamins are started 3 monthsprior to conception.
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Prenatal Vitamins
Folic Acid – helps prevent neural tube defects (defects of the
brain and spinal cord)
 Calcium – promotes strong bones and teeth for both you and
baby
 Iron – aids in the development of blood and muscle cells for mom
and baby
 Combined, these vitamins reduce the risk of low birth
weight babies
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Others
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Omega-3 Fatty Acids – help with brain development
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Source: Vitamins or Seafood
Vitamin D – important later in pregnancy
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Source: Low-fat Milk, Vitamin D Milk, Cheeses, or Yogurt
Making Healthy Choices
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Alcohol
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Caffeine
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NO! However, do not be concerned with the drinks you
may have consumed prior to knowing you were
pregnant. As long as the habit is discontinued
immediately, there should be no harm to your growing
baby.
Limit caffeine intake to 1-2 cups of coffee or 200mg of
caffeine daily.
Exercise
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YES! Any pregnant woman is encouraged to discuss an
exercise program with her practitioner; however, women
who exercise regularly before pregnancy are typically
encouraged to continue their routine.
Making Healthy Choices
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Smoking
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Marijuana
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NO! Pregnant mothers should make every attempt to quit
smoking cigarettes as soon as they believe they have
become pregnant (or sooner in the trying phase). Although
studies show quitting before 3 months gestation reduces
harm to your baby, we recommend quitting as soon as
possible. If you cannot quit, it is proven that reducing the
amount of cigarettes consumed each day may limit effects
to your baby.
NO! While any marijuana you may have consumed prior to
conception will not affect your baby, it is imperative that
you do not continue this habit while pregnant to avoid
harm to your growing child.
Cocaine & Other Drug Use
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NO! All of these substances will cause harm to your baby.
Making Healthy Choices
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Cats
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Keep them. Avoid changing the litter box of your
furry friend while pregnant, or at least do so with
disposable gloves. Cats can transmit a disease cause
Toxoplasmosis, however most cat owners are already
immune.
Hot Tubs & Saunas
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Within reason. Hot tub use is safe during
pregnancy, although we recommend feet only. The
problem being that any prolonged period with a body
temperature >102˚F may cause harm to the baby.
This is similar for saunas or steam rooms.
The First Trimester
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Your First Prenatal Visit (OB Intake)
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Confirming your pregnancy
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Urine and/or Blood Test
Date of your last period (LMP)
 We use this to calculate your Estimated Delivery Date
(EDD)
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Laboratory Testing
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This will be covered in a separate session.
A History
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LMP + 7 days – 3 months + 1 year = EDD
Medical History (illnesses, surgeries, medications, allergies)
Family History
Gynecologic History (date of your first period, typical cycle)
Obstetrical History (past live births, miscarriages, abortions)
Social History (occupation, alcohol or drug use, exercise)
A Physical Exam
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Vital Signs (for baseline weight, height, blood pressure)
Heart, Lungs, Abdomen
Gynecologic Exam similar to your annual exams
The First Trimester
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What to Expect
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Breast Changes—more common in women who have been pregnant
before
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Fullness, Heaviness, Tenderness, Tingling, Darkening of the
Areolas
Bloating, Flatulence, Heartburn
Fatigue
Frequency of Urination
Heightened Sense of Smell
Nausea typically begins at 6 weeks, but some
experience nausea and vomiting as early as the first
month
The First Trimester
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What to Expect
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Food Aversions and Cravings
Excess saliva, possible Drooling
Constipation
Vaginal Discharge—white in color
Mood Swings, Irritability, Irrationality, and Extreme
Weepiness
Anxiety
The Second Trimester
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Exciting things to look forward to…
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A baby bump around 4 months!
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Which also means outgrowing your pre-baby clothes.
Fetal movements begin between the 4th and 5th
months
 No more morning sickness!
 Your baby’s first (and typically only) ultrasound
around week 20!
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The Second Trimester
 What
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to Expect
Fatigue
 However a decrease from first trimester
Decrease in Urinary Frequency
Aching in the lower abdomen and groin
 due to stretching of the uterine ligaments
Constipation, Heartburn, Indigestion, Flatulence,
and Bloating
Breasts remain enlarged, but are less tender now
Nasal congestion and nosebleeds; Ear Fullness
The Second Trimester
 What
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Sensitive Gums
Increased Appetite
Increase in Vaginal Discharge
Varicose veins in the legs; Hemorrhoids
Skin color changes on your abdomen (linea nigra)
and face (melasma); as well as stretch marks
Navel “pops” around month five
Mood Changes
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to Expect
Irritability, Irrationality, Inexplicable Crying
Forgetfulness
The Third Trimester
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Exciting things to look forward to…
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Signing up for childbirth classes!
Forming your Birth Plan, if you so choose
Choosing a Pediatrician for your little one!
Beginning around week 38, your doctor will begin
examining you for labor progression.
Braxton Hicks Contractions
 these tend to be painless, and are merely a sign of
what is to come—labor & delivery!
The Third Trimester
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What to Expect
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Stronger and more frequent fetal movement
 This may be due to kicking or fetal hiccups
 Beginning in the 9th month, you may seem to think your
baby is moving less, but in reality he or she just has less
room to move; so don’t panic!
Increasing Vaginal Discharge
Achiness in the lower abdomen and groin
 due to ligament stretching
Heartburn, Indigestion, Flatulence, Bloating, and
Constipation
Nasal congestion, and the occasional Nose Bleed
Backache
The Third Trimester
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What to Expect
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Swelling of the Feet and Ankles
Hemorrhoids; Varicose veins of the legs
Itchy Abdomen
Stretch Marks
Difficulty sleeping
Shortness of breath – your baby will be against your
diaphragm by this point
Colostrum – a milky discharge from the nipples, which is more
common following nipple stimulation
Strange and Vivid Dreams
WHAT IF?
Common Complications of
Pregnancy
Common Complications of
Pregnancy
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Ectopic Pregnancy
A pregnancy that implants outside of the uterus—most commonly in
the fallopian tube
 This may be caused by an STD, Pelvic Inflammatory Disease, or can
be seen at a higher rate in women who have endometriosis or an
intrauterine device
 Causes heavy bleeding, severe pelvic pain, dizziness and possibly
death.
 Patients with these symptoms must seek emergency medical
attention immediately
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Rh Negative Disease
Rh Factor is determined by checking your blood type at your first
prenatal visit
 The Rh factor is the presence of a protein surrounding the red
blood cells
 If a mother is Rh negative and her baby is Rh positive, the mother’s
body will start to build antibodies against the baby
 If negative, RhoGAM is a medication given around 28 weeks to
prevent the build-up of these antibodies.
 RhoGAM is given again at birth, only if the baby is Rh positive.
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Common Complications of
Pregnancy
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Group B Strep
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The leading cause of infections in newborns.
Cultures are done after 35 weeks to predict if a patient is a carrier of the
infection
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Preterm Labor
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If you are a carrier, you will be treated during labor with IV antibiotics.
Defined as gestational age <37 weeks
It may feel like menstrual cramping or a backache
At some point your doctor may elect to keep you on bed rest or use
medications to prevent the progression of labor
Low Birth Weight
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Can be a result of poor maternal nutrition; substance abuse (cigarettes,
alcohol, or other drugs); the result of an STD or other disease; or a lack of
adequate prenatal care
Concerns with low birth weight babies or premature births include: risk of
respiratory infections, blindness, learning disabilities, cerebral palsy, and
heart problems
Common Complications of
Pregnancy
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Gestational Diabetes
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Diabetes that develops during pregnancy (usually second trimester), as
your body is unable to make enough insulin (a substance that breaks down
sugar in our bodies).
Most commonly this complication can be managed with simple changes in
diet.
Preeclampsia
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A diagnosis of high blood pressure during pregnancy; signified by a rise in
blood pressure, water retention, and leaking protein in your urine
Risks to Baby
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This can be managed throughout a pregnancy with the following
precautions:
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May decrease blood flow to the placenta and therefore decrease nutrition and oxygen
available to your growing baby.
Mild Disease: a healthy diet (high water intake, low salt intake)
Moderate-Severe Disease: blood pressure medication
Eclampsia
The result of uncontrolled or unresolved hypertension during pregnancy or
labor; manifested by seizures.
 The risk is very small as a result of routine prenatal care and proper
management of preeclampsia.
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When to call your doctor…
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Immediately if you have:
Heavy bleeding; bleeding with cramping
 Severe lower abdominal cramping, centrally or to
either side—regardless of bleeding
 Decreased urination for 24 hours, combined with
increased thirst.
 Painful urination accompanied with fever or chills
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Remember: a fever is defined as >101.5˚F
Fever >101.5˚F without other symptoms
 Any change in vision (blurring, dimming, double
vision)
 Severe headache for >2-3 hours
 Bloody diarrhea
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When to call your doctor…
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Within 24 hours if you have:
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Blood in your urine
Swelling of your hands, face, or eyes
Painful or Burning urination
Fainting or Dizziness
Chills or fever >100˚F that is not reduced with
Tylenol
Severe nausea and vomiting late in pregnancy; or
vomiting >2-3/day in the first trimester
Itching skin
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With or without dark urine, pale stools, or yellowing of the
skin or whites of the eyes
When to go to the hospital…
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If you are approaching your due date and
experience any of the following, you should go to
the hospital and notify your doctor:
Bloody Discharge consistent with your period
 Rupture of Membranes (your ‘water breaks’)
 Contractions 2-5 minutes apart for at least one
hour
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WHEN THE TIME
FINALLY ARRIVES
Labor & Delivery
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Phase One: Early Labor
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Dilation: 0cm – 3 cm
This is the longest phase of labor; the period where your
cervix thins (effaces) and dilates to 3 cm
Contractions last 30-45 seconds in this phase, and are
approximately 20 minutes apart
You will most likely still be at home during this phase, or
en route to the hospital
You may experience:
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Back Pain
Menstrual-like Cramps
Lower Abdominal pressure
Indigestion, Diarrhea
Bloody Show – a discharge of blood-tinged mucus immediately
before labor
Your amniotic sac may or may not rupture during this stage.
Labor & Delivery
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Phase One: Active Labor
Dilation: 3cm – 7cm
 This phase may last 2.5-3 hours, with contractions
that last 40-60 seconds, and occur 3-4 minutes
apart
 You may experience:
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Increasing pain and discomfort with contractions
 Increasing back pain
 Leg discomfort
 Fatigue
 Rupture of Membranes (if this has not already occurred)
 Emotionally, you may feel restless, exhausted, and lose
concentration. This is when your coach is key!
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At this point the anesthesiologist will administer
your epidural (if you so choose).
Labor & Delivery
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Phase One: Transitional Labor
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Dilation: 7cm – 10cm
This is the quickest phase of labor, but typically the
most demanding.
Contractions are now 2-3 minutes apart, and 60-90
seconds in duration.
You may experience:
More intense pain with contractions
 Strong pressure in the lower back
 Rectal Pressure (much like the sensation you have when
you need to make a bowel movement)
 Feelings of warmth, sweating, or chills
 Exhaustion
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Labor & Delivery
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Phase Two: Pushing and Delivery
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Duration: 30 min – 1 hour on average
You may experience:
Pain with contractions
 Urge to ‘push’
 Rectal Pressure
 Fatigue or an occasional Burst of Energy
 Visible Contractions
 An increase in blood-tinged discharge (the bloody show)
 Tingling, stretching, and burning sensation when the baby
is crowning
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Labor & Delivery
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Phase Three: Delivery of the Placenta
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At this point, your baby has arrived and you can
enjoy every minute of it!
Your practitioner will deliver the placenta and repair
any tear or episiotomy, should they occur during
delivery.
Labor & Delivery
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Your Choices for Pain Management
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IV Pain Medication
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Advantages:
 You can walk around during each phase of labor—or at least until your
doctor requires continuous fetal monitoring
Disadvantages:
 Sensation of drowsiness
 Side effects of the medication—which may include: nausea and vomiting
 If an emergency occurs during your labor, and an emergency cesarean is
required, you will be put under general anesthesia for delivery—which
comes with its own risks:
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You are not awake for the delivery
Your partner is not allowed in the room with you
Sedates the baby as well as mom
Epidural Pain Relief
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Advantages:
 Your baby does not get the medicine!
 You may still feel pressure, but your pain receptors are blocked!
 As soon as you ask for the epidural, you shall receive. The medication does
not “wear off” until after delivery.
 If there is an emergency during delivery, and a cesarean is required, you
will still be able to have your partner in the operating room if you already
have an epidural in place
Disadvantages:
 You are unable to walk around during labor with an epidural
Resources for you!
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What to Expect When You are Expecting
by: Heidi Murkoff and Sharon Mazel
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The American Pregnancy Association
www.americanpregnancy.org
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The Mayo Clinic
http://www.mayoclinic.com/health/pregnancy-weekby-week/MY00331