Answers to Common Questions During Pregnancy
If you have questions or concerns that you prefer not to wait until your next visit, please call or message us on patient portal. Our office number of (806) 791-1122 is answered 7 days a week, 24 hours a day. During business hours, our practice’s registered nurses Karen, Brittany, Kayla or Candy will return your call between seeing patients. After office hours, the phone is transferred to an answering service and Karen, RN or Candy, RN will be contacted. They will contact a physician, if needed. In the unlikely event that the phone system is not working, you can call the hospital labor and delivery unit (UMC FBC is 806 775-8800 and CMC-Lakeside L&D is 806 725-6494) and talk to a nurse after hours. .
Drs. Coon and Devine share call, and we prefer to deliver our own patients as often as our family commitments allow. We may ask one another to see our patients for daily rounds on weekends and holidays. For more information, see the FAQ page.
What's Ahead During Pregnancy!
Frequency of visits: We routinely see most patients every 4 weeks until 28 weeks, then every 2 weeks from 28 to 36 weeks. Weekly visits occur between 36 weeks and delivery.
Your first doctors visit: We will obtain a complete history, and perform a health assessment. This will include a measurement of your weight, a urine dip, and a blood pressure check all to serve as a baseline for subsequent visits. A manual breast exam, pelvic exam, will also be performed. If you have previously had your blood and urine collected, then we will review results with you at this appointment. We ask you to communicate your concerns and expectations with us.
10-12 weeks pregnant: We should be able to hear the baby's heartbeat with a Doppler type stethoscope. (It's at least 20 weeks before you can hear it with a conventional stethoscope). We can schedule you for nuchal fold translucency testing if you are interested in this screening test on your fetus. We can also start the sequential screen or do the cell free DNA testing for genetics testing.
15-19 weeks pregnant: At this time you can either complete the sequential screen started in the first trimester or opt to receive an optional test called the Tetra screen.
20-24 weeks pregnant: Most women will be referred for an ultrasound to screen for any abnormalities. It is usually possible to determine the gender of the fetus at this age.
24-28 weeks pregnant: During this time you will be screened for Gestational Diabetes. You do not have to be fasting to obtain an accurate test.. At the time of the test you will be asked to drink a small bottle of carbohydrate-rich drink and a blood test is drawn one hour after you have finished the drink. Along with this screening, we will check your blood count for anemia as well. Texas state law asks for an HIV at this visit as well. I will discuss both results with you at your next office visit unless the results are abnormal at which point a nurse will contact you as soon as possible. If your blood type is Rh negative you will need other tests we can discuss at your visit. The Tdap vaccine is optimally timed to be given between 27 and 36 weeks gestation.
35-37 weeks pregnant: This is the time when we will test for a bacteria called Group B Strep (GBS) using a cotton swab in the vagina. While it has no symptoms in your pregnancy, this bacterial colonization can cause newborn to become ill within the first 48 hours. If your GBS test is positive you will be given antibiotics when you are in labor.
Please note that further testing may be indicated at any time during your pregnancy. We can explain why the test is needed, what to expect before, during, and after the test. The result will be reviewed with you in detail at your next scheduled appointment. If you opt to be on patient portal, which we encourage, we will send all lab results to you over this secure system when we review the results. You can message us with any questions.
Safe Solutions for you and your Baby!
Although the ideal situation is to abstain from all medication throughout your pregnancy, this may not be realistic for you. Some medications can be safely taken in pregnancy. The following list is provided to make you more comfortable.
Aches- Many preventative measures can be taken to avoid muscle aches, such as; exercise, proper body mechanics, good posture, and frequent position changes. If "prevention" is too late, begin implementing these techniques and try placing a heating pad to the affected area or a warm bath for no longer than twenty minutes at a time. Back support belts designed for pregnancy are available in maternity stores and provide relief for many women. One type of support belt is called Prenatal Cradle. Vulvar varicosities or varicose veins of the vulva can be supported with a V2 Supporter. Tylenol ES or the generic equivalent, taken as directed, in combination with these suggestions may help eliminate your discomfort. You can also try relaxing in a pool, as this is often successful in relieving pressure by creating a type of weightlessness. If these measures are not helpful most women benefit from a consultation with a qualified physical therapist for individual therapy. Chiropractic care can also be very beneficial.
Bloating- Intestinal gas and bloating in pregnancy can often be managed by an over the counter remedy containing simethicone, such as Phazyme.
Congestion and runny nose- Saline nasal drops or Breathe-Right strips used as directed may provide relief of sinus symptoms. A humidifier may also help the symptoms. Antihistamines such as Chlortrimeton, Benadryl, Zyrtec and Claritin are not associated with any known problems in pregnant women. For allergies the Claritin and Zyrtec (or their generics loratadine and cetirizine) are best. If your symptoms are more from a cold or flu then the older antihistamines Chlortrimeton and Benadryl (chlorpheniramine or diphenhydramine) will relieve symptoms better but are known to cause more sleepiness than loratadine and certrizine. Decongestants in general should now be avoided in pregnancy. A recent study confirmed some rare fetal birth defects associated with the first trimester use of Sudafed or phenylephrine, phenylpropanolamine, and psuedoephedrine. This medications have be associated with The use of the nasal spray oxymetazoline (Afrin) should be avoided in the first and second trimesters due to concerns about its association with fetal renal collecting system anomalies or kidney problems in the baby. Reference: Am J Epidemiol 2013:178(2):198-208.
Constipation- By increasing the amount of fiber in your diet, increasing your fluid intake, and maintaining an active lifestyle as possible, you will decrease the occurrence of, or at least help in relieving, constipation. If you are without relief, you may take Colace, Surfak, or Fiber Con as directed.
Cough – Robitussin is often helpful in treating a minor cough, if necessary. Depending on the type of cough you have, increasing humidity with a cool mist vaporizer may provide some relief as well. Increasing fluids can also moisten your throat and thin secretions, which may be helpful as well. Nonmedicated lozenges with glycerin or honey are helpful and safe.
Diarrhea- It is important to prevent dehydration and electrolyte imbalance when suffering from diarrhea by drinking enough water and Gatorade to make the color of your urine clear. A clear liquid diet, including items like jello and popsicles, is recommended. You can slowly return to a regular diet as symptoms disappear and if tolerated well. Imodium AD or Kaopectate as directed are safe, however, be aware that constipation can be a side effect.
Fever- Tylenol ES as directed. If your temperature is 101.0° F or higher, please
call my office.
Hemorrhoids- Preventative measures are to avoid straining when having a bowel movement, lifting heavy objects (including children!), and standing in one position for extended periods of time. If prevention is too late, Anusol HC, Tucks, and Dermaplast spray used as directed should provide temporary relief. Tub baths with Epsom’s salt are often soothing.
Indigestion- Perhaps avoiding spicy and/or greasy food, eating small frequent meals, and remaining upright one hour after eating will reduce the frequency of indigestion. Antacids such as Tums and Rolaids also have added calcium your body may need. Mylanta and Maalox are safe to use in pregnancy. Medications like Tagamet or Pepcid taken as directed have been used successfully by many women and are safe to use.
Insomnia- Avoid naps during the day if possible. Don't consume food or beverages that are high in sugar and caffeine after 5:00 PM. If lack of sleep continues to haunt you, Benadryl or Tylenol PM taken as directed can be an excellent sleep aid.
Nausea- Eating food high in protein and complex carbohydrates while avoiding the ingestion (and the smell) of spicy or greasy food is a good start to preventing episode of nausea. Try to eat several small meals a day. Because a too empty or too full stomach can increase the nausea, try to keep your stomach about the same degree of fullness all day. A bedtime snack with meat or milk (protein) will sometimes help you avoid the morning nausea. Drink plenty of fluids between meals. Avoid extra stress and extreme fatigue. If nausea is inhibiting your activities of daily living, begin the day with crackers in bed. Proceed with other bland food such as dry toast, Cheerios, low salt pretzels, wheat/bran muffins, or ginger snaps until the nausea has subsided. Emetrol (syrup) or an antacid taken as directed is helpful to some people. "Sea bands" are acupressure wristbands worn to prevent motion sickness and effectively reduce nausea in some women. A variety of herbal remedies, often in the form of teas, including peppermint, spearmint, and ginger may reduce or even eliminate nausea. We can provide prescription medications for women in whom these methods are not helpful. Hospitalization is required for only a few percent of pregnant women and is generally limited to those women who are unable to continue to drink liquids. Nausea without vomiting, while miserable, generally does not require hospitalization.
Sore Throat- Any over the counter throat lozenge especially dyclonine (Sucrets Maximum Strength) or Chloraseptic spray taken as directed may be soothing. Tylenol can also help the pain. Treating runny nose and congestion as in the congestion section above will help with sore throat. A strep pharyngitis screening test can be done in the office by sending a sample to a lab to see if antibiotics are needed.
Good Nutrition...it does make a difference!
Remember a 20-35 pound weight gain is ideal during these next nine months. This weight needs to come from adequate amounts of foods consisting of protein, carbohydrates, calcium, iron, fruits, and vegetables.
Protein is essential for an appropriate birth weight in your newborn. By consuming four servings of protein a day, you can meet you and baby's needs. Be careful to avoid eating fish that is high in mercury (shark, swordfish, king mackerel and tilefish).
In order to avoid listeriosis, a bacterial infection potentially harmful to you and your baby, you should not eat pate` or store-made meat salads (chicken salad, tuna salad, etc.) and should only eat hot dogs, luncheon meats, bologna or deli meats if they have been re-heated until steaming hot. Also don’t drink raw or unpasteurized milk or milk products. Don’t eat soft cheeses such as feta, queso blanco, queso fresco, Brie, Camembert, blue-veined cheeses or Panela unless it is specifically labeled “MADE WITH PASTEURIZED MILK.” We recommend you review Food Safety for Pregnant Womenat this link or that you should have received at your prenatal visit. We also recommend www.fsis.usda.gov for information on food safety.
Five servings of complex carbohydrates a day will provide your baby with the required vitamins (B vitamins in particular) and minerals needed. Whole wheat, rice, oats, rye, soy, corn, barley, potatoes, and legumes are all wonderful sources of complex carbohydrates. Include a variety of these complex carbohydrates in your diet to get the maximum nutritional benefit.
Calcium is not only essential for the development of strong bones and teeth, but for the development of your baby's muscles, nerves, and heart as well. Four servings of calcium a day is crucial in supplying yourself and your baby adequately. Leg cramps in pregnancy are often due to insufficient calcium intake.
Because your body is expanding its blood supply while your baby is developing his or her own blood supply, the demand for large amounts of iron is great. Get as much iron from your diet as possible by including lean beef, pork, poultry, liver, green leafy vegetables, legumes, and dried fruits whenever possible. These iron-fortified foods, eaten with Vitamin C rich sources (orange juice, strawberries, cantaloupe, green/red pepper, tomatoes, and broccoli), increase the absorption rate of iron. With this in mind, combine the two daily.
Fruits and Vegetables contain vitamin A, vitamin E, folic acid, riboflavin, and a host of other vitamins and minerals that are essential in the development of healthy skin, eyes, and bones. By eating three to five servings a day you will be providing your little one with the necessary vitamins and minerals he or she needs to develop appropriately. To satisfy your sweet tooth, enjoy the sweetness of fruit, fruit juice concentrates, or dried fruit and benefit from its nutritional value. Avoid empty, and therefore wasted, calories found in sugar and sugar products.
Use this information as motivation to maintain excellent nutrition throughout your pregnancy and in return come as close as you can to guaranteeing your baby excellent health at birth!
Caffeine. Should I or should I not?
There may be an increased risk of miscarriage from moderate use of caffeine (around 200 mg per day). This corresponds to about 2 cups of coffee or 4-6 cans of Coke or Pepsi. Caffeine can also increase mood swings, decrease the absorption of iron, promote dehydration and cause irritation of the stomach (increasing nausea complaints). Because of these concerns we recommend that you avoid caffeine during your pregnancy, but smaller amounts are not of concern.
Due to limited human research on sugar substitutes in pregnancy, conclusive data of its effects are simply not available. However, conservative opinions suggest not to consume aspartame (NutraSweet™) or saccharin (Sweet'n Low™) on a regular basis.
Alcohol and Cigarette Smoking.
Many women express their concern about having a couple of drinks before they knew they were pregnant. There is no evidence that a few drinks consumed early in pregnancy will have harmful effects on your developing baby. However, continuing to drink heavily throughout pregnancy could cause a multitude of complications as well as inducing harm to your growing baby. Because of these risks, alcohol consumption is not recommended.
Cigarette smoking has proven to be one of the most common causes of prenatal problems. There is evidence that cigarette smoking during pregnancy directly affects the development of your baby. Small birth weight, early birth, premature detachment of the placenta, and premature rupture of membranes are among the most serious complications. Therefore, cigarette smoking is strongly discouraged. Please ask us about options for help in smoking cessation.
Labor and Delivery Experience
The goal for each patient is to have a healthy mother and baby. If the baby's heartbeat is reassuring on monitoring (category 1 strip) and the mother is doing well, we are flexible about particular birthing plans. The emphasis on each labor and delivery experience is on communication. A full explanation will be provided for each management decision we will make together. We encourage you to ask questions and express your concerns.
We prefer an intravenous access site for emergencies while admitted in labor. IV fluids will be required if you want an epidural for anesthesia. Continuous monitoring is required if there is not one-on-one nursing available. Internal monitors are encouraged if there is a problem with monitoring the baby on external monitoring.
Cesarean sections are avoided unless the baby is showing signs of intolerance of labor, the baby is breech, or progress in labor is abnormal indicating the baby cannot be delivered vaginally. An episiotomy will not be performed without discussing it with you at the time, unless there is significant fetal distress and time does not allow. Vaginal birth after cesarean section (VBAC) is encouraged but not required.
A tubal ligation can be provided at the time of cesarean delivery or after vaginal delivery during your hospital stay for patients who are certain they want permanent surgical contraception. Risks and benefits of this procedure need to be discussed in detail in the office. We have attached links to the contraceptive options of the favorite links page of this website.
If you are admitted in labor and desire an epidural anesthesia, this may be obtained whenever the laboring patient desires. Hydration with adequate fluid intravenously is required. We do not require a particular cervical examination change before an epidural can be administered.
Most patients with vaginal deliveries stay in the hospital one to two days after delivery. Patients with cesarean sections stay two to four days after delivery. You will be discharged with pain medication if needed and a plan for follow up and contraception.
Postpartum (after delivery)
We want to see you back in the office at 6 weeks for a routine checkup after all deliveries. If you have shortness of breath, fever, heavy bleeding, abnormal discharge or problems with breasts or breast feeding, please call our office. It is also important to let us know about postpartum blues or depression.
We recommend vaccinations of the baby as recommended by the American Academy of Pediatrics and the CDC, as we feel this is in the best interest of your baby's health.
Breastfeeding is a wonderful experience for most women, but can be one of the most frustrating if the baby does not nurse well. Support from our office, the LaLeche league or friends and family can help. Remember that the medications safe for pregnancy are not the same as for breastfeeding. Antihistamines like Benadryl are not used if breastfeeding a newborn. Breathe-right strips or saline nasal spray are better for symptoms of congestion. Sudafed may cause undesired reactions in your newborn. Ibuprofen (Motrin or Advil) is safe. Tylenol, antacids, and vitamins are also safely used.
For women who choose not to breast feed, engorged breasts can be treated with ice packs, cold cabbage as a pack to the breasts, Tylenol or Motrin, and binding the breasts. Mothers who are not breast feeding are sometimes relieved by expressing milk then rebinding if other measures do not help.
Intercourse, douching and tampons are to be avoided for 6 weeks. Vaginal bleeding may continue for several weeks, but is usually gone by 5-6 weeks.
Almost all moms have swollen ankles after delivery. This edema gets worse when at home from the hospital, because you are on your feet more. The swelling will go away on it's own. Keeping your feet above your heart for a portion of each day, and drinking extra fluid can speed the process. If the swelling is associated with shortness of breath and cough or a severe headache you should call us.
Most first time moms are surprised by how fatigued they are in the baby’s first year of life. You are encouraged to call us if you experience postpartum blues that are not improving with rest and time. This can be a serious problem for some women. It helps to take more time for yourself, to get out of the house and do something you enjoyed before the baby came. Increasing your rest time by pumping for a relief bottle, or simply allowing others to help, is invaluable. You may need to treat yourself to a cleaning service, or send out the laundry. By this point in your care, our office will consider you our friend. Call if we can help you through this time.
Remember that we would love a picture of your little baby for our scrapbook!
Susan Devine, M.D.