Services and Information
“What should I do when the home pregnancy test shows I'm pregnant?”
- Call or go to the OB/GYN to set up your new OB Pysical appointment. The Department can be reached at 915-742-CARE(2273) Select Option 3 for Clinical Services, then Option 6 for Specialty Care, then Option 3 for Women's Health Services. You do not need another pregnancy test done by the hospital lab before setting up the new OB Physical appointment unless you are not sure of your last menstrual period. Come to the OB/Gyn front desk to have the lab order placed for you.
- Most patients will have this new OB Physical appointment between 8-12 weeks of pregnancy.
Low Risk Pregnancy Schedule
Overview of OB Appointments for Uncomplicated Pregnancy
With each visit, your OB provider will provide you with the advice appropriate for that particular gestational age.
With each visit, your OB provider will address any issues that you have regarding your pregnancy.
For uncomplicated pregnancy, one ultrasound is all that is recommended. Further ultrasounds will be ordered by your OB provider if issues warrant.
Schedule for Uncomplicated Pregnancy
- 8–12 weeks
- OB Physical - Us to confirm dating.
- 15–18 weeks
- Listen to baby’s heart beat.
- Optional Maternal Serum Analyte screen.
- Provider will order anatomy ultrasound to be done between 18–22 weeks.
- 20 weeks
- Us to evaluate babies development.
- 24 weeks
- Listen to baby’s heart beat.
- Discuss ultrasound result.
- 28 weeks
- Listen to baby’s heart beat
- Screening for pregnancy induced diabetes.
- Rhogam if you are RH negative.
- 32 weeks
- Listen to baby’s heart beat - Monitor uterine growth.
- 36 weeks
- Listen to baby’s heart beat.
- Screening for Group Beta Streptococcus (Group B Strep Prevention )
- Go over birth plan, if you have one.
- 38–41 week, weekly visit
- Listen to baby’s heart beat.
- Cervical exam / membrane stripping if feasible.
- 41+ week
- Schedule for induction if still not delivered.
- Fetal surveillance.
- Cervical exam / membrane stripping.
OB New Physical Appointment
What is an the new OB Physical Appoointment?
- Usually done between 8 - 12 weeks of pregnancy.
- Typically conducted by a Nurse Practitioner and/or Certified Nurse Midwife
Before your new OB physical Appointment
Before your appointment make a list of:
- Go to the lab a day prior to your appointment to have your bloodword drawn. If you appointment is on a Monday, go to the lab the Friday before.
- Curernt and previous medical problems.
- Previous hospitalizations. Bring record available for review if possible.
- Any minor or major surgeries and complications associated with it.
- Any current and / or previous female problems (i.e. abnormal Pap smear, Sexually Transmitted infections, pelvic pain, etc.).
- Any medication that you are taking - those prescribe to you by a healthcare provider or those bought over-the-counter.
- All pregnancies (terminations, miscarriages, vaginal births, c-sections, stillbirth).
For those pregnancy(s) with complications, we need you to:
- Bring records for review.
- Find out the exact name of the hospital so medical correspondence can help you request these records.
- Write down questions and concerns you have regarding any issues.
Day of your new OB Physical Appointment
- Plan to arrive at the OB/Gyn Clinic at least 60 minutes prior to your appointment time.
- You will be given questionnaires and forms to fill out.
- Accurately fill out these questionnaires before you speak with your nursing staff.
- Bring the health history list you’ve prepared
Issues Discussed During new OB Physical
Education is provided regarding:
- The pregnancy course
- Labs, both highly recommended and optional ones
- General health
- Schedule of appointments during the pregnancy.
- Go over the Pregnancy and Childbirth book.
- Introduce the concept of Centering in Pregnancy.
- Go over all your health / pregnancy histories.
- Discuss any concerns that you may have regarding your current pregnancy.
- Referral to specialty services as medically indicated.
- Routine blood tests results are reviewed during this appointment. Other blood tests will be ordered based on your medical / pregnancy history.
This is usually scheduled between 10–12 weeks of pregnancy.
During this visit:
- Go over your health / pregnancy history again.
- Go over your blood test results.
- Physical examination.
- Pelvic exam
- Pap smear
- Screening for sexually transmitted infection of the cervix and vagina.
- Listen to the baby’s heart beat.
- An us is done to confirm dating of pregnancy unless one has previously been done.
- Go over plan for the pregnancy based on your history, the lab tests, and physical examination result.
- Schedule for follow up appointment.
What is CenteringPregnancy®?
This is a new concept in pregnancy care. It allows you to experience your pregnancy with other women of similar circumstances and learn from and support each other.
Groups of pregnant women with similar due date experience pregnancy together.
A facilitator, usually an Advanced Practiced Nurse (Nurse Practitioner or Certified Nurse Midwife), helps the group work through issues related to the pregnancy, delivery, care of the baby, non-medical, and other social/relationship issues.
The pregnant women, you, determines the agenda of the meeting.
The central themes of CenteringPregnancy® are Assessment, Support and Education.
Through group discussions, sharing of experiences, and sharing of emotions, each participant learns about themselves and their pregnancy.
The facilitator help the group discuss various aspects of health, pregnancy, relationships, and care of the newborn.
Education topics includes nutrition, common pregnancy problems, family issues, parenting styles, relaxation measures, comfort measures for labor, stress reduction, exercise/relation, nutrition/infant feeding, oral health, birth preparation and recovery, sexuality/birth control, etc.
The group usually develops a network of support for each other throughout the pregnancy, and many times, after the pregnancy.
Each participant learns how to monitor and assess their pregnancy symptoms and to listen to what their body is telling them.
The group have 4 sessions every 4 week during the 16, 20, 24 and 28 weeks of pregnancy.
The group then have 6 sessions every 2 weeks during the 30, 32, 34, 36, 38 and 40 weeks of pregnancy.
Each session is about 2 hours long.
Most women report having more self-esteem, less stress, better parenting skill, learned more about themselves and their pregnancy.
Some preliminary studies appears to show that women who participates in CenteringPregnancy® have less growth problem of the baby, less preterm labor, less labor & delivery complications, and less abuse after the delivery.
Women who had traditional pregnancy care and then participate in CenteringPregnancy® prefer the CenteringPregnancy®.
Yes, talk to your provider. Some of our participants have medical problems complicating their pregnancy. These patients see an Obstetrician between the CenteringPregnancy® sessions if necessary.
For more information:
- Contact OB/GYN clinic, ask for the Centering Coordinator
- Group Sessions are held on the 4th floor of the Bradley Building in room #4J16
When a woman is in pain during the birthing process, it is her right to request the form of pain management that is safe, affective, and desirable to her.
Pain Management Options
- This is a natural method of managing labor pain
- Your provider will recommend breathing techniques, walking, birthing balls, squatting, labor bar, shower, massage throughout your labor to help you deal with labor pain.
- If you choose this method of pain management, we highly recommend for you and your partner to attend a birthing / Lamaze class before birth.
- Some couples hire a professional labor coach.
- Most patient will use homeopathic pain management until they are ready for other forms of pain management
- Ask you CNM provider for details about homeopathic pain management during your pregnancy. This is usually not a decision made when you are in labor. It needs planning and training.
- A single or a combination of mild narcotics / anxiety medication is given through your IV.
- It is very effective during the early part of labor and moderately effective during the active part of labor.
- Works well with Homeopathic Methods
- These medications can sometimes make interpretation of the baby’s heart rate and condition difficult (i.e. not only is mom asleep, the baby is also asleep).
- The patient can sometimes be too drowsy to appreciate / enjoy the laboring process.
- This is usually not given when you are close to delivery. The medication may cause the baby to have difficulty responding to the demands of birth.
- May need to supplement with local numbing medicine.
During the early part of labor, this might be acceptable way of controlling your pain if you are not ready for IV or Regional anesthesia.
Pain medications are given through the various layers of the covering of the spine (Dura)
Myths about Regional Anesthesia
- I am going to be paralyzed forever!
- This is not true! You are only paralyzed (that is a desired affect) for the duration that you need pain control. After the medication wears off, your mobility is back in 2-6 hours.
- My friend had an epidural last year. Now she has permanent back pain!
- This is also not true! There are numerous studies that show those patient without a history of ever receiving regional anesthesia and patient with a history of regional anesthesia have the same rate of chronic back pain. In modern obstetrics, more than 80% of patients will get regional anesthesia for labor pain management.
- An epidural will slow down my labor
- This is also not true! In the past, we believed that epidural slowed down the laboring process and makes women have unnecessary C-sections. Therefore, epidurals were given if the woman is dilated to 4 centimeters or more. This has been refuted by recent studies. You may request an epidural whenever you want.
The American College of OB/GYN and American Society of Anesthesiologist jointly endorse the practice of offering to patients pain management whenever it is desirable for the patient:
“Labor causes severe pain for many women. There is no other circumstance where it is considered acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under a physician’s care. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor.The fear of unnecessary cesarean delivery should not influence the method of pain relief that women can choose during labor.” ACOG Committee Opinion #339, 2006
When you are admitted to labor, your Provider and anesthesia Provider will talk to you in more detail regarding the various options that are available to you. They can also make recommendations that are individualized to your needs / medical issues.
There are two common types for OB/GYN:
- The skin over the lumbar (lower back) part of the spine is numbed.
- A very small catheter is placed above the covering of the spine.
- Various types of pain medications are continuously infuse to create long lasting pain control during labor.
- The infusion is usually turned down or off during / before pushing.
- A longer acting morphine is administered for 12-24 hour pain management for C-sections. This does not interfere with walking
- Patient can move their legs and will be strong enough to walk 4-6 hours after the continuous infusion is stopped
- Just like an epidural. Instead of a catheter with continuous infusion, a fixed amount of medication is used to provide numbing affect that lasts for about 1-4 hours later.
Candidates for Spinal are those needing pain management only for a short period of time:
- Advance Cervical Dilation (greater than 7 centimeters)
- External Cephalic Versions
- Postpartum Tubal Ligation
- A longer acting morphine is administered for 12-24 hour pain management for C-sections.
- This does not interfere with walking.
- Patient can move their legs and will be strong enough to walk 4-6 hours.
These are usually injected in the Perineum during the pushing process when the baby is crowing; repair of the genital tract after delivery, injected into the wound after a C-section or any abdominal wound for gynecologic surgeries.
A mixture of some type of immediate acting and longer acting "caines" are used to numb a localized area so you will be more comfortable.
- This is to put the patient completely to sleep.
- The patient is paralyzed and sedated through medications that are given through the IV.
- A breathing tube is placed to help the patient breath.
- Various types of gases are administered through the breathing tube to keep you asleep and comfortable throughout the procedure.
- This is rarely used in obstetrics. This is only used when there is no time for Regional Anesthesia or when regional anesthesia is not effective.