Four OB/GYN Experts Talk About Pregnancy
This article ran in the Winter 2019 Edition of the Virginia Hospital Center Magazine.
The Preconception Visit
Why is it important to see your OB/GYN before becoming pregnant?
“By the time a woman has her first positive pregnancy test, she is already six weeks pregnant. I recommend coming to see your OB/GYN at least three months before trying to conceive. We can get you started on prenatal vitamins, including folic acid, which is critical to healthy brain and spine development during the early weeks of pregnancy. We address your medical history and any concerns proactively that may affect your pregnancy and also review current medications, assess any lifestyle risk factors, and look at family history for genetic conditions for you and your partner.
It’s also important to be up to date on vaccinations since the chicken pox and German measles vaccines can’t be given during pregnancy. The preconception visit is an opportunity to discuss the normal time frame for a healthy couple to conceive, as well as how to improve the chances of conception. Many of my patients are surprised to learn that a woman under 35 can take up to a year of regular cycles and timed intercourse to get pregnant.”
Your Birth Plan
Should I have a birth plan?
“A birth plan indicates your preferences surrounding the birth of your baby. We recommend that you discuss your birth plan with your OB/GYN during the 34- or 36- week visit. Many moms provide their preferences in writing. But whether written or not, your doctor can add notes about your preferences into your electronic health record to help make sure all members of your care team are on the same page.
Some things to consider in your birth plan are: Who do you want to be in the labor room during different stages of labor? What are your preferences for pain management? Do you want your support person to cut the umbilical cord? Do you want to do cord blood banking? If you’re having a boy, do you want him to have a circumcision? Even for experienced moms, each labor can be very different. The birth plan gives preferences, but we don’t want anyone to be disappointed if mom can’t stick to her plan because of medical or comfort issues. The safety of mom and baby are always of primary importance.”
Nutrition Do’s and Don’t’s
What do I need to know about nutrition during pregnancy?
“I meet with moms early in their pregnancy to educate them about increasing vitamins and minerals in their diet.
For example, folic acid, which is found in leafy green vegetables and fortified cereal, is very important in preventing neural tube defects. It’s hard to get enough folic acid from food alone, so we typically recommend a supplement. You should have at least 1000 mg of calcium and 600 IU of vitamin D for healthy bone and teeth development. During pregnancy, you may need to double the amount of iron to ensure adequate growth of your baby. Gummy vitamins, while popular, may not be fortified with enough iron to increase mom’s blood flow. Avoid swordfish, tilefish, orange roughy and mackerel, which can contain mercury, and uncooked fish such as sushi or rare ahi tuna. Err on the side of caution and limit your caffeine consumption to one cup a day. Do not smoke or drink alcohol during pregnancy. Choosing a colorful meal balanced with vegetables, complex carbs and fruits is a good way to promote healthy eating. Good for you. Good for your baby.”
What should I know about Maternal Fetal Medicine?
“If you are considered to be a high-risk pregnancy, you’ll see a specialist in maternal fetal medicine (MFM).
High-risk pregnancies can be high risk for maternal or fetal reasons. Maternal reasons include women with multiple gestation pregnancies (i.e., twins/triplets); women with pre-existing conditions such as high blood pressure, diabetes, HIV, autoimmune disorders, thyroid disease or mental health issues; and women who will be 35 years old or older at the time of delivery. Fetal reasons include babies diagnosed with birth defects or abnormal growth.
To become a MFM specialist, I completed three additional years of extensive training in the management of medical, obstetrical, fetal and genetic complications, as well as ultrasound. I work closely with your OB/GYN provider to make sure you have a safe delivery.”