Your Pregnancy Guide

Providers deliver at MemorialCare Miller Children’s & Women’s Hospital Long Beach.

• Christine Feigal, MD
  Obstetrics & Gynecology
• Deborah L Karm, MD, FACOG
  Obstetrics & Gynecology
• Mary Louise Kiernan, MD
  Obstetrics & Gynecology
• Briana Livingston, MD, FACOG
  Obstetrics & Gynecology
• Sunaina G Sehwani, MD
  Obstetrics & Gynecology
• Kenneth Spielvogel, MD, FACOG
  Obstetrics & Gynecology
• Cassidy Sullivan, MD
  Obstetrics & Gynecology
• Elise Vo, MD
  Obstetrics & Gynecology
• Elizabeth H West, MD, FACOG
  Obstetrics & Gynecology

Providers deliver at MemorialCare Orange Coast Medical Center.

• Gerardo Bustillo, MD
  Obstetrics & Gynecology
• G Thomas Ruiz, MD
  Obstetrics & Gynecology
• Yen H Tran, DO
  Obstetrics & Gynecology
• Stephanie M Wyckoff, MD
  Obstetrics & Gynecology
• Sarah Bartulis, CNM
  Certified Nurse Midwife
• Denise G. Castellanos, CNM
  Certified Nurse Midwife
• Patricia A. Evans, CNM
  Certified Nurse Midwife
• Lauren Sylwester, CNM
  Certified Nurse Midwife

Providers deliver at MemorialCare Saddleback Medical Center.

• Lisa Crane, MD
  Obstetrics & Gynecology
• Carla Wells, MD
  Obstetrics & Gynecology
• Miao Crystal Yu, MD
  Obstetrics & Gynecology

Providers deliver at MemorialCare Saddleback Medical Center.

• Rachael Lopez, MD
  Obstetrics & Gynecology
• Daniel Sternfeld, MD
  Obstetrics & Gynecology
• Vaya Tanamai, MD
  Obstetrics & Gynecology
• Miao Crystal Yu, MD
  Obstetrics & Gynecology

Providers deliver at MemorialCare Saddleback Medical Center.

• ​​​​​​Patricia Faraz, MD
  Obstetrics & Gynecology

This is a California state program that performs a risk assessment of the baby for certain birth defects through blood drawn from the mother and an ultrasound during the first and second trimesters. If the test returns as positive, you will have the option for additional screenings or diagnostic tests to confirm the presence of the birth defect.

This is the first genetic screening result will be given for all the defects tested.

• Maternal blood is drawn between 10-14 weeks of pregnancy.
• Specialized ultrasound called nuchal translucency measures the thickness of the fold on the baby’s neck, and is done between 11-14 weeks.

This is the second genetic screening and consists only of blood drawn from the mother. This can be done with or without the first-trimester screening.

• A blood draw is done between 15-20 weeks of pregnancy.

The birth defects tested in this screening are:

• Down syndrome (Trisomy 21): Intellectual disability.
• Trisomy 18 & 13: Intellectual disabilities and severe physical birth defects.
• SLOS (Smith-Lemli-Opitz Syndrome): A very rare condition causing intellectual disability and physical birth defects.
• Neural tube and abdominal wall defects such as spina bifida (open spine) and the baby’s intestines being on the outside of the body.

Babies born to mothers aged 35 and over are at an increased risk for chromosomal anomalies. Because of this, additional tests are available. Again, these are optional and only you can make the decision if testing is right for you.

Genetic counseling: This is an appointment with a geneticist who will review both you and your partner’s family history. The possibilities of having a child with genetic abnormalities based on your histories and statistics will help you to make an informed decision on which testing is right for you, your partner and your baby.

Non-invasive prenatal testing (NIPT): Provides accurate results for Trisomy 13, 18, 21 and gender through a blood test from the mother. Please discuss this with your OB provider if this test is appropriate for you. Chorionic villus sampling (CVS): A small piece of the placenta is removed from the uterus with a needle to study for birth defects. Second-trimester screening blood work is still needed.

Amniocentesis: A small amount of amniotic fluid (water around the baby) is drawn out of the uterus by a needle through the abdomen and studied for birth defects.

A routine ultrasound is done with every pregnancy between 18 and 21 weeks. This is the best time to check your baby for abnormalities by looking closely at all the major organs (brain, face, heart, kidneys, bladder, placenta, cord insertion, amniotic fluid, cervical length, arms and legs). If you desire to know the gender of your baby, it can normally be seen during this exam, but is not a guarantee.

If an abnormality is seen in the routine ultrasound or if a woman is 35 years old or older, a comprehensive ultrasound (Level II) will be done by a perinatologist. He or she will discuss the results with you while performing the ultrasound, thus you will know the results immediately.

Every baby inherits his or her genes from their parents. These genes pass on family characteristics like hair and eye color, but they also sometimes pass along genetic diseases. Some of the most common are listed below. As with any genetic screening test, carrier screening is optional and only you can decide what is right for you and your family.

Cystic fibrosis (CF): Affects the lungs and pancreas. Children with CF have frequent lung infections and digestive problems.

Sickle cell anemia: Red blood cells change shape. This shape change can cause the cells to die early and block blood flow, causing pain and anemia.

Ashkenazi Jewish heritage: Ashkenazi Jewish families are at higher risk for certain inherited diseases, such as cystic fibrosis and Tay-Sachs. Tay-Sachs is a fatty substance in the brain that destroys nerve cells causing a loss in motor skills and mental functions. It will eventually cause the child to become blind, deaf, mentally retarded and paralyzed. These children usually pass away by the age of 5.

Fragile X syndrome: Causes intellectual disabilities and autism. Only the woman needs to be a carrier to have a baby at risk for this disease.

Morning sickness is nausea and vomiting (throwing up) that many women have during pregnancy. Symptoms can be mild or severe. Even though it is called “morning” sickness, symptoms can happen any time of day. Morning sickness usually gets better after the first few months of pregnancy.

No, but it’s very common. As many as 9 out of 10 pregnant women feel nauseous early in pregnancy. A smaller number actually throw up. A very small number of pregnant women get very severe nausea and vomiting and lose weight. This is called “hyperemesis gravidarum.”

That depends on the woman and the pregnancy. Symptoms usually start during the first two months of pregnancy. They are often worst around the second and third months. Most women feel better by four or five months, or around the middle of pregnancy. But some women feel bad for much longer.

Yes.

• Eat as soon as you feel hungry, or even before you feel hungry.
• Snack often and eat small meals – the best foods to eat have lots of protein or carbohydrates, but are low in fat. Good choices are crackers, bread and low-fat yogurt. You should also avoid spicy foods.
• Drink cold, clear beverages that are either fizzy or sour, like lemonade and ginger ale.
• Eat ginger-flavored lollipops.
• If drinking plain water makes you nauseous, try having water-rich foods like cucumber, melon, popsicles and celery instead.
• Smell or eat fresh lemon, mint or orange.
• Brush your teeth right after you eat.
• Do not lie down right after you eat.
• Take your vitamins at bedtime with a snack, not in the morning. If you can’t tolerate a pill, try the gummy prenatal vitamins (over-the-counter at any pharmacy).
• Avoid things that make you feel nauseous – that might include stuffy rooms, strong smells, hot places, loud noises or not sleeping enough. Try to figure out if some foods and drinks stay down better than others. Avoid foods and drinks that seem to make you feel sick. This is different for different people.

Please call us right away if you:

• Throw up every day or throw up over and over during the day. This is even more of a concern if there is blood in your vomit.
• Are losing weight.
• Have strong pain or cramps in your belly.
• Think you have lost too many fluids. This is called “dehydration.” Signs include not urinating very much, having dark yellow urine, or feeling dizzy when you stand up.
• If you can’t keep anything down, you might need to be given fluids through a tube that is put into one of your veins, called an “IV.” Plus, you might need to get a medicine to prevent nausea and vomiting.

 Yes. There are medicines that can help with nausea and vomiting that are safe in pregnancy.

• Pyridoxine (vitamin B6): 25 mg three times per day.
• Doxylamine (sample brand name: Unisom®): This medication causes drowsiness so only use at nighttime. Doxylamine-pyridoxine (brand name: Diclegis®): This is a prescription medicine that combines two ingredients, doxylamine and pyridoxine (vitamin B6).
• Diphenhydramine (sample brand name: Benadryl®): This is similar to doxylamine, and is sold over-the-counter under different brand names. It will make you sleepy.
• Other medicines: There are other medicines that can sometimes be used if the above don’t work. Your doctor can help you figure out what treatments are best for you.
• There are also bands that you can wear on your wrists called “acupressure” bands. These bands are supposed to reduce morning or motion sickness. Some women feel better if they wear them.

All women who might get pregnant or who are pregnant should take a prenatal vitamin every day. The vitamin should contain 400 mcg (micrograms) of folic acid. Taking vitamins before pregnancy and in early pregnancy might decrease nausea and vomiting.

Being a vegetarian should not pose any specific problems to your pregnancy, but we do recommend you pay extra attention to the amount of protein you are consuming. Good sources of vegetarian protein include beans, tofu, cottage cheese and eggs.

Fish provides an excellent source of protein and omega-3 fatty acids and can safely be consumed during pregnancy. To avoid too much consumption of mercury during pregnancy, we recommend you limit your fish and seafood intake to 12 oz. or less per week. Albacore tuna tends to have slightly higher levels of mercury, so if you include this in your weekly diet, we recommend you consume 6 oz. or less per week. Fish to avoid due to high mercury levels include shark, swordfish, king mackerel and tilefish.

There are conflicting studies about miscarriage and caffeine use in pregnancy. Moderate caffeine use (200 mg, approximately two 8 oz. coffees per day) has not been shown to increase the risk of miscarriage or preterm birth. We recommend that if possible, you limit caffeine to one 8 oz. coffee per day. Caffeine can also lead to nausea, insomnia and dehydration which should all be avoided in pregnancy.

Unpasteurized milk, soft cheeses, deli meat, and raw or undercooked meats (including rare steak and sushi) can all carry bacteria called listeria. Listeria infections in pregnancy have been associated with miscarriage, preterm birth and stillbirth. For this reason, we recommend you avoid these foods. This does not mean you cannot eat out during pregnancy, we just recommend you order your steak cooked at least medium and that if you order sushi you opt for vegetarian rolls or cooked options.

We recommend that you avoid alcoholic beverages during your pregnancy.

• Reduces back pain, swelling and constipation
• Improves mood and energy level
• Reduces risk of gestational diabetes
• Improves posture
• Increases muscle tone and strength
• Helps with sleep

Your body changes as pregnancy progress in more ways than you might think and the following are changes to be aware of during exercise:

• Joints: Become more relaxed which can lead to easier injury. Avoid bouncing or jerking motions to prevent joint injury.
• Balance: As your uterus grows, your center of gravity will change which can lead to pelvic and back pain and make you more likely to lose your balance and fall. Take extra care while exercising for this reason.
• Heart rate: Your heart rate will increase during pregnancy as a natural response to your increased weight and blood volume. Because of this, you may find that you fatigue easier during exercise. For this reason, we suggest your exercise be mild to moderate in intensity. Listen to your body and do not overdo it.

• Downhill skiing: Due to the risk of falling and abdominal trauma.
• Contact sports (soccer, hockey, basketball, etc.): Due to the risk of abdominal trauma.
• Racquetball: The quick start and stop motions could be harmful to your joints.
• Scuba diving: The pressure changes can negatively affect your baby.

• Walking: This is a good place to start if you were not very active before pregnancy.
• Running: If you were a runner before pregnancy, you can likely continue running but may find you have to decrease your mileage as pregnancy progresses. We recommend that you keep your pace to a level where you can still carry on a conversation without becoming too winded.
• Swimming: This is an excellent form of exercise during pregnancy. With its minimal stress on your joints, it can also help with swelling and keep you cool.
• Yoga: Most studios offer prenatal yoga. This is excellent exercise to help with relaxation and flexibility. You can attend non-prenatal yoga classes, but make sure you let the instructor know you are pregnant so they can modify poses for you if needed.
• Cycling/elliptical/rowing: These are all excellent low-impact exercises for pregnancy. Just be aware of your growing uterus and worsening balance, and listen to your body for when it is time to stop.
• Strength training: This will help to strengthen muscles and improve some of the aches and pains of pregnancy (especially back pain).

• Start out slowly. Warm-up with a slow walk for 5-10 minutes followed by gentle stretching.
• Stay hydrated, especially if exercising in hot or humid weather.
• Wear comfortable clothing with a supportive bra.
• Keep your intensity to a level where you are able to carry on a conversation while exercising.
• You should not be losing weight during pregnancy. If you are, inform your OB provider so he or she can evaluate why this may be. You will likely need to modify your exercise routine if this is the case.
• Stop exercising and call your OB provider immediately if you experience any of the following: chest pain, increasing shortness of breath, leg pain or swelling, vaginal bleeding, leaking of fluid, decreased fetal movement or contractions.

Early in pregnancy: Nausea and vomiting during pregnancy is very common early in pregnancy. Depending on how bad it is, your OB provider might give you extra medications to take at home, or you might be admitted to the hospital. Most women start feeling better in the second trimester (around 14-15 weeks).

Later in pregnancy: Quick onset of nausea and vomiting further along in pregnancy, especially when associated with abdominal or back pain, may be a sign of infection. Women also may start feeling nauseous when they are starting labor.

Pregnant women get the stomach flu or food poisoning the same as for nonpregnant women but are often more sensitive. If you have a few hours of nausea/vomiting/ diarrhea, you can stay home and rehydrate yourself. If you have a fever, or your symptoms do not improve, come to the office or hospital for evaluation.

Anytime you have direct abdominal trauma: Like a slip or fall onto your abdomen, or someone hits you (either accidentally or on purpose), you should be evaluated. Trauma to the abdomen can sometimes provoke contractions, and in extreme cases, labor (even preterm).

If you are in a traumatic car accident: You should be evaluated at a hospital. Even if you do not have direct trauma to your abdomen, the sudden stopping movement has the potential to cause injury to your pregnancy (which is why pregnant women should not ride roller coasters).

A fever can be a sign of infection: Pregnant women can be more sensitive to infections. Some infections are more serious during pregnancy, like the flu. Let your OB provider know if you have a temperature greater than 101 Fahrenheit.

Bleeding is not normal in pregnancy; however, spotting generally is, especially after intercourse or a vaginal exam. 

Early in pregnancy (first half) For spotting, please call the clinic and let your OB provider know. He/she might want you to come to the office for an exam.

Heavy bleeding, especially with cramping pain, may be a sign of miscarriage. If the bleeding does not improve, or if you are using more than one pad per hour, come to the emergency room. Otherwise, call the office and make an appointment.

Later in pregnancy (second half) Bleeding can be caused by a few different problems. For example, your cervix may be sensitive and may bleed after intercourse. Your placenta may be in an abnormal position. You may be in preterm labor or have dilation of your cervix.

Your OB provider will check for these problems. Sometimes, no problem can be found. In these cases, it is still important that you see your OB provider. He/she will give you some precautions to follow.

it is normal to have increased vaginal discharge throughout pregnancy, which increases as the pregnancy progresses. When your bag of water breaks, you will likely feel a warm gush of fluid initially, followed by continuous leaking, especially when you cough or sneeze. Some women cannot tell the difference between normal discharge and leaking fluid. Your OB provider can examine you to tell you the difference. Many women lose control of their bladders during pregnancy from the weight of the uterus on their bladder. If you think your bag of water has broken, please call the office to be evaluated.

Most women whose bag of water break will go into labor spontaneously, but you should go to the hospital as soon as possible. If you are preterm, come to the hospital right away. Call the hospital if you’re unsure.

After 28 weeks, you should be doing fetal kick counts: once a day, usually at night, count how many times the fetus moves. It should move 10 times in two hours.

Any time of the day, including during your counting, if the fetus is not moving like normal: rest, drink something cold and eat a snack. Then continue your fetal kick counts. If the fetus is sleeping, this should wake him or her up. If you still do not feel the fetus moving normally, come to the hospital for further evaluation.

“Baby dropping” also referred to as lightening: As the baby’s head settles in your pelvis, it feels as if the baby has dropped lower in your abdomen putting a lot of pressure in your vagina. This can occur a few weeks to a few hours before labor begins.

Increased vaginal discharge: The mucus plug is released from the cervix when the cervix starts changing. This mucus plug is usually blood-tinged (slightly red or brown). This can occur several days before labor or when labor starts.

Contractions

• False labor contractions are also known as Braxton Hicks contractions. They can be uncomfortable or painful, and are usually felt in the front part of the uterus. You may notice them more later in the day. Time your contractions for one hour: if they are false labor contractions, they should be irregular and do not get stronger with time. They may stop with movement, position change or rest.
• True labor contractions last about 30 seconds to one minute, and come at regular intervals, increasing in strength and intensity over time.
• The 411 Rule: first baby – when your contractions are four minutes apart, lasting for one minute, for one hour, it’s time to come in for an evaluation. If this is your second or third baby, you may need to come in sooner.
• If you cannot walk or talk through your contractions, please come in for evaluation.

We believe that giving birth is a natural process and that our birth plan encompasses this. However, if there is something we have not covered or you have questions, please feel free to discuss this openly with us. As stated in the beginning, our goal is for you to have the safest, most enjoyable birth experience possible.

We have state-of-the-art birthing beds that allow for a variety of birthing positions. A squatting bar is available should you desire to use it. Water births and tubs are not available, nor are options of bringing your own. You are welcome to bring a birthing ball.

During labor, we will provide hospital gowns, sanitary pads and linen. You can bring a favorite pillow or blanket if you wish but be prepared that it may get soiled during delivery.

Besides your toiletries including shampoo and conditioner, bring shower shoes such as flip flops, bathrobe, nursing bras, clothes to go home (you will still need maternity clothes), an outfit for your baby for both pictures and going home, and a car seat. Please note that it is your sole responsibility to secure your baby in the car seat and car and the nurses cannot do either. Additional items you may choose to bring include a paper fan for use during labor, laptop or tablets (free Wi-Fi is provided), cell phone chargers and cameras.

Vaginal exams are kept to a minimum, particularly after rupture of membranes and are done only to determine if you are in labor and to assure that adequate progress is being made toward delivery.

No controlled studies have clearly demonstrated improved outcomes with fetal monitoring. However, the consensus of expert opinion is that it is safer and it has thus become the standard of care to provide at least intermittent fetal monitoring while in labor. While we generally will use continuous monitoring throughout labor, you may opt to have only intermittent monitoring as long as labor remains uncomplicated. If conditions warrant, you will be advised of the reason for continuous fetal monitoring.

Maternal and fetal conditions can change so rapidly in labor that IV access is essential for us to provide safe and effective treatment in the case of an emergency. While IV hydration has been shown in one study to shorten the course of labor, you may opt to have only a saline lock for IV access if the concept of an IV is troublesome to you.

When you are in active labor, your stomach will quit emptying effectively, making you at risk for aspiration from vomiting if you have solid foods during labor. You may continue to have clear liquids throughout labor. However, it is safer and more comfortable for you if you do not consume solids once you are in active labor.

We consider any spontaneous vaginal birth to be a “natural” birth regardless of what pain management you have chosen during labor. We offer IM (injection), IV analgesia and epidural anesthesia, having 24-hour in-house anesthesia coverage for all births. We encourage you to choose the level of pain management you desire but strongly encourage you to feel successful whether you require medication or not.

Pitocin is a natural hormone that has been exactly duplicated chemically for use in obstetrics. We do not routinely administer Pitocin during any labor, and only do so if labor is not progressing satisfactorily toward delivery. If Pitocin becomes necessary, we will explain to you the reason before proceeding. Studies have clearly demonstrated a decrease in blood loss and risk of postpartum (after delivery) hemorrhage with the administration of Pitocin after delivery. Therefore, we will routinely administer Pitocin after the baby is born and before abnormal bleeding develops.

Studies have consistently demonstrated a decreased risk of major tears in the vagina and rectum and decreased healing time when the baby is allowed to deliver without an episiotomy. While the incidence of periurethral and small vaginal tears may be slightly increased, we do not routinely perform episiotomies even in first babies.

The use of the obstetrical vacuum remains a viable option in a small minority of patients. Where immediate delivery is indicated due to fetal distress or where maternal exhaustion makes the prospects of a spontaneous delivery unlikely, the vacuum may be a reasonable alternative to cesarean in selected cases. In the event these situations arise, you will be counseled and given the option of vacuum-assisted vaginal delivery.

Two approaches to the delivery of the placenta have been advocated. The first is expectant or physiological delivery where no intervention is made for up to 30 minutes allowing the uterus to expel the placenta spontaneously. The second is active management with gentle traction on the umbilical cord while supporting the uterine fundus with the other hand. Studies in both the medical and midwifery literature consistently demonstrate a decreased blood loss, decreased risk of postpartum hemorrhage, and decreased risk of retained placenta with the active management of placental delivery.

Circumcision of male infants, while having no known medical benefit, is still practiced in the United States out of custom or tradition. Most insurance plans cover routine circumcision. Should you desire to have your infant son circumcised, we will make every effort to do this before you go home. We routinely use analgesia for the procedure. Please be sure to check with your insurance plan for coverage options. We also offer in-office circumcisions for a fee of $300 if your insurance doesn’t cover them. Payment is required before the circumcision is done, and can be paid anytime during the pregnancy at the registration desk of the office.

The length of your postpartum stay in the hospital will be determined by medical necessity. State law gives all new moms the right to stay 48 hours for a vaginal birth and up to 96 hours for a cesarean birth. You may elect to go home sooner if you and the baby are both stable. Should the baby need to stay beyond your expected discharge, it will not be possible to extend your hospitalization unless medically indicated.

Most of the time, your baby will be placed directly on your chest for skin-to-skin as soon as possible. A transitional nurse will care for your baby. After a few minutes, the partner in care (or whomever you designate, including yourself) will cut the cord. This also allows for delayed cord clamping. Provided the baby is doing well, the assessment, weighing and bathing will be done in the room. We encourage breastfeeding as soon as possible.

Although we will do everything possible for you to have a vaginal birth, sometimes there are situations where a cesarean section is the safest way.

You can have access to your medical records, check labs, have access to your children’s records and even email us. At your first visit, you will be provided an activation code to sign up with myChart.

Your OB providers have given you access to a mobile app to educate, engage and inspire you through every step of your pregnancy and postpartum journey. To help keep you and your baby safe, you will find the following within the app:

• A feed of daily customized content, from conception to your baby’s first birthday
• Provider-approved resources
• Weight monitoring
• Care team contact information

MemorialCare has partnered with Twistle, a healthcare application, to send messages, reminders, notes, health surveys, and other useful health education directly from your healthcare team to your mobile device after you leave the hospital.