After your first visit, which is generally the longest and most comprehensive, you will have regular visits with your primary physician. While the schedule of visits can be individualized to your particular situation, we generally recommend seeing you once a month for the first two trimesters (until 28 weeks), then every two weeks until the last month. At that point, we will see you weekly until your baby is born. In the third trimester, you will have an opportunity to meet the other physicians prior to your anticipated labor and birth.
At each visit, we will weigh you, take your blood pressure, listen to your baby’s heartbeat (by the end of the first trimester), measure your uterine growth (after 20 weeks), help you with any problems or symptoms you are having, answer any questions you have, and let you know what to expect until your next visit. There are some recommended standard tests along the way, and some tests that may be individually necessary or optional. We will inform you about any plans you should be making (for pediatric care, hospital pre-registration or childbirth classes) and forewarn you about any concerning symptoms you should watch for. We invite you to make a list of any questions you wish to discuss. If you have a question or concern, please call our office or message us via Meriter MyChart. If you have an emergency, there is someone available 24 hours a day—please call us at 729-6300 for true emergencies. We appreciate your consideration in consulting the information we have provided you to try to answer routine questions before calling after hours.
What are the lab and other tests I’ll have done?
After your first visit labs and first ultrasound, the option of the First Trimester Screen (FirstScreen, Nuchal Translucency Screen) will be discussed with you. This is an optional specialized ultrasound test done at Madison Women’s Health or at Meriter’s Perinatal Diagnostic center, which helps screen for your baby having any increased risk of chromosome problems, such as Down Syndrome. There are pros and cons of pursuing this test, and those will be discussed with you at your first visit. This test is generally done between 11-1/2 and 13 weeks. A new maternal blood test is available as early as 10 weeks, it detects fetal DNA in maternal blood and is referred to as Non-Invasive Prenatal Testing (NIPT). Trade names for these tests are MaterniT21 and Verifi. A simpler optional test, the Quad Screen, also helps to screen for these issues and this can be discussed with you. This involves a blood test on you between 15-18 weeks. Some situations may necessitate discussion of more invasive tests if you wish a more accurate diagnosis in specific instances.
We understand these decisions can be confusing and we offer the option to meet with our on-site Genetic Counselor to discuss options. To schedule an appointment, call (608) 729-6300.
You will be screened for anemia with blood tests a few times during your pregnancy. Between 24-28 weeks (or earlier if at risk), you will be screened for Gestational Diabetes, a temporary condition that generally occurs in the latter part of pregnancy and can generally be treated with exercise, a structured eating plan, careful blood sugar monitoring, and sometimes medications. This is done with a blood test drawn an hour after you drink a controlled amount of glucose. About a month before you are due, you will be screened with a vaginal swab for Group B Streptococcus. This is a normal vaginal bacteria that can put your baby at risk during labor and birth. You may have urine tests during the end of your pregnancy, to check for protein or infection. Other tests are done as needed, based on your individual situation and risks.
What about ultrasound tests?
Regarding ultrasounds, a confirming ultrasound is generally done as part of your first OB visit at MWH. The chromosomal screening will be discussed with you and may be done at the MWH clinic or the hospital based on your risks and wishes. An Anatomy Screening Ultrasound will be offered you at 20 weeks at Meriter Hospital Prenatal Diagnostics Center (they have improved technology for these detailed scans.) This ultrasound is helpful in assessing any anatomy issues your baby may need to be watched for, and can help localize the placenta for any delivery concerns. Other ultrasounds are usually done on an “as-needed” basis. Certain conditions of pregnancy may require repeated ultrasounds. Please ask us if you have questions about any ultrasounds.
What happens in the last month of my pregnancy?
About a month before your due date, we will do the Group B Streptococcus (GBS) swab, and that is also the time that we make sure that the baby is head down. We will likely examine your cervix with a vaginal examination at that visit. You can discuss with your physician whether or not you wish to have a cervical examination at each of your subsequent weekly visits or not. We will watch your blood pressure carefully and answer any questions you may have about labor and hospital care. We will also review with you our recommendations for calling us before you go to the hospital, based on your particular situation and circumstances.
How will my activity change during pregnancy?
Generally, we recommend that you remain active with your usual activities as tolerated during pregnancy. Bedrest is usually only recommended under specific situations, such as problems with high blood pressure, preterm labor, problems with your baby growing, or some other conditions. Common discomforts of pregnancy may make it harder to maintain your same activity level, so you can modify your level or intensity of activity to accommodate your body changes. There are many prenatal exercise and prenatal yoga classes available. Madison Women’s Health offers prenatal fitness classes, view the schedule here. Others are offered through Meriter Hospital, local health clubs, the YMCA, and other organizations. Backache, “sciatica” (shooting pain down the back, buttock and leg), rib pain, feet/leg swelling and many other annoying symptoms are common in many women. Please ask us if you have concerns.
What about prenatal childbirth classes?
For first-time parents, we strongly suggest that you undertake some type of childbirth class. Newborn care and breastfeeding classes are also strongly encouraged. In addition to these classes being offered through Meriter’s Health Education department, there are other options that may be available. Infant CPR is also a very desired skill to learn.
When will we talk about my Birth Plan?
Many sources and class instructors recommend that you write or formulate a Birth Plan. Certainly, it is very helpful to learn about the typical process of labor and birth, the variations that can occur, and some of the choices that you have for pain relief during labor. Because labor is naturally a variable process from woman to woman (and even from pregnancy to pregnancy with the same woman), it is sometimes hard to imagine how much can be “planned.” We encourage you to learn as much as you can from reassuring and reliable sources, formulate a vision of how you would like your labor to go, and be flexible enough to make decisions along the way…”go with the flow”. We will discuss any particular concerns or ideas you have and try to answer questions. We hope that you will trust us to advise you during the process, as this is what we do each day…and we want you to have a healthy labor and the birth of a healthy baby!
When will my doctor fill out my FMLA (Family Medical Leave Act), family leave or disability forms?
These are most commonly filled out during the last 2 months of your pregnancy. Please bring them with you to a clinic appointment during that time frame. Due to the complexity of these forms, we are unable to fill them out at the hospital. If more up to date information is needed, please mail or fax 729-1099 your forms to our clinic.
What is recommended for pain relief during labor?
Labor is work, it is “pain with a purpose”, and every woman gets through it in her own way. Many women choose to and are able to get through their labors with relaxation and support techniques: relaxation breathing, water therapy, position changes, counter-pressure and other techniques. Some women choose to use a few doses of pain medication to get through the strongest part of their labor; this will almost always take the “edge” off of contractions and allow some good relaxation between contractions, allowing you to continue to breathe through your contractions. Some women choose to receive a labor epidural, which provides the most complete labor pain relief. Epidurals are administered by Meriter’s Anesthesiology team, who are committed to providing you this option in a safe and timely manner if you choose it. All options have their pros and cons. We encourage you to make your pain relief decisions along the way, once you are in labor. Please let us know what questions you have about pain relief options.
What if I don’t get my own doctor for my labor and birth?
We all practice as a group of dedicated, like-minded practitioners who try to individualize our care to you and your situation. Our philosophies and ways of handling various situations are very consistent. We wish to have you meet each of us before the end of your pregnancy, so that we are familiar with your situation, you know who we are, and we will provide you with confidence and comfort in the care we give you in the hospital. We each take 24-hour call shifts, which go from 8 a.m. to 8 a.m. the next day. We commit ourselves to communicating well so that your care is our first priority.
Who else will take care of me at the hospital?
When you arrive at the hospital, you will be assessed in the Birthing Center Triage area. This area allows the staff to help decide what level of care you will need for the rest of your stay, whether you would be more comfortable staying at home for awhile in early labor, and to get any immediate treatments or plans initiated for you. You may be seen by a resident physician as you are admitted. We are all committed to furthering the same type of education that we all were privileged to receive, and it has helped to make us the practitioners that we are today. All of the UW Obstetrics and Gynecology Residents (both male and female) are physicians who have chosen to pursue caring for women for the rest of their medical careers. They are all aware and respectful of the privacy of your birth experience and the honor of being able to participate in your baby’s birth. We are ultimately supervising all of your care, and we work together as a team with the hospital staff to give you the best care. We consider the OB/Gyn residency to be a vital asset to your safety.
What happens after I have my baby?
You will continue to receive dedicated hospital care after your baby is born. You will be given recovery support, along with help with any breastfeeding or newborn care education. You will be watched more closely in the first few hours after birth, to insure that you do not have bleeding or blood pressure issues. Pain control will be discussed and several medicinal and non-medicinal interventions will be offered. Rest and time with your baby will be encouraged. Visitors are welcome at any time that you want them, but we strongly encourage you to consider what is best for you and your baby for those first several hours. You are allowed to stay for 2 nights after the time of a vaginal birth and 4 nights after the time of a Cesarean birth. Some mothers and babies who are doing well choose to go home earlier than that; this can be discussed if you wish. If your baby is doing well, your pediatric provider will see your baby on the next morning rounds (they are notified automatically by the hospital when your baby is born) and one of us will see you each day that you are in the hospital, also. Instructions and precautions will be reviewed with you prior to going home, and we generally see you for a visit within several weeks.
If I need a C-section, who performs this?
We all are trained and experienced in performing Cesarean deliveries, and will perform this surgery if you need it for the birth of your baby. We do our best to consider all safe and reasonable options before a Cesarean delivery, but will also advise you about the risks and benefits of various delivery options. You will have a team of nurses, an anesthesiology team, a surgical technician and newborn nursery doctors who help with the cesarean birth of your baby. You are able to have one support person in the room with you during your Cesarean birth. Safety and optimal care are our first priorities, and we also wish to make it a special birth experience for you.
Do I have to call my pediatrician after the birth of my child?
No, the staff at Meriter Hospital ensure that the pediatrician you choose is notified at the time of your baby’s birth.