The physicians, midwives and nurses at FOR WOMEN ONLY have developed this frequently asked questions section to alleviate the abundance of phone calls that may not be of the upmost importance during the busy office hours. If you think any other questions could help other women in similar situations, please feel free to drop us a line or tell us at your next appointment. We are striving to make this site an area of importance for our patients and we want you to be a part of it.

Obstetrical Questions

Flu Vaccine During Pregnancy
Is it safe to get a flu vaccine during pregnancy, even if I have never gotten a flu vaccine before? Are there any risks to mother or baby with the vaccine? Are there any risks to mother or baby from the flu?

Vaccination against influenza has been shown to be safe in pregnancy. In fact, it is recommended for patients who are at high risk of acquiring influenza in pregnancy, such as women with underlying medical disorders or healthcare providers. Women who are at low risk of acquiring the flu, however, are recommended to delay their flu vaccine until the second trimester. There are no known risks to either the mother or fetus with the flu vaccine. Influenza during pregnancy can lead to pneumonia in the mother. Most of the time this is a self-limiting process, lasting only 3 to 4 days. However, women can develop a superimposed bacterial infection that can be fairly severe and may require hospitalization. There are no proven congenital anomalies (birth defects) associated with influenza infection and pregnancy.

How can I tell if I am in labor?
One of a woman's greatest concerns is “How will I know if I am in labor?” This is especially true in first pregnancies. There are several signs of labor or pregnancy emergencies that should cause you to phone your physician or midwife.

The first sign of labor is uterine contractions. Uterine contractions are often described as tightening of the uterus or “balling up of the baby.” These contractions should be of significant strength to cause you to stop a conversation and take several deep breaths. When contractions are 5 minutes apart from the beginning of one contraction to the beginning of the next contraction, contact your physician.

The second sign of labor is your water breaking. Some women notice a large gush of fluid, and some women notice a constant leaking of small amounts of fluid. In either case, you should report to the hospital.

The third sign is vaginal bleeding. If at any point you have bright red bleeding similar in volume to a period, go to the hospital. This is a medical emergency and may be a sign that your placenta is separating from your uterus. If you have a small amount of bleeding mixed with mucus, this is probably your mucus plug. You can lose the mucus plug at many points during pregnancy, but this is not a signal of impending labor.Finally, if your baby is not moving normally, contact your physician. At a minimum you should notice at least 10 movements a day. Many people feel that you should notice at least 10 movements in 2 hours.

How do you know when it is not Braxton Hicks and time to go (to the hospital)?
This is my third child, both of my previous were preemies and my water did not break on them.

Braxton Hicks contractions are also known as false labor. They usually begin sometime after the 20th week of pregnancy. Sometimes they are felt earlier and are more intense in women who have had a previous pregnancy. The contractions are usually painless, but sometimes uncomfortable. They are actually a contraction of the uterine muscle and last about 30 seconds, but may last as long as a couple of minutes. Around 36 weeks or so, the contractions become more frequent. Changing your position will help stop the contractions.

So what are the symptoms of 'real labor'? It is probably 'real labor' if: (1) the contractions become stronger, rather than ease up with a change in position and over time, the pain begins in the lower back and spreads to the lower abdomen, (3) the contractions become progressively more frequent and painful, (4) the contractions are accompanied by a pinkish or blood-streaked discharge, (5) or if your water breaks.

You should begin the trip to the hospital when the contractions are 5 minutes apart for a couple of hours, your water breaks, or if you begin bleeding like a menstrual period.

Since you have had two premature deliveries, you are at risk for another premature birth. Therefore, you should be a bit more cautious about labor than someone who is already full-term. For you, if there is any question in your mind, you should be evaluated to make certain that you are not in labor.

How much weight should I gain during my pregnancy?
The average recommended weight gain during pregnancy is 25 to 35 pounds. If you are underweight prior to your pregnancy, your average weight gain should be 30 to 40 pounds. If prior to your pregnancy you are overweight, your average weight gain should be 20 to 30 pounds. Most women gain approximately 5 to 6 pounds during the first trimester of their pregnancy. After the first trimester (at approximately 13 weeks) weight gain is approximately 1 pound per week.

During pregnancy it is important to maintain good nutrition and adequate caloric intake. The average caloric intake for a pregnant woman should be approximately 300 calories more per day than usual. If you don't gain an adequate amount of weight during your pregnancy, you run the risk of a low birth weight infant. It is important not to diet during your pregnancy. On the same note, excess weight gain can lead to large babies with resultant traumatic deliveries. It is important to watch your weight gain closely during pregnancy.

How soon after delivery can I have intercourse?
During the delivery of your baby, many of your vaginal tissues are stretched and often torn. Your cervix dilates and often undergoes a certain amount of trauma. It takes approximately 6 weeks for your uterus, cervix, and vaginal tissues to return to their normal pre-pregnant state. Because of this, your physician will probably ask you to wait for six weeks after delivery to have intercourse.

Many women are concerned about pain during their first intercourse after delivery. Most women do not feel significant discomfort if it has been 6 weeks since their delivery. Additionally, if you had an episiotomy, your stitches should have dissolved during this time period. You should notice minimal discomfort at the site of your episiotomy.

I am 14 weeks pregnant. Can I go to the dentist? What if I need dental work done?
Dental work during pregnancy is safe. In fact, it is recommended that women take special care of their teeth and gums during pregnancy so they will be able to maintain adequate food intake.

It is safe to have x-rays of your teeth during pregnancy. According to the American College of Radiology there is no single diagnostic procedure that results in enough radiation to cause detriment to the developing fetus. Studies have shown that between 8 and 15 weeks the risk of severe mental retardation is approximately 4% for an exposure equal to 10 rads. The exposure from x-rays of your teeth is well below one millionth of a rad. Additionally, your dentist will shield your abdomen during the x-rays.

It is safe to have your teeth cleaned, cavities filled, root-canal work, or tooth extractions during pregnancy. Some women choose to wait until the second trimester to receive treatment, when the risk of teratogenesis decreases. Be sure to let your dentist know that you are pregnant, so that he or she can avoid certain anesthetic medications. All local anesthetics are safe during pregnancy. Additionally, most antibiotics used during dental procedures are safe during pregnancy. Again, just inform your dentist so he or she can contact your physician if there is a question.

No association between dental caries and pregnancy has been established. There is no evidence that dental caries worsen with pregnancy. An association between pregnancy and gingival hyperplasia has been proven. This condition causes an enlargement of the gingiva and is related to pregnancy hormones. In association with this, women may notice that their gums bleed. Once the gingiva shrinks back to normal size, bleeding should subside.

I am 16 weeks pregnant. I am having pain in both sides of my lower abdomen. Is this normal?
As pregnancy progresses, your uterus gradually enlarges. Many women have concerns regarding pain during this time period. As you reach 16 weeks, your uterus is significantly enlarged and most women become noticeably pregnant.

Although there are many reasons for abdominal pain during pregnancy, the most common condition is round ligament pain. The round ligaments are connective tissue ligaments that run from the upper aspect of the uterus down to the groin. As pregnancy progresses these ligaments enlarge and become stretched, and can cause pain. The pain sensation that women often feel involves both sides of the lower abdomen and sometimes the back. The pain is sharp in nature and can be worse on the right side. Certain movements may exacerbate the pain.

Round ligament pain has not been associated with any adverse outcomes of pregnancy. Treatments include heat on the affected area and rest. Medications often do not alleviate symptoms.

It is important to discuss any abdominal pain with your physician. There are several other causes of persistent pain. Your physician may need to do a physical exam and run other tests should your pain become severe or be associated with other symptoms.

I am 39 weeks pregnant. Should I have my labor induced?
There are several schools of thought on whether it is appropriate for a woman to choose to have her baby early. In medical terms this is known as elective induction of labor. Many factors come into play when physicians decide to induce labor. If you are experiencing medical complications associated with pregnancy, your physician may advise delivery if you are full term (greater than 37 weeks pregnant). Second, the accuracy of your due date will be an issue if plans are made to induce your labor early. If you had an ultrasound in the first trimester that verified the due date calculated by your last menstrual period, then your due date should be accurate, plus or minus one week. If you had a second trimester ultrasound that was consistent with the first, your due date should be accurate, plus or minus two weeks. Therefore, delivery at 39 weeks, even if off by 2 weeks, should still result in the delivery of a full term infant (greater than 37 weeks). Finally, the dilitation and effacement of your cervix prior to the induction of labor will be an issue. If your cervix has started to dilate and has started to efface, your physician may feel that an induction of labor is reasonable. If your cervix has not dilated or effaced, induction of your labor may significantly increase your risk of cesarean section.

Many physicians feel that electively inducing labor is not appropriate until 41 to 42 weeks, when there may be decreased functioning of the placenta. However, many physicians, including the American College of Obstetrics and Gynecology, feel it is reasonable to induce labor at 39 weeks if the mother has had prior rapid labor or has a long distance to travel to the hospital.

Is it safe to travel by air during pregnancy?
Many women have concerns about the safety of air travel while pregnant. Flying in airplanes is safe during pregnancy and there is no indication that it causes future complications. The change in barometric pressure noted during flight has no serious effect on pregnancy.

The biggest issue relates to the timing of your travel and whether there have been complications with the pregnancy prior to that time. Although it is safe to travel at any point during your pregnancy, many airlines have restrictions on air flight beyond 36 weeks. You may need permission from your physician to fly at a later date. Your physician may not want you to travel far distances by airplane after approximately 34 weeks. Access to medical care is restricted during the plane flight should you need medical attention. In addition, both you and your physician may prefer that you stay closer to home late in your pregnancy to ensure that you receive proper medical attention if you go into labor. If you have had complications during your pregnancy, your physician may prefer that you stay close to home so that prompt intervention may be undertaken if problems arise. Should you choose to travel, it is probably a good idea to take copies of your medical records with you in case of an emergency.

Is the Consumption of Fish Dangerous During Pregnancy?
Healthcare officials have issued an advisory on the dangers of eating fish. The advisory concerns the consumption of fish by expectant mothers, nursing mothers and women who are seeking to get pregnant. Healthcare officials are concerned that the level of mercury in fish might pose certain risks to a developing fetus.

How does Mercury Affect the Nervous System?
Methyl mercury is highly toxic and dangerous to babies because it can cross the placenta and the blood brain barrier. It is easy for mercury to become concentrated in the brain of the developing fetus because the metal is absorbed quickly and is not excreted efficiently.

Children exposed to mercury may be born with symptoms that resemble cerebral palsy, or other movement abnormalities. They are also more susceptible to convulsions, visual problems and abnormal reflexes. Autopsy results show loss of neurons in the cerebellum and throughout the cerebral cortex in the brains of children who have died as a result of mercury poisoning.

How are Fish and Water Contaminated with Mercury? Contamination from mercury in fresh waters can occur naturally through environmental factors or by contamination from industrial wastes. Larger fish (such as sharks, swordfish, king mackerel and tilefish), that prey on smaller fish accumulate the highest level of mercury and therefore pose the greatest risk.

How Much Fish Should I Eat? It is recommend that pregnant women and young children limit their consumption of freshwater fish to one meal per week or the equivalent of eight ounces of uncooked fish for adults and three ounces for young children.

What types of pain relief are available during and after childbirth?
Every pregnant woman is faced with the decision of whether she will use a form of pain relief during labor and delivery. Some women are very certain that they will want pain relief, while others are unsure. There are also those women who prefer to give birth without any form of pain relief. For women who do not desire any form of analgesia during labor, it is important that they understand the options. During an emergency delivery, some form of analgesia or anesthesia may be necessary.

Under ideal circumstances, an anesthetic agent would allow you to deliver your baby with minimal pain, minimal risk, and would allow you to push when it is time to do so. The ideal anesthetic would also not stop your contractions or make you or your baby sleepy. There are a variety of anesthesias that can be used during labor and delivery.

• Local anesthesia: Local anesthesia requires a series of injections in the vaginal outlet. It is generally used for women who need an episiotomy or who require the placement of sutures after delivery.
  
• Epidural: An epidural is an anesthetic delivered through a tiny catheter placed in the lower part of the back in the epidural space. A woman will continue to feel touch and pressure, but the pains of labor are significantly reduced.
  
• Spinal: The spinal is similar to the epidural, but the anesthetic is actually placed within the spinal fluid. Spinal anesthetics are sometimes used at the time of delivery (Saddle block) or at the time of cesarean section. Like an epidural, a spinal cannot be used if you are using blood thinners, have an infection in the back or the blood, or have an unusual spinal abnormality.
  
• General: General anesthesia is administered by giving an anesthetic intravenously and through breathing an anesthetic gas. A general anesthesia may be needed for an emergency, or if a cesarean section is required and the patient cannot have an epidural or spinal. Because it carries additional risks, it is not the first choice of pain relief during labor and delivery.

Is it safe to travel by air during pregnancy?
Many women have concerns about the safety of air travel while pregnant. Flying in airplanes is safe during pregnancy and there is no indication that it causes future complications. The change in barometric pressure noted during flight has no serious effect on pregnancy.

The biggest issue relates to the timing of your travel and whether there have been complications with the pregnancy prior to that time. Although it is safe to travel at any point during your pregnancy, many airlines have restrictions on air flight beyond 36 weeks. You may need permission from your physician to fly at a later date. Your physician may not want you to travel far distances by airplane after approximately 34 to 35 weeks. Access to medical care is restricted during the plane flight should you need medical attention. In addition, both you and your physician may prefer that you stay closer to home late in your pregnancy to ensure that you receive proper medical attention if you go into labor. If you have had complications during your pregnancy, your physician may prefer that you stay close to home so that prompt intervention may be undertaken if problems arise. Should you choose to travel, it is probably a good idea to take copies of your medical records with in case of an emergency.

What are your chances of being pregnant and still having a period?
You have asked a very common question, and an important one for all women to understand. Any bleeding during pregnancy is considered abnormal. Your menstrual period each month is triggered by ovulation and the production of progesterone. The progesterone support is then withdrawn and your period begins. Therefore, from a physiologic standpoint it is not possible to continue having a period while you are pregnant. While any bleeding during pregnancy is considered abnormal, it is not unusual to have some spotting early in pregnancy. You may also have some bleeding as a result of a break in one of the superficial blood vessels on the cervix. However, this should be rather minimal and should last only a short time. If you are pregnant, you should not be having any regular bleeding.

What is the possibility of my passing herpes to my child during labor/delivery?
Five years ago I was diagnosed with herpes and have been fortunate to not have had many outbreaks. Down the road, when I choose to become pregnant, can this STD hurt my newborn during the pregnancy or labor/delivery?
Twenty-five percent of American women have genital herpes. Eighty percent of herpes infections are asymptomatic, and therefore many women do not know that they have been exposed to herpes. If you have your initial herpes infection at the time of delivery and deliver vaginally, your infant has a 40% to 50% risk of being infected. If you have had herpes before and have a herpes recurrence at the time of delivery and deliver vaginally, your infant has a 1 in 2000 chance of being infected. Because of the risk of transmission to your infant, the American College of OB/GYN recommends cesarean section if any herpes lesions are present at the time of your delivery.

If your infant develops herpes at the time of delivery, the consequences can range from asymptomatic disease to severe eye and neurologic injury that may even result in death. Therefore it is very important to inform your obstetrician of your history of genital herpes and to notify him if you notice any lesions or have any symptoms close to the time of delivery.

Gynecological Questions

When should I start taking my birth control pills?
Birth Control Pills are generally started on the Sunday after your period starts. If your period starts on a Sunday, begin taking them that day.

What should I do if I miss taking one of my birth control pills?
If you miss a birth control pill, take it as soon as remembered and use back-up birth control measures for the rest of the cycle. If you miss your pill for one day, take two pills the next day.

Where can I get the morning after pill?
The "morning after" pill is available by prescription only. Please consult the nurse line at 913.541.9495.

What do I do if I am having problems with my current birth control pills or hormones?
You need to speak to your personal physician at your next appointment (or schedule one) in order to change birth control pills or hormone therapy due to complications. It is difficult to switch pills or hormones over the phone. Same day appointments are available for these questions.

My periods are getting irregular and heavy. Are there any conservative options available to treat this problem?
The 90 second uterine ablation performed in the office if you are finished with child-bearing is an excellent minimally invasive procedure that is covered by all health plans. Schedule an appointment to speak to any of our providers about this exciting procedure.

I keep hearing about bioidentical hormones, what are they and am I a candidate for them?
Refer to our home page for a complete detail regarding this type of hormone therapy for pre-menstrual syndrome, decreased sex drive, peri-menopause and menopausal problems.