Choosing a Health Care Provider For Your Prenatal Care

When searching for a health care provider to manage your pregnancy you want someone who is well-qualified, has clinical experience and has a good reputation among those who you trust the most. With this being said, there are still some additional (personal) factors that one should consider when selecting a provider for prenatal care. The prenatal care experience lasts close to one year (including postpartum follow-up) so you want to be sure the relationship you have with your prenatal care provider is well-suited.

Share The Same Philosophy As Your Prenatal Care Provider.

You should make sure you share the same philosophy about a few issues relating to prenatal care. You do not want to be in conflict with your prenatal care provider as you approach your delivery date. Often times there can be more than one management option for your prenatal care.  You and your provider must work together to decide what works best for you.  It is crucial to have a mutual understanding of the risks and benefits of a particular clinical approach.

Prenatal Care Provider With Your Best Interest At Heart.

The options available to you might be defined by the services offered within a particular clinical setting (hospital, birthing center etc.). Be sure your prenatal care provider's decisions regarding your care are not determined by what services are available when the services you want might be available at another health care facility.  You want to really be sure your prenatal care provider has your best interest at heart and will advocate for you when handling your prenatal care.

Prenatal Care Provider With Patient Loyalty.

If a provider is busy and has a loyal patient following, you should feel confident that your treatment will be based on what you desire. 

There are two main topics most often at the center of any discussion surrounding the choice of a prenatal care provider . It is crucial to address these topics right up front to secure a good relationship. You do not want to ever feel you were misunderstood or deceived about what your expectations were at the time of your delivery (assuming there were no unusual circumstances).

The topics I am referring to are: "natural" childbirth and pain management options. 

Whether you choose a midwife or an obstetrician as your primary provider the same holds true. In either case, providers can still vary tremendously regarding these topics. It is simply about being on the same page with your prenatal care provider at the start.

The definition of what natural childbirth is and what adequate pain management is, can differ depending on who you talk to and what resources you read. It is very easy to put these topics aside at first as there is so much excitement about the pregnancy and the fact that your delivery seems so far off in the future. My suggestion is to initially discuss these subjects thoroughly and do not gloss over them. 

I think pain control in labor is a crucial topic you should discuss with your prenatal care provider from the start. I can think of nothing more upsetting to a patient than to not be in control of her options for pain control particularly if she is not aware of what the options are.

This article is certainly not the place to define natural childbirth or discuss pain management during labor. I simply want to bring this important topic to your attention.

The last question to consider when choosing a prenatal care provider has to do with who is anticipated to be there for your delivery. As a result of the tremendous overhead (medical practice expenses) and lifestyle issues for practitioners, it is virtually impossible, in this day and age, to be assured that you will have your prenatal care provider at your delivery. As a result , it is important for you to be aware of your prenatal care provider's arrangement for on-call coverage. Cross-covering with other prenatal care providers at the same health care facility is not unusual and may be necessary depending on the size of the medical group you are seeing for your prenatal care. It is simply about having this discussion with your provider at the start. Discussing these issues is what maintains a trusting relationship with your prenatal care provider.  The timing of events surrounding labor and delivery is not always foreseeable and there is not a perfect solution every time. What is important and acceptable to most patients is that a reasonable effort is made to fulfill one's expectations.

By: Douglas Penta MD, OB/GYN (Platinum Author)

Avoid Long Waiting – How to Schedule Your Prenatal Care Office Visits

By: Douglas Penta MD OB/GYN  (Platinum Ezine Author)

This is the type of information I enjoy sharing with my readers. Advice that is intended to be practical and very applicable, to help you with the little things that can make a big difference.

When scheduling an OB/GYN office visit, it is helpful to first have an understanding of how a women’s health medical practice is managed on a daily basis.

In OB/GYN, there are many unpredictable factors that can impact how efficiently a practice will function from day to day. Unexpected events can disrupt even the most well thought out office schedule. Miscarriages, surgical emergencies and patients in labor are unpredictable events.

Granted there are always coverage arrangements in place to meet practice demands, but even with this being the case, there will always be occasions when the medical staff will be over-extended. When this happens, it is our hope, as providers, that patients will be understanding.

I am very sensitive to the total amount of time which can be lost by a prenatal patient during the course of her prenatal and postpartum care. Frequent visits can result in a significant amount of lost time from their daily schedules, including travel time, etc.

Providers dread running late for patients and even worse having to reschedule a patient, as this is not good for the relationship. Furthermore, it can often feel like a double standard to the patient, if the provider cannot see her. Patients wait for doctors… why shouldn’t doctors wait for patients?

The recommendations I am going to list below are extremely simple and intended to help minimize some of the inconveniences and frustrations associated with scheduling office visits:

• Book in advance.  Try to book as many appointments at one time as is possible/allowed so that you can get the times that you want. The intervals between appointments will be determined by the gestational age of your pregnancy.  Generally, appointments start about every 4 weeks, then become every 2 weeks, then every week as you approach your due date.
• Schedule early in the day.  You want to keep your appointments at the start of your provider’s work day. This will reduce the possibility of problems occurring that can set your provider behind. If you are scheduling an afternoon appointment, try to get a time immediately after lunch (at the start of the afternoon session). Most providers, who are running behind, will tend to use their lunch time as a buffer to catch up if their morning session runs late. Needless to say, this might mean giving up their allotted time for lunch but that is simply how schedules are kept on time in this setting.
• Call ahead.  Whenever possible, phone ahead to determine whether your provider is running on time. Most practices are glad to hear from you before you arrive so they can address a potential delay in the office schedule. When I am behind and am asked what to do about a patient who is inquiring, I much rather hear that the patient is on the phone and not sitting in the waiting room. I feel I have more flexibility, perhaps I can see the patient for the last appointment of the day or during a canceled appointment time that might have been called in earlier that day.
• Schedule when more than one doctor is in the office.  If there are choices to schedule your appointments, try to schedule on days when there are more than one provider in the office. As a result of surgical schedules, providers being on-call or just coming off call (at the hospital) there can be days with limited office coverage. This is no fault of anyone, it is simply part of the logistics of maintaining an office practice. If there is only one provider in the office (“your provider”) it can take just one urgent problem/emergency to disrupt a schedule for the rest of the day as there is no one else in the office to help catch up.

I hope these suggestions are helpful to you and also will help you have a better understanding of why there may be a wait for routine office visits.

Douglas Penta MD OB/GYN

Prenatal Care Blog

Gestational Diabetes By Douglas Penta MD

There is a distinct difference between adult onset diabetes and juvenile diabetes.

Pregnancy-related diabetes, better known as gestational diabetes, is also important to understand should this condition arise during your pregnancy. I hope this article will clear up any questions regarding the distinction between these various types of diabetes mellitus. Unlike many medical conditions that are not fully understood, diabetes is well understood and regardless of what type you are dealing with, the goal is the same: to maintain an overall normal range of blood sugar levels to prevent organ damage associated with uncontrolled diabetes, including heart disease, renal disease etc..

Juvenile diabetes is perhaps the easiest to understand as it relates to a lack of insulin production by cells in the pancreas and is thought to be a result of genetically predisposing factors and viral-mediated in certain cases.

Adult onset (AODM), is very different in terms of its cause as it is not related to a lack of insulin production, but instead, to the ability of insulin receptors to respond to the insulin. AODM is controlled well with life style changes and in many instances such changes alone can resolve the problem ( changes include weight loss and changes in diet and exercise). I have actually seen many overweight patients with AODM, lose weight such that the condition no longer required treatment with medication.

Finally, as an OB/GYN physician I must mention the diabetic condition I have dealt with most often during my career and that is gestational diabetes (diabetes relating to pregnancy). It is routinely screened for during pregnancy and is most like AODM as it is a lack of response of receptors to the insulin that is present and not a deficiency of insulin.

I have had many patients on very large doses of insulin for gestational diabetes to maintain normal ranges of blood sugar. The insulin receptors are not sensitive enough to normal levels of insulin and thus the need for additional insulin supplementation. Women with gestational diabetes are thoroughly educated about how to maintain normal blood sugar levels and it is a task that takes a great deal of education/instruction.

Gestational diabetes can be indicative of a predisposition to diabetes later in life and thus it is important to follow-up one’s blood sugar after delivery and be conscious of this possibility later in life. In the majority of cases the diabetic condition associated with pregnancy resolves immediately after delivery of the placenta.

I hope this information is helpful. It is not intended to diagnose, treat, cure or prevent any condition; however, the more one understands the cause of a particular condition the more proactive one can be about the management.

Douglas Penta MD

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Nesting!

Morning mommas! Today I want to talk a little bit about nesting.  A mother has an instinct to prepare the home before the baby comes.  It is important to get these things done now while there is the time because once the baby gets here you will be lucky if you have the time to shower.

Every momma is different and has different ways they go about “nesting”.  Some women clean their house until it is so clean you can see your reflection in the hard word floor and some women reorganize every ounce of their home so much you can’t find anything.  Whatever way your instincts lead you it is important to remember there are a few essentials that should be done before the baby arrives.

Something so important to remember is that you have a partner, friends and family who will be around to help and you don’t have to do everything alone.  If you are offered a helping hand, take it!  In my experience I wanted to do everything myself, and it is okay to do things yourself, but it is especially important to involve your baby’s daddy! Let him do some things to or let him do things with you.

Here are just some things to consider doing if your nesting instinct kicks in.

Load The Fridge!  You want to make sure you have enough food for you and your husband once the baby arrives.  Chances are that you will have friends and family bringing you cooked meals and stuff for the baby but you want to be all stocked just in case.  There will be no time for cooking for the first few weeks, and you most likely will not feel like cooking a big meal after you have just given birth.

Treat yourself!  You will no longer be able to pamper yourself the way you did before your bundle of joy.  The baby becomes the center of attention, and you take a backseat.  It is important to pamper yourself while you can.  Going on a little shopping spree is a great way to do this.  Purchasing new bras would be something beneficial for you because once the milk comes in your breast will get larger and need some extra support.  Get different types of bras to try them out and see which ones work for you.  Some women love nursing bras, some love sports bras, and some just like their regular bras..in a larger size.  Whatever works for you!  Also, get some comfy sweats, yoga pants, and cotton comfy underwear.  After childbirth, whether natural or c-section, you will be in comfy clothes for at least 6 weeks post birth.  For those of you who are planning natural birth and it goes according to plan, you will need comfy underwear that is roomy enough to fit in pads because you will have some bleeding afterwards.  Maxi pads are also something you will want to get.  You will get them in the hospital if you have a natural birth, but some women prefer certain types.  Go with whatever is most comfortable for you.  It also can’t hurt to have a spa day as a little treat.  Go get a pedicure and maybe a prenatal massage.  Your feet and back will love you after carrying around all the added weight.

Treat your baby!  I found buying things for the baby so much fun.  Your baby will need clothes, diapers, wipes, ointment, bibs..the list is endless.  Due to the fact that you aren’t 100% aware what size your baby will be, I found it most helpful to get one or two newborn one piece outfits and 0-3 month for the rest.  You don’t know what your baby will like so it would be beneficial to get a few small packages of different types of diapers so you can try them out and see which ones work best for you and your baby.  The same goes for wipes, ointments, pretty much all baby necessities are up to what woks for you and your baby.  Every mommy is different and y’all will like different things.  Get some samples of different products and give them a try.  Something I learned the hard way was not to buy products in bulk until I knew what I liked best and my baby liked.

Bake and cook some goodies!  If you are one of those women who love to cook or bake and nesting calls you to the kitchen go right ahead and bake or cook away!  You most likely won’t be cooking or baking much once your baby takes center stage.  If you are cooking, cook some things that will last a while, like lasagna, chicken cutlets, meatloaf, meatballs or a nice big gravy to go with a pasta dinner.  All of these foods you can stick in the freezer and then have at the ready once the baby arrives.  If you are one for baking, cookie dough is perfect to freeze and make later.  Bake or cook whatever you want while you can.  You partner will love it too!

Tidy Up!   It is always good to give your home a once over before the little one is home.  You want to make sure everything is super clean because you probably won’t get a chance to clean that thoroughly again for a little while.

Prepare your baby’s nursery!  I found this to be the most exciting part about preparing for the baby.  It is a great way to bond with your partner as well.  From going to pick out the crib and essentials to filming your partner attempt to put them together, it is a fun and exciting part of having a baby.

Get A Plan!  Something that is so crucial, is having a plan with your partner about delivery.  There are so many details about the delivery that you should be on the same page about.  I know in my own experience, my husband and I discussed not having any extended family come visit us after our son was born.  After the pregnancy I had and the induction and difficult delivery, the last thing I wanted was to entertain a bunch of people in a tiny room where I was barely dressed, trying to breastfeed every hour and constantly having to run to the bathroom to rub numbing ointments on myself.  It is up to you and your partner what you want to do, but make sure you are on the same page and your families will have to respect whatever decision you chose.  My husband was the one who actually made the choice to not have any visitors come see us until we got home and I was feeling a bit better.  We had my mom there, because she was in the room with us, my dad came because he knew how sick I had been for 9 months and was scared that something would go wrong since I had preeclampsia, and my uncle came because he worked in the hospital I gave birth and was already there.  Other than that, we didn’t see anyone until we arrived home and I was feeling a little better.  Make sure y’all have a plan and you stick to it together.  Even if it is as simple as where your partner stands during delivery, know your plan.

Prenatal Testing

During pregnancy there are a bunch of different tests done to be sure you and your baby are healthy and stay healthy to the end.  At each prenatal visit there will be some new test that you will have the option to have or one that your doctor or midwife may feel is necessary for your circumstance.  

Your first prenatal visit is where your doctor or midwife will learn a slew of information about you by the testing done and the questions they ask.  They will do tests to find things such as:

• Blood type
• Rh factor (+ or -)
• Anemia
• Infections
• Immunity to rubella and chicken pox

Your doctor or midwife may recommend a series of tests depending on:

• Age
• Family health history
• Ethnicity
• Results of routine testing

Some of the testing done are just screening tests. Screening tests only can determine risk or probability, not actuality.  From the information gathered of a screening test your doctor or midwife can then decide if further diagnostic testing should be done to give you a definitive result. Diagnostic tests and confirm and narrow down andy health problems in your or your baby.

Common prenatal tests that are offered and/or recommended throughout the pregnancy are:

Urinalysis - done routinely at prenatal visits to test, sugar, protein, ketones, leucocytes, white blood count, and bacteria -  used to diagnose:

--Urinary Tract Infection

--Dehydration

--Preeclampsia

Chorionic Villus Sampling - diagnoses some birth defects between 10 and 13 weeks such as:

--Down Syndrome

--Cystic Fibrosis

First Trimester Screening - detects some higher risk birth defects between 11 and 14 weeks such as:

--Chromosomal Disorders

--Heart Problems

--Multiples
--Paternity

Amniocentesis - diagnoses some birth defects between 14 and 20 weeks such as:

--Down Syndrome

--Cystic Fibrosis

--Spina bifida

Ultrasound -  Ultrasounds are not routine but common between 18 and 20 weeks.  They are used to detect any problems with the baby's organs and body systems and confirm the age of your baby and be sure he or she is growing properly.  You also may be able to find out the gender of your baby if he or she cooperates.

Glucose challenge screening - detects gestational diabetes between 26 and 28 weeks.  Depending on the results from the initial screening, your doctor may recommend the glucose tolerance test which is used to diagnose gestational diabetes.  

Non-stress test - If your baby is showing little to no movement or any signs of distress a non-stress test is done to determine the reasoning. It is a monitor placed around the baby bump to measure the baby’s heart rate based on his or her movement. Biophysical profile - This test is used along with a non-stress test to monitor the overall health of your baby and to help decide if the baby should be delivered early.

It is an ultrasound done after a non-stress test. The biophysical profile looks at 5 fetal things: 

--breathing

--movement

--muscle tone

--heart rate

--amount of amniotic fluid.

Group B streptococcus infection - used to find bacteria that causes pneumonia in newborns - done between 36 and 37 weeks.

If your doctor or midwife recommends certain prenatal tests, don't be worried.  Never hesitate to ask as many questions as you want.  It is so important to keep yourself informed about what is going on. Don’t fret and remember that screenings do not diagnose, they detect possible risk.  Your doctor or midwife will guide you in the right direction to keeping you and your baby healthy.  

Is This Normal?

There are so many aches and pain during pregnancy.  At times it is hard to tell what it is concerning and what is not.  A huge question I have been asked lately is, “When should I  call my doctor? Is this normal?”  The thing about pregnancy is, so much is going on with your body and everyone is different.  You can not pinpoint a “norm” because what may be completely normal for one woman, could be concerning for another.

It is very rare that women fly through pregnancy with ease and never have a situation where calling the doctor is necessary.  If you are one of those women, I am jealous!  I managed to have kidney stones, pyelonephritis (kidney infection), hyperemesis, fluid leak at 27 weeks, the list goes on.  Like you, I questioned, when do I need to all the doctor?  I was always so worried about being an alarmist because so many things feel uncomfortable and are changing during pregnancy.

A rule of thumb is when in doubt, call your doctor or midwife.  You want to be safe than sorry.  I just want to educate you further so when you do call your doctor or midwife you have a bit more knowledge on what you may be calling about.  So many times I went in a nervous wreck when it was nothing or I would go in completely calm and end up at the hospital.  Here are some questionable times for women, normal or not, and when to call your doctor or midwife.

Bleeding:

Bleeding can happen in the first trimester and this is because of implantation of the fertilized egg in the lining of the uterus.  No matter what the circumstance, if you have bleeding always call your doctor or midwife.  Especially if it is associated by cramping.

Fluid Leak:

Any fluid leak is tricky because some women can experience some incontinence throughout the pregnancy.  Yup, you could pee yourself.  This can often be confused with thinking your water has broken.  In my own experience, I had some fluid and at first I didn’t really say anything, then I showed my mom and we called the doctor.  When I called the doctor, she said it was probably urine and not to be too concerned.  I called back and they were closed so I got the on-call doctor who brought me right in to the hospital.  I kept having nurses and doctors explain that sometimes you can pee during pregnancy but I knew this wasn’t pee.  They did 3 tests to see what was going on and test the fluid, turns out it was NOT pee...it was amniotic fluid.  The story goes on, but back to my point, it is difficult to tell so don’t hesitate to call your doctor or midwife.  If you feel you aren’t getting answers you must be your own advocate!

Frequent Urination:

It is totally normal to be running to the bathroom more than ever before.  The baby can be pressing on the bladder causing this.  It becomes a problem when you are urinating frequently and have pain, burning or any discomfort during urination.  Also, beware of a constant urge to go.  This could be from the baby’s position but could also be signs of a Urinary Tract Infection.  

Changes In Discharge:

You will find changes to vaginal discharge throughout your pregnancy.  Discharge is totally normal but watch out for any itching, burning or unusual odor that may be associated with the discharge.  Be sure to mention any changes to your doctor or midwife.

Depression:

Prenatal Depression is something that is sometimes over looked.  How blue is too blue?  Being uncomfortable and miserable during pregnancy is normal depending on your situation.  If you find you are lethargic, having excessive mood swings, uncontrollable crying, and constantly feeling hopeless, you need to make sure you address this with your doctor or midwife immediately.

Nausea/Vomiting:

Be sure to monitor your nausea/vomiting.  If you are finding there is no relief and it is getting worse, it most likely is not just morning sickness.  The predictable spurts of nausea and vomiting that can be relieved would be classified as morning sickness.  If you are finding nothing will help and it is all day and all night with no let up, it could be hyperemesis.  Talk to you doctor immediately to see what you can do to help stay hydrated and as healthy as possible through your pregnancy.

Swelling:

Having swelling during your pregnancy can be normal, but it can also be a sign of some serious complications.  During pregnancy, all the hormonal changes will cause some water retention and minor swelling.  If you find any sudden swelling in your hands, feet, and/or face accompanied by headaches and/or blurred vision call your doctor or midwife immediately!  These are signs of a serious complication called preeclampsia.  You may also hear the terms, gestational hypertension, pregnancy induced hypertension or toxemia.

Contractions:

A huge sign of labor, contractions.  How do you know when they are real or not?  I kept asking my mom throughout my pregnancy, how will I know?  Her response was always..”you’ll know.”  It could not be more true.  I was in what is call inactive labor for 2 weeks prior to delivery.  Inactive labor is when you are have true contractions but not dilating.  Some women experience Braxton Hicks contractions, which are practice contractions, prior to real labor.  The Braxton Hicks can be uncomfortable but definitely are not the real deal!  I had Braxton Hicks which were tightening and slightly uncomfortable.  When the real thing hit, I couldn’t even speak when I was in a contraction.  It is a tough call of knowing when to go and when to stay.  Timing your contractions is important.  Contractions in early labor last from 30 to 60 seconds and will be 5 to 10 minutes apart.  Let you doctor or midwife know and they will guide you.

These are some just instances where it is hard to tell what is normal or not.  I hope this gives you some more information.  As I said before, when in doubt do not hesitate to call your doctor or midwife.  You can never be too safe when it comes to pregnancy.  So much is unknown so it is normal to question things going on with your body.