Pre Pregnancy Counseling

The decision to get pregnant is an important one for any woman. The significance of health prior to pregnancy has become increasingly recognized. Ideally, it's best to meet with me before you get pregnant for preconception counseling or pregnancy planning. During this time you and I meet to discuss your pregnancy plan and address any issues or concerns you may have. I can help you optimize your physical and emotional health and pave the way for a healthy, happy pregnancy prior to conceiving

I can help you understand any health conditions or risk factors that could affect your baby during pregnancy, as diet, bad habits, medications and medical conditions can all have an impact on a baby, even before he or she is conceived. I can also answer questions and concerns surrounding prenatal visits, labor, delivery and postpartum care.

Preconception care and counseling includes:

  • Physical Assessment
  • Fertility Awareness
  • Controlling bad habits and unhealthy lifestyle choices
  • Assessment of risks
  • Healthy diet
  • Prenatal vitamins
  • Exercise and fitness
  • Stress Relief

Pregnancy Care

  • Prenatal Care
  • Pregnancy
  • Postpartum Care
  • Takeaway

Overview

Pregnancy care consists of prenatal (before birth) and postpartum (after birth) healthcare for expectant mothers.
It involves treatments and trainings to ensure a healthy prepregnancy, pregnancy, and labor and delivery for mom and baby.

Prenatal Care

Prenatal care helps decrease risks during pregnancy and increases the chance of a safe and healthy delivery. Regular prenatal visits can help your doctor monitor your pregnancy and identify any problems or complications before they become serious.

Babies born to mothers who lack prenatal care have triple the chance of being born at a low birth weight. Newborns with low birth weight are five times more likely to die than those whose mothers received prenatal care.

Prenatal care ideally starts at least three months before you begin trying to conceive. Some healthy habits to follow during this period include:

  • quitting smoking and drinking alcohol
  • taking folic acid supplements daily (400 to 800 micrograms)
  • talking to your doctor about your medical conditions, dietary supplements, and any over-the-counter or prescription drugs that you take
  • avoiding all contact with toxic substances and chemicals at home or work that could be harmful

PREGNANCY

During Pregnancy

Once you become pregnant, you'll need to schedule regular healthcare appointments throughout each stage of your pregnancy. A schedule of visits may involve seeing your doctor:

  • every month in the first six months you are pregnant
  • every two weeks in the seventh and eighth months you are pregnant
  • every week during your ninth month of pregnancy

During these visits, your doctor will check your health and the health of your baby. Visits may include:

  • taking routine tests and screenings, such as a blood test to check for anemia, HIV, and your blood type
  • monitoring your blood pressure
  • measuring your weight gain
  • monitoring the baby's growth and heart rate
  • talking about special diet and exercise

Later visits may also include checking the baby's position and noting changes in your body as you prepare for birth. Your doctor may also offer special classes at different stages of your pregnancy. These classes will:

  • discuss what to expect when you are pregnant
  • prepare you for the birth
  • teach you basic skills for caring for your baby

If your pregnancy is considered high risk because of your age or health conditions, you may require more frequent visits and special care. You may also need to see a doctor who works with high-risk pregnancies.

Postpartum Care

While most attention to pregnancy care focuses on the nine months of pregnancy, postpartum care is important, too. The postpartum period lasts six to eight weeks, beginning right after the baby is born.

During this period, the mother goes through many physical and emotional changes while learning to care for her newborn. Postpartum care involves getting proper rest, nutrition, and vaginal care.

Getting Enough Rest
Rest is crucial for new mothers who need to rebuild their strength. To avoid getting too tired as a new mother, you may need to:

  • sleep when your baby sleeps
  • keep your bed near your baby's crib to make night feedings easier
  • allow someone else to feed the baby with a bottle while you sleep

Eating Right

Getting proper nutrition in the postpartum period is crucial because of the changes your body goes through during pregnancy and labor. The weight that you gained during pregnancy helps make sure you have enough nutrition for breast-feeding. However, you need to continue to eat a healthy diet after delivery. Experts recommend that breast-feeding mothers eat when they feel hungry. Make a special effort to focus on eating when you are actually hungry — not just busy or tired.

  • avoid high-fat snacks
  • focus on eating low-fat foods that balance protein, carbohydrates, and fruits and vegetables
  • drink plenty of fluids

Vaginal Care

New mothers should make vaginal care an essential part of their postpartum care. You may experience:

  • vaginal soreness f you had a tear during delivery
  • urination problems like pain or a frequent urge to urinate
  • discharge, including small blood clots
  • contractions during the first few days after delivery

Schedule a checkup with your doctor about six weeks after delivery to discuss symptoms and receive proper treatment. You should abstain from sexual intercourse for four to six weeks after delivery so that your vagina has proper time to heal.

TAKEAWAY

It's important to stay as healthy as possible during pregnancy and during the postpartum period. Stay on top of all of your healthcare appointments and follow your doctor's instructions for the health and safety of you and your baby.

Ectopic Pregnancy

An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes.

The fallopian tubes are the tubes connecting the ovaries to the womb. If an egg gets stuck in them, it won't develop into a baby and your health may be at risk if the pregnancy continues.

Unfortunately, it's not possible to save the pregnancy. It usually has to be removed using medicine or an operation.

In the UK, around 1 in every 80-90 pregnancies is ectopic. This is around 12,000 pregnancies a year.

Symptoms of an ectopic pregnancy

An ectopic pregnancy doesn't always cause symptoms and may only be detected during a routine pregnancy scan. If you do have symptoms, they tend to develop between the 4th and 12th week of pregnancy. Symptoms can include a combination of:

  • a missed period and other signs of pregnancy
  • tummy pain low down on one side
  • vaginal bleeding or a brown watery discharge
  • pain in the tip of your shoulder
  • discomfort when peeing or pooing

However, these symptoms aren't necessarily a sign of a serious problem. They can sometimes be caused by other problems, such as a stomach bug. How an ectopic pregnancy is treated

There are three main treatments for an ectopic pregnancy:

  • expectant management – you're carefully monitored and one of the treatments below is used if the fertilised egg doesn't dissolve by itself
  • medication – an injection of a powerful medicine called methotrexate is used to stop the pregnancy growing
  • surgery – keyhole surgery (laparoscopy) performed under general anaesthetic is used to remove the fertilised egg, usually along with the affected fallopian tube

You'll be told about the benefits and risks of each option. In many cases, a particular treatment will be recommended based on your symptoms and the results of the tests you have.
Some treatments may reduce your chances of being able to conceive naturally in the future, although most women will still be able to get pregnant. Talk to your doctor about this. Read more about treating an ectopic pregnancy.

Help and support after an ectopic pregnancy

Losing a pregnancy can be devastating and many women feel the same sense of grief as if they had lost a family member or partner.
It's not uncommon for these feelings to last several months, although they usually improve with time. Make sure you give yourself and your partner time to grieve.
If you or your partner are struggling to come to terms with your loss, you may benefit from professional support or counselling. Speak to your GP about this.
Support groups for people who have been affected by loss of a pregnancy can also help. These include:

  • The Ectopic Pregnancy Trust
  • The Ectopic Pregnancy Foundation
  • The Miscarriage Association
  • Cruse Bereavement Care

Read more about dealing with loss and find bereavement support services in your area.

Trying for another baby

You may want to try for another baby when you and your partner feel physically and emotionally ready.
You'll probably be advised to wait until you've had at least two periods after treatment before trying again, to allow yourself to recover. If you were treated with methotrexate, it's usually recommended that you wait at least three months, because the medicine could harm your baby if you become pregnant during this time.
Most women who have had an ectopic pregnancy will be able to get pregnant again, even if they've had a fallopian tube removed. Overall, 65% of women achieve a successful pregnancy within 18 months of an ectopic pregnancy. Occasionally, it may be necessary to use fertility treatment such as IVF.
The chances of having another ectopic pregnancy are higher if you've had one before, but the risk is still small (around 10%).
If you do become pregnant again, it's a good idea to let your GP know as soon as possible, so early scans can be carried out to check everything's OK.

What can cause an ectopic pregnancy?

In many cases, it's not clear why a woman has an ectopic pregnancy. Sometimes it happens when there's a problem with the fallopian tubes, such as them being narrow or blocked. The following are all associated with an increased risk of ectopic pregnancy:

  • pelvic inflammatory disease (PID) – inflammation of the female reproductive system, usually caused by a sexually transmitted infection (STI)
  • previous ectopic pregnancy – the risk of having another ectopic pregnancy is around 10%
  • previous surgery on your fallopian tubes – such as an unsuccessful female sterilisation procedure
  • fertility treatment, such as IVF – taking medication to stimulate ovulation (the release of an egg) can increase the risk of ectopic pregnancy
  • becoming pregnant while using an intrauterine device (IUD) or intrauterine system (IUS) for contraception – it's rare to get pregnant while using these, but if you do you're more likely to have an ectopic pregnancy
  • smoking
  • increasing age – the risk is highest for pregnant women who are aged 35-40

Recurrent Miscarriage

Recurrent pregnancy loss ( RPL , or recurrent miscarriages) is one of the most frustrating problems in reproductive medicine medicine today because we still do not understand it well. Patients with repeated miscarriages have hundreds of questions - and we still do not have all the answers !

If however, a patient has had two or more miscarriages consecutively, this is called RPL, or recurrent pregnancy loss. The old term for this as repeated or habitual abortion. Now although the risk of miscarrying again does increase, this risk is still quite small, and increases from the 15% risk a normal woman has to about 35% - which still means there is a 65% chance that they will not have a miscarriage again. Here are some facts:

  • Most women who miscarry do so only once. Their risk for miscarrying again is not increased and is the same as that of a normal woman's - about 15%
  • Women who are over thirty five are more liable to miscarry
  • Travelling, lifting weights and sex does not threaten a healthy pregnancy. As the old saying goes, " You cannot shake a good apple off a tree."
  • If you've had a previous miscarriage, it is very normal to be frightened and worried during your next pregnancy. It is important to understand that exercise, working and intercourse do not increase the risk of pregnancy loss
  • Likewise, staying at home and resting in bed probably do not prevent miscarriage.

Causes of a Miscarriage

Repeated miscarriages can happen because of any of the following:

  • Chromosomal abnormalities
  • Hormone imbalance
  • Physical Illness
  • Polycystic Ovary Syndrome
  • Immune problems
  • Antiphospholipid antibodies
  • Problems in the uterus
  • Life style of the woman
  • Oopause

Ultrasound scan

Ultrasound scans use sound waves to create a picture of your baby in your womb. The picture will be displayed on a screen that you will be able to see. Most scans are performed by a trained healthcare professional called a sonographer. These scans are painless and there are no risks to you or your baby

How is an ultrasound done?

Most ultrasounds that are done after 10 weeks of pregnancy are performed abdominally. The sonographer will place some gel on your belly, and will rub a hand-held device (probe) across your belly in order to obtain a picture of your unborn baby.
For an abdominal ultrasound during your first trimester, you may need to drink a few glasses of water. This is so your full bladder will push your uterus up out of your pelvis, allowing the baby to be seen clearly in the ultrasound images.
Sometimes the sonographer needs to perform a vaginal ultrasound. The probe used for this does not need to go in very deep, so most women find that it fits comfortably inside the vagina. This might be recommended if:

  • you are less than 8 weeks pregnant
  • you are overweight
  • the baby is deep inside your abdomen.

Cardiotocography (CTG)

Cardiotocography or CTG is a test usually done in the third trimester of pregnancy. It is done to see if your baby's heart beats at a normal rate and variability. A CTG done in your third trimester is also known as a 'non stress test' because your baby is not under the 'stress' of labour.

Normally, a baby's heart rate is anywhere between 110 and 160 beats per minute and increases when the baby moves. Checking that your baby's heart rate responds to his movements is an indirect way of knowing if he gets enough oxygen from the placenta. The test will also see how your baby's heart rate is affected by your contractions.

If you are in your third trimester and not yet in labour, the test will measure your Braxton Hicks contractions. You might not be aware of them but Braxton Hicks contractions are light contractions that your uterus has in preparation of labour.

Your doctor will ask you to have a CTG in your third trimester if:

  • you feel that your baby's movements have slowed down or become irregular
  • she suspects a problem with your placenta that restricts the blood flow to your baby
  • you have low levels of amniotic fluid
  • you are having twins
  • you have diabetes or hypertension

For this test, you will have two belt-like monitors strapped to your tummy. One measures your baby's heart rate and the other measures contractions of your uterus. You will have to remain seated or lying down during the test. It can last anywhere between 20 and 60 minutes.

The test result is either 'reactive' or 'non reactive'. A reactive test result indicates that your baby's heart rate increases by the expected amount after each of his movements. If your baby's heart rate does not increase after his movements, the test will be non reactive.

A non reactive result does not necessarily indicate a problem. Your baby might just have been fast asleep while the test was being done. Your doctor might try the test again after making you move around or using a fetal acoustic stimulator to wake your baby up. If your result is still 'non reactive', your doctor might ask you to come back for another test after an hour.

If a second CTG shows that your baby is not responding well and that his heart rate is not what it should be, your doctor will usually refer you for an ultrasound scan to assess your baby's biophysical profile.

The biophysical profile will rate your baby based on his movements, breathing, reactions and muscle tone. The test will be an indication of whether your baby is getting enough oxygen. If your baby doesn't score well on this test, your doctor might suggest an early delivery.

A CTG is also sometimes done during labour when your baby needs continuous monitoring. If your doctor gives you a Syntocinon drip to induce or speed up labour, you will usually get a CTG.

Syntocinon is an artificial form of the labour hormone oxytocin and can make your contractions more powerful. A CTG will detect whether your baby is responding well to the stronger contractions or not. In this case, your doctor will keep the belts on you until you reach the pushing stage of labour.

If the test shows that your baby's heart rate is decreasing too much with the contractions, your doctor will give you a drug to lessen their strength. If this doesn't help, you might need an emergency caesarean.

Painless Delivery

At Centre we offer all the support and advice for the expected parents. Our expert panels of doctor discuss the process with the patients and fixes appointments with the gynecology department to have regular checkups and record all data's relevant for the wellbeing of the patient.
All expected mothers may have worries and concerns regarding the birth process. Normal delivery is the natural way of giving birth to babies. Normal delivery is painful but it always depends on the perception of pain in each individuals. For a normal delivery it is important to follow proper nutritious diet, involve in less strain physical activities and to have a thorough knowledge on the birth process to reduce stress and anxiety during the delivery.
Painless delivery is the most recent advancement in the birth process. Painless delivery also known as Epidural Analgesia or Epidural Anesthesia is now adapted by most expected mothers. This method ensures that the mother have less pain during the birth process and can be in a comfortable state during the complete process..
Epidural anesthesia includes a local anesthetic which is injected near the spinal cord during the labor process. The anesthetic numbs the region around the waist. In this form of anesthetic the patient is fully conscious and there is no restriction to movement. Only the waist region will be numbed so that the expected mothers feel less discomfort and pain during the contraction of muscles through the labor process. The anesthesia is injected as a single or multiple doses through a catheter to the spinal canal.
The main advantages for painless delivery is that the mother can be conscious and active during the labor process and experience very less pain and discomfort. In case if the patient require an C section due to any reasons or complications the anesthetic effect can be increased and spread to other part of the body through the epidural catheter. When the labor pain is more, the blood pressure and hormone levels may raise causing discomfort and uneasiness. Epidural Anesthesia acts upon the elevated pressure and hormone levels bringing them to normal levels and can be comfortable. Painless delivery keeps the mother in relaxed state and can welcome the baby with joy.

Breast Feeding

Here are just some of the many good reasons why you should breastfeed your baby:

Breast milk is the most complete form of nutrition for infants. Breast milk has just the right amount of fat, sugar, water, and protein that is needed for a baby's growth and development. Most babies find it easier to digest breast milk than they do formula.
There are health risks to your baby if you do not breastfeed. Breast milk has agents (called antibodies) in it to help protect infants from bacteria and viruses. Babies who are not exclusively breastfed for 6 months are more likely to develop a wide range of infections diseases including ear infections, diarrhea, and respiratory illnesses. They are sick more often and have more doctor's visits. Infants who are not breastfed have a 21% higher postneonatal infant mortality rate in the U.S.
Breastfed babies score higher on IQ tests in childhood, especially babies who were born prematurely.
Nursing uses up extra calories, making it easier to lose the pounds of pregnancy. It also helps the uterus to get back to its original size and lessens any bleeding you might have after giving birth.
Breastfeeding lowers the risk of breast and ovarian cancers and possibly the risk of hip fractures and osteoporosis after menopause.
Breastfeeding can help you bond with your baby. Physical contact is important to newborns and can help them feel more secure, warm and comforted.

Post Delivery Care

The time after delivery is known as the postpartum period and this is one of the most essential phases in a woman's life. During this stage, your body undergoes several changes. It develops its own requirements which need to be fulfilled in order to return to a normal lifestyle.

The postpartum stage starts right after the time of delivery and it ends when you nearly return to the pre-pregnant state. In these six to eight weeks, you need to take very good care of yourself. In general, as a new mother, you would require lots of sleep, rest and good nutrition

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Abortion Services

There are two ways of ending a pregnancy: in-clinic abortion and the abortion pill. Both are safe and very common. If you’re pregnant and thinking about abortion, you may have lots of questions. We’re here to help.

GET THE FACTS ABOUT ABORTION
Considering Abortion

Is abortion the right option for me?

Having an unintended pregnancy is very common, and many people decide to have an abortion. Only you know what’s best for you, but good information and support can really help you make the decision that is best for your own health and well-being.

Why do people decide to have an abortion?

If you’re thinking about having an abortion, you’re so not alone. Millions of people face unplanned pregnancies every year, and about 4 out of 10 of them decide to get an abortion. Some people with planned pregnancies also get abortions because of health or safety reasons. Overall, 3 in 10 women in the U.S. will have an abortion by the time they’re 45 years old.

What can I think about to help me decide?

Family, relationships, school, work, life goals, health, safety, and personal beliefs — people think carefully about these things before having an abortion. But you’re the only person walking in your shoes, and the only person who can decide whether to have an abortion. The decision is 100% yours. Who can I talk with about getting an abortion?

No one should pressure you into making any decision about your pregnancy, no matter what. So it’s important to get the info and support you need from people who give you the real facts and won’t judge you.

If you’re having a hard time finding someone in your life to talk with, check out All-Options. All-Options has a free hotline that gives you a confidential space to talk about making decisions about a pregnancy. They’ll give you judgment-free support at any point in your pregnancy experience, no matter what you decide to do or how you feel about it.

When do I have to make a decision?

It’s important to take the time you need to make the best decision for you. It’s also a good idea to talk to a nurse or doctor as soon as you can so you can get the best medical care possible. The staff at your local Planned Parenthood health center is always here to provide expert medical care and support, no matter what decision you make.

Contraception

Contraception is the use of hormones, devices or surgery to prevent a woman from becoming pregnant. It allows couples to choose if and when they want to have a baby.

Most types of contraception don't protect against sexually transmitted infections (STIs). The male condom is the only form of contraception that protects against STIs as well as preventing pregnancy. Therefore, if you're using another type of contraception, such as the contraceptive pill, you should also use a condom to protect yourself against getting an STI.

Types of contraception

Condoms (male and female)

Condoms are a form of barrier contraception. They prevent pregnancy by stopping sperm from reaching and fertilising an egg. Condoms also provide protection against STIs, including HIV, and stop them being passed from one sexual partner to another. Condoms are used during penetrative sex (vaginal or anal) and oral sex to protect against STIs. Combined contraceptive pill

The combined contraceptive pill, usually just referred to as the 'pill', contains synthetic (man-made) versions of the female hormones oestrogen and progesterone, which women produce naturally in their ovaries. It is quoted as being over 99% effective if taken as per instructions. The pill is usually taken to prevent pregnancy but it can also be used to treat:

  • painful periods
  • heavy periods
  • premenstrual syndrome
  • endometriosis.

You should not take the combined oral contraceptive pill have had a blood clot, or you have health conditions including severe liver problems or are on certain medications. If you smoke the risk of serious side effects is increased. Always ask your doctor if this is the safest choice of contraceptive for you. Progestogen-only contraceptive pill

The progestogen-only pill, sometimes called the mini pill, doesn't contain any oestrogen. It is not as effective as the combined pill and it must be taken at the same time every day. It is an option for women who have side effects when they take oestrogen, or who cannot have the combined pill for health reasons. This contraceptive is commonly used just after childbirth especially when a mother is breastfeeding.

Contraceptive implants and injections

Contraceptive implants and injections are long-acting, effective, reversible and progestogen-only methods of contraception. They are over 99% reliable in preventing pregnancy but they do not protect against STIs. The injection is given every 12 to 14 weeks and the implant lasts for three years.

Diaphragms and caps

Diaphragms and caps are barrier methods of contraception used by women. They fit inside the vagina and prevent sperm from passing through the entrance of the womb (cervix). Again these forms of contraception do not prevent STIs.

Emergency contraception

A woman can use emergency contraception (sometimes called the 'morning-after pill') to prevent pregnancy after having unprotected sex, or if a method of contraception has failed. There are two types of emergency contraception:

the emergency contraceptive pill is a single pill containing progesterone. You can get it from a doctor or from most pharmacies without a prescription. You need to take it as soon as possible, preferably within 24 hours of having sex, but it will still work for up to five days . It prevents up to 85 per cent of pregnancies.

the copper intrauterine device (IUD) (see below).

Intrauterine devices (IUD)

An intrauterine device (IUD) is a small, T-shaped contraceptive device made from plastic and copper that fits inside the womb (uterus). The IUD used to be called a 'coil' or a 'loop'. It's a long-acting and reversible method of contraception, which can stay in the womb for five to ten years depending on the type. It can also be an effective emergency contraception if fitted by a healthcare professional within five days (120 hours) of having unprotected Some IUDs contain hormones that are gradually released to prevent pregnancy. These IUDs can also be used to manage heavy periods. IUDs are 99% effective.

Vasectomy

Vasectomy or 'male sterilisation' is a simple and reliable method of contraception. It's usually considered permanent and is therefore a big decision that should be fully discussed with your doctor beforehand. A vasectomy is a quick and relatively painless surgical procedure. It's usually done under local anaesthetic.

Female sterilisation

Female sterilisation is an effective form of contraception that permanently prevents a woman from being able to get pregnant. Like a vasectomy, female sterilisation is a big decision that should be fully discussed with your doctor.

The operation usually involves cutting or blocking the fallopian tubes, which carry eggs from the ovaries to the womb (uterus). This prevents the eggs from reaching the sperm and being fertilised. It's a fairly minor operation and many women can return home the same day.

Vaginal ring

The vaginal ring is a small, soft plastic ring that's placed inside the vagina on the first day of a woman's period. It is removed after 21 days. Seven days later a new ring is used. A vaginal ring is about 4mm thick and 5.5cm in diameter. It contains oestrogen and progestogen, so it's not suitable for women who can't take contraception that contains oestrogen.