Obstetrics
At Premier Healthcare for Women, we are dedicated to helping our patients navigate through this special time. We are honored to go through this journey with you!
We provide continuous and complete obstetrical care, from pre-pregnancy planning, the pregnancy confirmation, to the birth of your baby, and through the healing of the postpartum period. The full range of obstetrical services include the ultrasounds (sonogram), genetic testing, and fetal monitoring, for low to high-risk pregnancies.
We work in helping guide you through the entire process with our compassionate and dedicated team.
Obstetrical Services
PREGNANCY
Pre-Pregnancy Planning
We are dedicated to educating patients on what steps they can take to be healthy prior to pregnancy. If you are planning on becoming pregnant, it is important to let your doctor know so that you’ll be best equipped for a healthy pregnancy.
Pregnancy
As soon as you discover you are pregnant, whether it is your first or your last, schedule your prenatal care with us. Pregnancy is a time full of questions, preparations and excitement. Premier healthcare for women will be with you to provide care every step of the way. Our practice is an intimate and caring environment with state-of-the-art facilities. We embrace evidence-based medicine which is directed at improving prenatal care for women. Our team is here to ensure that you have individualized health care for you and your baby.
We treat each patient as an individual, not a number, and as women and mothers ourselves we understand and respect the enormous trust that you put in your caregivers at this miraculous time in your life.
Cord Blood Banking
What is Cord Blood Banking?
Cord blood banking involves collecting blood left in your newborn’s umbilical cord and placenta and storing it for future medical use.
Cord blood contains potentially lifesaving cells called stem cells.
The stem cells in cord blood are different from embryonic stem cells.
For cord blood storage, you have two main options: you can donate your baby’s cord blood to a public cord blood bank for anyone who needs it.
You can pay to store your baby’s cord blood in a family cord blood bank for your family’s use.
For cord blood storage, you have two main options:
• You can donate your baby’s cord blood to a public cord blood bank for anyone who needs it.
• You can pay to store your baby’s cord blood in a family cord blood bank for your family’s use.
Benefits
Benefit Studies
Benefits
Cord blood is a rich source of blood stem cells. Stem cells are the building blocks of the blood and immune system. They have the ability to develop into other types of cells, so they can help repair tissues, organs, and blood vessels and can be used to treat a host of diseases.
Cord blood stem cells have been used successfully to treat more than 70 different diseases, including some cancers, blood disorders, and immune deficiencies. Among these are leukemia, aplastic anemia, thalassemia, Hodgkin’s disease, and non-Hodgkin’s lymphoma. (cord blood stem cells have also been used to treat sickle cell anemia, but that procedure is not yet on the FDA-approved list. ) cord blood transplants are also used to treat rare metabolic disorders that would otherwise be fatal for infants (Krabbe disease and Sanfilippo syndrome, for example).
Benefit Studies
Studies are under way around the world to explore new ways of using cord blood. Children in clinical trials are being treated with their own cord blood for cerebral palsy and autism. Babies and young children in the united states are also being reinfused with their own cord blood stem cells in clinical trials to develop therapies for hydrocephalus (fluid in the brain), oxygen deprivation at birth, traumatic brain injury, type 1 (juvenile) diabetes, and congenital heart defects that require surgery.
If the clinical trials are successful, these therapies may become commonly available within a few years. A full list of the current clinical trials with cord blood is available on the diseases treated page of the parent’s guide to cord blood foundation website. The odds that a child will ever use his or her own stored cord blood are small. According to a 2005 editorial in the journal obstetrics and gynecology, the chances are about one in 2,700. Other estimates range widely. Advertising from one private cord blood bank puts the odds at 1 in 27. The American academy of pediatrics suggests it’s more like 1 in 200,000.
Cord Blood Banking Options
Public Banking:
There is a public bank through MD Anderson (MDACC) that is available for cord blood donation. There are MDACC staff at the hospital that are available to consent you for cord blood donation and help the with cord blood collection process at the hospital you do not need to pre-register for the donation prior to admission to the hospital. The MDACC staff will come to your room to register you if you desire to donate your cord blood once you are admitted for delivery.
Private Banking:
There are multiple reputable cord blood collection companies that are available for patients who want to store their cord blood. You do need to register for this service prior to delivery. Most companies have a registration process that you complete and they then will mail you a collection kit to your home. You then bring the collection kit to the hospital for your delivery. After collection, your cord blood company arranges a courier to pick up the cord blood from the hospital.
Pregnancy Loss
Understanding Pregnancy Loss
As women and mothers ourselves we understand how devastating pregnancy loss can be, even if it is very early. We know that a bond is formed as soon as the pregnancy test is positive, and we cant help but make plans surrounding the baby’s due date, and all the exciting possibilities about the baby’s future. When the pregnancy doesn’t continue the disappointment and grief can be overwhelming. Not only have we lost the pregnancy itself, but we also suffer the loss of those hopes and dreams. If you are going though the process of miscarriage we are here to help guide you through both the physical and emotional aspects of your loss. Several of your caregivers here at premium healthcare for women have been through this themselves, so we truly understand how you feel.
The facts about miscarriage may not give you much solace at this time, but it is important to know that 15% of diagnosed pregnancies end in miscarriage, and a lot more than that miscarry before we even recognize that we are pregnant. So pregnancy loss is very normal and it is very unlikely that there is anything wrong with you or your partner that caused this to happen. The great majority of miscarriages occur before 8 weeks, and most often the baby has a chromosomal problem that causes the growth to stop at an early stage. Chromosomal problems occur right after conception when the cells are dividing and a mistake in cell division occurs. For this reason there is nothing you (or we) can do to change the outcome, it happens at the time of conception and it just take us a few weeks to be aware of it.
It is important to remind yourself that whatever you did, or did not do, it was not your fault.
Miscarriage
If you are in early pregnancy (less than 8 weeks) and have vaginal bleeding or cramping at home you may not be sure if you are having a miscarriage. If this happens please call us and we will give you instructions. Often we may tell you to rest at home and come in the next day for an ultrasound. Patients often ask if they need to go to the emergency room and we generally recommend waiting until office hours so that you do not have to be subjected to the cold and clinical er environment. Since there is unfortunately nothing we can do if you are in the process of a miscarriage it is ok to wait until the next day to be seen. We are not minimizing the problem by not sending you to the er, there is just simply nothing that anyone can do. Hopefully by doing an ultrasound the next day we will reassure you that everything is ok, since sometimes bleeding in early pregnancy can be normal.
If you have questions that are not addressed here please let us know.
What To Do
Consecutive
Treatment
Grieving
What To Do
After one miscarriage we do not recommend any testing to evaluate for problems, because it is so rare that there is anything wrong.
We know that going into the next pregnancy is very scary, but try to have faith that the great majority of the time the second pregnancy is fine.
While 15% of pregnancies don’t make it, 85% do make it, so try to keep that in mind.
There is no good evidence that waiting any certain period of time after a miscarriage is necessary. If you are ready to try again right away that is fine. It is a good idea to wait until you have one normal period on your own, which may occur 4-6 weeks after the miscarriage, then start trying if you are emotionally ready. (if you have not had a period 6 week after a miscarriage, do a pregnancy test, because some people get pregnant again before they have their first period.)
Consecutive
If you have had 2 consecutive miscarriages it is still most likely that this is just really bad luck, since it is possible to fall into that 15% group twice in a row. We do however recommend doing some testing at this point to try to determine if we can prevent a 3rd miscarriage.
The testing includes blood work for both you and your partner to check your chromosomes (rarely some people carry an abnormal chromosome that may be transmitted to the baby while they themselves are totally normal), as well as some other tests for rare blood clotting disorders that may affect the pregnancy. We may also recommend a test to look at the shape and size of your uterus as some women have a uterine abnormality that predisposes them to miscarriage. Sometimes we may recommend high doses of folic acid, progesterone supplements, blood thinners or other treatments to try to reduce the risk of a 3rd miscarriage.
Treatment
Once you have been diagnosed with a miscarriage we may suggest one of three things. Sometimes you may pass the fetus on your own and have a very heavy period which is usually safe if you are less than 8 weeks pregnant. Sometimes we may give you a medication to cause the fetus to be expelled more quickly.
If you are 8 weeks or more we will recommend a dilation and curettage (d and c) which is a minor outpatient procedure (under anesthesia) to remove the fetus with gentle suction.
Grieving
It is ok to allow yourself to grieve.
Sometimes the sadness can last for weeks and is exacerbated by seeing other pregnant women or babies. Learn to forgive those around you who don’t know what to say or say the wrong thing. Comments like it was just meant to be, or you will have another one, don’t worry sometimes can be hurtful and not place the appropriate importance on the loss that you are feeling. Your partner will grieve differently than you and may seem to get over it more quickly, which can create some conflict. Sometimes even your friends or family may avoid you because they simply don’t know what to say or do.
Sometimes talking to others who have suffered a miscarriage is most helpful, they will understand how you feel.
LABOR & DELIVERY
Labor & Delivery
Our care does not end at 40 weeks. Our team is ready to be by your side during labor and delivery – vaginal birth or cesarean section – to make your birth experience wonderful, unique and safe.
We deliver at the Woman’s Hospital of Texas, the first facility in Texas dedicated solely to the health of women and children.
They offer state of the art pregnancy, maternity and pediatric care.
POST-PARTUM
After Vaginal Delivery
You will usually be discharged 24-48 hours after you deliver. Insurance companies do not allow you to stay longer unless you have a medical problem. We will give you prescriptions for Ibuprofen 600 mg (or you can take 3 over the counter strength tablets at one time) and Norco (Tylenol with non- codeine narcotic) which you can take as needed. It is ok to take both of these together if necessary.
We also recommend staying on your prenatal vitamin if you are breastfeeding, as well as taking an additional calcium supplement daily.
If you have stitches it is normal to have some discomfort for about 2 weeks. All the stitches dissolve and do not need to be removed.
You may feel some suture material for 1-4 weeks depending on what type of suture was used.
Symptoms
Self Care
Restrictions
Symptoms
Bleeding after delivery will continue for 4-8 weeks but should get lighter after the first few days. You may have a return of bright red bleeding 7-10 days after delivery, this is normal if it is similar to a period or less.
You may pass some clots of blood, since blood tends to pool in the vagina and will form a clot which comes out when you stand up or move around, and sometimes bleeding seems heavier when you are active for the same reason. Call us if you are bleeding more than a heavy period for more than a few hours (for example repeatedly filling a pad more than once an hour).
It is very normal to have an increase in swelling in your feet and legs in the first few days postpartum. This will resolve in a few days and is caused by the excess of fluid that you have in your system after delivery, both from the pregnancy itself and the fluids you were given in labor.
Self Care
We recommend showering only for the first 2 weeks so any suture material does not dissolve too rapidly and any tear is allowed to heal.
After 2 weeks it is ok to take a bath or submerge in water if you like.
If you don’t have stitches you can take a bath right away. (there are no germs in Houston water, there are way more germs in the vagina, so this does not increase the risk of infection. )
Restrictions
Generally, we recommend waiting 6 weeks until you resume sexual activity or tampon use. There is certainly no harm in using tampons before 6 weeks if you are not having any pain and the vaginal area is clearly well healed. There are very few activity restrictions after a vaginal delivery, with the exception of intercourse as above.
Some women feel ready to go back to the gym as soon as 2 weeks postpartum, while others do not. Listen to your body and don’t do anything that hurts. There is no limit to what you should lift, and you can drive as soon as you are not taking narcotic pain medicine.
After C-Section
You will usually be discharged 2-4 days after you deliver. Insurance companies do not allow you to stay longer than 4 nights after delivery unless you have a medical problem. We would like to see you in the office approximately 2 weeks after delivery.
We will give you prescriptions for ibuprofen 600 mg (or you can take 3 over the counter strength tablets at one time) and Norco (Tylenol with a non- codeine narcotic) which you can take as needed. It is ok to take both of these together if necessary. We also recommend staying on your prenatal vitamin if you are breastfeeding, as well as taking an additional calcium supplement daily.
Symptoms
Bleeding
Self Care
Restrictions
Symptoms
It is normal to have some discomfort for about 2-4 weeks. All the stitches dissolve and do not need to be removed. You will notice small tapes or steri-strips over the incision. These need to be left in place for 2 weeks if possible in order to reduce the risk of scar separation. If they fall off on their own before 2 weeks that is fine, but do not remove them deliberately, we will take them off at your 2 week postpartum visit. It is normal to have some swelling, mild redness and superficial bruising around the incision.
Call us if the redness or bruising seems to be getting worse or expanding. If you feel swollen we recommend wearing a supportive garment over the incision to apply gently pressure. Even Spanx or similar underwear will work. It is normal to see a small amount of bleeding or clear drainage from the incision. If you see more than a small amount of bleeding or drainage, please call us to schedule an appointment for an incision check.
Bleeding
Bleeding after delivery (even a c-section) will continue for 4-8 weeks but should get lighter after the first few days. You may have a return of bright red bleeding 7-10 days after delivery, this is normal if it is similar to a period or less. You may pass some clots of blood, since blood tends to pool in the vagina and will form a clot which comes out when you stand up or move around, and sometimes bleeding seems heavier when you are active for the same reason.
Call us if you are bleeding more than a heavy period for more than a few hours (for example repeatedly filling a pad more than once an hour).
Self Care
We recommend showering only for the first 2 weeks so the steri-strips do not come off too quickly. You do not need to use any soap or other products on the incision, just let water run over it and pat it dry. It is important that the incision is kept as dry as possible between bathing.
After 2 weeks it is ok to take a bath or submerge in water if you like.
Generally, we recommend waiting 6 weeks until you resume sexual activity or tampon use. There is certainly no harm in using tampons before 6 weeks if you are not having any pain in that area.
Restrictions
While there is no strict limit on what you should lift, we recommend not lifting anything heavier that the baby for the first 2 weeks. Get help with the car seat, baby bag and other heavy equipment for the first 2 weeks. Driving requires movements that could be harmful to the incision in the first 2 weeks so it is generally better not to drive until you come to your 2 weeks checkup. It is fine to leave the house if someone else drives and you don’t have to walk too far when you get there.
Staying confined at home increases the risk of postpartum blues and depression, so getting out and about is a good idea within the boundaries listed above. After your 2 week visit you can usually drive, carry the car set and baby bag, and do most normal activities. You can generally start gently walking (or other low impact activities) for exercise after 2 weeks. We recommend waiting 4-6 weeks before resuming a full exercise program, particularly exercise that uses the abdominal muscles.
Post-Partum Pregnancy Prevention
Occasionally patients will begin to ovulate (and therefore be fertile) as soon as 6-8 weeks postpartum. Exclusively breastfeeding patients have a low risk of pregnancy in the first 6 months but we recommend starting some form of birth control as soon as you are sexually active (condoms) if you do not want to become pregnant again right away. We will go over other birth control options with you at your postpartum visit.
Post-Partum Depression
Postpartum depression is a serious condition that generally starts 4-8 weeks after delivery. We all feel a little overwhelmed or tearful at times, but if a sad or depressed mood continues for several days and starts to affect your function (for example if you stop getting out of bed, stop taking appropriate care of the baby, or stop doing other normal activities), or if you have thoughts of hurting yourself for the baby it is important to seek immediate help.
BREASTFEEDING
Breastfeeding 101
Breast milk does not normally appear for 3-5 days after delivery. Initially the baby will be sustained by colostrum which is small in volume but high in nutrition. When your milk comes in you may feel that your breasts grow very large and firm. Occasionally you can get a low grade temperature elevation (99-100) when your milk comes in.
If your breasts are engorged (remain very full, painful and firm without milk being released) applying hot compresses, standing in the hot shower, and gentle massage can help. If you have not experienced significant milk production by the 5th day postpartum please call us so we can offer assistance.
If you feel that your milk volume is low (less than 1 ounce /hr total, or 3-4 ounces every 3-4 hours when pumping) please refer to our information on increasing milk production in the section below.
Pain Management
Mastitis
Follow Up
Pain Management
It is normal to experience some pain after any type of delivery, both vaginal and c-section. These should improve greatly as the days pass after delivery and your body heals and recovers from pregnancy and delivery. You will receive pain medications upon discharge from the hospital including ibuprofen (anti-inflammatory) and Norco (a non-codeine narcotic pain medication).
It is important to use and alternate between the two options as they treat pain and inflammation differently. It is important to use these only until you do not feel severe or intense pain. We are no longer using Tylenol with codeine (t-3) or tramadol in the postpartum period. There is concern that these medications could cause sleepiness in the newborn breastfed infant. If you do not feel that your pain from delivery is improving with the pain medications, it is important to notify us to schedule an early postpartum follow-up.
Please call us if you have a fever greater than 100, persistent very heavy bleeding, severe pain, or any other problems that we can assist with.
Mastitis
Mastitis or breast infection is diagnosed if you have a fever, redness and pain in the breast accompanied by symptoms similar to the flu-body aches, chills, headaches.
It is usually caused by the organisms in the baby’s mouth so is not infectious to the baby and you should continue to breastfeed and/or pump.
Please call us if you feel that you have mastitis so that you can start on antibiotics.
Follow Up
We would like to see you approximately 6 weeks after delivery to do a gentle pelvic exam, talk about birth control, and any other issues that you may have.
Increasing Milk Supply
Congratulations on your efforts at breastfeeding and on your new baby! This can be a very challenging yet very rewarding experience and we would be honored to help you in any way that we can.
Please understand there is no perfect answer on how to increase your milk supply, there are many reasons your milk supply may be low, and this is simply meant to educate you to options that we support and can prescribe if appropriate.
There are many non-prescription or natural products that have been utilized for many years which we also encourage.
Supplements
Medication
General
Sleep
Supplements
• Drinking plenty of fluids. You should be drinking non-caffeinated beverages and using the restroom frequently and noticing clear, light colored (dilute) urine.
• Drink mother’s Milk Tea 3 -5 times per day. Purchased at Central Market, whole foods, and A Woman’s Work.
• Fenugreek 3 capsules 3 times per day. Purchased at Central Market, whole foods, and A Woman’s Work. This is an herbal supplement that has been around for many years and is used frequently by lactation specialists. You will typically notice an increase in your milk supply in 48 -72 hours.
• Some pediatricians also suggest drinking malt. You can have this in the form of malted milk 2-3 times per day.
Medication
A prescription medication we can provide is Reglan 10mg three times per day. Many patients do very well with this medication and for some it can double their milk supply in a 48 hour period! However, if you have a history of depression or are currently experiencing symptoms of postpartum depression this is a medication that could make those symptoms worse. It can also increase fatigue and increase gastrointestinal movement (it is a GI motility agent with a side effect of increasing milk supply).
Most people do not get diarrhea but if you have a history of irritable bowel syndrome you would want to start at a low dose and increase slowly to avoid these potential side effects. Thus, it goes without saying, all medications whether prescription or over the counter, have potential side effects so we always want to be careful.
General
Increased demand equals increased supply. The more you nurse or pump and demand of your breast the more your body realizes you need to make more. Try nursing and pumping every 2-2.5 hours for 48 hours (this includes waking up at night) and then go back to your regular schedule). I know this sounds exhausting and it is, but it can reap many benefits for your milk supply.
Remember, there are also many medications that can reduce your milk supply. Some medications that are safe during pregnancy are not safe during lactation. For example, antihistamines like Benadryl , Zyrtec, Allegra, etc., these medication can dry up your milk. So please call us if you are breastfeeding and need clarification on the safety of a medication while breastfeeding.
Sleep
The last suggestion can be one of the most difficult for some people and that is to sleep when the baby sleeps.
Stress and sleep deprivation can definitely affect your milk supply and the more sleep you get and the more continuous sleep you can get (a goal of 5 hours at one time when your baby will let you) will help your milk supply.
We hope this information is helpful to you and please let us know if there is anything we can do to help you through this incredibly rewarding and bonding experience.