Most Commonly Asked Questions
FAQ - Obstetrics
What about sex?
Sex is safe in pregnancy unless you have complications such as bleeding, preterm contractions, or a low-lying placenta. While sex may make you have mild contractions, it will not make an otherwise healthy pregnant woman go into premature labor. Unless we tell you otherwise, continue your normal sexual practices if you want to.
Can I paint my baby’s room?
Inhaling volatile paint fumes is not good for any human, pregnant or not. While normal casual exposure to paint does not cause birth defects, use good judgment if you are painting and make sure the room is well ventilated.
Can I travel?
If you have an uncomplicated pregnancy, it is safe to travel until you are likely to go into labor. We generally recommend staying close to home after 36 weeks, and not leaving the country in the third trimester (after 28 weeks) unless absolutely necessary. Flying is safe in pregnancy but may increase your risk for blood clots, so wear support hose on long flights and move about the cabin once an hour. With long road trips make frequent rest stops to stretch your legs and maintain circulation.
Which vitamins and supplements should I take?
Folic acid is a B vitamin that has been shown to reduce the risk of spina bifida. 1 mg (1000 micrograms) is recommended during the month prior to pregnancy and for the first 2 months after conception to reduce this risk. More folic acid may be recommended if you have a personal or family history of spina bifida including a prior affected child.
A prenatal vitamin is a general multivitamin with 800-1000 micrograms of folic acid, as well as calcium and iron. Most women continue their vitamins after the second month to help reduce anemia and make up for any imperfections in diet. If you are not anemic and eat a well-balanced diet, stopping prenatal vitamins at 2 months of pregnancy is acceptable.
After 12 weeks the baby begins to make bone and will draw the necessary calcium from your bones. To prevent bone loss 1000-1500 mg of calcium is recommended. This equates to 4-5 servings of milk, yogurt, or non-dairy alternatives such as almond milk or soy milk. Since this is difficult to consume, we suggest that you take a calcium supplement (usually 500-600 mg) to make up the difference. Don’t take calcium and iron (in the multivitamin) at the same time as they can offset each other’s absorption.
If you eat fish 3 times weekly you are getting plenty of Omega-3 fatty acids, or Essential Fatty Acids (EFAs). If not, take a supplement containing 200mg of DHA (from fish oil or flax seed oil). There is a growing body of evidence that EFA deficiency may contribute to a number of pregnancy complications including preterm labor and pre-eclampsia. EFAs may help fetal eye and brain development, improve mom’s skin, maintain hair and nails and are passed into the breast milk.
Should I have the baby tested for Down’s syndrome and other diseases?
There are several genetic tests that will be discussed and recommended during your pregnancy. The American College of Ob/Gyn (ACOG) and the American College of Medical Genetics (ACMG) recommend genetic testing for all pregnant patients. During the first trimester, you will be offered a panel of fourteen genetic tests representing the most common inherited recessive diseases which could potentially affect your baby. Recessive diseases require one copy of the gene to come from each parent for the disease to be expressed and carriers of a single copy of the gene are unaffected, so if your test is positive, we will recommend testing your partner.
Some examples of the most common diseases covered in the panel are cystic fibrosis (CF), spinal muscular atrophy (SMA), Fragile X, and Tay-Sachs disease. CF is a disorder that causes severe lung and digestive problems and significantly affects the lifespan. SMA is a neurologic disease which affects the muscles of the body and usually causes death prior to the age of 2. Fragile X Syndrome is the most common form of genetic intellectually disability in boys. Tay-Sachs disease causes progressive degeneration of nerve cells and usually results in death by the age of 4.
Can I go to the dentist?
Routine dental work is safe during pregnancy, and we encourage you to keep up with your normal dental health routine. Most dentists will require a note from us saying that the visit is safe, and we can give you a standardized letter to take to your visit. If you need extensive dental work, we can discuss the best options for medications with your dentist.
How do I register at the hospital and take a tour?
You can register online at The Woman’s Hospital , click on “on-line pre-registration” (in the “patients and visitors” section). If you would like to schedule a tour or a class, the schedule can be found on the website under “patient education” (also in the “patients and visitors” section).
Who will deliver me?
You may be delivered by any of the doctors in our call group. Our doctors share a call schedule for nights and weekends, and each doctor is responsible for deliveries and surgeries at the hospital on one day of the week. If you would like to be sure that Dr. Middleton delivers you, she may offer induction at full term (on or after 39 weeks) on a day that she is on call.
Who will my baby’s doctor be?
You will need a pediatrician with privileges at The Woman’s Hospital of Texas to see your baby before discharge. If you do not have one already, we will recommend some excellent doctors for you to consider (look at the online form called “referral list”). Some patients like to meet and interview the doctor before delivery, or you may be comfortable meeting the doctor when he/she comes to see your baby in the hospital. After discharge, the first visits with the pediatrician are usually at 2 weeks of life, and you can make this appointment as soon as the baby is born.
Should I get an epidural?
This is a personal choice, but in our practice the great majority of patients do opt for an epidural. Epidurals are a very safe and effective means of controlling the pain associated with childbirth. Complications from an epidural are extremely rare and often easily corrected (such as a severe headache). You do not have to make any arrangements for an epidural prior to your delivery day. Anesthesiologists are available 24 hours a day to help you whenever you request their services.
Can I deliver vaginally after a C-section?
Vaginal birth after C-section (VBAC) is offered, but only in the right patient. There is a 1% risk that when a mother is in labor with a C-section scar on the uterus, the scar could open up and expel the baby and the placenta into the mother’s abdomen. This is called a uterine rupture and is a catastrophic emergency which can result in the death or permanent disability of the baby, as well as serious complications for the mother including severe blood loss and hysterectomy. As a mother myself, this 1% risk is too high when it comes to a baby’s safety, when not attempted in the right patient. After all, we go to enormous lengths to prevent much rarer events such as injury in a car accident (using car seats) or exposure to life threatening illnesses (getting vaccinations), for example.
Will I have an episiotomy?
There is no evidence that routine episiotomies are beneficial, and we try to avoid them. At times your doctor may decide that it is safer to make a small episiotomy than to risk a large tear, but this decision is not made until the baby’s head is partially delivered. There are variable factors that we cannot control including the size of the baby and your body’s ability to stretch, which ultimately affect your ability to deliver without an episiotomy. It is less likely that you will have an episiotomy with each successive pregnancy.
Should I collect my baby’s cord blood?
Blood from your baby’s umbilical cord contains stem cells, which may be collected and stored after the baby’s birth. Stem cells have numerous current and possible future medical uses that warrant consideration. At present there is no public banking system, but you can pay a private company to store it for you. If you are interested in cord blood collection, visit the websites of Cord Blood Registry and Viacord to learn more. We can give you the necessary collection kits in our office if you decide to proceed.Blood from your baby’s umbilical cord contains stem cells, which may be collected and stored after the baby’s birth. Stem cells have numerous current and possible future medical uses that warrant consideration. At present there is no public banking system, but you can pay a private company to store it for you. If you are interested in cord blood collection, visit the websites of Cord Blood Registry and Viacord to learn more. We can give you the necessary collection kits in our office if you decide to proceed.
When should I call the doctor? How do I contact my doctor in an emergency?
If you have a true emergency that cannot wait until the office reopens (if you are in labor, for example) our office number will prompt you to connect to an operator who will page the doctor on call. While we are always available in emergencies, we ask you to use your judgment and not disturb the doctors after hours with matters that can be dealt with the next business day.
If you are worried or not sure if you are in labor, it is always best to call. If you feel that you need to go to the hospital at any time, please call us first so that the doctor on call can advise you and let the hospital know that you are coming. During business hours you can always email a nurse with non-urgent questions.
Examples of reasons to call the 24-hour emergency line in the first and second trimester include heavy vaginal bleeding, persistent cramping, severe pain, fever higher than 101.0 F, or vomiting that is preventing fluid intake for more than 24 hours.
What can I expect at my appointments?
If you have a normal pregnancy your scheduled visits will be monthly until 30 weeks, then every 2 weeks until 36 weeks, then weekly until delivery. At each visit we will record your weight and blood pressure, check your urine, listen to the baby’s heartbeat and assess the baby’s growth.
We do our best to be on time but occasionally the doctor is delayed due to unpredictable events. Bring a book to your appointments, as we cannot predict when this may happen. We will do our best to inform you of the delay if there is one.
Some appointments will include specific events as follows:
1st Visit from last period. A pelvic exam and pap smear will be done as well as tests for vaginal infection. A standard panel of blood tests will be done to check your blood type, blood count, immunity to Rubella, as well as tests for exposure to HIV, hepatitis, and syphilis. An ultrasound will be done to confirm your due date and check for viability. First trimester screening for Down’s syndrome and other chromosomal abnormalities will be offered.
The test for recessive genetic diseases will be offered and a sample will be collected. Other necessary tests based on your individual health assessment will be done.
What medications can I take?
Please refer to our medication list at the end of this document to see safe choices for medications in pregnancy. If you need a medication that is not on the list, please email us during business hours for advice.
There is no medication considered to be 100% safe for long-term use in pregnancy. Each medication carries risks and benefits. Therefore, it is recommended that you:
- Limit the use of medication unless you are severely impaired, or the medication is recommended by your doctor.
- Minimize the number of days or doses taken.
These medications are generally safe choices for:
Increase your fluids and rest. Report a fever over 101.0.
- Tylenol or Extra Strength
- Mucinex DM.
- Saline Nasal spray.
- Robitussin DM, and/or Cough Drops
Increase fiber and fluids in your diet
- Milk of Magnesia
Report any headache not relieved by Tylenol
Extra Strength Tylenol
- Prilosec OTC
- Anusol Cream or Suppositories
- Preparation H
- Witch Hazel
- Dom Burrows soaks
- Zovirax cream
- Vitamin B6 (25 mg) 4 times a day
- Ginger in any form
- Unisom (will make you sleepy)
- Dramamine for motion sickness
Warm salt water for gargling
Chloraseptic throat spray
Tylenol for pain
- Calamine lotion
- Any topical steroid including hydrocortisone
- Neosporin Ointment
- Any benzoyl peroxide products
FAQ - GYNECOLOGY
What If I Have Medical Conditions Such as Diabetes or High Blood Pressure?
We typically will ask for a “Medical Clearance” from your doctor to ensure that you are in good health before undergoing surgery. We will also have you meet with our Anesthesia team prior to your surgery date to review your medications and health records.
What If I Smoke? Do I Really Need to Quit Prior To Surgery?
It is highly encouraged to quit smoking 2 to 6 weeks before surgery. Smoking may cause breathing problems during surgery and has been shown to delay the healing and recovery process.
I Am Sick the Week of My Surgery; Do I Need to Cancel?
If you have any unexpected medical problems before your scheduled surgery, such as a fever, cold, cough or flu please contact the office immediately as your surgery may have to be rescheduled.
How Do I Take Care of My Incision When I Get Home?
Try to keep your incision clean and dry. You may shower after 24 hours from your surgery. Do not soak or bathe.
Signs or symptoms to call the office about:
- any redness or warmth around the incision
- any drainage or pus from the incision
- if the incision is starting to open
- if the incision is exquisitely tender
- if you have a fever
What Should My Level of Activity Be When I Go Home?
In the first 24 hours after your surgery:
- Do not drive or operate power equipment and do not engage in activities that require coordination for the ability to respond quickly. You may walk, ride in a car, or climb stairs after your surgery.
- Rest the first day home. You may resume light activity the next day. You may feel weak or tired for a few days after your surgery. Increase your activity as tolerated.
- Do not do any heavy lifting or vigorous exercise for a week or two (if you had a laparoscopy), or for 4-12 weeks if you had a hysterectomy or prolapse surgery, as directed by your surgeon.
- There are no restrictions on activity after a D&C or ablation.
- You may drive when you can control the car fully and are not taking any narcotic pain medication.
- Please abstain from sexual intercourse until your two-week follow-up appointment where further activity instructions will be given.
- No tub baths, hot tubs, or swimming until you see your doctor for your 2–3-week postoperative check. Showers are okay.
- Activity, such as walking, can help bowel function return to normal and decreases the chance of postoperative blood clots.
- Avoid tampon use until you see your doctor for your 2–3-week postoperative visit. No touching.
- You may return to work when you are released to do so by your surgeon.