preconception counseling

The goal of this visit is to learn about things that can affect the pregnancy.

Learning about these potentially harmful issues will enhance chances of a healthy pregnancy and baby. Your lifestyle, diet, family and medical history directly and indirectly affect the pregnancy. Be prepared to discuss these topics in detail.

A food diary may help you and the provider identify items that can potentially harm the pregnancy. Your overall nutrition and weight status will be discussed. Being overweight or underweight may have negative effects on your body during pregnancy and create risks during labor and delivery that can be avoided with a plan. There is debate about whether certain substances may or may not cause harm to the pregnancy and in many cases, studies are limited. For example, there are many opinions about the quantity of daily alcohol consumption that is safe. This is the ideal time to discuss with your provider your opinion and understand what has been studied about this subject.

Pregnancy itself can cause a medical condition to worsen. If you suffer from a chronic condition like diabetes mellitus or Lupus, you can discuss with your obstetrician how to maximize treatment to avoid complications during pregnancy.

The amount of vitamins and minerals necessary to support a normal pregnancy differs from our needs as individuals. Specifically, folic acid consumption during a normal diet hardly ever matches what your body needs to support a normal pregnancy, therefore supplements should be started while you are planning a pregnancy, before the pregnancy arrives.

First Visit

If you think you may be pregnant, start by looking for signs and symptoms of early pregnancy. The most obvious sign is a missed period accompanied by:

Tender or swollen breasts

Excessive tiredness

Nausea

Mood swings

If you’ve already missed your period, or if it’s a few days late, take an at-home pregnancy test. If your results are positive, congratulations!! Look at the calendar and see when your last period started. That is the official first date of your pregnancy (even though you weren’t pregnant then). Count forward 40 weeks to find your due date. If you are not already doing so, start taking prenatal vitamins. Although most over the counter prenatal vitamins have the right combination of vitamins and minerals, make sure that the one you get has 800 mcg of folic acid and DHA.

The best way to protect your pregnancy is to avoid exposure to substances that can harm the baby. Refer to the next section for a list of foods, chemicals and activities that may hurt the pregnancy in the first trimester.

During your first visit, your pregnancy will be confirmed. The physician will review your medical, gynecologic and family history to help outline the individualized care that you will receive during your pregnancy.

Activities that may harm the pregnancy will be discussed to help you avoid them. You will receive a prescription for prenatal vitamins and an information packet that will outline your pregnancy care during the first trimester. An ultrasound will be performed to determine your “due date”.

Once your pregnancy is confirmed, you will be scheduled for an initial obstetrical visit, your second appointment. At this visit, you will have a full physical exam, including a pap smear, if needed. Routine and special blood tests will be ordered, along with the offering of early, non-invasive genetic screening to evaluate your baby’s risk of having a condition that may impact his/her health.

prenatal care

Pregnancy is one of the most exciting and emotional times in your life. It can also be scary for you, as you experience new feelings and worry about your developing child. A&A Women’s Health is here to answer all your questions.

Schedule

You are expected to visit our office for prenatal visits regularly during your pregnancy. Visits will take place every 4 weeks for the first 28 weeks, then every other week until 36 weeks and weekly until delivery. If you have complications or a condition that increases you pregnancy or your risk, visits take place more frequently.

labor and birth care

A&A Women’s health believes that patient’s involvement in their own birth process is the first and most important step toward a safe and satisfying delivery. We will guide all patients through every step of the labor and delivery of their precious little angel.

We know that no two patients are alike. We will treat this time with the individualized attention that every patient deserves. We will help our patients develop a delivery plan that is consistent with each individual own needs and goals. While we support women who choose an epidural for pain relief, we are also advocates of labor support doulas and natural childbirth.

One of life’s most joyous occasions is the birth of a new baby. At A&A Women’s Health, we know that every family’s birth experience is unique and every baby is a special and precious gift. Childbirth and parenting are more enjoyable and successful when you have personal attention and know what to expect.

First trimester

The first trimester is a period of major development for your fetus and of profound physical and emotional challenges for you. It is important to understand that all sacrifices made during pregnancy are worth it and will be rewarded.

You may not realize that you are pregnant until week 4 or 5, some women don’t realize until much later. This is one of many reasons why women are encouraged to plan ahead. You will have scheduled visits every month, but are encouraged to visit us as often as you need to satisfy your needs and obtain the education necessary to maintain a healthy pregnancy.

During this initial stage of pregnancy, your body will experience considerable changes. You may experience one or more of the following symptoms:

Fatigue - It is most likely that you will feel exhausted during the first trimester. Your fetus development depends solely on your body to provide all the energy, which sometimes leaves you with an empty tank. You should take plenty of time to rest. If you feel like taking an afternoon nap, try it. This may be the time to find help around the house. Your partner can help or some chores may have to be left undone.

Nausea - Everyone has heard of morning sickness. Some pregnant patients experience nausea at all times of the day. A certain smell or food may cause nausea. If you experience only slight nausea, eating smaller more frequent meals may help. Not eating can make nausea worse. Also, research shows that eating large quantities of ginger may help. Avoid certain foods and strong smells. If nausea is severe and frequent, you may need medication, so make an appointment.

Urinary Frequency - Frequency of urination is one of the most common early symptoms of pregnancy, which you may begin to experience as early as one week into pregnancy. Fortunately, it the frequency decreases during the second trimester. An increase in progesterone levels and secretion of HCG, causes the blood supply to the pelvic area increases, resulting in bladder irritation. In the third trimester, as the uterus grows, it puts pressure on the bladder, resulting in the need to pass urine more often. Near the end of the third trimester, the fetus head drops into the pelvis causing direct pressure on the bladder. This descent of the fetal head causes urinary frequency and urgency “gotta go now.”

Breast Changes Increasing levels of the hormones estrogen, prolactin and progesterone, which start very early in pregnancy, are responsible for breast tenderness (sore to touch), darker nipples breast enlargement, and heavy feeling or the feeling of fullness in your breasts.

Many of these early breast symptoms may mimic those associated with premenstrual syndrome (PMS). These are caused by a rise in the hormone progesterone.

During the first trimester, blood volume increases to help feed the growing uterus and fetus. This may cause veins on your breasts to enlarge and become more visible and bluer. Breasts may grow in size.

The nipples become larger and more sensitive and the areola may darken. Montgomery tubercles may also develop on the areola. These are small, painless bumps with antiseptic and lubricating qualities that help support breastfeeding.

second trimester

You will be seen every four weeks at this stage in your pregnancy. Patients usually feel well and maintain normal physical activity. Your pregnancy starts showing during this trimester.

At 18 to 20 weeks a full fetal anatomy, comprehensive sonogram is performed to ensure that the baby is developing normally. If the baby allows, we can see the gender, if you want to know.

A screening test for diabetes, further genetic testing and test for spina bifida may be performed. You will receive information on Stem Cell Cord Banking and guidance on what will happen as you enter the last trimester of pregnancy.

Third trimester

During this time another sonogram is performed to determine the growth, position and overall status of the baby. You are seen every 2 weeks until 36 weeks, when you are seen weekly until delivery.

A vaginal culture will be taken to screen for a bacteria called Group Beta Streptococcus. This bacteria doesn’t affect you or your partner and is part of the normal vaginal flora of 20 to 30 % of women in the US, but it may affect the baby at birth.

During the third trimester we are happy to discuss and assist you in developing a delivery plan.

Menopause

Menopause occurs when a woman’s ovaries stop producing hormones, resulting in the end of her menstrual periods. It is defined as having no menstrual periods for 12 months.  Perimenopause is defined as “around menopause.” It is also known as the menopause transitional phase. Common signs and symptoms of menopause and perimenopause are: changes in menstrual periods, hot flashes, night sweats, chills, sleep problems, vaginal dryness, weight gain and slowed metabolism, mood changes, thinning hair and dry skin, loss of breast fullness, leaking, frequency and urgency of urination and sexual dysfunction.

hormone replacement therapy

To manage menopause symptoms, such as hot flashes and vaginal dryness, women may choose to begin hormone therapy. Hormone therapy is medication that contains female hormones, estrogen, progesterone, testosterone or combinations of some or all of these hormones, to replace the ones the body is no longer making. There are risks and benefits to hormone therapy.

WHAT CONDITIONS CAN BE TREATED?

For most patients, minimally invasive techniques are the best chance for a strong and healthy recovery. Occasionally, open surgery may still be required. We will discuss the risks and benefits and alternatives of minimally invasive surgery with you as we discuss treatment options.

Some of the conditions that can be treated this way are:

• Uterine Fibroids

• Adenomyosis

• Ovarian Cysts

• Endometriosis

• Abnormal uterine bleeding

• Urinary Incontinence

• Pelvic organ prolapse

• Certain causes of infertility

• Some causes of pelvic pain

RISKS AND COMPLICATIONS

Risks and complications can occur with any surgery but are reduced with minimally invasive techniques. Risks include bleeding and the possible need for blood transfusion, infection, unusual reactions to anesthesia and damage to surrounding organs.

There is no specific “minimally invasive” procedure. Unlike other providers, A&A Women’s Health offers a wide range of minimally invasive surgical approaches, including vaginal, laparoscopic, hysteroscopic and will offer robotic gynecological surgery in the near future.

Every patient is different and some techniques are better suited for certain patients and medical conditions. What’s important to remember is that there are other options beyond traditional or open surgical techniques.