Obstetrics

I’m Pregnant! Now What?

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Outline of OB Visits

Initial OB visit-

At your first visit we will orient you to our practice, review your medical history, and discuss any current concerns that you are having. We will provide routine pregnancy counseling and education and answer any questions that you may have. You will have a transvaginal ultrasound to confirm the dating of the pregnancy. Lastly, you will have your initial prenatal labs drawn, and will have a full physical exam, with a pap smear, if needed.

Follow up OB visits-

All follow up visits include the assessment of blood pressure, weight, urinalysis, baby’s growth, and fetal heart sounds. Below is a schedule for the routine OB appointments. If at any point you feel like you need to be seen by a provider, please do not hesitate to call and speak with our staff so we can address your needs and concerns.

Routine OB schedule-

-Up to 28 weeks – appointments every 4 weeks

-28-36 weeks -appointments every 2 weeks

-36 weeks until delivery – appointments every week

Labs & Testing

Initial OB visit-

The routine prenatal lab panel consists of routine blood count, a test for rubella antibodies, the pap smear, genital cultures, a test for syphilis, hepatitis B, HIV, blood type and antibody screen. Other testing if necessary might include a sickle cell screen. The American College of Obstetrics and Gynecology and The American Academy of Pediatricians recommends routine HIV testing in pregnancy.

Follow up OB visits-

  • Anatomy Ultrasound:  We offer an ultrasound to all patients between 18 and 22 weeks.  This gives an opportunity to take a detailed look at how the baby is developing, and to detect any abnormalities.  It is at this ultrasound that a patient can find out the gender of the baby, if the genitals can be clearly seen by the sonographer.
  • Glucose Challenge Test:  The likelihood of developing diabetes increases during pregnancy therefore we will perform routine screening at the 24-28 week visit. 
  • Group Beta Strep:  This is a test done between 35 and 36 weeks.  This culture is looking for bacteria called beta strep.  It is a normal bacteria that is sometimes found in our bodies.  If you are a carrier, we will treat you with IV antibiotics during labor.

Additional testing and follow-up may be indicated and a provider will discuss this with you as needed throughout the pregnancy.

Medications in pregnancy

Call your doctor if:

  • You can’t keep liquids down for 12-24 hours
  • You have abdominal pain, dizziness, extreme weakness
  • You have a fever of 101 degrees or higher
  • You develop a rash
  • You experience pain or burning with urination

*DO NOT use products that contain phenylephrine or pseudoephedrine*

Below is a list of medications approved to treat common ailments during pregnancy. We only recommend taking medication during pregnancy if necessary.

COMPLAINT MEDICATION ALTERNATIVE REMEDY
Colds/Congestion Oral decongestants (guaifenesin)
1st trimester: Tavist (plain) Afrin spray (3 days) No Sudafed
2nd trimester: Tylenol Cold, Actifed, Triaminic (all types), Benadryl, Claritin(plain)
Drink at least 80 oz. fluid daily and use vaporizer or humidifier; Breathrite Strips (anytime)
Sore Throat/Cough Throat sprays, lozenges, Zyrtec 2nd trimester: Robitussin, Triaminic Honey and lemon, tepid fluids
Headache/Fever Acetaminophen (Tylenol). Avoid aspirin, ibuprofen, and naproxen Take a nap, cold compress to head or back of neck
Nausea/Vomiting Emetrol, Pepto Bismol, vitamin B6 50mg twice a day and 50mg at bedtime Eat saltine or whole wheat crackers before getting out of bed. Use seabands
Diarrhea Kaopectate, Imodium Increase fluid intake, avoid high fat, spicy foods
Indigestion Antacids, Titralac, Mylanta, Tums, Maalox Avoid high fat, spicy foods, eat smaller, more frequent meals; drink fluids between meals
Constipation Stool softener- Colace (docusate) or fiber laxative (avoid stimulant laxatives)- Metamucil, Citrucel Drink at least 80 oz water daily; increase exercise; increase intake of fiber (prunes), fresh fruits, and vegetables
Frequent Urination   Avoid coffee and tea
Hemorrhoids Anesthetic ointment, preparation H, tucks Warm sitz bath

Nutrition in Pregnancy

Most women only require 300 extra calories per day during pregnancy. Extra nutrients needed during pregnancy include iron, folic acid, and protein. Some of these may be obtained with a prenatal vitamin supplement.

Some iron rich foods include poultry, pork, eggs, green leafy vegetables, sweet potatoes, enriched cereals/breads/rice, green beans, and black beans. Some protein rich foods include chicken, turkey, steak, eggs, pinto beans, nut butters, Greek yogurt, cottage cheese, milk/soy milk, and string cheese.

Due to the common occurrence of nausea and vomiting in pregnancy, especially during the first trimester, some pregnant women find it very helpful to eat smaller more frequent meals throughout the day versus 3 large meals.

Foods to avoid:

-Unpasteurized milk or soft cheeses

-Unpasteurized/cold pressed juices and kombucha

-Prepared meats, like hotdogs, and deli meats, unless they are heated until steaming hot

-Raw or undercooked meat, poultry, shellfish

-Shark, swordfish, king mackerel, tilefish

Seafood that is low in mercury, including shrimp, canned light tuna, salmon, and catfish ARE SAFE to eat during pregnancy. You can safely eat 2 servings, or 12 oz. of these fish per week during pregnancy.

Exercise during pregnancy

Not only is exercise safe in pregnancy, but it is recommended that all healthy women should begin or continue moderate aerobic activity during pregnancy! Guidelines recommend exercising at least 30 minutes per day. A good rule of thumb for intensity or exertion level is still being able to speak in short sentences while exercising.

Exercise has many benefits for your pregnancy and overall health! Walking, swimming, stationary cycling, and aerobics are just a few examples. Activities with a high risk of falling or abdominal injury should be avoided during pregnancy. Some examples of this are snow and water skiing, horseback riding, and other contact sports.

After the 1st trimester avoid exercises that require you to lie flat on your back for long periods of time.

Caffeine in pregnancy

Caffeine intake should be limited to 200mg or less each day. This is the equivalent of 1-2 small cups of coffee per day. Be mindful that all coffee is not created equally and some varieties may contain different amounts of caffeine. Caffeine is also present in many sodas, teas, chocolate, and some medications. Check labels with the nutritional information and caffeine amounts.

Although studies are limited, excessive caffeine intake can affect your baby’s ability to grow well, or be smaller than average. In addition, there is a very small increase in miscarriage with large consumptions of caffeine, thus the restrictive recommendations to 200mg/day.

Immunizations during pregnancy

Immunization is an essential part of care for adults, including pregnant women. The American College of Obstetrics and Gynecologists recommend the following vaccines during pregnancy:

-Influenza

-Tdap

-COVID-19

There are many vaccines that are not safe during pregnancy and therefore may not be given during pregnancy including MMR and Varicella vaccines.  Please consult your provider before receiving a vaccine during pregnancy.

I think Dr. Grana and her assistant (Mandy) are the best. I have been going to TP4W for years – at least 20, and I have never been disappointed with the level of care I have received. I can be a challenge as my level for pain tolerance is low and they put up with me! I can’t help but highly recommend the practice to anyone looking for exemplary women’s healthcare.

Love love love Dr. Grana and her crew. Love going to Holly Springs office. The girls are the best from Lisa at the front desk to all the girls in the back. Your music and atmosphere is great. Thanks for making these appointments fun!! Yes believe it or not, fun!!!

Dr V and the office staff were all very professional, understanding, caring and very efficient. I would be happy to recommend this practice to friends, family and associates. – Barbara M. Lucas

My visit was great! & my past visit have all been great.Kristy helped me even with me being a bit stressed & in a hurry because I had to be seen & my job is super strict. Her urgency to get me seen was phenomenal. I even got to see Heather, she’s awesome & amazing. She helped deliver my baby girl a year ago. My whole family loves her and Dr Sheshadri. We actually can’t wait to get pregnant again hahaha. Everyone treats you with respect and always makes sure your okay & answers whatever questions you have before you leave. Even leaving a message for the nurses,they get back to you so quickly.  This practice really makes you feel taken care of.  We appreciate you all!  – Erika Hooks

My experience with the TP4W staff has been top of the line.  They helped me through three pregnancies and coached me through every step of the way.  Eternally thankful I chose TP4W.  – Britney

TP4W have such amazing doctors, midwives and nurses.  I cannot say enough about Dr. Grana and the rest of the staff for all the help, advice, guidance and medical care they provided me with all of my kids.  She made me feel safe and calm through both c-sections.  My routine care and pregnancy care have always been top notch and I would recommend them to anyone looking for an OBGYN.  – Brooke

We were honored to receive a hand written note..

Dr. Grana, Angie, Jessica, Heather, April, Sarah and the rest of the staff –

Thank you all so much for taking such good care of me through both of my pregnancies and births, especially my latest one on 10/29! most of yall know how nervous I was from having gone through a lot (to say the least) with my first in 2016. You all made me feel so comfortable and at ease before, during and after. And going through a touch year with my dad, you guys always asked how he was doing at every appointment, which was so thoughtful and beyond your job description. I know that you all see many women go through what i did each and every day and deliver many babies and perform many c-sections. But I hope you know how special Ruby’s delivery was to me. You all have amazing jobs! I cannot thank you all enough. Merry Christmas!

Love, Lucy

I have been going to TP4W since 2010/11 and could not be happier.

The staff, nurses, midwives, and doctors are all amazing. I have 2 sons, both delivered via cesarean by Dr. V. Every visit and every provider did everything in their power to give me the birth experience I wanted, and also ensure that myself and my babies were safe and healthy. Dr. V even did everything in his power to help me avoid my first c-section and VBAC with the second, but that turned out to be out of his hands and he was the absolute best surgeon. With my two pregnancies, I experienced a few scares and some unusual circumstances that would be too long and too private to write in a review, but every single hurdle was handled with grace, honesty, and professionalism. I am so thankful for the recommendation from a friend to come to this office. I can’t imagine ever going to another practice.

TP4W is amazing and I am so very thankful I found them 9 years ago!! Amazing partnership between midwives and doctors, sweet nurses and front end staff, and relaxing environment. I literally recommend them to all my friends! I look forward to my appointments and feel like I’m going to catch up with old friends.

I’ve always had wonderful experiences at TP4W. Everyone is friendly, knowledgeable, and thorough in their care. April delivered my son and I can’t say enough wonderful things about her. She is patient and compassionate. I had the best labor and delivery experience thanks to her. I do and will continue to recommend them to my friends and family!