There may be no event in a woman’s life that brings as much joy and excitement, combined with uncertainty and anxiety, as pregnancy – especially when expecting a first child. Although you will no doubt receive plenty of pregnancy advice from well-meaning family and friends, it’s important to develop a relationship with an obstetrician and gynecologist (OB/GYN) as soon as possible.
“One of the most important and rewarding things that we do as OB/GYNs is help our patients have a healthy pregnancy,” says Dr. Morgan McDougal, an OB/GYN with offices in Fort Worth and Willow Park. “Privia Medical Group North Texas’ (PMGNTX) team of 59 OB/GYNs throughout North Texas have collectively delivered tens of thousands of babies.”
There are several important factors that go into the period leading up to pregnancy, the pregnancy itself, delivery and after childbirth, all of which help protect the health of the mom and the baby. Taken together, the time from pre-pregnancy to post-pregnancy is referred to as maternal health.
Why Maternal Health Matters
There has been an increased focus on maternal health in the last few years, and for good reason. The United States has the highest rate of maternal mortality of any wealthy country in the world. Put another way, an American woman is more likely to die during pregnancy, childbirth or after giving birth than a woman in many other nations across the globe.
Here are some additional facts about maternal mortality:
- The U.S. maternal mortality rate doubled between 1999 and 2019
- Black women, by far, are most at risk: Black women are three times more likely to die from pregnancy than white women
- Age is a risk factor for maternal mortality: women over age 40 are at significantly greater risk than younger women
One of the biggest risk factors for maternal mortality is not having access to prenatal care – the care a woman receives from a doctor while she is pregnant. Continued access to care in the months following childbirth is also crucial.
“For many women, pregnancy and childbirth are wondrous and joyous times. But the reality is, it can be dangerous, as well,” says Dr. Alicia Larsen, an OB/GYN in Fort Worth. “That is why maternal health care – before, during and after pregnancy is so important.”
Maternal Health Gains in Texas
Texas is working to reduce maternal mortality. Legislative efforts extended public insurance funding for postpartum coverage from two months to a full year and mandated that Managed Care Organizations explicitly designate maternal mental health providers in their directories. Additionally, more than 92% of the state’s delivery hospitals are enrolled in Texas AIM safety bundles. These evidence-based practices have successfully reduced severe maternal morbidity caused by obstetric hemorrhages.
“The North Texas Maternal Health Accelerator is backed by a $25 million philanthropic investment and partnered with the Burnett School of Medicine at TCU and UT Southwestern to launch a regional network spanning 60 clinic sites focused on improving maternal health. Many of our OB providers are leading these efforts at local North Texas Labor and Delivery Units,” explains Dr. Jamie Erwin, an OB/GYN in Fort Worth.
Preconception Health
For women who are trying to get pregnant, there are several things they can do to increase their chances of having a healthy and safe pregnancy. Of course, half of all pregnancies are unplanned – so if you’re a woman of child-bearing age, it’s still a good idea to keep these things in mind:
- If you smoke, talk to your doctor to get help stopping. Smoking is linked to birth defects.
- Alcohol use: there is no safe level of alcohol that may be consumed during pregnancy. It is best to avoid alcohol altogether if you may become pregnant.
- Focus on overall health: if you have chronic conditions such as hypertension, diabetes, asthma or obesity, it is important they are under control during pregnancy. Your doctor can help you manage all these conditions, improving your overall health and increasing the odds of a healthy pregnancy.
- Take folic acid, a supplement that helps protect against birth defects. Your doctor can advise you on how much to take.
Pregnancy & Prenatal Care
A full-term pregnancy lasts 40 weeks. Pregnancy is categorized in three stages, called trimesters:
- First trimester: 1-12 weeks
- Second trimester: 13-27 weeks
- Third trimester: 28-40+ weeks
Most women find out they are pregnant through an at-home pregnancy test. As soon as you know you are pregnant, make an appointment with your OB/GYN.
Regular visits to your doctor during pregnancy are the foundation of prenatal care; the health care you receive before delivering the baby. Access to good prenatal care is one of the most important factors in preventing maternal mortality. Prenatal care is essential to a healthy pregnancy and healthy baby.
The First Trimester – What to Expect
“It’s normal to be nervous and have lots of questions at your first doctor’s visit after finding out you are pregnant,” says Dr. Rachel Lusby, an OB/GYN serving patients in Fort Worth and Willow Park. “There is nothing to be worried about; we are here to answer all your questions and help you have a healthy pregnancy.”
In addition, you can expect the following at your first prenatal visit to your doctor:
A discussion about:
- Personal medical history, especially any previous pregnancies or gynecological conditions
- Family medical history
- All prescription and over the counter medications you take, as well as any supplements
- Lifestyle: your diet, exercise routine, whether you drink alcohol and caffeine or smoke
- The kind of work you do and if it requires travel
Establishing a due date for your baby
Your doctor can calculate this based upon when your most recent period started. While most women will not give birth on their precise due date, this is helpful for you and your doctor to know as you track stages of the pregnancy
A physical exam
Your doctor gets your height and weight, takes a blood pressure reading and may administer a Pap test, if it has been a while since your last one. Your doctor may test other aspects of your health, including your heart, lungs and thyroid
Lab tests
The doctor will likely order lab tests to check for various conditions
Discussion
You’ll discuss lifestyle adjustments during your pregnancy, such as exercise, diet and travel, as well as anything else on your mind.
During the first trimester, you will visit your doctor every four weeks for a checkup. These follow-up visits will generally not be as long or involved as the initial visit, but the doctor will always check your weight and blood pressure, measure your abdomen, check the baby’s heart rate and address any concerns or questions you have.
Morning Sickness & More
You may find that pregnancy brings lots of changes to your body throughout the first trimester. These are normal. Some of the most common side effects in the first trimester include:
- Morning sickness (nausea)
- Constipation
- Feeling tired
- Headache
- Mood swings
- Heartburn
- Cravings for/avoidance of certain foods
- Tender breasts
Second & Third Trimester Prenatal Care
Doctor visits continue every four weeks through the second trimester, as your physician continues to monitor the development of the baby and helps you manage any challenges you may be having.
Your doctor will perform ultrasounds periodically to check the baby’s development. By the 20th week, if not earlier, you can find out the baby’s sex, if you wish.
In the third trimester, office visits increase to every two weeks and ultimately every week. At this time, your doctor is preparing for delivery and conducting additional tests to monitor your baby’s development.
This is the time when your doctor may advise you to get additional vaccinations, such as flu, COVID-19, RSV and Tdap. These are recommended to protect both you and your child from preventable diseases.
As in the first trimester, your body will continue to adapt to the pregnancy and prepare itself for giving birth. Common symptoms in the second and third trimester include:
Second Trimester:
- Weight gain
- Muscle aches
- Patches of dark skin
Third trimester:
- Shortness of breath
- Frequent need to urinate
- Lower back pain
Again, all these symptoms are common and normal.
“As an expectant mother, one of the most important things you can do for your baby’s health and your own is to make every one of your scheduled prenatal visits,” says Dr. Lindsay Breedlove Tate, an OB/GYN in Fort Worth and Willow Park. “Not having access to prenatal care is one of the leading causes of pregnancy complications. And at every visit, please ask us all the questions you have! We are here to answer them and make your pregnancy as smooth as possible.”
The third trimester is also a good time to research pediatricians. You will feel less rushed after delivery if you already know who will be checking up on your newborn.
Keys to a Healthy Pregnancy
One of the most important aspects of prenatal care is your doctor and health care team giving you guidance on how to stay healthy during your pregnancy and give yourself the best opportunity to deliver a healthy baby.
Maintain a Healthy Weight
It’s normal and natural for women to gain weight while pregnant. A woman who is normal weight prior to becoming pregnant should gain between 25 to 30 pounds during pregnancy. Your doctor will give you specific guidance on weight gain and what you should expect.
Maintaining weight within the recommended range is important for the health of the mother: research suggests that women who gain more than the recommended weight and do not lose it within six months of giving birth are at higher risk of obesity ten years later. The keys to avoiding unhealthy weight gain are eating right and getting enough exercise.
A Healthy Diet
There is a lot of advice and information out there about what a pregnant woman should eat and what she should avoid. Your doctor will give you specific advice on what is best for you and your baby, but here are some general guidelines:
Healthy “eating for two”
It is true that a pregnant woman has to feed herself and the baby that is growing inside her. But “eating for two” should not be interpreted as consuming twice the number of calories as normal; in general, a pregnant woman should be consuming an additional 300 calories per day.
It’s important that those calories be healthy and beneficial; eat plenty of vegetables, fruits and whole grains. Foods high in fiber, calcium and iron and low in sugar and saturated fat are most beneficial.
Try to avoid foods with “empty calories” – those that provide no nutritional value to you or your baby but will contribute to weight gain. Soft drinks, candy, cookies and ice cream fall into this category.
Thoroughly wash fruits and vegetables to remove bacteria and any pesticides that may be present. It is also very important that meat be cooked completely to ensure food safety – in other words, no medium or medium rare steaks until after the baby comes.
Fish
Pregnant women should avoid certain fish known to be high in mercury. This includes swordfish, tilefish, king mackerel, bigeye tuna, orange roughy, marlin and shark.
However, many types of fish are quite beneficial to a pregnancy, due to their high omega-3 fatty acid content. Omega-3 fats promote heart health in all people, and research suggests they may combat depression in pregnant women, as well as promote brain and eye development in the baby.
Experts recommend eating a variety of fully cooked, low-mercury fish, between 8-12 ounces per week. Exceeding 12 ounces per week is not advised, as this could lead to an unacceptably high level of mercury intake.
Stay hydrated
Drink plenty of water. A general guideline is to drink ten cups of fluid per day to stay properly hydrated. This will also help reduce the risk of conditions that sometimes occur during pregnancy, including constipation, hemorrhoids, and urinary tract and bladder infections.
Caffeine
It is safe to consume under 200mg of caffeine a day, equivalent to 12 oz of coffee.
No alcohol
Just as in pre-pregnancy, it’s very important to avoid alcohol while pregnant. There is no safe amount of alcohol that can be consumed while pregnant.
Vitamins and minerals
Taking a pre-natal vitamin high in folic acid throughout pregnancy remains important. Additionally, pregnant women need to consume more calcium, iron, Vitamin A and Vitamin B12 than they normally would.
Exercise
During pregnancy, it’s important to stay active and get regular exercise. Moderate-intensity aerobic activity throughout the week is recommended. Getting at least 2.5 hours of physical activity per week will help maintain a healthy weight, keep your body and mind feeling good, and may contribute to an easier delivery and faster recovery. Additionally, exercise may reduce the risk of pregnancy complications.
Other Health & Safety Tips
Here are a few other things that women should be mindful of when pregnant:
- Avoid x-rays: Avoid x-rays whenever possible. It’s important to maintain good oral health before and during pregnancy but be sure to let your dentist know you are pregnant and ask for x-rays to be postponed until after you give birth.
- Wear your seatbelt: It is safe to wear a seatbelt while pregnant, both in a car and on an airplane. Many domestic airlines allow women to fly up through the 36th week of pregnancy, though some carriers restrict travel as early as 28 weeks.
- Avoid: Pesticides, solvents and second-hand smoke.
Pregnancy Warning Signs
While pregnancy brings lots of changes to a woman’s body, some pregnancy side effects are not normal and require immediate care.
Any of the following is reason to seek medical attention immediately:
- Persistent headache
- Dizziness or fainting
- Vision changes
- High fever (100.4 degrees or more)
- Severe swelling in hands or face
- Thoughts of self-harm or harm to your baby
- Difficulty breathing
- Chest pain or racing heartbeat
- Severe nausea/vomiting
- Severe belly pain
- Baby’s movement stops or slows (there is not a “normal” amount of movement, but being able to notice changes is important)
- Significant swelling or redness in legs or arms
- Vaginal bleeding or leaking fluid
Gestational Diabetes
Sometimes, women who have no history of being diabetic develop diabetes while pregnant. This is known as gestational diabetes.
Pregnancy hormones increase blood sugar levels in the body. If the body is not producing enough insulin, gestational diabetes can result. This condition can complicate childbirth and poses risks for the mother and child.
Most women are screened for gestational diabetes in the second trimester. If gestational diabetes is diagnosed, your doctor will work with you on dietary and exercise modifications and may prescribe medicine to help manage the condition
Gestational diabetes goes away after childbirth, but it also increases risk for the mom developing Type 2 diabetes later on.
High Blood Pressure
High blood pressure, or hypertension, is another common health risk during pregnancy. For woman who have hypertension before becoming pregnant, it is very important to follow your doctor’s instructions on the best way to manage your blood pressure to protect your and your baby’s health.
Some women have normal blood pressure before becoming pregnant and then develop hypertension during pregnancy. This is called gestational hypertension.
High blood pressure during pregnancy is defined as a reading of 140/90 mm Hg (in two readings, at least 4 hours apart). Severe high blood pressure is defined as 160/110 mm Hg in two readings.
Preeclampsia
Sometimes, hypertension during pregnancy can lead to preeclampsia, which is one of the top causes of pregnancy-related deaths. This condition occurs when a woman with hypertension (either pre-existing or brought on by pregnancy) has protein in urine or other complications after the 20-week mark.
If your doctor believes you may be at risk for preeclampsia, he or she may recommend low dose aspirin.
Preeclampsia symptoms include:
- Headache that won’t go away
- Vision changes, including blurry vision
- Pain in the upper abdomen
- Nausea/vomiting
- Swelling in hands or face
- Difficulty breathing
Labor & Delivery
As your delivery date approaches, you will likely notice indications your body is preparing to have a baby! These include:
- The baby dropping to the lower part of your pelvis, also called “lightening”
- Feeling a sudden rush of energy
The following are signs it’s time to call your doctor. It may be time to come into the hospital:
- You experience contractions (the tightening of the uterus) that are increasingly strong and/or at more frequent intervals
- Your water breaks – this can happen as a sudden gush or a gradual trickle
- Cramping or lower back pain that will not go away
At the hospital, your doctor can give you medicine to alleviate the pain, though some women decline this option. In some circumstances, the doctor may induce labor – this is usually done if the mom is past her due date or there is some other factor at play.
In some cases, the doctor will recommend delivering the baby through Caesarian delivery, commonly called a c-section. In this procedure, the baby is surgically removed from the mom through her abdomen.
Most healthy women can deliver their baby vaginally, but c-section is an option if the mom or baby’s circumstances necessitate. This is also a decision that the doctor and patient have likely made together earlier in the pregnancy.
No matter how your baby is delivered, your doctor and health care team are there to support you and your child every step of the way.
Post-Delivery
After childbirth, your focus turns to caring for your newborn and experiencing the wonder and love he or she has brought into your life. You also want to continue taking care of yourself. You’ll likely experience soreness for a while. The physical impacts of childbirth will subside, but your doctor can help you manage any pain or side effects you are experiencing.
Some women experience mood changes or depression after giving birth. Lean on your family and friends for support if you are experiencing feelings of sadness or anxiety. These feelings usually go away after a couple of weeks, but if they last longer and become severe, talk to your doctor. Postpartum depression impacts some new mothers and is nothing to be ashamed of – but it is something to be treated by your doctor.
All new moms should call or visit with their doctor a couple of weeks after delivery to touch base on how they and the baby are doing and to ask any questions you have.
Your OB/GYN will want you to come in for a post-delivery checkup 6-12 weeks after giving birth. You’ll get a comprehensive post-partum exam at this visit and discuss how you are feeling, how you’re sleeping, how you are adjusting and address any questions you have.
The year after giving birth is a critical time for a mother’s health. Your established relationship with your physician is the foundation for a healthy post-pregnancy.
Maternal Health Care Matters
Pregnancy and childbirth are miraculous and incredibly special times in a mother’s life. They can also be stressful and challenging for the body and the mind. No two pregnancies are exactly alike, just as no two women are exactly alike.
That’s why it’s vital that every expecting mother has a trusted relationship with an OB/GYN who will guide them from preconception through pregnancy and delivery and post-partum care.
If you don’t have an OB/GYN and are thinking about starting a family, please give one of our doctors a call today. They would love to help you bring your child into the world.
This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.
This article contains information sourced from:
Office on Women’s Health, U.S. Department of Health & Human Services
