FAQs
How do I get referred to the Primary Care Obstetrical Clinic?
You can be referred to the clinic by your family physician or by a walk-in clinic. Please have your initial blood work and dating ultrasound ordered by your physician prior to your first visit.
When should I be referred?
Ideally we prefer referrals to be made by 10 weeks gestational age.
Please obtain a dating ultrasound between 7-10 weeks and ask your physician to send you for the 1st prenatal visit labwork on the forms download page. If you are over 35 years at the time of delivery, ask for a nuchal translucency ultrasound.
If you are referred later in your pregnancy your family doctor will care for you until you have been transferred to our clinic.
To calculate how far along you are in your pregnancy you can use the B.C. Prenatal Genetic Screening’s Pregnancy Dating Tool. http://www.perinatalservicesbc.ca/health-professionals/professional-resources/edd-calculator
What happens at my 1st visit?
You should plan to be at the clinic for approximately 1 – 1.5 hours.
Our nurse will review your medical history with you and then you will see the doctor for your exam. Any missing lab tests or ultrasounds will also be ordered.
We charge a one-time fee of $40 to cover administrative costs that are not covered by the medical services plan.
As we are affiliated with the Royal Columbian Hospital, we have medical students and residents working closely with us from the UBC Medical School. If you would prefer not to be seen by them, then let the front staff and nurse know ahead of time.
An excellent website with practical information and reliable resources for women, expectant parents, and families with babies and toddlers up to 2 years of age is available at: http://www.fraserhealth.ca/health-info/pregnancy-and-babies/
What blood tests will be offered?
Hopefully, your blood tests should have been done when you see us for the first time.
If not, we may request the remaining prenatal blood tests including: CBC (complete blood count), Blood Type and group, Rubella (German Measles) titre to check immunity, Hepatitis B and C testing, HIV test, Syphilis test, TSH (for thyroid function) and VZV (for chicken pox immunity). If you have contact with cats you should also consider being tested for Toxoplasmosis immunity.
There are optional screening blood tests offered to evaluate your risk of chromosomal abnormalities and neural tube defects. These are called the Serum Integrated Prenatal Screening (SIPS) tests and are time sensitive. The first blood test is done at 9 to 13+6 weeks (ideal time is 10 – 11+6 weeks) and the second blood test is done at 15 to 20+6 weeks (ideal time is at 15+2 – 16 weeks). If you will be over 35 years at the time of delivery, you also qualify for a NT or nuchal translucency ultrasound which measures the fetus neck fold width. – see ultrasound information below. For more information on prenatal screening please visit www.bcprenatalscreening.ca.
At 24-28 weeks it is recommended that you have a test for gestational diabetes. This is a one hour glucose tolerance test which is non fasting. You will be given a 50g glucose drink and a serum blood sugar level is drawn after one hour. At the same time you will have your hemoglobin checked to rule out iron deficiency anemia. If the one hour glucose tolerance test is abnormal, you will need to go back and do a 75g 2 hour sugar test. If the 2 hour sugar test is abnormal, then you would be referred to the diabetes clinic.
What other tests are recommended?
A urine culture is also taken at your 1st visit to rule out a bladder or urinary tract infection. Another urine sample can be drawn to rule out sexually transmitted diseases such as chlamydia and gonorrhea. If either of these tests come back abnormal, we will inform you and discuss with you and your partner regarding treatment options.
If your blood type is Rh negative you will need a rhogam injection at 28 weeks and possibly after delivery. Since rhogam is a blood product, we will need you to sign an authorized consent form to file on your chart before we administer it to you.
Certain ethnicities are also susceptible to thalassemia and you and your partner may be subjected to further testing if required.
At 36-37 weeks, expect a swab for Group B Strep (GBS) from the vaginal and anal region. Group B Strep exists in 15-40% of the normal prenatal population. This will determine whether intravenous antibiotics will be required when you go into established labour.
Non-Invasive Prenatal Testing (NIPT) is a relatively new non-invasive blood test that measures the amount of cell-free fetal DNA circulating in maternal serum. NIPT accurately measures the quantity variance of fetal and maternal chromosomal material and provides a screen risk for Down syndrome (trisomy 21), trisomy 18, and trisomy 13. The Down syndrome detection rate is >99% with a false positive rate of 0.1%.
For more information on NIPT, please see http://www.perinatalservicesbc.ca/health-professionals/professional-resources/screening/prenatal-genetic/non-invasive-prenatal-testing-(nipt)
What about ultrasounds?
It is recommended that women get a first trimester ultrasound for dating, ideally between 7-10 weeks. This is especially important if you have irregular periods or are unsure of the first day of your last menstrual period. Ask your physician to order one for you when you see them for the first time to confirm your pregnancy and estimate your due date. The first trimester ultrasound ( < 13 weeks) is the most accurate method of determining your due date as there is less variation in growth of the fetus at this time compared to later on in the pregnancy.
If you are over 35 years of age at the time of your delivery, you may also qualify for a nuchal translucency (NT) ultrasound. These ultrasounds are extremely time sensitive and are performed between 11 – 13+6 weeks at an accredited imaging facility. For more information on criteria for a Nuchal Translucency Ultrasound see Medray Medical Imaging. http://medrayimaging.com/page/nuchal-translucency-ultrasound
A detailed ultrasound is offered at 18-20 week gestational age. You may want to inquire about the gender of your child. If you do not wish to know the gender, please inform us so we can specify ” Do not disclose gender” on your ultrasound requisition.
3D ultrasounds and ultrasounds for gender identity specifically are done privately at various imaging facilities. Please inquire at each facility regarding their protocol and fees.
How often are my appointments?
Your appointments are monthly until 30 weeks, then every 2 weeks until 36 weeks and then weekly until you deliver. We will schedule appointments all the way up until 40 + 6 weeks since most are induced at 41+0 weeks for post dates. If you are over age 40 at the time of due date, we would induce you at 40 weeks.
Elective repeat C- Sections are usually scheduled around 39 weeks.
Royal Columbian Hospital and our clinic are teaching facilities and we usually have students and residents seeing you in addition to the physician. IF YOU DO NOT WANT TO BE SEEN BY THE STUDENTS OR RESIDENTS, LET US KNOW BEFOREHAND. There is nothing wrong with declining to be seen by the students or residents.
What if I don’t have medical coverage?
Primary Care OB Clinic currently does not provide care for patients who do not have BC MSP coverage.
What medications are safe to take during my pregnancy?
It is always a good idea to check with your physician first.
Who do I call if I am sick?
If anything is related to your pregnancy, then you should call the clinic since we are taking care of your pregnancy. Anything that is not related to your pregnancy, you should consult your own family doctor. The reason is because since they are your family doctor, they know your entire history, what you are susceptible to, what antibiotics work for you, if you’ve had these previous problems and what works best for you.
Who do I call when I go into labour?
After hours you are encouraged to call the Royal Columbian Hospital labour and delivery ward at 604-520-4587.
We suggest you call the hospital first since the staff are always available 24/7 as we are also but in case the labor and delivery room is extremely busy or on diversion, the staff will advise you when the best time to come to the hospital would be.
The doctor on call for our clinic can also always be reached at our office number 604-520-6263. If it is after office hours, our answering service will take the call and contact the physician on call.
Which hospital will I be delivering my baby at?
The physicians at the Primary Care OB Clinic deliver at Royal Columbian Hospital only. However, from time to time, the Royal Columbian Hospital goes on diversion and you may be diverted to a different hospital which is not full at the time.
Other hospitals also may go on diversion and for those patients, they may be sent to the Royal Columbian Hospital in return, so it works both ways.
Which doctor will be delivering my baby?
When you go into labour, the Primary Care OB Clinic physician that is on call will take care of you during labour and delivery. We usually work on 24 hour shifts so it could be any of our 12 doctors who deliver in our clinic. At shift change, you will be transferred to the oncoming physician who is on call for the next 24 hours. In the event of a forceps delivery or cesarean section, an obstetrician and pediatrician or anesthetist will also be involved in your delivery.
If your case is deemed high risk, you care will be transferred to an Obstetrician.
Twins are an example of a high risk situation and thus we do not get involved in delivering twins at the PCOC. Your twins would be transferred to an obstetrician of your choice who would take over your care.
What if I am planning a elective C-Section?
You will be referred around 30 weeks to the obstetrician of your choice. If you do not have an obstetrician, we will choose an obstetrician for you.
The obstetrician will see you once to discuss your c-section and then you will continue seeing us until your delivery date. C-Sections are usually planned for 39 weeks. However if you go into labor early, we will confirm that you are in actual labor and the obstetrician would be notified and the c-section would be arranged in the next few hours or as soon as the operating room is available.
What if I am overdue? When am I induced, and do I have to be induced?
At the Royal Columbian Hospital, we calculate that you become overdue at 41+0 weeks gestational age based on your earliest ultrasound.
We would offer you induction at 41+0 weeks but if you are age 40 years or older at the time of the due date, then we would offer you induction of labor at 39 + 0 weeks on your due date.
If you have gestational diabetes and are on insulin, we would consider inducing you at 38+0 to 39+0 weeks depending on the severity.
It is your option if you do not want to be induced but we would ask that you be assessed at 41+0 weeks ( 39+0 weeks if you are 40 years or older at the time of delivery). You may choose to decline induction as long as you understand the risks associated. We would request a non stress test on your baby and an ultrasound to be performed to make sure your baby is still well if you decline induction.
How long will I be in hospital?
Most new moms usually stay 1-2 days in hospital following a normal vaginal delivery. In the event of a cesarean section, you will usually stay 2-3 days depending on circumstances.
Usually, the main determining factor is how long it takes for you to get your baby breastfeeding. People usually will have the most difficulty with getting the hang of breastfeeding. Please ask your nurse for help or ask to see a Lactation Consultant.
Occasionally, your baby may develop jaundice, a yellowing of the skin and eyes from elevated Bilirubin levels and that may prolong your stay in the hospital if your baby requires phototherapy.
Sometimes, your baby will need to be transferred to the neonatal intensive care unit or NICU if they are born too premature or have issues such as fever, breathing issues or other complications that could have happened at delivery.
In those situations, a paediatrician in the NICU would be looking after your baby and you may be discharged from the maternity ward separately if your baby will be staying down in the NICU.
Who provides baby care after I am discharged from the hospital and when should I see them?
Your baby is followed by your family doctor after discharge from hospital. The first visit is usually at one week of age. If you do not have a family physician you may need to go to a walk-in clinic for newborn care.
For the delivering mom, if you have any problems within the first 6 weeks after delivery, we would rather you come back and speak to us about any issues that have happened during the delivery such as possible wound infection or nonhealing perineum’s or prolonged vaginal discharge.
A blood sample was taken from my baby prior to discharge. What was the indication? How do I find the results of those tests?
The BC Newborn Screening Program is a province wide program which samples blood from all babies born in British Columbia. It is most accurate when drawn after 24 hours.
If you or your baby are discharged before 24 hours, we may ask you to come back to the hospital laboratory to repeat this blood test as an outpatient. To read more about it, please refer to our Newborn Screening Program Parent Information Sheet.
When is the post-partum check-up?
We see you at six weeks post-partum for a routine follow-up exam to make sure your blood pressure is good and that you have healed properly from your delivery. We will also discuss contraception issues at that time. We feel a post-partum visit provides a nice opportunity to follow up with you and your baby. This visit however is not intended to be a baby check as we have discharged your baby back into the care of your family physician when you leave the hospital.
If you are having any issues before the 6 weeks, again, please call the PCOC so we can see you. It makes sense for you to come and see us since we are the ones that delivered you and we know what happened to you during and after your delivery.
What if I want my son circumcised?
Please speak to the physician you are seeing in the clinic or who attended your delivery for information regarding circumcision. It would be best to have your son circumcised when they are around 7 1/2 to 8 1/2 lbs. or 3300g to 3800g. If they are born premature, it is best to wait until they would have been around their due date for their circumcision. If they are born quite large, ie > 9 lbs or 4000g, it is best done sooner than later.
The statements on this page hereafter are not to be taken as direct medical advice. They are only here to be used as a guide for your convenience. If you are unsure about the health of your unborn child or yourself, please phone directly and speak to a qualified health care professional.
When should I start feeling my baby move?
Fetal movement varies from person to person. Most moms start to feel their baby move around 18 to 21 weeks. Sometimes, people feel their baby move earlier at 16-17 weeks and others don’t feel their baby move until after 21 weeks.
What if I don’t feel my baby move as much?
Fetal movements also vary between babies as they do in people. Some babies are very active and some aren’t. You should feel a minimum of 10 movements by the time 5:00 pm comes around. If you are unsure if your baby is moving enough, drink something sweet or cold, then lay down in a quiet area. You should feel your baby move 3 times in 1 hour or 6 times in the next 2 hours. If you don’t feel much movement or have noticed a significant decrease in your baby’s movement overall please don’t hesitate to contact our office.
Is it safe to travel on a plane?
Generally air travel during pregnancy is considered safe for women who have healthy pregnancies unless you have been directed by your physician. Most airlines restrict travel by pregnant women after 34 weeks.
Ideally the best time to fly is between 20 – 30 weeks gestational age. This is when you’re likely to feel your best and have the majority of the blood tests and ultrasounds done. If you are planning to travel abroad, let your physician know so he or she can determine the necessity of bringing along your prenatal records. With faxing availability, a copy of your records have been sent to the Royal Columbian Hospital ( fax 604-520-4834) after 20 weeks such that another hospital or facility could be able to access your records with your permission by phoning the Royal Columbian Hospital Labor and Delivery Ward at 604-520-4587 and requesting it.
Travel in Canada is usually uncomplicated if you are a Canadian citizen since your medical coverage extends to other provinces. This is not true if you are travelling to foreign countries so it is important to check your travel insurance qualifications before you travel.
Sitting for long periods increases the risk of blood clots so it is advised that you get up and walk every two hours that you are sitting for about ten minutes to increase circulation in your legs. This will decrease your risk for blood clots especially on long flights.
I’m leaking milk from my breasts but I’m only 28 weeks pregnant. Is this normal?
Yes, some moms do start leaking milk at this time in the 3rd trimester while others only start after their baby is delivered. Once your baby has delivered, your estrogen levels will drop and your prolactin levels will increase signaling to your body that this is the time for lactation to begin.
I seem to get nosebleeds on and off. Is this normal?
Yes, spontaneous nosebleeds happen in pregnancy quite often. They usually will stop on their own. If they persist for an extended period, please do not hesitate to call us.
I feel dizzy from time to time. Is this normal?
This is one of the most common issues we hear about. It can be non pregnancy related such as from a sickness coming on, or a middle ear infection or sinus congestion. It can also be from anemia so check your blood level.
In terms of pregnancy, the body purposely lowers your blood pressure to allow better flow to the placenta. If your blood vessels constrict, your blood pressure rises but it also can decrease blood flow to the placenta so we worry about toxemia and pregnancy induced hypertension.
Therefore the body lowers your blood pressure, but if it lowers it too much, you get dizzy.
To minimize your chance of dizziness, don’t get overheated and dress so you are cooler rather than warmer. If you overheat yourself, the body needs to dissipate that heat by sending more blood flow to the surface of the skin but that will take blood away from the core, causing you to get flush and drop your pressure.
Drink fluids! If you get dehydrated and your blood pressure is already low, you are just asking for trouble.
Keep moving. If you stand or sit for a long time, the heart pushes blood down to the legs and feet but you need to move to pump that fluid back up to the heart. Jobs where you stand for long periods of time are bad for pregnancy especially as you move further along in the pregnancy.
Eat regularly and add in protein with each meal. Hypoglycemia can cause dizzyness so eating regularly will prevent your blood glucose level from dropping low. Protein will stabilize your blood sugar levels. Ask any diabetic pregnant lady who attends the diabetes clinic. Protein with each meal will minimize major fluctuations in your blood sugar levels.
Always talk to your doctor if your dizzyness persists.
Is it safe to have sex with my partner?
Sexual activity is fine during pregnancy, but be aware that uterine contractions may occur after intercourse. For women who are at risk for preterm labor, sexual activity is discouraged. It is also unsafe if there is bleeding from the vagina which has not been diagnosed to the exact cause or if you have been told you have a placenta previa.
Should I attend prenatal classes?
If this is your second or third pregnancy, you may not wish to. However if this is your first pregnancy and you have minimal experience in childbirth education, it is a good option.
Where can I attend prenatal classes?
Nest Prenatal classes are offered by a group of nurses that work specifically out of the Royal Columbian Hospital.
Prenatal classes are also available through Douglas College or you can phone the Public Health Unit in your area for more information.
What about a doula?
A doula or a support person is welcomed in the delivery room. They are hired privately by yourself. Word of mouth is the best way to find a good doula.
More Generalized Information Including Exercise, Activity and Driving
You may participate in normal, everyday activities unless otherwise indicated by your physician. Heavy lifting, excessive physical activity, contact sports, or activities requiring fine balance should be avoided. Swimming is acceptable throughout pregnancy. Diving is discouraged. You may work until the day you deliver, if your job presents risks no greater than those in daily life. Bottom line: if there is discomfort with activity, it should be tapered or discontinued.
Driving is acceptable during pregnancy, unless otherwise indicated by your physician. Seat belts need to be worn under the abdomen and across your lap as pregnancy progresses.
Showering and bathing is permitted during pregnancy, however, avoid Jacuzzis or immersion in hot tubs. Douching is not recommended.
Dizzy spells may be common during pregnancy, especially during the 2nd and 3rd trimesters. If this occurs, sit or lie down on your side immediately. Avoid prolonged standing or lying flat on your back in the 3rd trimester. Lie on your side if possible. Always hydrate yourself (i.e. 6-8 glasses of water daily) to minimize fluid shifts in your body.
Leg swelling may occur in the last 2-3 months of your pregnancy. If this occurs, lie down on your side for 2-3 hours during the day to alleviate the problem. Avoid salty foods which may contribute to the swelling.
Tobacco, caffeine and alcohol are discouraged. Avoid second hand smoke.
Over the counter medication such as TUMS, Maalox, Tylenol, and Robitussin DM can be taken without harm to you and baby. If you are not sure, just call the office.
Avoid contact with cat feces or contaminated soil. Have someone else clean the litter box daily. Always wash your hands after touching pets.
Emotional ups and downs are common during pregnancy.
Heartburn
This tends to be more common during the last three months of pregnancy. However, it may occur throughout the pregnancy as well. This is due to combination of hormonal changes and uttering growth. Slower motility of the stomach along with the added intra-abdominal pressure from the growing uterus cause the stomach acids to be pushed back into your esophagus and throat, causing a burning sensation and or discomfort in your chest. You can follow the advice for nausea.
Remember to eat slowly, avoid spicy foods and don’t overeat. Do not lie down immediately after eating.
Use pillows to prop you head up at a 45 degree angle when you’re sleeping to minimize regurgitation. You can use liquid antacids or TUMS as prescribed.
Lightheadedness
Some women may experience this during the 2nd and 3rd trimesters, though this can occur throughout pregnancy. Lightheadedness may be cause by fluid (i.e. blood) to the uterus, thus decreasing flow to other areas of the body including the head and leading to lightheadedness with abrupt movements or prolonged standing. Another cause may be due to lack of calories (i.e. sugar). This is the source of your energy, and during pregnancy, the amount of calories that you need to sustain both you and your baby may exceed what you are normally used to prior to pregnancy. This problem can be minimized by having adequate hydration (6-8 glasses daily), eating several small meals throughout the day to maintain calories, and avoiding abrupt movement. If these suggestions don’t ameliorate your symptoms, other causes must be investigated.
Nausea
Better known as morning sickness, nausea can occur anytime during the day and some women may vomit occasionally. This is a temporary condition that peaks during the first three months of pregnancy and usually done by the 4th month. Suggestion for nausea control:
Avoid sudden movement while getting out of bed as this may make you lightheaded and contribute to nausea. Get up slowly.
Eat several small meals daily rather than the usual three large ones.
Avoid fatty, fried, greasy, spicy, and seasoned foods.
Drink fluids separate from meals.
Ginger has been shown to be effective to combat nausea.
If you are still having problems, call the office and schedule an appointment to be seen.
We may refer you to the Hyperemesis Clinic at the Royal Columbian Hospital if your symptoms are severe.
Urinary Frequency
This will occur in the first three months when the uterus places increased pressure on the bladder. This problem will improve when the uterus grows beyond the pelvic area in the 2nd trimester. In the 3rd trimester, the fetal head will press against the bladder, and the symptoms may return. This problem is normal. However, if there is burning associated with frequent urination, flank pain or fever, this should be investigated further to rule out an infection.
Weight Gain and Diet
Keep in mind that “eating for two” doesn’t mean eating twice as much. The average pregnant woman only needs an extra 300 calories a day (i.e. a glass of skim milk and a half sandwich). A well-balanced diet is crucial to your health and the growth of your baby, so choose your calories well.
During pregnancy, the average women will gain between 25-35 pounds. Ideally, you should gain no more then 25-35 pounds, and less if you are overweight. The breakdown is as follows:
Baby6-8 poundsMaternal and amniotic fluids7-9 poundsPlacenta1-2 poundsBreast1-2 pounds Maternal body fat8-9 poundsUterus2 pounds Total weight gain25-35 pounds
Supplements:
Prenatal vitamins with folic acid (1000mcg or 1mg) daily
Suggestions: Materna from most pharmacies, One Source (available at Wal-Mart), Gummi-Vites (four gummie-bears daily).
Calcium Carbonate (500mg- 1000mg daily). Vitamin D (1000- 2000 IU Daily) Iron pills, as needed.
Cold or Flu Illness during Pregnancy
In general, a cold is limited to upper respiratory tract (nose and throat). The most common symptoms of a cold are: sore throat, runny or stuffy nose, cough with white or clear mucus, fatigue, fever not more that 101 F. Nearly all colds are due to viruses, not bacteria. Therefore, antibiotics such as penicillin or erythromycin are useless. Your own body will overcome the cold in about 7-10 days. Be patient. The most important thing to do is rest; drink plenty of liquids and sleep! You may safely use the over the counter medication such as Tylenol Cold for your symptoms. Robitussin DM is also safe to use. Do not take Nyquil, Ibuprofen or Aspirin. If you smoke, PLEASE STOP!!! If you have any questions, please call the office.
Hospital Discharge Information
An excellent website:
Filled with pertinent information for practical information and reliable resources for women, expectant parents, and families with babies and toddlers up to 2 years of age. is available at Best Beginnings
http://www.fraserhealth.ca/health-info/pregnancy-and-babies/
For Baby:
After hospital discharge, all of your infant’s medical care and concerns will be followed by your own family doctor. Please make an appointment for your baby’s follow-up examination with your family doctor within 5 to 7 days after birth.
We recommend that babies who are exclusively breast-fed be supplemented with Vitamin D drops (D· VISOL or D-drops), one dropperful once a day (or 400IU/day), until the diet provides a sufficient source of vitamin D.
Weight Loss and Weight Gain:
It is common for your baby to lose weight for the first few days since they are urinating and passing meconium out yet the milk intake is usually less. We usually accept anywhere from 8-10% weight loss but it should start increasing when your milk comes in and then returns to birth weight by about day 10-12. Average weight gain for a term infant is usually 1 ounce a day or 30 g a day for the first few months.
Umbilical Cord Care:
Nowadays, the plastic cord clamp may be left on after delivery until the stump falls off. It takes about 10-12 days usually for the umbilical stump to fall off. Remember, it is a dead piece of tissue, like a scab on your skin. You wouldn’t pull or pick at a scab on your skin and you should do the same for the umbilical stump and clamp. It may smell funny but it’s decaying tissue! You also don’t need to put alcohol around the stump. It actually kills the good bacteria and delay the stump from falling off.
Mucousy Baby:
It is common for babies to be quite mucousy for the first 24 hours. You may see them froth and foam at the mouth and it may scare you! Just turn their heads to the side and wipe off all the foam and phlegm.
It usually happens as a result that the babies chest did not get squished long enough as it came through the birth canal and the fluid in the oral cavity and stomach did not have enough time to clear out. This will happen in certain types of deliveries: super fast deliveries, sunny side up or OP babies with their backs against the mom’s back, elective c- sections, late rupture of membranes. All of these deliveries have in common is that there wasn’t enough time to clear secretions out of the mouth and chest.
Your baby will not want to feed properly until this mucous clears out of their gastrointestinal tract.
For Mom:
Please call us to let us know that you have delivered and then make a follow-up appointment at the PCOC in 6 to 8 weeks after your delivery for a complete post-partum check. For any postpartum concerns or problems you have within the six weeks following your delivery, you are welcome to be seen at the clinic for an examination or consultation.
Again, if you are having issues from your delivery, call us anytime to address your issues. You do NOT have to wait until the 6 weeks to bring up your concerns. If you can, it is always better to see the physician who attended your delivery as they have the most information about what went on but all of the doctors are capable of handling your concerns if your delivering physician is not available.
It is expected that you will have a number of questions and concerns once you have been discharged from the hospital. Here are some answers to a few of the more common ones:
Vaginal Birth:
Flow may continue for a few days to a few weeks after birth. It will initially be like a heavy menstrual flow and then slowly taper off. Please watch for and follow-up on any increase in abdominal cramping,increase in bright red flow or clots larger than a plum, fever or chills, or unusual odor of the vaginal secretions. We would likely ask that you come in for assessment and examination, possibly needing treatment.
Any stitches for repair of tears or episiotomies will self- dissolve, usually within 2 to 4 weeks after delivery, and therefore do not have to be removed. Occasionally some of the ends of the stitches may cause a little discomfort and you may let the clinic know if this is a problem. If you think the stitches have come open, please make an appointment to be seen for review and management.
Daily Sitz baths (warm water soaks), are highly recommended for local comfort and cleansing of the vaginal and rectal areas. This is particularly helpful if you have had a tear repaired or have swollen hemorrhoids.
C-section:
Recovery from C-sections may take a little longer and you should try to avoid unnecessary lifting (anything heavier than your baby) or twisting for at least 3 to 4 weeks to avoid any injury to the healing tissues.
Tissues heal from the inside out, and a little oozing from the wound is often seen in the first 7 to 10 days. If you had staples which were removed and steri-strips applied, you may remove the strips 7 to 10 days after the day of delivery and can get the wound wet with a shower anytime after you leave the hospital. The wound must be kept dry, often easier with a hair dryer and / or a panty- liner applied to your underwear across from the line of the wound.
Flow vaginally may continue for a few days to a few weeks after birth and the signs of infection and inflammation are the same for those with a vaginal delivery (increasing pain or blood flow, fever or chills, or an odorous discharge from the wound). You should also check for any increasing redness around the wound, often tender and warm. Please report these to the clinic and come in for follow-up.
The obstetrician who performed the C-section may wish you to have a follow-up visit in their office and will let you know prior to discharge if this is to be arranged.
Nutrition / Medication:
It is advised to continue your prenatal vitamins while you are breastfeeding unless they make you feel nauseous or sick.
Good fluid intake is important if you are breast feeding. You can’t make any milk if you are dry and dehydrated. The best fluids would be water and those without a lot of caffeine or sugar.
Acetaminophen (Tylenol) , Ibuprofen (Advil, Motrin) and Naproxen (Aleve) are all acceptable to take after delivery for pain and are compatible with breast feeding.
Remember, Ibuprofen and Naproxen are from the same family of anti inflammatories so take 1 or the other but not both together.
If you have lost a sufficient amount of blood during the delivery of your child and you have been told you are anemic, (Hemoglobin < 90), it is reasonable to be taking your iron pills for the next 2 months to build back your blood supplies unless the pills make you sick. Palafer, Ferrous Gluconate, Ferrous Sulfate and Feramax are all options. Please speak to your pharmacist about this. Or go online and look up the best sources of iron from natural foods and follow the diet accordingly.