Your Pregnancy MD
Pregnancy Week Five
Author James W. Brann, M.D.
Your Body at 5 Weeks of Pregnancy
While others can’t yet detect your pregnancy, by 5 weeks pregnant you may start feeling pregnant. If you have given birth previously you might notice your abdomen looks slightly larger than usual. This is largely the result of bloating. The uterus doesn’t rise out of the pelvis until roughly 14 weeks pregnant but many women start experiencing bloating during early pregnancy. You may find your belly looks more “poofy” at the end of the day than early in the morning.
Some women mistake this early pregnancy sign as a premenstrual sign. If your period is more than a few days late you should take a pregnancy test. During early pregnancy some women may experience complications. One of the more devastating complications of pregnancy is an ectopic pregnancy, where the egg fertilizes but then implants outside the uterus. This usually happens in the fallopian tubes and can be life threatening if undetected. Fortunately ectopic pregnancies are uncommon. Some women are however more at risk than others including those that have had pelvic inflammatory disease (PID) or other complications. Signs that something might be wrong include increasing vaginal bleeding, severe abdominal pain and nausea. Keep in mind that many of these signs however also mimic normal pregnancy symptoms. If you are uncertain be sure to contact your doctor immediately so your doctor can make sure your pregnancy is progressing normally.
When you are around 5 weeks pregnant you may start feeling morning sickness. Other women will start noticing they need to urinate more frequently, while still others will start noticing their breasts are growing (and quite tender). Keep in mind that morning sickness (nausea in early pregnancy) doesn’t necessarily happen in the morning. Some women experience morning sickness during their entire pregnancy! Fortunately this is the exception to the rule rather than the norm.
There are a number of steps you can take to help relieve morning sickness as your pregnancy continues. Usually it helps to keep something in your stomach. For this reason consider having a steady supply of saltines and seltzer water by your bedside. Try a little before getting up in the morning and any time your stomach is empty. You may find you feel a lot better in no time at all!
The Benefits of Exercise
You are newly pregnant and may not feel up to exercising, but being active and exercising may provide some relief from your first trimester pregnancy symptoms. In addition, exercise during pregnancy may increase your energy levels (which you definitely need in the first 13 weeks of pregnancy), improves your overall mood, and even helps you sleep better at night. What other reason do you need to exercise when pregnant?
For safe exercise in pregnancy, it’s important that you talk to your doctor or healthcare provider first before starting any exercise regimen. Sometimes, there are special obstetric complications and health problems that would make exercising off-limits. In most cases, however, you are having a low risk pregnancy and exercising is perfectly safe.
Moderation is key when you’re pregnant. Safe exercises for expectant mothers include walking, swimming, cycling, and aerobics. It’s healthy for pregnant women to exercise for at least 30 minutes on most days.
When you’re pregnant, you will want to avoid any exercises that put you at high risk for falling. These exercises include horseback riding and gymnastics, since you can have severe injuries and falls from that kind of activity. As a rule of thumb, downhill snow skiing, contact sports (such as soccer, basketball, and ice hockey), and scuba diving should also be avoided.
Changes in Your Growing Baby at 5 Weeks Pregnant
During pregnancy week 5 your baby is still very tiny, roughly 1mm or slightly longer. For those of you that need a visual reference that is roughly about the sizes of a small lentil bean!
Your baby’s vital organs are growing at a furious pace. Your baby’s heart, central nervous system and even bones and muscles will start forming rapidly from this point on. Right around now your baby also starts forming a skeleton.
This is a critical week for heart development in your baby. The heart begins to separate into different chambers and starts pumping blood as early as five weeks of pregnancy. Some transvaginal ultrasounds may be able to pick up a heartbeat as early as now, though this often occurs much later. Much like other organs in your baby’s body the heart is formed from multiple layers of cells, in this case cells labeled the mesoderm. Other organs that will also develop from this layer include your baby’s cartilage, muscles and bones.
Understanding a Miscarriage
When pregnancy ends before week 20, it is called a miscarriage. A fully developed pregnancy will last approximately 40 weeks.
How is a miscarriage caused?
A miscarriage may be caused by different problems. It may result when either the fetus, or rather your unborn child, stops growing. Oftentimes this is due to genetic problems. Other times, though, a miscarriage may be caused due to medical problems in the mother. This may include poorly controlled diabetes or issues with the shape of her uterus, also called the womb in which a baby grows.
Symptoms of miscarriage
Commonly, the signs of miscarriage include vaginal bleeding, cramping or belly pain. Contact your nurse or doctor right away if you’re pregnant and develop these types of symptoms. If you don’t know whether you’re pregnant, you’ll want to go ahead and take a home urine pregnancy test.
Call your nurse or doctor right away during pregnancy if:
- There’s anything solid that comes out of your vagina
- You experience thick, foul-smelling fluid from your vagina
- You’re running a fever of 100 degrees Fahrenheit or more (37.8 degrees Celsius)
If for any reason you can’t reach your nurse or doctor, or if
you’re bleeding is so heavy that you’re soaking through a sanitary pad in one
to two hours, go to the ER.
While these types of symptoms don’t signify a miscarriage every time, your doctor should be able to help determine if there’s anything wrong.
Should I have tests?
Possibly by just asking you some questions and conducting a pelvic exam, your doctor may be able to tell if you’ve had a miscarriage. She or he may also want to take a look at your uterus via ultrasound. This type of machine creates a picture of inside your body by using sound waves. By doing this, your doctor can see the fetus and know whether there’s a heartbeat. If there is, you haven’t had a miscarriage. You doctor may be able to tell you, though, if you’re likely to have one in the future. You may also need to have a blood test, and then repeat it again in a few days to check up on the pregnancy.
If you have a blood type that’s negative, you may need to have a special injection which helps prevent potential problems with future pregnancies. If you’re unsure of what your blood type is, you can always ask your nurse or doctor to check.
Treating a miscarriage
Once a miscarriage begins, you can’t stop it. With a miscarriage, your body will need to get rid of the extra fluid and the fetus. In some cases, your doctor may just want you to wait until this naturally occurs. In other cases, though, this isn’t an option. Instead, your doctor may either give you medicine which will help your body go through the process or need to conduct a surgery that removes the contents of the pregnancy from your uterus.
Preventing a miscarriage
Unfortunately, there’s no way to prevent a miscarriage altogether. You are able, though, to decrease your chances of it occurring by avoiding any type of belly injury, as well as avoiding alcohol and cigarettes. Certain infections or a fever may also put you at risk, so talk to your doctor about what you can do to avoid infections.
There are certain invasive tests during pregnancy that, in rare cases, may cause a miscarriage. If your doctor should suggest testing your fetus, find out whether that test could put you at risk of miscarriage. There are also some treatments or medicines that may harm a fetus. Before you take any prescription, over-the-counter or herbal medicines, and before you have any type of medical treatment or an X-ray, make sure you find out from your nurse or doctor whether it could harm your unborn child.
After a miscarriage
If you’ve had a miscarriage, you don’t want to put anything inside your vagina for two weeks, or have sex during this time. You’ll want to talk to your doctor before you restart birth control, too.
While many women do feel anxious or sad following a miscarriage, there are cases where women really become depressed. If this happens to you, make sure you talk to your doctor. He or she will be able to suggest some ways you can cope, or even some treatments.
Having a normal pregnancy
While some women who’ve had a miscarriage may find themselves more likely to have future miscarriages, many women who’ve had a miscarriage do later have a healthy pregnancy.
Some doctors suggest waiting between two and three months, though, before trying to get pregnant again. If you’ve had at least three miscarriages, your doctor may want to conduct some testing to try to find out why.
Identifying a Threatened Miscarriage
While many women may have some idea of the symptoms of a miscarriage, a threatened miscarriage may be more difficult to understand. In a miscarriage, a pregnancy ends before a woman reaches her 20th week. Common signs include cramping, belly pain or vaginal bleeding.
A threatened miscarriage, on the other hand, means a woman has vaginal bleeding but the pregnancy is not over. In medical terms it’s described as a “threatened spontaneous abortion.” When this happens there are two outcomes. In most cases, the bleeding stops and a normal pregnancy continues. In other situations, though, a threatened miscarriage turns into a miscarriage.
Did I cause the threatened miscarriage?
In most cases the answer is no. Remember, too, if a threatened miscarriage develops into a miscarriage, you probably did not cause that either. In most cases, a miscarriage occurs because the pregnancy has not been normal from the start.
What symptoms should I be aware of?
When it comes to a threatened miscarriage, you should expect vaginal bleeding. In some cases, women may also experience belly pain. Keep in mind, though, there are certain conditions other than a threatened miscarriage that may result in vaginal bleeding during the first half of your pregnancy.
Should I call someone?
If you’re pregnant and having vaginal bleeding or belly pain, it’s important that you call your nurse or doctor immediately. Sometimes, bleeding during a pregnancy may be a sign of an emergency.
What kinds of tests should I expect?
Your doctor will first want to talk to you about any symptoms you’re having and conduct an exam. They’ll check your baby’s heartbeat in one of two ways. In the first, a fetal Doppler monitor is placed on your belly, allowing you to hear your child’s heartbeat through sound waves. An ultrasound, on the other hand, uses sound waves to make pictures of your baby and the inside of your body. Using an ultrasound shows your child’s heartbeat.
There’s also a test that measures how much “hCG”, a pregnancy hormone, is in your blood. You may have to have this same test repeated in a few days.
How do you treat a threatened miscarriage?
Despite the wide spread use of progesterone to treat threatened miscarriages, there is no evidence to support the routine use of progestagens for the treatment of threatened miscarriage. [Ref]
Treating a threatened miscarriage is difficult and there really aren’t very many reliable treatments out there. You doctor may recommend if you’re having vaginal bleeding that you avoid having sex or lie down in bed. Unfortunately, however, there’s no proof this can actually prevent a miscarriage.
In the meantime, your doctor will keep tabs on you until either your pregnancy begins growing normally after the bleeding stops, or you have a miscarriage or some other condition affecting your pregnancy. In this case, your doctor will help guide you on what you should do in the future.
What is a Blighted Ovum?
Experiencing a miscarriage or pregnancy loss can be devastating, especially for women who desperately want a baby. Over 80 percent of miscarriages occur in the first 12 weeks of gestation, and 50 percent of all pregnancy losses in the first trimester are due to a blighted ovum – a pregnancy complication that occurs very early in the conception process.
With a blighted ovum, the fertilized egg implants into the lining of a woman’s uterus, but the embryo either doesn’t develop or it stops forming early on. Cells from the fertilized egg attach to the uterus, and they form the gestational sac but the embryo is missing.
Your body naturally stops the progression this pregnancy, since a healthy baby can’t grow. As a result, you will miscarry. You may experience an early miscarriage, even before you realize you’re pregnant. Some women discover they have this complication when an ultrasound confirms an absence of an embryo within the gestational sac.
Even after you know you have a blighted ovum, you may have to wait weeks before your body discharges the gestational sac and related tissues. This can be emotionally draining, and it may even be painful (especially for women who experience cramping during this time).
What Causes a Blighted Ovum?
In most cases, early pregnancy miscarriages caused by a blighted ovum are due to chromosomal problems. Abnormal cell division following conception can also lead to a blighted ovum.
Although it is heartbreaking to lose a pregnancy so early, the fertilized egg would not have been able to develop into a healthy, normal baby.
What are the Signs and Symptoms of a Blighted Ovum?
When you have a blighted ovum, a home pregnancy test will give you a positive result. Even though the gestational sac doesn’t contain an embryo, the placenta is secreting human chorionic gonadotropin (hCG) – the special hormone that home pregnancy tests measure.
As a result of this increase in hCG, you might begin to notice common signs of pregnancy, like sore breasts, nausea, and fatigue or excessive tiredness. In a few weeks, when your hormonal levels begin to decrease, you will start to feel better.
Common signs of a blighted ovum include spotting and bleeding. Since spotting can also be normal in early pregnancy, you cannot diagnose this pregnancy complication without the help of a doctor and an ultrasound exam.
If you have a miscarriage due to a blighted ovum, you might also have uncomfortable abdominal cramps and vaginal bleeding.
What Are the Chances of Another Blighted Ovum?
Try not to worry about having another blighted ovum. For a majority of women, a blighted ovum only occurs once. Their next pregnancy goes on to be normal, and they have a good chance of carrying a healthy baby.
Experiencing this complication does not mean that anything is wrong with you. You should probably only be worried if you suffer two or three consecutive miscarriages. If you have multiple miscarriages, your doctor or healthcare provider may recommend genetic testing or special blood tests to figure out what’s causing your miscarriages.
After a blighted ovum, it’s advisable to wait four to six weeks (when you’ll have your next period) before trying to conceive again. Because it is possible for you to ovulate two weeks after you miscarry, you’ll want to use birth control to avoid another pregnancy so soon.
Since losing a pregnancy can be emotionally difficult, make sure that you don’t rush into conceiving right away. You may need some extra time – whether this is weeks or months – before you start thinking of getting pregnant again. Take your time and make sure you are 100 percent ready before trying for pregnancy again.
Understanding Repeated Miscarriage
When your pregnancy ends on its own before reaching the 20th week of pregnancy, it’s called a miscarriage. When this happens two or more times in a row, doctors call it a repeated miscarriage. The question is what causes it. This may be difficult to pinpoint, but sometimes these things cause a repeated miscarriage:
- A mother’s autoimmune condition – In this situation, a woman’s infection-fighting system doesn’t attack infections, but rather attacks her body’s healthy tissue.
- A change in shape inside a woman’s uterus.
- Chromosomal problems inside the fetus – The fetus is the growing baby in a pregnant woman’s womb. Chromosomes are the structures inside of cells, which hold thousands of genes. Problems with chromosomes normally occur by chance. However, sometimes they occur due to a chromosomal problem with either the mother or father. These problems also occur more frequently with older moms.
- Additional medical conditions of the mother – These may include such conditions as thyroid disease, hormone problems, blood clotting problems or diabetes.
However, in a large number of situations, doctors aren’t able to figure out the cause of repeated miscarriage. To try to come up with a better idea, though, doctors will do a number of things including:
• An exam, as well as a pelvic exam
• Ask questions about your former pregnancies, medical conditions and monthly periods.
• Conduct an imaging test of your uterus – There are different types of tests available; one of the most common is a certain type of ultrasound. This uses sound waves to display an image of the inside of your body.
• Blood tests – This will check your blood clotting system, hormone levels and immune system. Tests also look for medical conditions including diabetes or thyroid disease.
• Chromosomal tests on mother and father – Before you and your partner are tested, and after, you’ll likely speak with a genetic counselor that is an expert in genetic problems.
• Look inside your uterus – To do this test, a thin tube with a camera and light is inserted in your vagina, and upwards into your uterus.
Depending on your personal situation, other tests may be ordered, as well.
Treating a repeated miscarriage
As for treating a repeated miscarriage, a doctor will treat the problem if they can find a possible cause. Finding and treating a cause may help you have a successful pregnancy in the future. If the problem is in your uterus, you may be able to treat it with surgery. Medicine may help if you have certain hormone, immune or medical problems.
Preventing another miscarriage
Unfortunately, you can’t completely void all chances of having
another miscarriage in the future. However, you may be able to reduce the chances
of having a repeated miscarriage if you avoid things like caffeine, alcohol,
cigarettes and any type of belly injury. Staying at a healthy weight can also
The good news is, in many cases, women with repeated miscarriage do have successful pregnancies later on. If you’re planning to get pregnant, make sure your doctor knows. Also, make sure you tell them immediately if you discover you might be pregnant. This gives your doctor the opportunity to treat you with things like hormones or other types of treatments early on. This also gives your doctor the ability to start monitoring you from the beginning.
A repeated miscarriage can be a tough thing for a mother, or even a couple, to deal with. If you need help, ask your nurse or doctor for recommendations of a counselor. You may also want to look for a local support group of people who understand your situation because they’ve gone through the same thing.
Understanding Ectopic Pregnancy
When your pregnancy is outside of your uterus, in the wrong part
of your body, it’s called an ectopic pregnancy. It’s definitely a serious
condition, and could even become life threatening.
The beginning of pregnancy
is when a woman’s egg joins up with a man’s sperm. These cells then grow in a
much larger group of cells, referred to as an embryo. During normal
pregnancies, the embryo attaches itself to the lining of your uterus and grows
into a baby.
During an ectopic pregnancy, a woman’s egg also joins up with a man’s sperm, forming an embryo. However, the embryo never attaches itself to the lining of the uterus. It instead attaches to another place in a woman’s body and starts growing. While the embryo is growing larger, it can’t ever actually grow into a baby. It will, however, start causing bleeding and pain, and cause some additional problems, too. These could include life-threatening problems.
In most cases, during an ectopic pregnancy, the embryo attaches itself to the lining of a fallopian tube. These tubes are what connect your ovaries to your uterus. In this case, a doctor calls it a “tubal pregnancy”. The embryo may also attach itself to the ovary, inside of your belly or cervix, but these are all rare cases.
Am I at risk of ectopic pregnancy?
Certain women are at an increased risk of having ectopic pregnancy. This may be the case if you:
- Smoke cigarettes
- Had a previous ectopic pregnancy
- Are receiving certain treatments to increase the chance of getting pregnant
- Have damaged or abnormal fallopian tubes from past surgeries or infections
If you use a certain type of birth control called an “IUD”, or rather intrauterine device, you have an extremely low chance of even getting pregnant. However, if you’re using an IUD and you become pregnant, you’re at a much higher risk of ectopic pregnancy. In this case, you’ll want your doctor to check to see if you have an ectopic pregnancy.
Symptoms of ectopic pregnancy
As for the symptoms of
ectopic pregnancy, you may not have any symptoms in the beginning. If you do,
though, they may include vaginal bleeding. This may be light or heavy, or even
just brown staining or spots of blood. You may also experience lower belly
For some women, they won’t have any symptoms until their ectopic pregnancy begins causing more serious problems. If the embryo is growing in a fallopian tube that tube may actually burst open. Symptoms to watch out for include:
- Heavy vaginal bleeding
- Passing out or fainting, or feeling like you may
- Severe pain in your lower belly
If you’re pregnant and start experiencing any of these symptoms, head to the ER immediately.
Testing for ectopic pregnancy
There are some tests to see if you have an ectopic pregnancy. A
certain type of imaging test, called an ultrasound, takes pictures of the
inside of a woman’s body to show where the embryo is. A blood test can also
measure hCG. This is a hormone made during pregnancy. The blood test sees how
much is being made, and checks to make sure you’re pregnant.
While a test may show an ectopic pregnancy immediately, your doctor may also have to repeat the test after a few days to know with certainty that you indeed have an ectopic pregnancy.
Treating ectopic pregnancy
If you have an ectopic pregnancy, your doctor has two ways to treat it. This will depend on your symptoms and the size of the embryo, among other things. Both of the treatments, however, involve taking the embryo out. This may be done with either medicine or surgery. With medicine, you’ll get a shot, which stops the embryo from growing and makes it dissolve. If you receive this treatment, you’ll need to come back in a few weeks for blood tests to make sure it worked. With surgery, your doctor will remove the embryo. He or she may, or may not, need to also remove your fallopian tube.
Preventing ectopic pregnancy
While you can’t prevent most ectopic pregnancies, you can reduce your chances of having one. Use a condom when you have intercourse. You can catch an infection during sex, which gives you an increased chance of having an ectopic pregnancy.
Getting pregnant again
A majority of women can go through a normal pregnancy even after having an ectopic pregnancy. You need to let your nurse or doctor know, though, if you’re trying to conceive. They’ll be able to follow your pregnancy along to ensure everything is progressing normally.
How to Announce Your Pregnancy
The little stick has turned pink! Your blood test came back
positive! This is just the news you’ve been waiting for and you can’t wait to
share it. But should you? When is the right time to announce your pregnancy?
Two key people need to be informed immediately, your partner and your doctor.
What is the best way to tell your partner that the two of you are about to become the three of you? Or that the three children you have are about to become four? Or the… okay, you get the point. Telling your sweetheart that a baby’s on the way can be both exciting and a little nerve wracking.
How to tell him, when to tell him, where to tell him, whether
he’s as anxious to parent as you are, or whether he’s more reserved about
parenting, you announcing the pregnancy is the emotional equivalent to his
popping the big question (or asking you to move in together if that’s the
lifestyle choice you’ve made). Think of the planning you’d want to go into such
an event if you were on the receiving end of such tremendous news.
Make your announcement special. After all what is more special than creating a life together? This is not the time for an email. Unless hubby’s a techno wizard, in which case that might be an apropos means of giving him the news. How about a romantic dinner topped off by a cake with a pacifier on top?
Make this announcement truly special. After all, Dads are often left out of all the fuss that is made over pregnancy. Make a fuss over him, the rest of the fuss (from friends, family, and even strangers) will be all about you. Oh, yes and the baby, of course.
Call your doctor within a day or two of learning you are pregnant. You need
to get yourself into the office’s system and schedule your first prenatal
appointment. You should inform your insurance company, as well.
What about everyone else? When does the rest of the world need to know you’re expecting? The only answer to that question is: they need to know when you are good and ready to tell them. Some women spread the news right away. Some wait until after their first prenatal appointment. Others wait until the end of the first trimester. Others until they are showing and there’s no hiding it. Telling or keeping the pregnancy a sweet little secret…both are very personal choices. Do not feel pressured in either direction. There are a few reasons people choose to keep their good news private initially, personal reasons like a history of miscarriages, cultural ones like family tradition, or medical reasons. If you feel that it’s best to wait until you have gone through the first trimester and your risk of miscarriage has decreases tremendously, then you should wait to announce your pregnancy.
One key concern is timing when to make the announcement to
The age of your children is the key factor in when they should be told. If
children are old enough to notice changes in your health and behavior, like
morning sickness, weight gain, or uncontrollable excitement, they should be
told right away in terminology they can understand. No need to go into full
detail…rather tell them that you are pregnant and when the baby is expected
to arrive. Invite them to ask questions and remind them that if questions come
up later, they should not be afraid to ask them.
When dealing with young children, the wait to announce your pregnancy should be longer. Think about it. Nine months is an awfully long time to wait for something. Keep in mind how hard it’s going to be for you and you’re an adult. Some psychology professionals recommend waiting to inform big brothers and sisters about little brothers or sisters until Mom is showing. That way, they do not worry that Mom is ill and their wait is that much shorter.
If you choose to hold off on making the big announcement to your children or stepchildren, it is important that they do not pick up on the tail ends of conversations. Choosing not to announce your pregnancy to children right away should influence your decision regarding who else to tell. After all, other than you and Dad, they are the ones who will be most affected by baby’s arrival.
To tell or not to tell, that’s a question with no single correct answer. Regardless of when you choose to share your news, obviously everyone in your life will know eventually. And they’ll be thrilled no matter when you tell them!
Choosing a Healthcare Provider
A majority of expectant
women choose an obstetrician-gynecologist (OB/GYN) for their prenatal care and
delivery. An OB/GYN is a physician who specializes in obstetrics, reproductive
medicine, and women’s health issues. He or she undergoes a four-year residency
in obstetrics and gynecology after completing a general medicine program (which
is typically four years of medical school).
As a result of their extensive training, OB/GYNs are specialists that can manage both low-risk and high-risk pregnancies.
It is highly advisable that you go see an OB/GYN for your pregnancy care if:
- You have a pre-existing condition, such as a STD, diabetes, high blood pressure, and etc.
- You are over 35 years of age.
- You are carrying twins or multiple babies.
- You have a history of pregnancy problems.
An OB/GYN can handle all
stages of your pregnancy, from preconception family planning to postpartum recovery.
These doctors often work in group practices with nurses and other medical
professionals; however, some OB/GYNs work in a private practice setting.
OB/GYNs typically deliver in a hospital setting with the latest medical technology. These doctors can perform elective and emergency cesarean sections, episiotomies, and other medical and operative interventions that may become necessary.
Over 80 percent of American women choose to see an obstetrician-gynecologist for their pregnancy and childbirth care. Between 8 to 9 percent choose midwives, and 6 to 7 percent choose family physicians.
Keep in mind that your obstetrician-gynecologist may not be available when you deliver your baby. In fact, a growing number of OB/GYNs only offer prenatal care and they do not deliver babies. Your baby may be delivered by a laborist – a board certified OB/GYN whose job is simply to deliver babies at the hospital.
Laborists, also called OB hospitalists, are responsible for inpatient hospital care of pregnant women. They are immediately available throughout the day and night, so they can monitor the progression of your labor, react to complications that can occur, and provide a safe delivery.
An advantage of having a laborist at the hospital where you are delivering is that you will not have to wait for your doctor to get to the hospital. You always have a skilled obstetrician to monitor your care. Although this doctor may be a stranger to you, you can rest assured that he or she is very knowledgably about the birthing process.
If you are concerned about a stranger delivering your baby, talk to your OB/GYN about his policy on delivering.
A Specialized OB/GYN called a Perinatologist
If you’re experiencing a
high-risk pregnancy, your healthcare provider may refer you to a specialized
OB/GYN called a perinatologist. This type of OB/GYN is sometimes referred to as
a maternal-fetal medicine specialist.
A perinatologist is a physician who has extensive medical training in taking care of high-risk pregnancies. After graduating from medical school (or another general medicine program), this doctor undergoes a four-year obstetrics and gynecology residency, then another two or three years in a maternal-fetal medicine fellowship.
Perinatologists often serve as consultants for regular OB/GYNs rather than as primary obstetric care providers. In addition, they work with family physicians and certified nurse-midwives to handle pregnancy complications. In some cases, you may be referred to a perinatologist and see them regularly for the rest of your prenatal care, labor, and delivery.
These doctors are only available in a large hospital setting, such as a university hospital that is set up to take care of very ill babies. Because perinatologists are so specialized, they need access to the latest medical technology to treat any pregnancy complication that arises.
You may be referred to a perinatologist if:
- You are under age 18 or over 35. Maternal age can sometimes play a role in causing a high-risk pregnancy.
- You have pre-existing medical conditions, such as a sexually transmitted disease, diabetes, hypertension, immune system deficiency disease, and genetic disorders. These can complicate your pregnancy.
- Your unborn baby has already been diagnosed with a serious medical condition, such as spina bifida
Depending on your situation, you may see both a perinatologist and your regular obstetrician during your pregnancy. In some cases, you may see the perinatologist exclusively. If this is the case, he or she will also deliver your baby. However, if you have continued to see your regular OB/GYN, the perinatologist most likely will not be present at your baby’s birth, but he or she may consult with a neonatologist (a doctor who specializes in taking care of high risk babies) before delivery to make sure that everything is in place for your baby’s care.
Your Family Practitioner (FP)
Instead of switching to
an OB/GYN, you may want to receive your pregnancy care from your existing
family practitioner (FP). A FP is a medical doctor who specializes in taking
care of the entire family through every stage of life, including pregnancy and
birth. Your FP can even take care of your baby after delivery.
Keep in mind that you should only use a family physician if you are experiencing a low-risk pregnancy. All FPs are trained to provide normal prenatal care, but they will refer you to an OB/GYN if you start to experience pregnancy complications.
If you choose your family doctor for your pregnancy care, this doctor will also deliver your baby. However, most FPs perform only minor surgical procedures. Only a small number of family doctors perform c-sections.
A family practitioner may work alone, or in a larger group practice with nurses and other doctors. Many FPs have a close relationship with their patients because they are involved in all aspects of their care, and they may have treated them for a number of years.
Many expectant women who have a good relationship with their FP and have no high-risk issues often trust their pregnancy, labor and delivery to this doctor.
A family physician always delivers in a hospital setting.
Not all family physicians practice obstetrics. You will have to ask your individual FP for their policy.
You may Choose to see a Certified Nurse-Midwife (CNM)
For pregnant women who
want a more “natural” approach to childbirth, they may choose to see
a certified nurse-midwife (CNM) rather than a physician. A CNM is a registered
nurse who undergoes specialized training in midwifery. CNMs are required to
pass a national exam, so they can be certified by the American College of Nurse-Midwives.
They are licensed in the state that they practice.
Unlike most obstetricians and family practitioners, certified nurse-midwives have very close relationships with their patients. They often provide gentler, more attentive care than most physicians.
CNMs provide care for pregnant women from their first prenatal visit through labor and delivery, and after the birth of their baby. CNMs work with obstetricians, who serve as their back up if complications arise during pregnancy, labor, or delivery.
You can only choose a certified nurse-midwife if you are healthy and have a low-risk pregnancy.
Some CNMs may be licensed to use medical interventions during labor and delivery, including electronic fetal monitoring, labor-inducing drugs, epidurals, pain medication, and episiotomies. However, a certified nurse-midwife can only use these techniques under a medical doctor’s supervision. CNMs do not perform cesarean sections.
Certified nurse-midwives deliver in birth centers and/or in a hospital setting.
It is not recommended that you use a lay midwife for labor and delivery. Lay midwives do not hold nursing degrees, and most are not associated with a doctor. They do not provide care in a hospital setting. If unexpected complications occur, this can leave you and your baby in a dangerous situation.
Midwife or a Doula
A midwife or a doula can tell you
that there are many differences between a traditional or more medically managed
birth than a natural childbirth either at home or in the hospital. Some of
these differences are discussed in greater detail below.
A midwife might delivery your baby in your home, in a medical care facility or in a hospital. Accredited midwifes are certified and generally have the option of delivering in the home or at a hospital. Non-accredited midwives traditionally will delivery your baby within your home or theirs.
The primary difference between a midwife and an OB/GYN is the parents. It really depends on who you are most comfortable with. Some women prefer to seek the care of a well qualified physician, whereas others are more comfortable utilizing the services of a nurse/midwife.
Women have been birthing babies since the dawn of time. Usually women who have had more than one child are more comfortable using the services of an alternative health provider such as a midwife.
Doulas are labor
assistants. They have been credited with relaxing and soothing many moms to be
during and after the labor process.
A doula might serve a variety of functions during the labor process, including working with you to reduce your stress level, and hopefully helping reduce the complications and problems associated with a high stress or anxious birth process. Most doulas will continually attend a mother during the birthing process.
Their services include but are not limited to the following:
- Comfort techniques and physical care during the labor process.
- Emotional support for the mother.
- May act as labor coach.
- May offer massage or aromatherapy during labor.
- May help mother to be with breathing process and labor positions.
- May offer meditation exercises.
- Helps the mom to be create a birth plan.
A doula will not take the place of your husband during the birth process, however they will provide invaluable support to you and your partner should you need it during labor and delivery.
Deciding on the Right Caregiver for You
Deciding on the type of
caregiver that is best for you depends on the type of birth experience you are
looking for. Remember that it is just as possible to have a natural childbirth
with an OB/GYN attending as it is with a midwife.
A doula can also work in conjunction with an OB/GYN to assist you during the birth process.
If you have a high risk pregnancy, your best bet might be to go with a traditional OB/GYN particularly if you require monitoring during the entire pregnancy. If however you have a low risk pregnancy, you might look into midwifery as an option when seeking out a health care provider.
What to Expect at Your HealthCare Providers Office
Your first visit to
midwifery practice will be similar to that of a traditional medical
You will go over your medical history, including any medical conditions you have or previous pregnancies.
You might also discuss your birth plan, and practice labor and delivery positions as well as relaxation techniques later in your pregnancy.
When selecting a practitioner, you should come to your first appointment armed with a number of questions, the same type of questions you might ask a prospective OB/GYN.
Still not sure what type of practitioner is right for you? Consider the following questions:
- Are you comfortable with the idea of birthing in your home?
- Do you want to use medication for pain relief during the labor process?
- How important to you are interventions such as routine ultrasounds?
- Are you willing to cover part of the costs incurred by delivery?
- Do you prefer to deliver in privacy?
- Do you prefer to have someone familiar at your side at all times during delivery?
Remember that the decision to select a healthcare provider is a personal one. Ultimately you will make the decision that is best for you and your baby. Selecting a midwife or doula can be a rewarding experience for you and your baby!