Transcript: 10 Reasons To Call Your Doctor or Midwife
Preggie Pals
“10 Reasons to Call Your Doctor/Midwife”
Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
[Theme Music]
Erin Phillips : They say every pregnancy is different which means the symptoms that you are experiencing now you may not experience with your next baby. So, how do we know what’s normal? And how do we know when it’s time to call the doctor or midwife because something may be wrong? I am Erin Phillips, a certified nurse midwife, a nurse practitioner with Scripps Coastal Medical Center and this is Preggie Pals, Episode 14.
[Theme Music/Intro]
Sunny Gault : Welcome to Preggie Pals broadcasting from the birth education center of San Diego, I am your host Sunny Gault. In addition to listening to our episodes be sure to visit our website which is https://www.preggiepals.com to check out our blog and product reviews of pregnancy products. And that’s also were you can subscribe to our Preggie Pals newsletter featuring exclusive behind the scenes contest from our show, special giveaways and contests, discounts and much more. And don’t forget you can now take Preggie Pals wherever you go because our apps are now available in the Amazon Android market and the iTunes apps store. So, they have great features like the ability to able to star your favorite episode as well as instant access to our most recent episodes and social networking sites. So, let’s meet our panelists that are joining us here in the studio. Stephanie, why don’t you kick things off.
Stephanie Saalfeld : Hi, I am Stephanie Saalfeld, I am 29 years. I am a Gemologist. I am due January 9th with my first child and we don’t know the gender yet and we are having a hospital birth.
Misty Davies : Hi, my name is Misty Davies, I am 33 years. I am a Gemologist as well. I am due October 10th and it’s a girl. It’s my first and I am hoping for un-medicated hospital birth.
Sunny Gault : Alright, well thanks for joining us ladies.
[Theme Music]
[Featured Segment: News Headlines]
Sunny Gault : Alright, we are gonna kick things off with our news headlines and all of these headlines are posted to our Preggie Pals Pinterest Board! If you guys wanna check out them out this is a fun one I am so excited what you have to say. So, I found this just the other day apparently this took place at Moncado, Minnesota, a bar has installed a pregnancy test dispenser like, you would have like for tampons. This is how I am visioning it in my head and it’s only in the women’s restroom and he says it’s an effort to prevent fetal alcohol syndrome. So, he says this is the owner of spa, this may sound a little bit strange but, you know, when someone approached him with the idea he thought about it and really quickly made this decision. And obviously wants to help make sure that people who are drinking in his bar, you know, don’t inadvertently, you know, get pregnant have a baby but then I am like so they are gonna find out they are pregnant but how does that really start fetal alcohol syndrome? I am not really quite sure on the correlation right there but, I am so curious to hear what you guys have to say about this?
Erin Phillips : That is the weirdest thing I have ever heard, seriously. So, what you are having some cocktails and you know, like what if I just, if I make sure?
Sunny Gault : Yeah.
Erin Phillips : Yeah, that seems a little bit strange.
Sunny Gault : I think it’s so terrible.
Erin Phillips : I guess it is, I guess his heart is in the right place, you know, it seems like he is trying to something good.
Sunny Gault : But, the same time when you find out you know, I mean, I guess if you just stop right that in there you just didn’t take another sip. Maybe that’s what he is trying to say. We got the fetal alcohol center but I am kind of like, people are hanging out in your bar long time and I don’t know.
Erin Phillips : Usually it takes a couple of weeks for and over the counter and your pregnancy test to become positive. So that is kind of a catch 22 of this scenario. You could have become pregnant and still have a negative in pregnancy test when you are really pregnant. So, it is better that if you think that you could be pregnant to avoid alcohol until you have your next menstrual period.
Sunny Gault : Alright, well the one thing that this article does say and those of you who have taken you know, pregnancy test I am sure all of our panelists have what I have obviously have 2 kids at home, I had to find out somehow. But, it does say that the pregnancy tests are only 3 bucks which have you gone in the store to buy a pregnancy test those are expenses, right?
Erin Phillips : Yeah.
Sunny Gault : And then for me at least with my first born we had a hard time conceiving and so I did all the ovulation tests and stuffs and those were expensive too. So, when I was first reading this I was like “Oh! I am like what is this guy doing?” And I am like “$3 dollar pregnancy test Oh! My god.” It’s a fantastic idea, Misty what do you think?
Misty Davies : It’s a little, it’s a little strange but I am starting to think that maybe it’s not a bad idea. I mean, if you have to if you go into the bar and then eventually yes you have to go to the rest room. You go in there you see it. It kind of makes you stop and think.
Sunny Gault : Yeah, so you really wanna have another drink?
Misty Davies : And then yeah, do I wanna have a another drink? Just make sure you know, on the other side I don’t see anything I am starting to, it’s strange but I don’t know, it’s sounding like a better and better idea.
Erin Phillips: How would you know to look in the tampon machine though see…
Sunny Gault : Well, I am sure it’s gonna be its own separate machine.
Erin Phillips: But I am thinking of it in my head like flashing lights.
Misty Davies : Alright.
Sunny Gault : Are you pregnant? It’s fine don’t know. But the owner says that it is gonna be less embarrassing than having to go to a drug store. We guys are embarrassed to buy pregnancy tests? Yeah I was always embarrassed by condoms but pregnancy tests?
Misty Davies : No.
Sunny Gault : I guess it all depends on your situation and how you kind of got into that position. But I was always trying to have a baby.
Misty Davies : Yeah, you see the tests.
Sunny Gault : Yeah, very always happy about it. Okay, alright well, thanks for your opinions ladies.
[Theme Music]
Sunny Gault : Today we are talking about the top 10 reasons you should call your doctor or midwife while pregnant. Erin Phillips is joining us here in the studio you heard her in the beginning she is a certified, “I can’t talk!” Let me just pick it okay, okay today, we are talking about the top 10 reasons you should call your doctor or your midwife while pregnant and Erin Phillips is joining us here in the studio, she is a certified nurse midwife and nurse practitioner with Scripps Coastal Medical Center right here in San Diego. So, Erin first of all welcome to the show.
Erin Phillips : Thank you.
Sunny Gault : Thank you so much. So, let’s go through this top 10 lists and I do wanna say some things off the top here and that is we are not rating these and you know, matter of importance or not importance you know we are just literally giving you the top overall reasons. But you can always call your doctor. We are not saying “don’t call your doctor if you don’t see this stuff. That’s always a fallback.” But I know for me when I was pregnant I have always thought twice about you know, should I call them you know should I not call them, should I bug them, they have lot of patients already. So, really this episode is just to basically service a buffer if you are filtered you know, if you are experiencing any of these obviously call your doctor. But at any time but if you are concerned you should call your doctors. So, I just wanted to clear the area in the beginning with that. Okay, Erin let’s get through some of these the first one we want to talk about is vaginal bleeding. What’s going on when we see you know, blood?
Erin Phillips : There are multiple causes of vaginal bleeding in pregnancy. So I am gonna break it up between first trimester and beyond the first trimester. In first trimester you could have bleeding from several things either from implantation as the fertilized egg is implanting into the uterine wall, you can have a little bit of spotting. That’s very; very common. It does not mean you are going to have a miscarriage. But, another common reason possible miscarriage because miscarriage occurs in one out of five or six pregnancies. That’s actually something that I see on a fairly regular basis and we usually see several times a week in my practice. There are also more unusual causes like a cervical polyp or something that you can’t really see or know you have unless you see your physician or midwife. Later in pregnancy, vaginal bleeding can be caused by intercourse or it can also be caused by placenta previa which means you may have your placenta covering your cervix. So, if you have a contraction it can cause a little bit of bleeding beneath the placenta which actually will come out through the cervix. That’s not something that is very common. Although, we do see it on a regular basis because of the high volume that we have in our office but we are tending to see placenta previa more because of the higher cesarean section rate. So, the placenta will tend to implant over any abnormal surface in the uterus so you do see more, lower uterine segment implantation of the placenta. Also, labor is a cause of vaginal bleeding so when you get to full term which is 37 weeks or more and you start having regular contractions you may see some vaginal bleeding and little bit is okay, we expect that as the cervix thins out and starts to dilate we call it as “bloody show.” I usually tell patients if you are bleeding and you are not sure if you should come in and you are full term, put a pad on and see how much bleeding you are having. If you are starting to soak a pad or even half a pad like you are on your period that’s more than “bloody show.” You should probably come in or call your doctor.
Sunny Gault ; Yeah, I think if I saw any blood at any time it might freak me out.
Erin Phillips : Yeah, you are right. It does freak more patients out and it should. I think it’s good to be very cautious. I also warn my patients when I check their cervix whether I check them you know, if they are preterm or full term I usually warn them and say you may have a little bit of vaginal bleeding after my exam, or after I do a transitional ultrasound in the first trimester, you will often see a little bit of spotting because the cervix is more sensitive when you are pregnant, when it is touched it bleeds more easily. So, occasionally patients will have spotting after inner course and I usually will triage them over the phone and ask them a few questions about their bleedings and symptoms and what happened recently and then make a determination of whether or not their symptoms were in for further investigation in the office.
Sunny Gault : Okay, our next one is headache, fainting and dizziness which could be caused by a lot of things. So when do you know when it’s something that you should really be concerned about?
Erin Phillips : Well, I think the most important thing is to make sure that you are really well hydrated. I think sometimes it’s hard to sort out all these different symptoms in pregnancy. In pregnancy you are more fatigued. You tend to become more anemic which lends itself to having more dizziness in pregnancy. But, the most common cause that I see is dehydration. So, when patients call me with dizziness I usually recommend that they drink a liter of water, lay down for an hour and if it’s not getting better you know, call me. The other times you can have low blood sugars. So, if you haven’t eaten for a long period of time you may need to have a snack and lay down for a little while you know, before you start to feel better. So, I usually recommend trying a snack, fluids and rest and if your dizziness still persist then come into see your doctor for you know, for them to be able to probe a little bit further, ask them more questions and find out if there is really something more to it.
Sunny Gault : What could it be if there is something more to it, any idea?
Erin Phillips : Well, anemia is probably the most common thing that I see in my practice. I will often checked a blood count on a patient to make sure that they are not iron deficient because if you are , if you don’t have enough hemoglobin which is the molecule that carries oxygen, you are gonna get less oxygen to your tissues into your brain and you are gonna feel more fatigued and dizzy. So, you know there are potentially other causes for you know, dizziness, headache, a lot of women get migraines so that is the potential cause. And of course there are other illnesses such as the flu that could cause the symptoms.
Sunny Gault : Okay, now Misty, I’m looking over to you and you made some sign over to Stephanie. So, have you experienced any of these or what was the look for?
Misty Davies : No she was just talking about headaches.
Sunny Gault : Yeah.
Stephanie Saalfeld : I have headaches every morning when I wake up. So, it is probably dehydration you know not drinking throughout the night because I don’t wanna wake up more than 3 times what normally I do. So, do you recommend drinking more water throughout the night too?
Erin Phillips : Absolutely, I think you need at least 3 liters of water per day in your pregnancy and most women are not getting enough. They may be drinking 3 liters but it’s not always the water if you are drinking caffeinated beverages like, tea or coffee and those tend to be very dehydrating. So, you will tend to urinate more and be more dizzy.
Stephanie Saalfeld : So, it should be 3 liters of water?
Erin Phillips : Yeah, 3 liters of water per day and then if you wanna add to that with some Gatorade or you know your drink of choice you know, outside of wine and beer, etc. Then you know, that would be helpful to prevent it from happening. So, in pregnancy I usually recommend that my patients try extra strength Tylenol for their headaches and also you know, if you are having them on a regular basis you can try that. At the end of pregnancy the headaches tend to be a little bit more cause for alarm just because headaches can’t be one of the symptoms of preeclampsia so when you are talking to your doctor or midwife about headaches we do take into consideration you will gestation or longing to try to sort out you know that this is something that is dangerous or not.
Stephanie Saalfeld : Okay, and on that note we will try to drink some water.
Sunny Gault : Okay, our next one is frequent and painful urination, what could that be?
Erin Phillips : Well, unfortunately I know too well that a painful urination is often a sign of urinary tract infection or bladder infection. The reason why it is so significant in pregnancy is too full, one is urinary tract infections can cause preterm contractions. So, it is very important to treat your urinary tract infections in pregnancies so that you won’t have preterm labor because of it. Because of that phenomenon, we screen all of our patients with the urine analysis and culture at their first OB appointment. So, a lot of times I do call patients back and let them know that they have a urinary tract infection. Even if they are not having any symptoms I do treat it in pregnancy and then when they come back for their follow up visit in 4 weeks I usually re-screen them to make sure that their urinary infection has resolved. Another reason urinary tract infections can be detrimental to pregnancies because we don’t want the bacteria to work its way up the uterus into the kidneys and the patients can develop something called Pielonefritis which is a kidney infection that usually starts with a bladder infection that can be very serious for moms and babies both.
Sunny Gault : Okay, I actually had this happened with my last pregnancy probably within the first couple of months I had a urinary tract infection and then unfortunately I have had some bladder complications in the past so I am quite familiar with your urinary tract infections. But I got really nervous because as like I have heard that this could lead a preterm labor and I think they told me that the medicine that they put me on is slightly different if you are pregnant as opposed to have a urinary tract infection and not being pregnant.
Erin Phillips : Well, yes and no there are couple of antibiotics that we tend not use in the last month of pregnancy because of uterus in the baby. But you know, earlier in pregnancy I usually use the same antibiotics that I would use for non-pregnant patient but it also depends on the patient’s allergies and it depends on the urine culture. So, you may start a patient on an antibiotic because they tell you that you have a burning with urination and while you are waiting for the culture to come back which usually takes about 3 days, by the 3rd day you might find out that the bacteria that is in the urine is not sensitive to the antibiotic that you started the patient on. So, you often have to switch the antibiotics. So, urine cultures are very valuable.
Sunny Gault : Okay, bouts about pelvic pain, what could that be a result off? Sounds bad, right?
Erin Phillips : Well, I hate to break it to you guys but, everybody that’s pregnant is probably gonna experience some degree of pelvic pain. Have you ladies experienced that?
Stephanie Saalfeld : Yeah.
Misty Davies : Yeah.
Stephanie Saalfeld: Yeah, so how do you know what’s normal and what’s not normal?
Erin Phillips : That’s a good question, usually as you get bigger you tend to experience heaviness in your pelvis. You might feel some separation of the pubic bones. A lot of women have pain right at the symphysis pubis which is where the bones connect in the front by little band of cartilage. And as you have that relaxing hormone produced, the hip separates and it pulls on that cartilage bond in the middle so a lot of patients have a short pain there on the bone. So, the reasons that I would be concerned about pelvic pain would be if you have other symptoms like vaginal bleeding, spotting, leaking of fluid or if you are feeling preterm contractions which feel like menstrual cramps usually. Some people describe them as a Charlie horse in your belly. So, it is sometimes hard to distinguish okay, is this normal or not normal? I encourage all my patients to get a pregnancy support belt which can be kind of like a bra for your belly. It kind of pulls the belly up and in so that when you are moving around or working you are not jiggling so much with less pressure on your pelvis. And also it helps to back support because women often have that exaggerated lower lumbar curviture or that lower dosis from being pregnant so that can be very helpful. But I find if women are using that and they are still having pelvic pain it’s definitely something to look into.
Sunny Gault : Yeah, I think the Charlie horse pain that you are talking about I would feel everyone for a while it’s just really, it is really brief but I just felt like the shooting pain. It wasn’t like a consistent menstrual cramping or something like that but it felt like just kind of shot up through your body you know. And so every time I did I was like “Oh! I hope it doesn’t happen again” but sometime it happens a couple of seconds later or whatever. So, I am assuming that one of the things that a lot of women, I am hoping that I am not the one that is experiencing.
Stephanie Saalfeld : No, I felt that but it wasn’t really like a sharp pain. It was little bit like a clamp and then it would kind of go, it didn’t hurt.
Erin Phillips : And what you are describing right now are Braxton Hicks Contractions. Braxton Hicks Contractions are just those irregular painless contractions where you feel like you are balled up or you just feel tight but then it goes away and it doesn’t really turn into anything. And those are okay but once they become rhythmic and painful, that’s when you will be getting into preterm labor. So, the rule that I use for my patients is if you are having 6 painful contractions per hour which would be one every ten minutes, then you need to call us and let us know so that we can decide whether or not to bring you in. So, usually I use that rule once in 24 weeks or more which is really when you are in that window for preterm labor.
Sunny Gault : Okay, so we are on this pain kicks so, let’s continue to talk about leg pain and Misty I am so curious you have had some belts with leg pain, what was your experience?
Misty Davies : Well, I found out that I had a deep pain thrombosis, I just, for a few days my, around my hip area it was hurting around the same time I was having pelvic pain too. So, I thought it was just the relaxant in my system kind of, making everything like stretch and grow and I was dark sitting. So, I felt that may be you know, I had overdone a little bit but then, I called my doctor you know it was about 3 days and it was getting harder and harder to look. And then I noticed a little bit of swelling so I called the doctor and they told me that I should come in since I am having some swelling, went to the doctor you know, found out I should go to the emergency room and yeah so I got the DPT.
Sunny Gault : And you got the full work out, right?
Misty Davies : Yes.
Erin Phillips : So, leg pain is very common in pregnancy and DPT has the vein thrombosis which means a blood clot somewhere in your leg it’s most commonly in the calf area. The reason why that is more common in pregnancy is because your blood is in a state where it clots more easily during the pregnant period as well as the post-partum period. So, we are always very suspicious of one sided leg pain or one sided leg swelling. The first question I always ask my patient is are you having this pain on both sides? If you are having it on both the sides, you know, and they are pretty even, I usually think it’s probably less likely to be a blood clot in the leg versus if you are having it on one side and not the other. That raises my eyebrows a little bit. So you don’t want it, if you are having pain on one side you don’t want to massage it until you check with your doctor because you don’t wanna dislodge your blood clot.
Misty Davies : How long would you suggest someone wait? I mean, it was 3 days I was having pain in my leg but it wasn’t really swelling.
Erin Phillips : Well, I think that I would do some stretching exercises first in case if it’s just a tight muscle but I think if you have done stretching exercises, you have rested, you have taken some extra strength Tylenol then I would suggest going to see your doctor or midwife if the pain isn’t getting better.
Sunny Gault : Okay, well when we come back we are gonna wrap up our top 10 lists. So, we will be right back.
[Theme Music]
Sunny Gault : Welcome back! We are chatting with Erin Phillips, a certified nurse midwife and nurse practitioner about the top 10 reasons we should call our doctor or midwife when we are pregnant so, let’s go ahead and wrap up the list. Chills or a fever higher than 103 degrees and I guess we can add vomiting to that list as well?
Erin Phillips : Yeah, usually I tell patients if you have fever, aches or chills that’s something that you should call your doctor or midwife about. I do always caution them, if you think that you are ill with a bacterial, viral illness you may wanna call primary care because I don’t like to bring sick patients into my office because they are exposing other patients. Usually, I use the rule fever greater than 101 rather than a 103 at least for my patients and the reason is in adults your fevers tend to not get quite as high as in kids. So, I know with my kids, my daughter had a urinary tract infection as a little girl and her temperature got to 104 and I am thinking “Oh! My gosh! This is outrageously high” and I called our Pediatrician and she said “You know that’s normal for little kids they tend to get higher fevers but in you and I as adults are feverish just don’t get that high.” So if it’s 101 and above then I usually recommend you call and so we can bring you in or even just talk to you over the phone to try to find out what are your other symptoms because as we discussed earlier it could be urinary tract infection. You know, it could be something that’s relatively easy to treat or it could be something more serious like the flu.
Sunny Gault : And what about vomiting, I mean, we are talking about excessive vomiting or if you just vomit once or what?
Erin Phillips : That’s a good question. In the first trimester I usually tell my patients if you are throwing up and you can’t food or fluids down then you need to call me. We do prescribe anti medics which are anti-notion medications in pregnancy that can alleviate your symptoms you can at least tolerate small meals or bland foods like crackers, toast, chicken noodles, soup and if that doesn’t work often times we do have to send patients to urgent care so that they can get IV fluids and some IV notion medications. In extreme cases we actually refer patients to home health so that they can fluids on a regular basis if they are not keeping anything down. So, don’t hesitate to ask your doctor if or not the vomiting if you’re having is normal. I also look at weight gain or weight loss you know, if a patient comes to me and says you know, I have been feeling really sick and I see that they have lost 5 pounds that’s a red flag for me. Then I know that they are not just exaggerating. They really mean it they are not eating normally. So, later in pregnancy vomiting can be a sign of labor. I probably see patients at least have nausea if not vomiting during labor about 50% of the time. So we can use those anti-nausea medications in labor. But occasionally patients will have nausea and vomiting that is totally unrelated to the labor either in the second or third trimester. They are lot of different causes of nausea and vomiting. It could be pancreatitis it could be gall stones, it could be something related to pregnancy called hellp syndrome which stands for hemolysis elevated liver enzymes and low platelets. And so whenever patients comes in with these symptoms before we send them home we usually do a panel of test to check their liver and kidney function before we send them home or I refer them over to primary care if we think it’s something that’s not related to pregnancy.
Sunny Gault : Okay, what about steady and heavy vaginal discharge?
Erin Phillips : Well, that’s a hard one because almost everybody has vaginal discharge in pregnancy and it’s hard to know okay, is this normal or not normal? So, the first thing I ask patients are, is No.1, is it itchy? No.2, does it smell bad? No.3, does it hurt when you have intercourse? And No.4, does it keep coming out when you have no pants on?
Sunny Gault : So, we have to work on it?
Erin Phillips : Exactly, exactly well you know in cases we are trying to figure out whether or not their water is broken especially if they are calling me on the phone I say you know take your underwear off wear a skirt, walk around the house for a while. Is it dripping down your leg? If it’s dripping down your leg you know, it’s very possible it could be your amniotic fluid whereas if it’s just a discharge usually you are not gonna have that much excess. Yeah, so, so the most common reasons for excess vaginal discharge is just you know, the mucus that your cervix produces bacterial vaginosis you could have overgrowth of bacteria, you could have an yeast infection and then it could be your amniotic fluid. And the most important one to tell your doctor about is whether or not it’s amniotic fluid so and sometimes you don’t know until you come in and you actually have a few tests done to rule that out.
Misty Davies : Right, I remember when I was in labor with my first born I was like, I don’t know if my water broke or if I am just peeing myself and I had no control because you know you get to a point you know, you are about ready to burst then there is so much you can control down there. It might just be happening.
Erin Phillips : That’s right, that’s right. And a lot of women are very embarrassed when they come see me and they tell “I think my water broke” and then I end up telling them in the end “I think you might have just got a little bit of incontinence you know, it’s very embarrassing. But, I always reassure patients most other pregnant ladies are experiencing the same thing so you are not the only one it’s kind of like hemorroids, everybody that has hemorroids says “Oh! My gosh this is the worst thing ever” and I tell them you know what look around the room and anybody who has ever had a baby in here has probably had a hemorrhoid before.”
Sunny Gault : Yeah.
Erin Phillips : So,
Sunny Gault : Exactly, makes us feel better.
Erin Phillips : Yeah.
Sunny Gault : Sudden swelling of hands, feet and face as you know, swelling for me it wasn’t sudden on any of my pregnancies but man, sometimes I feel like a big sausage you know, your feet or you know, your ankles and stuff like that. So, really that’s the key here we are talking about something hadn’t happening suddenly?
Erin Phillips : Yeah, you know from personal experience when I was pregnant with my first I developed severe preeclampsia and had a 10 pound weight gain in 1 week. That is not normal. You know, that’s something that you will see with swelling to happen suddenly as a sudden weight gain, you are not feeling well, you might have chest pain, upper right sided abdominal pain, headache, blurry vision those are all symptoms of preeclampsia. It’s very common in pregnancy to become swollen in the third trimester and a little bit of swelling as considered normal. But, we start seeing patients more frequently in the third trimester because we are on the lookout for preeclampsia which typically is high blood pressure in pregnancy with little bit of protein in your urine, your kidneys leak out protein when they are not supposed to. There are a few other signs that we see in blood test that you wouldn’t know that you had unless you go and see your doctor.
Sunny Gault : Okay, and this is an obvious one if you know you are having contractions you should probably call your doctor but my question is lets break this down a little bit, can you actually have regular contractions you know, in your first or second trimesters or is this really just geared more towards the third trimester?
Erin Phillips : You can have contractions in the first and second trimester. We don’t necessarily call them contractions because you can’t really distinguish one from the other. It just feels like constant clamping. A lot of women experience clamping which is just the growth of the uterus versus if you are gonna have miscarriage or a threatened miscarriage you would feel just constant menstrual like clamping or low back ache. So, and that essentially is the uterus contracting. It’s just you don’t have this 5 or 10 minutes break between every time the uterus contracts. In the second or third trimester you know, so let’s say 24 weeks and on I usually tell patients between 24 weeks and 37 weeks so that’s the preterm time frame, call your doctor if you have 6 or more contractions per hour or if you are full term 37 weeks or more I usually tell patients you wanna call once your contractions are occurring at 5 minutes intervals lasting 1 minute each for at least one hour. So, if you have taken child birth classes before, they have probably talked about the 511 rule which is exactly that contraction every 5 minutes lasting 1 minute for an hour. And realistically, you really need strong painful contractions that you can’t even talk through in order to start dilating.
Sunny Gault : Okay.
Erin Phillips : Unfortunately pain equals progress.
Sunny Gault : I like that saying that’s kind of catchy.
Erin Phillips : Yeah.
Sunny Gault : Okay and lack of fetal movement which this is why do kick counts and stuffs like that and we go to the doctor. It is one of those things and it is kind of annoying to me beyond what is your kick count level? “Oh! I don’t know what it is this time” but that’s why we do it because our babies aren’t as active something could be wrong.
Erin Phillips : Absolutely, some practitioners don’t use fetal movement counts and I am gonna call them fetal movement counts instead of fetal kick counts. Kick counts is little bit more catchy but it doesn’t have to be a kick. Usually we say you should have 10 movements within an hour and I usually start my patients monitoring the movements about 28 to 30 weeks because babies have their peak movements at 27 to 28 weeks. So, before that time it’s hard to keep a little tiny baby to that expectation because they are probably moving more than you actually feel. So, if you sit down and you try to count the movements and it takes 5 minutes to feel the baby moved 10 times, it’s awesome you are done for the day and you don’t have to count until the next day. But if you are sitting there for an hour and you haven’t felt 10 movements try drinking something super cold like a big glass of ice water or try having a snack and usually the baby will wake up. If the baby doesn’t wake up then that could be a sign of wrong. So it’s a good idea to call your doctor or midwife or just go into the hospital. I tell my patients “if I am not here and there isn’t somebody in the office just go ahead and go to an interview the delivery and monitor to make sure everything with the baby is okay.” Occasionally it will just be a sleep cycle where the baby will be sleeping for an hour or two and we have a few little tricks that we can use in the hospital to wake the baby up and get them to move like we want them to. I had a patient couples years ago on the call to our office complaining of decrease fetal movement. She was 32 weeks. She had just started doing her movement counts and she did end up having hysteria which is a bad organism that can be acquired through eating.
Sunny Gault : Yeah.
Erin Phillips : Exactly, exactly it can cross the placenta and cause still birth in the babies. So, anyway we ended up delivering that patient early because of it. So, fetal movements counts actually saved the baby. So, since that experience for me I feel strongly that movement counts are very valuable.
Sunny Gault : Yeah, and no one knows your baby better than yourself.
Erin Phillips : Absolutely, you have to just use your intuition. You know, if you have a baby that moves just nonstop and even if you feel the baby moving a little bit but it just doesn’t seem normal for you, I would go ahead and call. You tend to feel the babies move a little bit less in the last month of pregnancy because they are so squished, their head down, they are big, they are chunky and can’t understand their arms and their legs so their movements tend to be more subtle. So, you have to kind of look for more subtle movements at the end but, I still think you have to use your intuition if something doesn’t feel right you have to definitely go and get it checked out.
Sunny Gault : Yeah, I think that applies to everything you have talked about today. You know, use your mother’s intuition you know if you don’t think something is right like I said in the beginning of the show “Call your doctor.” But these are some of the big things we definitely want to call your doctor if you do notice.
Erin Phillips : Absolutely.
Sunny Gault : Erin, thank you so much for joining us.
Erin Phillips : It’s my pleasure. Thanks for having me.
Sunny Gault : It was a great conversation I absolutely loved it. If you would like to share your experience with having any of these symptoms that we mentioned today we would love to hear it. You can continue our conversation on twitter just use the hash tag new mommy media and you can also find this on Facebook or simply leave a message on our website under the episodes page.
[Theme Music]
[Featured Segment: Baby Registry Secrets]
Sunny Gault : Before we wrap today’s show here is some baby registry secrets.
Evian : Hi, Preggie Pals, my name is Evian, sales associate at Agana Baby. I am here to discuss some tips you have to consider when creating the perfect baby registry. Our fifth and final topic is to spread the word you want everyone to know that you have registered as well as where you have registered at. The only way people will know to check out your registry is if you inform them. Of course, you don’t want to be pushy about it. Don’t start off the conversation with a friend but turn them registered but if they ask about your pregnancy or ask about what you are doing to help. You can kindly tell them that you are registered so checking that out would be more than enough. Most people will want you to get you some sort of gift so the registry is also a good way of getting things you actually would need or want so it’s good to use it to your advantage as fast as you can. Don’t feel like you’re being selfish or needy. Registries actually make every things easier for everyone else. They take all of the trouble add up shopping and deciding what might be the best gift for you and your baby. If they know you already want certain items it would be easy for them to decide on and they can feel good about their gift if they already know that you are certain to appreciate it. Be sure to also tell everyone where you have registered especially if you are registered at multiple locations. Not every store has everything you want so even if someone knows that you want an item it is good to let them know where to make the purchase. Also some stores will give special discounts for registry items so that will be a benefit to both you and your friends. For more tips on creating perfect baby registry as well as what to include in the registry, visit https://www.aganababy.com or follow us on Facebook and twitter at Agana Baby and be sure to listen to Preggie Pals for great registry tips in the future.
[Theme Music]
Sunny Gault : That wraps up our show for today if you have any questions about today’s topic or any pregnancy related questions you can always ask our experts. Simply send us an email or you can call our Preggie Pals hotline at 619-866-4775 and we’ll answer your question on an upcoming episode. If you have a pregnancy topic you would like to suggest, I would love to hear it you can visit our website at https://www.preggiepals.com and send me an email. Thanks for listening to Preggie Pals, your pregnancy your way.
[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Suggestions and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. For such information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating any house care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
[00:39:18] [End Of Audio]
Episode Transcript
Preggie Pals
“10 Reasons to Call Your Doctor/Midwife”
Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
[Theme Music]
Erin Phillips : They say every pregnancy is different which means the symptoms that you are experiencing now you may not experience with your next baby. So, how do we know what’s normal? And how do we know when it’s time to call the doctor or midwife because something may be wrong? I am Erin Phillips, a certified nurse midwife, a nurse practitioner with Scripps Coastal Medical Center and this is Preggie Pals, Episode 14.
[Theme Music/Intro]
Sunny Gault : Welcome to Preggie Pals broadcasting from the birth education center of San Diego, I am your host Sunny Gault. In addition to listening to our episodes be sure to visit our website which is https://www.preggiepals.com to check out our blog and product reviews of pregnancy products. And that’s also were you can subscribe to our Preggie Pals newsletter featuring exclusive behind the scenes contest from our show, special giveaways and contests, discounts and much more. And don’t forget you can now take Preggie Pals wherever you go because our apps are now available in the Amazon Android market and the iTunes apps store. So, they have great features like the ability to able to star your favorite episode as well as instant access to our most recent episodes and social networking sites. So, let’s meet our panelists that are joining us here in the studio. Stephanie, why don’t you kick things off.
Stephanie Saalfeld : Hi, I am Stephanie Saalfeld, I am 29 years. I am a Gemologist. I am due January 9th with my first child and we don’t know the gender yet and we are having a hospital birth.
Misty Davies : Hi, my name is Misty Davies, I am 33 years. I am a Gemologist as well. I am due October 10th and it’s a girl. It’s my first and I am hoping for un-medicated hospital birth.
Sunny Gault : Alright, well thanks for joining us ladies.
[Theme Music]
[Featured Segment: News Headlines]
Sunny Gault : Alright, we are gonna kick things off with our news headlines and all of these headlines are posted to our Preggie Pals Pinterest Board! If you guys wanna check out them out this is a fun one I am so excited what you have to say. So, I found this just the other day apparently this took place at Moncado, Minnesota, a bar has installed a pregnancy test dispenser like, you would have like for tampons. This is how I am visioning it in my head and it’s only in the women’s restroom and he says it’s an effort to prevent fetal alcohol syndrome. So, he says this is the owner of spa, this may sound a little bit strange but, you know, when someone approached him with the idea he thought about it and really quickly made this decision. And obviously wants to help make sure that people who are drinking in his bar, you know, don’t inadvertently, you know, get pregnant have a baby but then I am like so they are gonna find out they are pregnant but how does that really start fetal alcohol syndrome? I am not really quite sure on the correlation right there but, I am so curious to hear what you guys have to say about this?
Erin Phillips : That is the weirdest thing I have ever heard, seriously. So, what you are having some cocktails and you know, like what if I just, if I make sure?
Sunny Gault : Yeah.
Erin Phillips : Yeah, that seems a little bit strange.
Sunny Gault : I think it’s so terrible.
Erin Phillips : I guess it is, I guess his heart is in the right place, you know, it seems like he is trying to something good.
Sunny Gault : But, the same time when you find out you know, I mean, I guess if you just stop right that in there you just didn’t take another sip. Maybe that’s what he is trying to say. We got the fetal alcohol center but I am kind of like, people are hanging out in your bar long time and I don’t know.
Erin Phillips : Usually it takes a couple of weeks for and over the counter and your pregnancy test to become positive. So that is kind of a catch 22 of this scenario. You could have become pregnant and still have a negative in pregnancy test when you are really pregnant. So, it is better that if you think that you could be pregnant to avoid alcohol until you have your next menstrual period.
Sunny Gault : Alright, well the one thing that this article does say and those of you who have taken you know, pregnancy test I am sure all of our panelists have what I have obviously have 2 kids at home, I had to find out somehow. But, it does say that the pregnancy tests are only 3 bucks which have you gone in the store to buy a pregnancy test those are expenses, right?
Erin Phillips : Yeah.
Sunny Gault : And then for me at least with my first born we had a hard time conceiving and so I did all the ovulation tests and stuffs and those were expensive too. So, when I was first reading this I was like “Oh! I am like what is this guy doing?” And I am like “$3 dollar pregnancy test Oh! My god.” It’s a fantastic idea, Misty what do you think?
Misty Davies : It’s a little, it’s a little strange but I am starting to think that maybe it’s not a bad idea. I mean, if you have to if you go into the bar and then eventually yes you have to go to the rest room. You go in there you see it. It kind of makes you stop and think.
Sunny Gault : Yeah, so you really wanna have another drink?
Misty Davies : And then yeah, do I wanna have a another drink? Just make sure you know, on the other side I don’t see anything I am starting to, it’s strange but I don’t know, it’s sounding like a better and better idea.
Erin Phillips: How would you know to look in the tampon machine though see…
Sunny Gault : Well, I am sure it’s gonna be its own separate machine.
Erin Phillips: But I am thinking of it in my head like flashing lights.
Misty Davies : Alright.
Sunny Gault : Are you pregnant? It’s fine don’t know. But the owner says that it is gonna be less embarrassing than having to go to a drug store. We guys are embarrassed to buy pregnancy tests? Yeah I was always embarrassed by condoms but pregnancy tests?
Misty Davies : No.
Sunny Gault : I guess it all depends on your situation and how you kind of got into that position. But I was always trying to have a baby.
Misty Davies : Yeah, you see the tests.
Sunny Gault : Yeah, very always happy about it. Okay, alright well, thanks for your opinions ladies.
[Theme Music]
Sunny Gault : Today we are talking about the top 10 reasons you should call your doctor or midwife while pregnant. Erin Phillips is joining us here in the studio you heard her in the beginning she is a certified, “I can’t talk!” Let me just pick it okay, okay today, we are talking about the top 10 reasons you should call your doctor or your midwife while pregnant and Erin Phillips is joining us here in the studio, she is a certified nurse midwife and nurse practitioner with Scripps Coastal Medical Center right here in San Diego. So, Erin first of all welcome to the show.
Erin Phillips : Thank you.
Sunny Gault : Thank you so much. So, let’s go through this top 10 lists and I do wanna say some things off the top here and that is we are not rating these and you know, matter of importance or not importance you know we are just literally giving you the top overall reasons. But you can always call your doctor. We are not saying “don’t call your doctor if you don’t see this stuff. That’s always a fallback.” But I know for me when I was pregnant I have always thought twice about you know, should I call them you know should I not call them, should I bug them, they have lot of patients already. So, really this episode is just to basically service a buffer if you are filtered you know, if you are experiencing any of these obviously call your doctor. But at any time but if you are concerned you should call your doctors. So, I just wanted to clear the area in the beginning with that. Okay, Erin let’s get through some of these the first one we want to talk about is vaginal bleeding. What’s going on when we see you know, blood?
Erin Phillips : There are multiple causes of vaginal bleeding in pregnancy. So I am gonna break it up between first trimester and beyond the first trimester. In first trimester you could have bleeding from several things either from implantation as the fertilized egg is implanting into the uterine wall, you can have a little bit of spotting. That’s very; very common. It does not mean you are going to have a miscarriage. But, another common reason possible miscarriage because miscarriage occurs in one out of five or six pregnancies. That’s actually something that I see on a fairly regular basis and we usually see several times a week in my practice. There are also more unusual causes like a cervical polyp or something that you can’t really see or know you have unless you see your physician or midwife. Later in pregnancy, vaginal bleeding can be caused by intercourse or it can also be caused by placenta previa which means you may have your placenta covering your cervix. So, if you have a contraction it can cause a little bit of bleeding beneath the placenta which actually will come out through the cervix. That’s not something that is very common. Although, we do see it on a regular basis because of the high volume that we have in our office but we are tending to see placenta previa more because of the higher cesarean section rate. So, the placenta will tend to implant over any abnormal surface in the uterus so you do see more, lower uterine segment implantation of the placenta. Also, labor is a cause of vaginal bleeding so when you get to full term which is 37 weeks or more and you start having regular contractions you may see some vaginal bleeding and little bit is okay, we expect that as the cervix thins out and starts to dilate we call it as “bloody show.” I usually tell patients if you are bleeding and you are not sure if you should come in and you are full term, put a pad on and see how much bleeding you are having. If you are starting to soak a pad or even half a pad like you are on your period that’s more than “bloody show.” You should probably come in or call your doctor.
Sunny Gault ; Yeah, I think if I saw any blood at any time it might freak me out.
Erin Phillips : Yeah, you are right. It does freak more patients out and it should. I think it’s good to be very cautious. I also warn my patients when I check their cervix whether I check them you know, if they are preterm or full term I usually warn them and say you may have a little bit of vaginal bleeding after my exam, or after I do a transitional ultrasound in the first trimester, you will often see a little bit of spotting because the cervix is more sensitive when you are pregnant, when it is touched it bleeds more easily. So, occasionally patients will have spotting after inner course and I usually will triage them over the phone and ask them a few questions about their bleedings and symptoms and what happened recently and then make a determination of whether or not their symptoms were in for further investigation in the office.
Sunny Gault : Okay, our next one is headache, fainting and dizziness which could be caused by a lot of things. So when do you know when it’s something that you should really be concerned about?
Erin Phillips : Well, I think the most important thing is to make sure that you are really well hydrated. I think sometimes it’s hard to sort out all these different symptoms in pregnancy. In pregnancy you are more fatigued. You tend to become more anemic which lends itself to having more dizziness in pregnancy. But, the most common cause that I see is dehydration. So, when patients call me with dizziness I usually recommend that they drink a liter of water, lay down for an hour and if it’s not getting better you know, call me. The other times you can have low blood sugars. So, if you haven’t eaten for a long period of time you may need to have a snack and lay down for a little while you know, before you start to feel better. So, I usually recommend trying a snack, fluids and rest and if your dizziness still persist then come into see your doctor for you know, for them to be able to probe a little bit further, ask them more questions and find out if there is really something more to it.
Sunny Gault : What could it be if there is something more to it, any idea?
Erin Phillips : Well, anemia is probably the most common thing that I see in my practice. I will often checked a blood count on a patient to make sure that they are not iron deficient because if you are , if you don’t have enough hemoglobin which is the molecule that carries oxygen, you are gonna get less oxygen to your tissues into your brain and you are gonna feel more fatigued and dizzy. So, you know there are potentially other causes for you know, dizziness, headache, a lot of women get migraines so that is the potential cause. And of course there are other illnesses such as the flu that could cause the symptoms.
Sunny Gault : Okay, now Misty, I’m looking over to you and you made some sign over to Stephanie. So, have you experienced any of these or what was the look for?
Misty Davies : No she was just talking about headaches.
Sunny Gault : Yeah.
Stephanie Saalfeld : I have headaches every morning when I wake up. So, it is probably dehydration you know not drinking throughout the night because I don’t wanna wake up more than 3 times what normally I do. So, do you recommend drinking more water throughout the night too?
Erin Phillips : Absolutely, I think you need at least 3 liters of water per day in your pregnancy and most women are not getting enough. They may be drinking 3 liters but it’s not always the water if you are drinking caffeinated beverages like, tea or coffee and those tend to be very dehydrating. So, you will tend to urinate more and be more dizzy.
Stephanie Saalfeld : So, it should be 3 liters of water?
Erin Phillips : Yeah, 3 liters of water per day and then if you wanna add to that with some Gatorade or you know your drink of choice you know, outside of wine and beer, etc. Then you know, that would be helpful to prevent it from happening. So, in pregnancy I usually recommend that my patients try extra strength Tylenol for their headaches and also you know, if you are having them on a regular basis you can try that. At the end of pregnancy the headaches tend to be a little bit more cause for alarm just because headaches can’t be one of the symptoms of preeclampsia so when you are talking to your doctor or midwife about headaches we do take into consideration you will gestation or longing to try to sort out you know that this is something that is dangerous or not.
Stephanie Saalfeld : Okay, and on that note we will try to drink some water.
Sunny Gault : Okay, our next one is frequent and painful urination, what could that be?
Erin Phillips : Well, unfortunately I know too well that a painful urination is often a sign of urinary tract infection or bladder infection. The reason why it is so significant in pregnancy is too full, one is urinary tract infections can cause preterm contractions. So, it is very important to treat your urinary tract infections in pregnancies so that you won’t have preterm labor because of it. Because of that phenomenon, we screen all of our patients with the urine analysis and culture at their first OB appointment. So, a lot of times I do call patients back and let them know that they have a urinary tract infection. Even if they are not having any symptoms I do treat it in pregnancy and then when they come back for their follow up visit in 4 weeks I usually re-screen them to make sure that their urinary infection has resolved. Another reason urinary tract infections can be detrimental to pregnancies because we don’t want the bacteria to work its way up the uterus into the kidneys and the patients can develop something called Pielonefritis which is a kidney infection that usually starts with a bladder infection that can be very serious for moms and babies both.
Sunny Gault : Okay, I actually had this happened with my last pregnancy probably within the first couple of months I had a urinary tract infection and then unfortunately I have had some bladder complications in the past so I am quite familiar with your urinary tract infections. But I got really nervous because as like I have heard that this could lead a preterm labor and I think they told me that the medicine that they put me on is slightly different if you are pregnant as opposed to have a urinary tract infection and not being pregnant.
Erin Phillips : Well, yes and no there are couple of antibiotics that we tend not use in the last month of pregnancy because of uterus in the baby. But you know, earlier in pregnancy I usually use the same antibiotics that I would use for non-pregnant patient but it also depends on the patient’s allergies and it depends on the urine culture. So, you may start a patient on an antibiotic because they tell you that you have a burning with urination and while you are waiting for the culture to come back which usually takes about 3 days, by the 3rd day you might find out that the bacteria that is in the urine is not sensitive to the antibiotic that you started the patient on. So, you often have to switch the antibiotics. So, urine cultures are very valuable.
Sunny Gault : Okay, bouts about pelvic pain, what could that be a result off? Sounds bad, right?
Erin Phillips : Well, I hate to break it to you guys but, everybody that’s pregnant is probably gonna experience some degree of pelvic pain. Have you ladies experienced that?
Stephanie Saalfeld : Yeah.
Misty Davies : Yeah.
Stephanie Saalfeld: Yeah, so how do you know what’s normal and what’s not normal?
Erin Phillips : That’s a good question, usually as you get bigger you tend to experience heaviness in your pelvis. You might feel some separation of the pubic bones. A lot of women have pain right at the symphysis pubis which is where the bones connect in the front by little band of cartilage. And as you have that relaxing hormone produced, the hip separates and it pulls on that cartilage bond in the middle so a lot of patients have a short pain there on the bone. So, the reasons that I would be concerned about pelvic pain would be if you have other symptoms like vaginal bleeding, spotting, leaking of fluid or if you are feeling preterm contractions which feel like menstrual cramps usually. Some people describe them as a Charlie horse in your belly. So, it is sometimes hard to distinguish okay, is this normal or not normal? I encourage all my patients to get a pregnancy support belt which can be kind of like a bra for your belly. It kind of pulls the belly up and in so that when you are moving around or working you are not jiggling so much with less pressure on your pelvis. And also it helps to back support because women often have that exaggerated lower lumbar curviture or that lower dosis from being pregnant so that can be very helpful. But I find if women are using that and they are still having pelvic pain it’s definitely something to look into.
Sunny Gault : Yeah, I think the Charlie horse pain that you are talking about I would feel everyone for a while it’s just really, it is really brief but I just felt like the shooting pain. It wasn’t like a consistent menstrual cramping or something like that but it felt like just kind of shot up through your body you know. And so every time I did I was like “Oh! I hope it doesn’t happen again” but sometime it happens a couple of seconds later or whatever. So, I am assuming that one of the things that a lot of women, I am hoping that I am not the one that is experiencing.
Stephanie Saalfeld : No, I felt that but it wasn’t really like a sharp pain. It was little bit like a clamp and then it would kind of go, it didn’t hurt.
Erin Phillips : And what you are describing right now are Braxton Hicks Contractions. Braxton Hicks Contractions are just those irregular painless contractions where you feel like you are balled up or you just feel tight but then it goes away and it doesn’t really turn into anything. And those are okay but once they become rhythmic and painful, that’s when you will be getting into preterm labor. So, the rule that I use for my patients is if you are having 6 painful contractions per hour which would be one every ten minutes, then you need to call us and let us know so that we can decide whether or not to bring you in. So, usually I use that rule once in 24 weeks or more which is really when you are in that window for preterm labor.
Sunny Gault : Okay, so we are on this pain kicks so, let’s continue to talk about leg pain and Misty I am so curious you have had some belts with leg pain, what was your experience?
Misty Davies : Well, I found out that I had a deep pain thrombosis, I just, for a few days my, around my hip area it was hurting around the same time I was having pelvic pain too. So, I thought it was just the relaxant in my system kind of, making everything like stretch and grow and I was dark sitting. So, I felt that may be you know, I had overdone a little bit but then, I called my doctor you know it was about 3 days and it was getting harder and harder to look. And then I noticed a little bit of swelling so I called the doctor and they told me that I should come in since I am having some swelling, went to the doctor you know, found out I should go to the emergency room and yeah so I got the DPT.
Sunny Gault : And you got the full work out, right?
Misty Davies : Yes.
Erin Phillips : So, leg pain is very common in pregnancy and DPT has the vein thrombosis which means a blood clot somewhere in your leg it’s most commonly in the calf area. The reason why that is more common in pregnancy is because your blood is in a state where it clots more easily during the pregnant period as well as the post-partum period. So, we are always very suspicious of one sided leg pain or one sided leg swelling. The first question I always ask my patient is are you having this pain on both sides? If you are having it on both the sides, you know, and they are pretty even, I usually think it’s probably less likely to be a blood clot in the leg versus if you are having it on one side and not the other. That raises my eyebrows a little bit. So you don’t want it, if you are having pain on one side you don’t want to massage it until you check with your doctor because you don’t wanna dislodge your blood clot.
Misty Davies : How long would you suggest someone wait? I mean, it was 3 days I was having pain in my leg but it wasn’t really swelling.
Erin Phillips : Well, I think that I would do some stretching exercises first in case if it’s just a tight muscle but I think if you have done stretching exercises, you have rested, you have taken some extra strength Tylenol then I would suggest going to see your doctor or midwife if the pain isn’t getting better.
Sunny Gault : Okay, well when we come back we are gonna wrap up our top 10 lists. So, we will be right back.
[Theme Music]
Sunny Gault : Welcome back! We are chatting with Erin Phillips, a certified nurse midwife and nurse practitioner about the top 10 reasons we should call our doctor or midwife when we are pregnant so, let’s go ahead and wrap up the list. Chills or a fever higher than 103 degrees and I guess we can add vomiting to that list as well?
Erin Phillips : Yeah, usually I tell patients if you have fever, aches or chills that’s something that you should call your doctor or midwife about. I do always caution them, if you think that you are ill with a bacterial, viral illness you may wanna call primary care because I don’t like to bring sick patients into my office because they are exposing other patients. Usually, I use the rule fever greater than 101 rather than a 103 at least for my patients and the reason is in adults your fevers tend to not get quite as high as in kids. So, I know with my kids, my daughter had a urinary tract infection as a little girl and her temperature got to 104 and I am thinking “Oh! My gosh! This is outrageously high” and I called our Pediatrician and she said “You know that’s normal for little kids they tend to get higher fevers but in you and I as adults are feverish just don’t get that high.” So if it’s 101 and above then I usually recommend you call and so we can bring you in or even just talk to you over the phone to try to find out what are your other symptoms because as we discussed earlier it could be urinary tract infection. You know, it could be something that’s relatively easy to treat or it could be something more serious like the flu.
Sunny Gault : And what about vomiting, I mean, we are talking about excessive vomiting or if you just vomit once or what?
Erin Phillips : That’s a good question. In the first trimester I usually tell my patients if you are throwing up and you can’t food or fluids down then you need to call me. We do prescribe anti medics which are anti-notion medications in pregnancy that can alleviate your symptoms you can at least tolerate small meals or bland foods like crackers, toast, chicken noodles, soup and if that doesn’t work often times we do have to send patients to urgent care so that they can get IV fluids and some IV notion medications. In extreme cases we actually refer patients to home health so that they can fluids on a regular basis if they are not keeping anything down. So, don’t hesitate to ask your doctor if or not the vomiting if you’re having is normal. I also look at weight gain or weight loss you know, if a patient comes to me and says you know, I have been feeling really sick and I see that they have lost 5 pounds that’s a red flag for me. Then I know that they are not just exaggerating. They really mean it they are not eating normally. So, later in pregnancy vomiting can be a sign of labor. I probably see patients at least have nausea if not vomiting during labor about 50% of the time. So we can use those anti-nausea medications in labor. But occasionally patients will have nausea and vomiting that is totally unrelated to the labor either in the second or third trimester. They are lot of different causes of nausea and vomiting. It could be pancreatitis it could be gall stones, it could be something related to pregnancy called hellp syndrome which stands for hemolysis elevated liver enzymes and low platelets. And so whenever patients comes in with these symptoms before we send them home we usually do a panel of test to check their liver and kidney function before we send them home or I refer them over to primary care if we think it’s something that’s not related to pregnancy.
Sunny Gault : Okay, what about steady and heavy vaginal discharge?
Erin Phillips : Well, that’s a hard one because almost everybody has vaginal discharge in pregnancy and it’s hard to know okay, is this normal or not normal? So, the first thing I ask patients are, is No.1, is it itchy? No.2, does it smell bad? No.3, does it hurt when you have intercourse? And No.4, does it keep coming out when you have no pants on?
Sunny Gault : So, we have to work on it?
Erin Phillips : Exactly, exactly well you know in cases we are trying to figure out whether or not their water is broken especially if they are calling me on the phone I say you know take your underwear off wear a skirt, walk around the house for a while. Is it dripping down your leg? If it’s dripping down your leg you know, it’s very possible it could be your amniotic fluid whereas if it’s just a discharge usually you are not gonna have that much excess. Yeah, so, so the most common reasons for excess vaginal discharge is just you know, the mucus that your cervix produces bacterial vaginosis you could have overgrowth of bacteria, you could have an yeast infection and then it could be your amniotic fluid. And the most important one to tell your doctor about is whether or not it’s amniotic fluid so and sometimes you don’t know until you come in and you actually have a few tests done to rule that out.
Misty Davies : Right, I remember when I was in labor with my first born I was like, I don’t know if my water broke or if I am just peeing myself and I had no control because you know you get to a point you know, you are about ready to burst then there is so much you can control down there. It might just be happening.
Erin Phillips : That’s right, that’s right. And a lot of women are very embarrassed when they come see me and they tell “I think my water broke” and then I end up telling them in the end “I think you might have just got a little bit of incontinence you know, it’s very embarrassing. But, I always reassure patients most other pregnant ladies are experiencing the same thing so you are not the only one it’s kind of like hemorroids, everybody that has hemorroids says “Oh! My gosh this is the worst thing ever” and I tell them you know what look around the room and anybody who has ever had a baby in here has probably had a hemorrhoid before.”
Sunny Gault : Yeah.
Erin Phillips : So,
Sunny Gault : Exactly, makes us feel better.
Erin Phillips : Yeah.
Sunny Gault : Sudden swelling of hands, feet and face as you know, swelling for me it wasn’t sudden on any of my pregnancies but man, sometimes I feel like a big sausage you know, your feet or you know, your ankles and stuff like that. So, really that’s the key here we are talking about something hadn’t happening suddenly?
Erin Phillips : Yeah, you know from personal experience when I was pregnant with my first I developed severe preeclampsia and had a 10 pound weight gain in 1 week. That is not normal. You know, that’s something that you will see with swelling to happen suddenly as a sudden weight gain, you are not feeling well, you might have chest pain, upper right sided abdominal pain, headache, blurry vision those are all symptoms of preeclampsia. It’s very common in pregnancy to become swollen in the third trimester and a little bit of swelling as considered normal. But, we start seeing patients more frequently in the third trimester because we are on the lookout for preeclampsia which typically is high blood pressure in pregnancy with little bit of protein in your urine, your kidneys leak out protein when they are not supposed to. There are a few other signs that we see in blood test that you wouldn’t know that you had unless you go and see your doctor.
Sunny Gault : Okay, and this is an obvious one if you know you are having contractions you should probably call your doctor but my question is lets break this down a little bit, can you actually have regular contractions you know, in your first or second trimesters or is this really just geared more towards the third trimester?
Erin Phillips : You can have contractions in the first and second trimester. We don’t necessarily call them contractions because you can’t really distinguish one from the other. It just feels like constant clamping. A lot of women experience clamping which is just the growth of the uterus versus if you are gonna have miscarriage or a threatened miscarriage you would feel just constant menstrual like clamping or low back ache. So, and that essentially is the uterus contracting. It’s just you don’t have this 5 or 10 minutes break between every time the uterus contracts. In the second or third trimester you know, so let’s say 24 weeks and on I usually tell patients between 24 weeks and 37 weeks so that’s the preterm time frame, call your doctor if you have 6 or more contractions per hour or if you are full term 37 weeks or more I usually tell patients you wanna call once your contractions are occurring at 5 minutes intervals lasting 1 minute each for at least one hour. So, if you have taken child birth classes before, they have probably talked about the 511 rule which is exactly that contraction every 5 minutes lasting 1 minute for an hour. And realistically, you really need strong painful contractions that you can’t even talk through in order to start dilating.
Sunny Gault : Okay.
Erin Phillips : Unfortunately pain equals progress.
Sunny Gault : I like that saying that’s kind of catchy.
Erin Phillips : Yeah.
Sunny Gault : Okay and lack of fetal movement which this is why do kick counts and stuffs like that and we go to the doctor. It is one of those things and it is kind of annoying to me beyond what is your kick count level? “Oh! I don’t know what it is this time” but that’s why we do it because our babies aren’t as active something could be wrong.
Erin Phillips : Absolutely, some practitioners don’t use fetal movement counts and I am gonna call them fetal movement counts instead of fetal kick counts. Kick counts is little bit more catchy but it doesn’t have to be a kick. Usually we say you should have 10 movements within an hour and I usually start my patients monitoring the movements about 28 to 30 weeks because babies have their peak movements at 27 to 28 weeks. So, before that time it’s hard to keep a little tiny baby to that expectation because they are probably moving more than you actually feel. So, if you sit down and you try to count the movements and it takes 5 minutes to feel the baby moved 10 times, it’s awesome you are done for the day and you don’t have to count until the next day. But if you are sitting there for an hour and you haven’t felt 10 movements try drinking something super cold like a big glass of ice water or try having a snack and usually the baby will wake up. If the baby doesn’t wake up then that could be a sign of wrong. So it’s a good idea to call your doctor or midwife or just go into the hospital. I tell my patients “if I am not here and there isn’t somebody in the office just go ahead and go to an interview the delivery and monitor to make sure everything with the baby is okay.” Occasionally it will just be a sleep cycle where the baby will be sleeping for an hour or two and we have a few little tricks that we can use in the hospital to wake the baby up and get them to move like we want them to. I had a patient couples years ago on the call to our office complaining of decrease fetal movement. She was 32 weeks. She had just started doing her movement counts and she did end up having hysteria which is a bad organism that can be acquired through eating.
Sunny Gault : Yeah.
Erin Phillips : Exactly, exactly it can cross the placenta and cause still birth in the babies. So, anyway we ended up delivering that patient early because of it. So, fetal movements counts actually saved the baby. So, since that experience for me I feel strongly that movement counts are very valuable.
Sunny Gault : Yeah, and no one knows your baby better than yourself.
Erin Phillips : Absolutely, you have to just use your intuition. You know, if you have a baby that moves just nonstop and even if you feel the baby moving a little bit but it just doesn’t seem normal for you, I would go ahead and call. You tend to feel the babies move a little bit less in the last month of pregnancy because they are so squished, their head down, they are big, they are chunky and can’t understand their arms and their legs so their movements tend to be more subtle. So, you have to kind of look for more subtle movements at the end but, I still think you have to use your intuition if something doesn’t feel right you have to definitely go and get it checked out.
Sunny Gault : Yeah, I think that applies to everything you have talked about today. You know, use your mother’s intuition you know if you don’t think something is right like I said in the beginning of the show “Call your doctor.” But these are some of the big things we definitely want to call your doctor if you do notice.
Erin Phillips : Absolutely.
Sunny Gault : Erin, thank you so much for joining us.
Erin Phillips : It’s my pleasure. Thanks for having me.
Sunny Gault : It was a great conversation I absolutely loved it. If you would like to share your experience with having any of these symptoms that we mentioned today we would love to hear it. You can continue our conversation on twitter just use the hash tag new mommy media and you can also find this on Facebook or simply leave a message on our website under the episodes page.
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[Featured Segment: Baby Registry Secrets]
Sunny Gault : Before we wrap today’s show here is some baby registry secrets.
Evian : Hi, Preggie Pals, my name is Evian, sales associate at Agana Baby. I am here to discuss some tips you have to consider when creating the perfect baby registry. Our fifth and final topic is to spread the word you want everyone to know that you have registered as well as where you have registered at. The only way people will know to check out your registry is if you inform them. Of course, you don’t want to be pushy about it. Don’t start off the conversation with a friend but turn them registered but if they ask about your pregnancy or ask about what you are doing to help. You can kindly tell them that you are registered so checking that out would be more than enough. Most people will want you to get you some sort of gift so the registry is also a good way of getting things you actually would need or want so it’s good to use it to your advantage as fast as you can. Don’t feel like you’re being selfish or needy. Registries actually make every things easier for everyone else. They take all of the trouble add up shopping and deciding what might be the best gift for you and your baby. If they know you already want certain items it would be easy for them to decide on and they can feel good about their gift if they already know that you are certain to appreciate it. Be sure to also tell everyone where you have registered especially if you are registered at multiple locations. Not every store has everything you want so even if someone knows that you want an item it is good to let them know where to make the purchase. Also some stores will give special discounts for registry items so that will be a benefit to both you and your friends. For more tips on creating perfect baby registry as well as what to include in the registry, visit https://www.aganababy.com or follow us on Facebook and twitter at Agana Baby and be sure to listen to Preggie Pals for great registry tips in the future.
[Theme Music]
Sunny Gault : That wraps up our show for today if you have any questions about today’s topic or any pregnancy related questions you can always ask our experts. Simply send us an email or you can call our Preggie Pals hotline at 619-866-4775 and we’ll answer your question on an upcoming episode. If you have a pregnancy topic you would like to suggest, I would love to hear it you can visit our website at https://www.preggiepals.com and send me an email. Thanks for listening to Preggie Pals, your pregnancy your way.
[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Suggestions and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. For such information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating any house care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
[00:39:18] [End Of Audio]
