My Doctor Online The Permanente Medical Group

Early Signs of Pregnancy

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Do you think you may be pregnant? Some women can tell almost immediately because of certain changes in their body. The most common symptom is a skipped period. Other early signs include:

• Going to the bathroom more frequently. You may notice that you even have to get up in the middle of the night, something you never used to do. This is caused by a pregnancy hormone which increases urinary frequency.
• Nausea and vomiting. This is typically called "morning sickness." However, nausea and vomiting is not just limited to the mornings. Some women feel nauseous or even vomit at different times of the day, sometimes all day. Please call us if you experience vomiting that is:
  • Severe (with pain or fever)
  • Frequent (more than 2 to 3 times a day)
  • Lasts more than an hour
• Fatigue. Fatigue is also due to a pregnancy hormone. Just hang in there – many women begin to feel better by the second trimester. Try to get extra rest.
• Sore and enlarged breasts. The soreness may feel like what you feel before your periods, except now it is all the time! This also usually lessens or disappears with time.

If you have any of these symptoms and you have not yet had a pregnancy test, please have one soon. You can stop by our lab for a pregnancy test. No appointment or lab order is needed.

Fetal Growth and Development

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The first trimester is a time of rapid growth for your baby. Your baby started out as a fertilized egg no bigger than the period at the end of this sentence. Arms and legs will develop in the first 14 weeks, and most vital organs will take shape as well.

At 4 weeks:

• The embryo is the size of a grain of rice, and the heart, brain, and lungs are forming.
• Your baby's heart can start beating as early as 3 to 4 weeks.

At 8 weeks:

• The fetus starts to look like a tiny human with arms, legs, muscles, and skin.
• The eyes, ears, and face are also forming. The brain, stomach, liver, and other organs continue to grow.
• Because the brain is developing faster than other organs, the head is large compared to the rest of the body.

At 12 weeks:

• The fetus is about 3 inches long, and the circulatory and urinary systems are working.
• Reproductive organs are developed, but an ultrasound at this time will not show clearly whether the fetus is a girl or a boy.
• Your baby is moving now, but you can't feel it yet.

Prenatal Testing Options

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During your pregnancy, there are many kinds of prenatal tests that can help you learn more about your baby's health. All prenatal testing is optional, though many kinds of tests are a routine part of every pregnancy. We can discuss your options and decide which tests might be appropriate for you.

Routine prenatal tests and screening

These are tests that we recommend for all pregnancies to check the health and development of your baby. These routine prenatal tests are safe for you and your baby. During your first trimester we may recommend tests for:

• Anemia
• Rh status, blood type, and antibody screen
• Hepatitis B virus
• Syphilis
• Rubella and varicella immunity
• Human immunodeficiency virus (HIV)
• Diabetes (in some patients)

In addition, we routinely offer an ultrasound test during your first trimester of pregnancy.

Optional prenatal screening

Certain blood tests can help you find out if you have a higher or lower chance of having a baby with certain birth defects, but they can't make a definitive diagnosis. These are optional prenatal tests, and they are very safe for you and your baby. Serum-integrated screening, sequential integrated screening, and quad tests are examples of optional screening tests. These tests are most effective when done at a certain stage of fetal development. Depending on which trimester you are in, we can discuss which screenings are available for you.

Prenatal diagnostic tests

While there is no test that can detect all potential problems, these tests can diagnose certain kinds of birth defects. Prenatal diagnostic tests are more invasive than other prenatal tests, and there is a very small associated risk of miscarriage. Some women choose diagnostic tests based upon their family history or their age during their pregnancy. Examples of diagnostic tests are amniocentesis and chorionic villus sampling. These involve using a thin needle to collect a small amount of amniotic fluid or tissue from the placenta.

Benefits of Breastfeeding

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Breast milk is the perfect food for your baby. There are many health benefits for you and your baby. According to the American Academy of Pediatrics, breast milk is the only food that your baby will need during the first 6 months of life. We recommend that you continue to breastfeed your baby for up to 1 year if you are able to. Even after you introduce solid foods, you can continue breastfeeding for as long as you wish.

Breastfeeding decreases your baby's risk for many types of infections and allergies. Benefits include:

• Fewer ear infections
• Less risk of respiratory infections and asthma
• Fewer urinary tract infections
• Less diarrhea and constipation
• A lower chance of childhood obesity
• A lower risk of certain childhood cancers
• Improved development of the baby's immune system
• Better digestion
• Improved brain growth

Benefits to you may include:

• More rapid recovery from your delivery
• Decreased blood loss after delivery if you breastfeed immediately after the baby is born
• More rapid loss of pregnancy weight
• Increased sense of well-being
• More opportunity for mother-baby bonding
• No need for preparation, heating, refrigeration, or sterilization of breast milk and a significant cost savings when compared to formula

There are rare medical conditions where breastfeeding is not advised. We can talk further if this applies to you.

Preparing for Breastfeeding

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You and your baby will be more successful at breastfeeding if you are prepared. You can begin preparing now and continue throughout the last weeks of pregnancy. Suggestions for how to prepare include:

Learn all you can about breastfeeding

Take a class, read a book, or read our article on breastfeeding for more information. Talk to women who've had successful breastfeeding experiences. Remember, breastfeeding is a learned skill and takes practice.

To locate classes near you, search our health class directory or contact your local Health Education Center or department.

Think about how long you would like to breastfeed

Breastfeeding does take time, but it is time well spent. You're giving your baby the best possible food, holding your baby close, and making a strong connection. Breast milk is the best food for your baby and has all the nutrition your baby needs for the first 6 months of life. The longer you breastfeed, the greater the benefits will be for you and your baby.

Make a list of breastfeeding resources

Get phone numbers of hospital lactation consultants, your local Pediatric Department, or members of your local La Leche League. Have these numbers ready so you can call after you and your baby go home from the hospital. For breastfeeding questions, call the 24-hour helpline at 877-4-LALECHE.

Learn about expressing your milk

Expressing and storing your breast milk allows you to get extra milk from your breasts that can be given to your baby when you're not there.

Ask for help

All new mothers will need help in the beginning, so ask your friends and family to plan to help out. After the baby arrives, they can assist with meals, shopping, and the care of older children. This will allow you to spend plenty of time with your new baby.

Common Discomforts and Concerns

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I feel tired all the time.

Fatigue is due to high levels of the pregnancy hormone progesterone. It usually gets better by the second trimester as your body adjusts. Sometimes fatigue can be due to anemia. We will check this with your prenatal lab work and will let you know if you are anemic. What you can do:

• Try to get plenty of rest. You may need to take naps during the day.
• If you had an exercise regimen before you got pregnant, continue it in moderation. Exercise can help boost your energy level.

My breasts are getting bigger and they hurt.

The milk glands in your breast are enlarging so that you will be able to breastfeed your baby. You may notice some bluish veins on your skin. This is due to the increase in blood supply to your breasts. You might notice your nipples and the areolas (the dark skin around the nipple) getting darker. What you can do:

• Wear a bra that provides good support.
• Try wearing the bra at night.
• Increase your bra size. Since you will have to buy new bras anyway, you should go ahead and buy some nursing bras. That way you can wear them now and then you can use them while you are nursing.

I feel nauseated and sometimes vomit.

You are not alone. This is a common symptom of early pregnancy and often gets better by the second trimester. Even though this is commonly called "morning sickness," it can happen at any time during the day. What you can do:

• Drink fluids. Sip small amounts of apple juice, grape juice, lemonade, or caffeine-free carbonated beverages. If drinking with meals gives you a stomach ache, try drinking between meals instead. Try fruits with high water content, like melons, oranges, or grapefruits.
• Eat small meals. Eat 5 or 6 small meals each day. Try to eat something every 2 to 3 hours, even if you don't feel hungry. If you don't eat, nausea usually gets worse. Eat crackers or dry toast in bed in the morning before getting up and before you go to sleep. Don't eat greasy, fried, or highly seasoned foods.
• Keep a window open and get plenty of fresh air. Use an exhaust fan to get rid of cooking odors. Certain food odors can trigger nausea. Your triggers might be foods with strong odors or something very ordinary that you normally like.
• Try wristbands that press on your wrist to reduce nausea (for example, Sea-Bands).
• Stop taking prenatal vitamins but keep taking folic acid. Some prenatal vitamins can trigger morning sickness or make it worse. You need to take folic acid but can temporarily stop taking other prenatal vitamins while you are nauseated unless we have told you that you must take them despite your nausea.
• Try vitamin B6 (25 milligrams every 8 hours or as needed, up to 75 milligrams a day). This vitamin is safe to take while you are pregnant and is available in most pharmacies without a prescription.
• Try to rest during the day. Taking naps can help diminish nausea.
• Ginger, either in tea or in tablets, can also be helpful in reducing nausea.

Please call us if you have vomiting that is:

• Severe (with pain or fever)
• Frequent (more than 2 to 3 times a day)
• Lasts more than an hour

I always have to go the bathroom, even in the middle of the night.

Frequent urination at this stage of pregnancy is caused by pregnancy hormones. Also, as your belly gets bigger your uterus presses on your bladder. What you can do:

• Please call us if you have frequent urination with burning or blood. This may be a sign of a bladder infection.

I get frequent headaches.

Headaches may occur more frequently when you are pregnant for many different reasons. The most common types occur because of tension or from sinus/nasal congestion. If you have a prescription headache medication, please check with us before you use it. What you can do:

• Take acetaminophen (one brand name is Tylenol). Do not exceed the daily recommended doses.
• Apply an ice pack to your forehead or the back of your neck.
• Rest in a quiet, low-lit room. Take deep breaths.
• If your headache is not relieved by the above recommendations or is also associated with nausea, vomiting, or visual disturbance (like blurry vision or seeing spots), please contact us right away.

I am having problems with constipation.

Pregnancy hormones cause the digestive tract to relax and function more slowly, which can cause constipation. As your uterus enlarges, this can also cause constipation. What you can do:

• Drink plenty of fluids or add prune juice to your diet. Keep a bottle of water near you during the day.
• Increase your fiber intake (whole-grain foods, fresh fruits, and vegetables).
• Set a regular time for bowel movements; this will often happen naturally after meals. Avoid straining since this can cause hemorrhoids.
• Please let us know if you think you need a laxative or stool softener.

I'm having problems with heartburn.

Heartburn (sometimes also called reflux) is caused by stomach acid coming up into your esophagus (the tube connecting your mouth to your stomach). Heartburn during pregnancy is caused by a hormone which relaxes the stomach sphincter that normally keeps the acid out of the esophagus. This same hormone causes a delay in stomach emptying so that more acid builds up. What you can do:

• Eat several small meals a day (about 6) instead of 3 large meals.
• Avoid spicy, fried, or rich foods.
• Avoid caffeine. This causes the stomach sphincter to relax even more.
• Do not lie down right after eating. Stay upright for at least 30 minutes.
• Keep the head of your bed higher than the foot of the bed.
• Try an antacid (like Tums or Maalox).

If your heartburn is still a problem, please let us know. There are prescription medications that you can use.

Possible Complications

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Bleeding

Spotting is not uncommon during the first trimester. It can happen because the cervix is very sensitive to touch during pregnancy. It can happen after a pelvic exam in the office or after having sex. Bleeding from the cervix does not hurt the baby. However, if you bleed every time you have sex, you may want to refrain from intercourse for a while so that you are not always wondering if everything is okay. There are many other ways to give and receive pleasure. Talk with your partner and decide together.

Spotting can also be a sign of a miscarriage. You should call us if you have:

• Light bleeding that lasts longer than a day
• Heavy bleeding
• Passing anything that looks like tissue
• Severe pain in your belly or shoulders
• Fever

We will do an ultrasound and/or blood work to determine if the pregnancy is progressing normally.

Excessive vomiting

It is normal to have daily nausea or vomiting during the early part of pregnancy. However, some women can develop hyperemesis gravidarum (excessive vomiting). Symptoms could include:

• Excessive vomiting (lasting more than 24 hours)
• Reduced urinary frequency or darker-colored urine
• Dryness of the eyes, nose, or mouth
• Extreme fatigue or fainting

If you have any of these symptoms, please call us as soon as possible. You may need IV fluids (to rehydrate you) and medications to help with the nausea and vomiting. This can be done in the office during office hours or in the Emergency Department after hours.

Urinary tract and kidney infections

Urinary tract infections (UTIs) are more common during pregnancy. You may have a UTI and not know it, which is why we check your urine every time you come in to see us. You may have a UTI if you have:

• The constant urge to urinate
• Pain or burning with urination
• Blood in your urine

If you have any of these symptoms, we will do a urinalysis and urine culture. If you have a UTI, we will prescribe medications that are safe to use during pregnancy. It is also important to drink plenty of fluids to help flush out the bacteria. After you have been treated for a UTI, you will need to provide another clean urine sample so that we can make sure that the UTI has cleared.

An untreated UTI could turn into a kidney infection, which is a more serious infection. Symptoms, in addition to UTI symptoms, include:

• Back pain that may be localized to one side
• Fever
• Nausea and/or vomiting

If you develop a kidney infection, you may have to be hospitalized for treatment with IV antibiotics and fluids.

Ectopic pregnancy

An ectopic pregnancy is when the fertilized egg implants outside the uterus. The most common place is in the fallopian tube (a tubal pregnancy). Risk factors for an ectopic pregnancy include:

• History of pelvic inflammatory disease (PID)
• Endometriosis
• Previous ectopic pregnancy
• Any tubal surgery
• Fertility treatments

Signs of an ectopic pregnancy can include:

• Sudden abdominal pain
• Vaginal spotting or bleeding
• Feeling faint or passing out

If you have any of these symptoms, you need to be seen right away. If you have had an ectopic pregnancy in the past, then you should be seen early in the current pregnancy to make sure that the pregnancy is developing normally in your uterus.

Your Care with Me

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Please call our Appointment and Advice line right away if you’re experiencing:

• Pain or dizziness
• Vaginal bleeding
• A bladder infection (pain or blood with urination)

If you're thinking of getting pregnant:

• Take advantage of my online tools and resources that will help you prepare for a healthy pregnancy.
• Start taking folic acid or prenatal multivitamins. They’re available in our pharmacy without a prescription or at your neighbourhood drugstore.

If you think you might be pregnant:

• You can stop by our lab for a pregnancy test. You don’t need to make an appointment or bring any paperwork.
• You can buy a home pregnancy test in our pharmacy or in your neighborhood drugstore.

When you know you're pregnant:

• Please call our Appointment and Advice line to schedule your first prenatal visit. 
• If you have had a tubal (ectopic) pregnancy in the past, call us as soon as you know that you’re pregnant.

If you have an unplanned pregnancy, let me know. We can talk about your options.

During your first appointment

I will perform an exam to confirm your pregnancy and estimate your due date. I'll also recommend the first routine prenatal tests. Your visit may also address paperwork and lab work related to your pregnancy. My staff will also schedule you for your next visit at around 12 to 14 weeks.

Early in your pregnancy, we'll begin discussing your prenatal testing options. These tests are available to women who want to screen or test for certain birth defects and are different from the routine tests given to all pregnant women. Several of the tests need to be performed during the first trimester.

When you're learning about the different types of tests and choosing which tests you'd like to have, please review our health tool called Prenatal Testing Options to get additional information.

Subscribe to our Healthy Beginnings newsletter. The newsletter is delivered to your e-mail inbox every week of your pregnancy, and it has information and answers to common questions as your pregnancy progresses.

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Contacting Me

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

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Convenient Resources for You

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As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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