Troy Williams, MD  Board Certified OBGYN - Director of Trillium Medical Corporation
             Pregnancy Advice
                   Congratulations!
     I am personally thrilled that you are pregnant and have chosen to
deliver under my supervision. It is an honor and a privilege to be a
part of your growing family. I hope that you have a very enjoyable and
fulfilling experience during your time with us receiving prenatal
care. There are several philosophies that we have adopted that I would
like to share with you.
     I have an open door policy. If at anytime you have additional
questions regarding any aspect of your care or risks during your
pregnancy, we will be happy to arrange time for us to talk in person.
     We care about you as a whole. If you are facing financial
challenges due to your pregnancy then we are here to help. We will
explain your health plan in detail to you including upcoming costs and
ways of lessening the burden.
     Our mission is that you will have the type of experience that you
would want to share with others. Many patients refer their neighbors,
sisters, mothers, co-workers, and their own patients to our office.
The idea is that if you find something great, you want others to
experience it too!
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                Signs of labor: Know what to expect
Do you know the typical signs of labor?
Understand the changes your body will go through as you prepare to give birth.
On television, babies are often born with a rush of emotion and swift action. The mother doubles over from the pain of a single contraction, and the baby appears before the commercial break. In reality, however, labor usually begins less dramatically. Find out common signs of labor and what they mean for you and your baby.
Effacement: Ripening of the cervix
One of the first signs of labor is your cervix softening and thinning, or effacing. Most of the effacing happens in the last weeks before delivery and you won't feel this preparation for labor happening. Instead, your health care provider might check for signs of cervical change with vaginal exams.
Effacement is often expressed in percentages. The cervix starts out about 4 centimeters (cm) long. When you're 50 percent effaced, your cervix is half its original thickness, or 2 cm. Your cervix must be 100 percent effaced, or completely thinned out, before a vaginal delivery.
Dilation: Opening of the cervix
Another of the early signs of labor is your cervix beginning to open, or dilate. For most women, some dilation occurs before labor. Your health care provider will measure the dilation in centimeters from zero to 10.
At first, these cervical changes can be very slow. In fact, some women are dilated 2 to 3 cm for days or even weeks before labor actually begins. Dilation isn't a good indicator of when labor will begin, but rather a general sign that you're getting ready for labor. Once you're in active labor, expect to dilate more quickly.
Bloody show: Loss of mucous plug
During pregnancy, a thick plug of mucus blocks the cervical opening to prevent bacteria from entering the uterus. When your cervix begins to thin and open, this plug may fall out. You might notice stringy mucus or a thick discharge. It's typically brown and sometimes tinged with blood.
Losing the mucous plug is among the telltale signs of labor, but it's not a guarantee. Labor may still be days or weeks away.
 
          Signs of labor: Know what to expect
Nesting: Spurt of energy
You might wake up one morning feeling energetic, raring to attack dust bunnies under the couch, set up the crib and arrange your baby's outfits according to color. This urge to clean and organize is commonly known as nesting. No one knows for sure, but it could be a primal instinct that hearkens back to a time when physical preparation was necessary for a safer childbirth.
Nesting might begin months before your due date, but the instinct is usually strongest just before delivery. Do what you must, but don't wear yourself out. Save your energy for the harder work of labor ahead.
Rupture of membranes: Your water breaks
The amniotic sac is a fluid-filled membrane that cushions your baby in the uterus. Sometimes the sac leaks or breaks before labor begins. If this happens, you might notice a slow trickle of fluid or a more obvious gush.
If your water breaks at home — or if you're uncertain whether the fluid is amniotic fluid, urine or something else — consult your health care provider right away. He or she will evaluate you and your baby to determine the next steps.
If the amniotic sac is no longer intact, timing becomes important. The longer it takes for labor to start after your water breaks, the greater the risk of developing an infection. If labor doesn't begin on its own, your health care provider might need to induce your labor. In the meantime, avoid doing anything that could introduce bacteria into your vagina, such as having sex.
Contractions: When labor pains begin
During the last few months of pregnancy, you might experience occasional, sometimes painful contractions — a sensation that your uterus is tightening and relaxing. These are called Braxton Hicks contractions. They're your body's way of warming up for labor.
Eventually, Braxton Hicks contractions will be replaced by the real thing. To tell the difference, consider these questions:
Are the contractions regular? Time your contractions from the beginning of one to the beginning of the next. Look for a regular pattern of contractions that get progressively stronger and closer together. False labor contractions will remain irregular.
How long do they last? True contractions last more than 30 seconds at first and get progressively longer — up to 90 seconds. The contractions of false labor vary in length.
Can you stop the contractions? True contractions continue regardless of your activity level or position. In fact, they often grow stronger with increased activity, such as walking. With false labor, you might be able to stop the contractions by changing your activity or position, lying down or taking a walk.
Expect false alarms
The boundary between your body's preparation for labor and the actual process of labor isn't always clear. Some women have painful contractions for days with no cervical changes, while others might feel only a backache — or nothing at all.
Remember, no one knows for sure what triggers labor, and every woman's experience is unique. Sometimes it's hard to tell when labor begins. Don't hesitate to call your health care provider if you're confused about whether you're in labor. Preterm labor can be especially sneaky. If you have any signs of labor before 36 weeks — especially if you also experience vaginal spotting — consult your health care provider.
At term, labor will nearly always make itself apparent. If you arrive at the hospital in false labor, don't feel embarrassed or frustrated. Think of it as a practice run. The real thing is sure to be on its way!
Childbirth classes: Get ready for labor and delivery baby!
Childbirth classes can give you confidence as you head for labor and delivery — whether you're a first-time mom or a delivery room veteran.
You've probably read about childbirth and heard countless labor stories from friends and loved ones. Do you really know what to expect during labor and delivery, though? Childbirth classes can demystify the process.
Why should I take childbirth classes?
Whether you're delivering your first child or fifth, childbirth classes can help you prepare to meet the challenges of labor and delivery.
 Consider the opportunities:
Learn things you never knew about labor, delivery and postpartum care. You'll find out how to identify the signs of labor and what happens to your body as your baby makes his or her way into the world.
Address your fears. During childbirth classes, you'll have the chance to talk about your fears with other women who probably share the same concerns. The instructor can dispel myths and help put your mind at ease.
Connect with your partner or labor coach. Childbirth classes offer your partner or labor coach the chance to understand childbirth, too — as well as how to support you during labor.
Discuss options for handling pain. You'll practice various methods for coping with contractions, such as breathing techniques, relaxation and visualization. Most classes also cover the pros and cons of common medications, such as narcotic analgesics and epidural blocks.
Get the basics on medical interventions and possible complications. Find out how routine interventions can influence the course of labor.
Check out the facility. You might tour the facility where you'll give birth and find out about its policies and resources.
Brush up on newborn care. In addition to labor and delivery, you'll likely get a primer on newborns. Common topics include choosing a pediatrician, breast-feeding, diapering and bathing.
Create a social network. Meet other pregnant women and listen to their experiences.
Are there different types of childbirth classes?
Some childbirth classes cover specific types of births, such as C-section, vaginal birth after C-section (VBAC) and multiple births. Refresher courses are available for parents who simply want to review the basics. Other classes focus on specific methods of childbirth. For example:
Lamaze. The goal of Lamaze is to increase confidence in your ability to give birth. Lamaze classes help you understand how to cope with pain in ways that both facilitate labor and promote comfort — including focused breathing, movement and massage.
Bradley. The Bradley Method emphasizes birth as a natural process. You're taught to manage labor through deep breathing and the support of your partner or labor coach.
Many other classes borrow elements from these popular methods. In addition, you might find classes on other approaches to childbirth, such as hypnobirthing.
What's the best way to find a class?
Childbirth classes are offered at most hospitals and birthing centers. Some classes are available online or in video format. Ask your health care provider about available classes. A representative from your medical insurance plan might offer suggestions. You might also check with parents who've recently had babies.

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Prenatal testing: Quick guide to common tests
Prenatal testing can provide information about your baby's health before he or she is born. Consider the timing and what the tests can reveal.
Prenatal testing is offered in most pregnancies. Here's an overview of common prenatal screening tests:
What it is,When it's done, What the results might tell you:
Noninvasive prenatal testing involves a blood test as early as week 10 in high-risk groups. It can assess the  risk of Down syndrome (trisomy 21) and certain other chromosomal conditions. Possible chorionic villus sampling or amniocentesis may be advised based on the results.
First trimester screening
Blood test and ultrasound11-14 weeks risk of Down syndrome (trisomy 21) or Edwards syndrome (trisomy 18), Possible chorionic villus sampling or amniocentesis
Quad screen
Blood test15-20 weeks risk of Down syndrome or spina bifida. Possible targeted ultrasound, chorionic villus sampling or amniocentesis
Some health care providers choose to combine the results of first trimester screening with the quad screen — although you won't learn the final results of this sequential testing until both tests are completed and analyzed.
In addition, fetal ultrasound often plays an important role in prenatal care. Early in pregnancy, ultrasound can be used to confirm and date a pregnancy. Later, ultrasound can be used for many things — such as checking a baby's well-being, monitoring a baby's growth and development, and detecting certain birth defects.
Blood tests and ultrasounds pose no risks for you or your baby. If the results of a blood test or ultrasound are positive or worrisome, your health care provider might recommend a more invasive diagnostic test — such as chorionic villus sampling or amniocentesis. These tests provide more detailed or definitive information, but they carry a slight risk of pregnancy loss.
If you're concerned about prenatal testing or wonder whether you need specific screening or diagnostic tests, discuss the risks and benefits with your health care provider.
Sex during pregnancy: What's OK, what's not
Has pregnancy spiked your interest in sex? Or is sex the last thing on your mind? Either way, here's what you need to know about sex during pregnancy.
     If you want to get pregnant, you have sex. No surprises there. But what about sex while you're pregnant? The answers aren't always as obvious. Here's what you need to know about sex during pregnancy.
Is it OK to have sex during pregnancy?
As long as your pregnancy is proceeding normally, you can have sex as often as you like — but you might not always want to.
At first, hormonal fluctuations, fatigue and nausea might sap your sexual desire. As your pregnancy progresses, weight gain, back pain and other symptoms might further dampen your enthusiasm for sex.
Your emotions might take a toll on your sex drive, too.
Concerns about how pregnancy or the baby will change your relationship with your partner might weigh heavily on your mind — even while you're eagerly anticipating the addition to your family. Fears about sexual activity harming the baby or anxiety about childbirth might team up to sap your sex drive. Changes in your self-image might play a role as well, especially as your pregnancy progresses.
Can sex during pregnancy cause a miscarriage?
Although many couples worry that sex during pregnancy will cause a miscarriage, sex isn't generally a concern. Early miscarriages are usually related to chromosomal abnormalities or other problems in the developing baby — not to anything you do or don't do.
Does sex during pregnancy harm the baby?
Your developing baby is protected by the amniotic fluid in your uterus, as well as the strong muscles of the uterus itself. Sexual activity won't affect your baby.
What are the best sexual positions during pregnancy?
As long as you're comfortable, most sexual positions are OK during pregnancy.
As your pregnancy progresses, experiment to find what works best. Rather than lying on your back, for example, you might want to lie next to your partner sideways or position yourself on top of your partner or in front of your partner.
Let your creativity take over, as long as you keep mutual pleasure and comfort in mind.
Sleep during pregnancy: Follow these tips

How should I position myself for sleep during pregnancy?

To minimize discomfort during sleep:
Favor your left side. Research suggests that lying on your left side can help improve blood flow to your baby and to your body. Also, try to keep one or both knees bent. Don't worry, however, if you wake up in a different position.
Use pillows. To prevent discomfort, consider using pregnancy or support pillows between your bent knees, under your abdomen and behind your back.
Elevate your head. Elevating the head of your bed can prevent or decrease heartburn or snoring.
What can I do to rest comfortably?
You can take steps to manage sleep disturbances during pregnancy. For example:
Maintain a sleep routine. Regularly go to bed and wake up at the same time. If you need more sleep, try napping early in the day.
Watch your fluids. Drink plenty of fluids during the day. To prevent frequent urination at night, cut down on how much you drink late in the day.
Eat healthy foods. Strive for a balanced diet rich in vitamins. A healthy diet can help you improve your energy levels and keep your pregnancy weight gain on target. To prevent heartburn, eat small, frequent meals and avoid fried foods, carbonated drinks, citrus fruits or juices, and spicy foods.
Keep active. Regular physical activity during pregnancy might help prevent excess weight gain and leg cramps, as well as help reduce stress and boost energy. Although exercise is safe for most pregnant women, make sure you have your health care provider's OK before beginning an exercise program.
Stretch. Stretching your calf muscles before bed may help prevent leg cramps during pregnancy.
Practice relaxation techniques. Breathing techniques, in particular, can help reduce tension.
Use nasal saline sprays or mechanical nasal dilators. These can relieve the nasal congestion that often occurs during pregnancy. Also, avoid smoking and exposure to secondhand smoke.
Set the mood. A dark, quiet and comfortably cool environment can help encourage sleep.
Relieve pain safely. If minor pain caused by muscle stretching or your increased weight during the late stages of pregnancy is keeping you up, occasional use of acetaminophen (Tylenol, others) might help.
If you continue to have trouble sleeping during pregnancy or you're concerned about your fatigue, talk to your health care provider.
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Pregnancy and exercise: Baby, let's move!
Activities to approach with care

If you're not sure whether a particular activity is safe during pregnancy, check with your health care provider. It's best to avoid any exercises that force you to lie flat on your back, especially as your pregnancy progresses. Activities such as scuba diving and hiking at high altitudes are generally discouraged, as are contact sports and activities that pose a high risk of falling — such as water skiing, downhill skiing and in-line skating, and running beyond 20 weeks pregnancy.
Staying motivated
You're more likely to stick with an exercise plan if it involves activities you enjoy and fits into your daily schedule. Current recommendations include incorporating 20 minutes of aerobic exercise into your daily routine atleast 4 times per week!
Consider these simple tips:

Start small. You don't need to join a gym or don expensive workout clothes to get in shape. Just get moving. Try a daily walk through your neighborhood. Vary your route to keep it interesting.
Find a partner. Exercise can be more interesting if you use the time to chat with a friend. Better yet, involve the whole family.
Use a headset. Listen to music or a book while you exercise. Use lively songs to energize your workout.
Try a class. Many fitness centers and hospitals offer classes designed for pregnant women. Choose one that fits your interests and schedule.
Get creative.
Don't limit yourself. Consider hiking, rowing or dancing.
Give yourself permission to rest. Your tolerance for strenuous exercise will probably decrease as your pregnancy progresses.
Listen to your body
As important as it is to exercise, it's also important to watch for danger signs. Current recommendations are that you keep your heart rate under 140 beats per minute. Stop exercising if you notice:
Dizziness
Headache
Shortness of breath
Chest pain
Abdominal pain
Vaginal bleeding
If your signs and symptoms continue after you stop exercising, contact your health care provider.
A healthy choice
Regular exercise can help you cope with the physical changes of pregnancy and build stamina for the challenges ahead. If you haven't been exercising regularly, use pregnancy as your motivation to begin.
Pregnancy Nutrition: Foods to avoid
You want what's best for your baby. That's why you add sliced fruit to your fortified breakfast cereal, top your salads with chickpeas and snack on soy nuts. But do you know what foods to avoid during pregnancy? Start with the basics in pregnancy nutrition. Understanding what foods to avoid during pregnancy can help you make the healthiest choices for you and your baby.
Avoid seafood high in mercury
Seafood can be a great source of protein, and the omega-3 fatty acids in many fish can promote your baby's brain development. However, some fish and shellfish contain potentially dangerous levels of mercury. Too much mercury could damage your baby's developing nervous system.
The bigger and older the fish, the more mercury it's likely to contain. The Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) encourage pregnant women to avoid:
Swordfish
Shark
King mackerel
Tilefish
So what's safe? Some types of seafood contain little mercury. Although concerns have been raised about the level of mercury in any type of canned tuna, the FDA and EPA say pregnant women can safely eat up to 12 ounces (340 grams) a week. Similarly, the 2010 Dietary Guidelines for Americans recommend 8 to 12 ounces of seafood a week for pregnant women. That's about two average meals of:
Shrimp
Crab
Canned light tuna (limit albacore tuna, chunk white tuna and tuna steak to no more than 6 ounces, or 170 grams, a week)
Salmon
Pollock
Catfish
Cod
Tilapia
Not all researchers agree with these limits, however, citing a study that noted no negative effects for women who ate more seafood than the FDA-approved guidelines.
Avoid raw, undercooked or contaminated seafood
To avoid harmful bacteria or viruses in seafood:
Avoid raw fish and shellfish.
It's especially important to avoid oysters and clams.
Avoid refrigerated smoked seafood, such as lox. It's OK to eat smoked seafood if it's an ingredient in a casserole or other cooked dish. Canned and shelf-stable versions also are safe.
Understand local fish advisories. If you eat fish from local waters, pay attention to local fish advisories — especially if water pollution is a concern. If advice isn't available, limit the amount of fish from local waters you eat to 6 ounces (170 grams) a week and don't eat other fish that week.
Cook seafood properly. Cook most fish to an internal temperature of 145 F (63 C). The fish is done when it separates into flakes and appears opaque throughout. Cook shrimp, lobster and scallops until they're milky white. Cook clams, mussels and oysters until their shells open. Discard any that don't open.
Avoid undercooked meat, poultry and eggs
During pregnancy, you're at increased risk of bacterial food poisoning. Your reaction might be more severe than if you weren't pregnant. Rarely, food poisoning affects the baby, too.
To prevent foodborne illness:
Fully cook all meats and poultry before eating. Use a meat thermometer to make sure.
Cook hot dogs and processed deli meats, such as bologna, until they're steaming hot — or avoid them completely. They can be sources of a rare but potentially serious foodborne illness known as listeriosis.
Avoid refrigerated pates and meat spreads. Canned and shelf-stable versions, however, are OK.
Don't buy raw poultry that's been pre-stuffed. Raw juice that mixes with the stuffing can cause bacterial growth. Frozen poultry that's been pre-stuffed is safe when cooked from its frozen state.
Cook eggs until the egg yolks and whites are firm. Raw eggs can be contaminated with the harmful bacteria salmonella. Avoid foods made with raw or partially cooked eggs, such as eggnog, raw batter, hollandaise sauce and Caesar salad dressing.
Avoid unpasteurized foods
Many low-fat dairy products — such as skim milk, mozzarella cheese and cottage cheese — can be a healthy part of your diet. Anything containing unpasteurized milk, however, is a no-no. These products could lead to foodborne illness.
Unless these soft cheeses are clearly labeled as being pasteurized or made with pasteurized milk, don't eat:
Brie
Feta
Camembert
Blue cheese
Mexican-style cheeses, such as queso blanco, queso fresco and panela
When selecting eggs, consider buying the pasteurized variety. In addition, avoid drinking unpasteurized juice.
              
 Medications in Pregnancy
 
 
     Many patients worry that they cannot safely consume any medications in pregnancy. This is simply not true. Medications that have FDA approval for use in pregnancy have met a standard showing that they are of low risk for causing birth defects or detrimental outcomes.
 
Pregnancy Category A : Adequate and well-controlled human studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
Pregnancy Category B : Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.
Pregnancy Category C : Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Pregnancy Category D : There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Pregnancy Category X : Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.
 
 
Best Choices for Nausea - 1. Phenergan - Category B
                                             2. Reglan- Category B
                                             3. Zofran - Category C
                                             Note: Ginger products (tea, soda, and candy                                               can  be very helpful and also Vitamin B6
 
 
Best Choices for Headache - 1. Tylenol 325 -500mg or ES (with Codiene)     
                                               Category B - one tablet every 4-6 hours as needed
 
 
Best Choices for Insomnia - 1. Benadryl 25mg Category B - one tablet every 6  
                                               hours as needed
 
 
Best Choices for Stuffy Nose - 1. Claritin Category B - one tablet each day
                                                 
 
Best Choices for Constipation - 1. Colace Category B - one to two tablets every    
                                                 12 hours as needed
 
 
* Please avoid all anti-inflammatory medications during pregnancy that are over the counter. Examples: Motrin, Advil, Ibuprofen, Exedrin, Naprosyn
 
 
 
For further information consider www.mothertobaby.org
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