OBSTETRICS & GYNECOLOGY CLINIQUE • 514 736-2496 • info@origyne.com
Obstetrics SERVICES
Obstetrics at Clinique Origyne involves a team of specialists, including physicians, nursing, mid-wives, dietetics and physiotherapy. We are honored to be members of the St. Mary’s Hospital birthing centre.
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While most babies are born healthy and without birth defects, approximately 3-5% of all babies are born with a birth defect. Some of these babies will have birth defects that are due to or associated with genetic disorders or syndromes.
There are a variety of reasons that a pregnancy may be at increased risk for birth defects or genetic disorders. For example, if the mother or the father of the baby has a personal or family history of a genetic disorder or birth defect, that baby may be more likely to also have that birth defect or genetic disorder. If this is the case for you, please talk to your doctor or advanced practice nurse about scheduling a consultation with a genetic counselor to discuss possible risks to your pregnancy or future pregnancies.
Other names for pregnancy ultrasounds are a pregnancy dating scan, commonly done within the first trimester, and the pregnancy anomaly or screening ultrasound. This is most commonly done at around 18-20 weeks of gestation. If the maternity care provider is concerned about the baby’s growth in the third trimester, then an additional ultrasound at this stage may be recommended. Determining the baby’s size, weight and growth as well as the amount of amniotic fluid present can provide a good, comprehensive assessment of the baby’s status.
Sometimes during a third trimester ultrasound, findings reveal that the baby would be safer in a neonatal intensive care unit than to remain in the uterus. And despite the risks associated with prematurity these are not considered to be as significant to the baby’s health if the pregnancy continued.
This is when an ultrasound machine sends high-frequency sound waves through a mother’s uterus. These sound waves are higher than can be registered by the human ear, which is why pregnancy ultrasound is a quiet procedure. The sound waves are emitted from a small, vibrating crystal housed in a hand-held device known as a transducer. It is a painless procedure and will not hurt you or your baby. During pregnancy ultrasound, the sound waves which are created bounce off the baby and in turn are interpreted into an image on a screen. These images are occurring in real time; there is no delay between when the images are picked up and when they can be seen on the screen. So the baby can be seen moving around and kicking, as it actually is, rather than “snapshots” of still imagery.
Warm, translucent gel is first applied to the mother’s abdomen. This helps to reduce the traction between the transducer and the skin and assists in transmitting the ultra sound waves with less interference so they can pass from the transducer through mother’s body.
Hard tissues such as bone appear as white and soft tissues appear as grey. Amniotic fluid appears black because the sound waves just go through them as there are no firm tissues for them to bounce off. Each shade and its intensity are interpreted by a sonographer and provide different information.
There are many reasons for having a pregnancy ultrasound, but some of the most common are:
- To diagnose a viable pregnancy.
- To assess the gestational age of the baby.
- To check the baby’s growth and development.
- To check how many babies are present in the mother’s uterus.
- To see where the placenta is positioned.
- To do a nuchal fold measurement at the back of the baby’s neck and to assess if there is an increased risk of the baby having Down Syndrome. This specific measurement needs to be conducted between 11 – 13 weeks.
- To assess for specific problems the baby may have, such as spina bifida.
- To assess the baby’s gender; though this is not a primary reason for pregnancy ultrasound it is often determined at the 20 week screening scan.
- To assess the cause of pregnancy complications. This may be bleeding, a reduction in the baby’s movements or if the mother has been experiencing pain.
- To detect whether there is an ectopic pregnancy. This is when the baby is growing outside of the mother’s uterus, most commonly in one of the fallopian tubes.
- When an amniocentesis or chorion villus sampling test is being conducted, a pregnancy ultrasound is done at the same time. This is to ensure that the needle is inserted into the correct area and there is no risk to the baby.
- To check for uterine fibroids or ovarian cysts.
- Chorionic villus sampling (CVS)
- Transvaginal Scan
Most women will have at least one pregnancy ultrasound, either in very early stages of their pregnancy or at around 20 weeks of gestation. So even if you have never personally had one, you will probably have heard of pregnancy ultrasounds and aren’t entirely unfamiliar with how they are done. Pregnancy ultrasounds are just one of the many screening tools available to assess that all is going well with a mother’s pregnancy and the growth and development of her baby. Other names for pregnancy ultrasounds are a pregnancy dating scan, commonly done within the first trimester, and the pregnancy anomaly or screening ultrasound. This is most commonly done at around 18-20 weeks of gestation. If the maternity care provider is concerned about the baby’s growth in the third trimester, then an additional ultrasound at this stage may be recommended. Determining the baby’s size, weight and growth as well as the amount of amniotic fluid present can provide a good, comprehensive assessment of the baby’s status.
Sometimes during a third trimester ultrasound, findings reveal that the baby would be safer in a neonatal intensive care unit than to remain in the uterus. And despite the risks associated with prematurity these are not considered to be as significant to the baby’s health if the pregnancy continued.
Chorionic villus sampling (CVS)
CVS is a diagnostic test that is performed during the first trimester, typically between 10+ to 13 weeks of pregnancy. The main purpose of CVS is usually to determine whether or not a baby has a normal number of chromosomes (46). Therefore, CVS is diagnostic for birth defects like Down syndrome, trisomy 18, trisomy 13, and some other chromosome abnormalities. CVS can also be used to test for some other genetic conditions that your baby may be at risk for based on family history or carrier screening. CVS is generally performed in one of two ways, either by inserting a needle through a mother’s abdomen or through the cervix into a pregnancy’s placenta. A small piece of the placenta is then removed and sent to the laboratory for genetic testing. Results from a CVS are usually available about 1-2 weeks after the procedure. This risk of miscarriage after a CVS is approximately 1/250 to 1/300. Patients who have CVS performed will need a blood test in the second trimester to evaluate for risk of neural tube defects.
Amniocentesis
Amniocentesis is a diagnostic test that is performed during the second trimester, typically between 15 and 18 weeks of pregnancy, but can be performed at anytime during a pregnancy. The main purpose of amniocentesis is usually to determine whether or not a baby has a normal number of chromosomes (46). Therefore, amniocentesis is diagnostic for birth defects like Down syndrome, trisomy 18, trisomy 13, and some other chromosome abnormalities. Amniocentesis can also be used to test for some other genetic conditions that your baby may be at risk for based on family history or carrier screening. It is also normal to use an amniocentesis sample to screen a pregnancy for open neural tube defects (like spina bifida). Amniocentesis is done by inserting a needle through a mother’s abdomen into the amniotic fluid that a baby is floating in inside the uterus. About three tablespoons of the amniotic fluid is then removed through the needle under ultrasound guidance. In that fluid are floating some of a baby’s cells that have naturally fallen off as a baby develops. These cells are then used by the laboratory for the genetic testing. The risk of miscarriage after an amniocentesis is 1/500 to 1/1000.
- Standard Ultrasound
- Transvaginal Scan
- Fetal Echocardiography
- 3-D Ultrasound
- Dynamic 3-D Ultrasound
OPTIMISING YOUR PREGNANACY
A Healthy Diet During Pregnancy
Exercise During Pregnancy
First ask your doctor, of course, as any discussion of this topic can only be a general one. You may be surprised at what you can safely do, as long as your pregnancy is low risk. First-time exercisers should proceed more cautiously. If you have a chronic disease or have had problems in a previous pregnancy, please consult your doctor before exercising. The American College of Obstetricians and Gynecologists (ACOG) recommends that you exercise three times a week or more at a comfortable pace, but cautions that you should limit the length and intensity of your workout.
Morning Sickness
Call your doctor if you experience:
– Persistent vomiting shortly after eating or drinking anything, including water
– Weight loss
– Dehydration
– Concentrated, dark-colored urine
Foods that Alleviate Pregnancy-Related Nausea (Morning Sickness) Candied Ginger Mint
Get help
Remember, to ask for help. Ask your partner, friends, and family for help. Jot down small, helpful things people can do as they occur to you. When people offer to help, check the list. For example:
- Ask friends or relatives to pick things up for you at the market, stop by and hold your baby while you take a walk or a bath, or just give you an extra hand. Or ask loved ones to drop off a meal.
- Hire a neighborhood teen — or a cleaning service — to clean the house occasionally, if possible.
- Investigate hiring a doula, a supportive companion professionally trained to provide postpartum care.
There’s no way to predict exactly when labor will start. And even when you notice early signs of labor, your baby’s birth could still be days or weeks away.
Your body actually starts preparing for labor as much as a month before you give birth, so you may begin to notice new symptoms as your due date approaches. Early signs are:
Lightening
Lightening is a term used to denote the descent of the fetal head into the pelvis as labor approaches. It can occur up to two weeks prior to the onset of labor, or it may not occur at all. At that time there may be increased pressure on the maternal bladder accompanied by the urge to urinate more frequently. Many women find it easier to breathe after lightening occurs because upward pressure on the diaphragm diminishes.
Mucus plug
Release or passage of the “mucus plug” can be another sign that labor is near. Mucus produced by the cervical glands normally blocks the entrance to the cervix and helps prevent infection. When the fetal head impinges on the cervix, mucus from the cervical glands, along with a small amount of blood, is expelled. This results in a blood-tinged or brownish discharge being expelled from the vagina. Passage of the mucus plug may occur days before or after labor begins. It is also common after a vaginal examination.
Water breaking
Spontaneous rupture of the fetal membranes is referred to as one’s “water breaking.” This means that the membranes that surround the baby have ruptured, and clear amniotic fluid is often expelled from the vagina at that time. Once this occurs, labor will generally ensue spontaneously. If it does not, induction of labor may be necessary to avoid infection ascending upward through the vagina into the uterus. Most commonly rupture of the membranes does not occur until labor has already begun.
Contractions
Finally, labor begins with the onset of contractions. At that point the cervix begins to thin out and dilate. When contractions begin to occur less than ten minutes apart, this frequently signals the onset of labor. Irregular contractions, known as Braxton-Hicks contractions or “false labor,” occur toward the end of pregnancy during the third trimester, and they do not necessarily signify that labor is imminent. Some women even experience these contractions during the second trimester. Braxton-Hicks contractions are usually milder than those of true labor, and they do not occur at regular intervals.
What are the stages of labor and delivery?
Labor is divided into three stages; corresponding to the dilation of the cervix, the birth of the baby, and the delivery of the placenta.
Stage 1 of labor and delivery
Stage 1 is the longest stage of labor. It is characterized by thinning (effacement) and dilation of the cervix. Sometimes doctors subdivide this stage into three separate phases: the latent phase, the active phase, and the transition phase. Contractions, occurring with increasing frequency, are present during all phases of Stage 1. Early contractions last from 30 to 45 seconds and are several minutes apart. During the latent phase the cervix dilates to about 3 to 4 centimeters. Many women are admitted to the hospital during this phase. In the active phase, the cervix dilates to about 7 centimeters, and the contractions become more intense. During the transition phase the cervix dilates completely to 10 centimeters, and the contractions are strong and painful. Contractions can occur every 3 to 4 minutes and last from 60 to 90 seconds.
Stage 2 of labor and delivery
Stage 2 refers to the passage of the baby through the birth canal until delivery. It begins when the cervix has fully dilated and voluntary pushing is initiated. Sometimes this is referred to as the “pushing” stage. The head is typically delivered first, and sustained pushing allows for delivery of the infant’s shoulders and body. Some women prefer different body positions during this stage of labor. These may include kneeling, squatting, lying down, or even on the hands and knees. This stage may take minutes to a few hours. According to the American College of Obstetricians and Gynecologists (ACOG), a woman giving birth for the first time should complete Stage 2 within 2 hours if no regional anesthesia has been used, and up to 3 hours if she has received anesthesia. Stage 2 is usually shorter in subsequent pregnancies; up to 2 hours if anesthesia has been given and 1 hour if none has been used.
- Lightening
- Mucus plug
- WATER BREAKING
- CONTRACTIONS
Every woman’s experience is unique. Below are typical guidelines that will help you understand what to expect:
- Normal labor can begin three weeks prior to the anticipated due date up until two weeks afterwards.
- There is no way to precisely predict when labor will begin.
- In the first stage of labor the cervix dilates and effaces (thins out). Once contractions begin they will usually increase in strength, duration, and frequency.
- The second stage of labor begins when the cervix is completely (i.e. 10 centimeters) dilated. It ends when, following expulsive efforts (pushing) by the mother, the infant is delivered.
- During the third stage of labor the placenta and membranes are delivered.
- There are a number of methods for monitoring the fetus that may be used during labor. Options for pain control during labor include breathing exercises, imagery, relaxation techniques, medications, and regional anesthesia.
The process of labor and birth is divided into three stages:
The first stage begins when you start having contractions that cause progressive changes in your cervix and ends when your cervix is fully dilated. This stage is divided into two phases:
- Early labor: Your cervix gradually effaces (thins out) and dilates (opens).
- Active labor: Your cervix begins to dilate more rapidly, and contractions are longer, stronger, and closer together. People often refer to the last part of active labor as transition.
The second stage of labor begins when you’re fully dilated and ends with the birth of your baby. This is sometimes referred to as the “pushing” stage.
The third stage begins right after the birth of your baby and ends with the delivery of the placenta.
Every pregnancy is different, and there’s wide variation in the length of labor. For first-time moms, labor often takes between ten and 20 hours. For some women, though, it lasts much longer, while for others it’s over much sooner. Labor generally progresses more quickly for women who’ve already given birth vaginally.
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3 stages of labor
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- Sore breasts. Your breasts may be painfully engorged for several days when your milk comes in and your nipples may be sore.
- Constipation. The first postpartum bowel movement may be a few days after delivery, and sensitive hemorrhoids, healing episiotomies, and sore muscles can make it painful.
- Episiotomy. If your perineum (the area of skin between the vagina and the anus) was cut by your doctor or if it was torn during the birth, the stitches may make it painful to sit or walk for a little while during healing. It also can be painful when you cough or sneeze during the healing time.
- Hemorrhoids. Although common, hemorrhoids (swollen blood vessels in the rectum) are frequently unexpected.
- Hot and cold flashes. Your body’s adjustment to new hormone and blood flow levels can wreak havoc on your internal thermostat.
- Urinary or fecal incontinence. The stretching of your muscles during delivery can cause you to accidentally pass urine (pee) when you cough, laugh, or strain or may make it difficult to control your bowel movements, especially if you had a lengthy labor before a vaginal delivery.
- “After pains.” After giving birth, your uterus will continue to have contractions for a few days. These are most noticeable when your baby nurses or when you are given medication to reduce bleeding.
- Vaginal discharge (lochia). Initially heavier than your period and often containing clots, vaginal discharge gradually fades to white or yellow and then stops within several weeks.
- Weight. Your postpartum weight will probably be about 12 or 13 pounds (the weight of the baby, placenta, and amniotic fluid) below your full-term weight, before additional water weight drops off within the first week as your body regains its balance.
Emotionally, you may be feeling:
- “Baby blues.” Many new moms have irritability, sadness, crying, or anxiety, beginning within the first several days after delivery. These baby blues are very common and may be related to physical changes (including hormonal changes, exhaustion, and unexpected birth experiences) and the emotional transition as you adjust to changing roles and your new baby. Baby blues usually go away within 1 to 2 weeks.
- Postpartum depression (PPD). More serious and longer lasting than the baby blues, this condition is present in 10%-15% of new moms and may cause mood swings, anxiety, guilt, and persistent sadness. PPD can be diagnosed up to a year after giving birth, and it’s more common in women with a history of depression, multiple life stressors, and a family history of depression.
Also, when it comes to intimacy, you and your partner may be on completely different pages. Your partner may be ready to pick up where you left off before baby’s arrival, whereas you may not feel comfortable enough — physically or emotionally — and might crave nothing more than a good night’s sleep. Doctors often ask women to wait a few weeks before having sex to allow them to heal.
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Do not rush the healing process
MEET OUR DOCTORS
DR. SONIA MACFARLANE
DR. SONIA MACFARLANE
DR. SABRINA JACKSON
DR. SABRINA JACKSON
