Natural births, High Risk Pregnancies, External cephalic versions, Twin vaginal deliveries,

I love it all!!

PRENATAL CARE

WITH

DOCTOR REBECCA LEE PERLOW

Pregnancy for doctors and patients is separated into trimesters of First ( zero to 13 weeks), Second (13 to 28 weeks), and Third ( 28 to 40 weeks) because each trimester offers it’s own unique challenges, fun, and worry.

 

FIRST TRIMESTER

I, generally, start your prenatal care at 8 to 11 weeks of pregnancy. If you are a new patient this is what I call the "Biochemistry of Pregnancy." We will talk about antenatal testing that is offered for you or your partner, such as genetic mutations like Cystic Fibrosis, Fragile X, Spinal Muscular Atrophy (SMA). You do State of California blood work such as your blood type ; It never changes but they want it done every pregnancy:( .You are offered testing for the health and genetic make-up of your baby, meaning Maternal Serum Alpha Fetoprotein aka MSAFP, Nucelotide Peptide Testing aka NIPT (this is the early blood test that tells YOU gender, and me Trisomy 21,18,13 risks) as well as invasive testing such as Chorionic Villous Sampling aka CVS or Amniocentesis. AM I RIGHT!!! BIOCHEMISTRY TO THE MAX!

Finally, if you want to, we can do an Transvaginal ultrasound to determine if you have one or 2 babies, where they are in the uterus, how fast the heart is beating, and the really fun stuff, if it wiggles:) We will confirm your due date aka EDC (Estimated Date of Confinement). I will then prescribe you prenatal vitamins with DHA, or manage your pregnancy malaise (see handout Options for Malaise of Pregnancy) and send you off to a Perinatologist for all of your subsequent ultrasounds.

You will make appointments to see me every 4 weeks, and since the pregnancy is 40 weeks, we have plenty of time to cover all the bases of preparing your body, your family, and your spirit before you bring a baby home. I love lists! Bring them in to every visit.

Preconception also known as before you get pregnant can get rid of almost all of the BIOCHEMISTRY of PREGNANCY by getting done your Counsyl (Counsyl.com Universal Plus Fragile X) testing and Starting Folic Acid (in your prenatal vitamins) 4 months before pregnancy to prevent fetal neural tube defects.

Additionally, the first visit physical exam and history can be done before pregnancy also.

 

SECOND TRIMESTER

15 to 18 weeks - this visit has you finish your fetal testing with a State of California MSAFP test. You can read through the brochure and decline it, if you wish. Hopefully, by now you will notice that you feel, and think more clearly. Your malaise is easing up, and our conversations are less of a fog. From now on your exam is simple, wight check, blood pressure, urine check (not for infection unless you tell us you have symptoms) for protein. I’ll measure the size of your baby with a tape measure. They call this a Fundal Height, which is the top of your uterus, noted by Hippocrates in 300 BC. Even in the 21st Century it correlates very nicely with gestational age ; so the fundal height matches your gestational age: 16 weeks,16 centimeters. Isn’t that cool ! Then the fetal heart rate. Because most sites you guys read ( I don’t read them, you tell me) say your baby starts moving now. This visit is still full of worry because you don’t feel your baby move, or it happened once (that’s what happened to me.) About 4 days before this visit you get anxious and have nightmares or super weird dreams. The heart rate with a doppler is very reassuring. It pounds, and you can feel it with your physical being. I lay it on your upper abdomen and lay your hands and your partner or parents hand on it to enjoy that beautiful sound and you begin to feel that it’s real. I tend to talk to your baby at all the visits. I just love it.

Because you’re baby is getting bigger now, and starting to lay down more bone. I will start to supplement you with Calcium and Vitamin D3. (Separate handout)

- this visit has you finish your fetal testing with a State of California MSAFP test. You can read through the brochure and decline it, if you wish. Hopefully, by now you will notice that you feel, and think more clearly. Your malaise is easing up, and our conversations are less of a fog. From now on your exam is simple, wight check, blood pressure, urine check (not for infection unless you tell us you have symptoms) for protein. I’ll measure the size of your baby with a tape measure. They call this a Fundal Height, which is the top of your uterus, noted by Hippocrates in 300 BC. Even in the 21st Century it correlates very nicely with gestational age ; so the fundal height matches your gestational age: 16 weeks,16 centimeters. Isn’t that cool ! Then the fetal heart rate. Because most sites you guys read ( I don’t read them, you tell me) say your baby starts moving now. This visit is still full of worry because you don’t feel your baby move, or it happened once (that’s what happened to me.) About 4 days before this visit you get anxious and have nightmares or super weird dreams. The heart rate with a doppler is very reassuring. It pounds, and you can feel it with your physical being. I lay it on your upper abdomen and lay your hands and your partner or parents hand on it to enjoy that beautiful sound and you begin to feel that it’s real. I tend to talk to your baby at all the visits. I just love it.

Because you’re baby is getting bigger now, and starting to lay down more bone. I will start to supplement you with Calcium and Vitamin D3. (Separate handout)

 

20 to 23 weeks - I call this the BABY MOON,  fun month. All the biochemistry and scary perinatology visits are over. You have popped! Everyone knows you are NOT FAT, you are pregnant. It’s a beautiful state of being that you only experience a few times in your life. Take the interval 4 weeks to just enjoy being pregnant. Throw away all the negative thoughts that people can’t stop themselves from saying “You’re too small, you’re too big, are you sure it’s not twins, you’re not eating enough.” Most of the time you handle the comments all day without an issue but at night when you try to sleep, they come creeping back. So purposely try to get them out of your head. I will notify you if you are “too big or too small” and we will talk about nutrition every visit. Try not to do any “Homework,” meaning specifically, no classes, hospital tour, registration at the hospital (unless you feel it will decrease your anxiety. )   Just enjoy being out of the Biochemistry of pregnancy........Please...... it's once in a LIFETIME :)

 

24 to 28 weeks - Now is where the Homework begins. I will give you a folder with information about the Classes I recommend and the numbers to call for them, Stem Cell Collection, Registration at Tarzana Hospital, Breastfeeding resources, Pediatrician recommendations, Labor Doulas, Placental Encapsulation, getting help if your having twins.

Also you will do the glucose test. This is a drink of 50 grams of glucola, you drink it within 5 minutes.Then have nothing to eat or drink or chew (gum) for 1 hour. It is a timed test and should be drawn fro blood within 5 minutes of you finishing the drink. There are alternates to the glucose drink, just ask. Also with this blood draw we are checking for anemia, thyroid, and vitamin D3 levels. We will add anything you may need for a medical condition to alleviate too many blood draws.

 

28 to 32 weeks - Many people choose a 3D ultrasound at this time to get a good picture of your baby. You will do this with a separate company or a perinatologist. If you have a medical reason for checking the growth of your baby or we are following your for a medical condition that could effect your baby then I will send you to a perinatologist for this follow up ultrasound. You may decline these ultrasounds if you choose. 

THIRD TRIMESTER

At 32 weeks I will give you a prescription, ACOG informational handout on TDAP (Whooping Cough) vaccination. This is an ideal time to get it because , if you are a breastfeeding mom, the baby will get the most antibodies against whooping cough through your breastmilk in those first 6 weeks of life when they are vulnerable. Even if you are not breastfeeding babies can be vulnerable to Whooping Cough so TDAP is recommended. 

I will also give you a Breastpump prescription. Your insurance company should give you a free one. I prefer the Medela Double breast Pump-in-Style. (Insert click to handout).

We discuss what is going on in your classes, what are your fears, helpful information, clarifications of terms learned. I call it your pregnancy homework.

 

After 32 weeks - Your visits will be scheduled for 35 weeks, 37 weeks, then every week after that until you deliver.

 

34 to 35 weeks - I will perform a Group B Streptococcus (GBS) culture with a Q-Tip swab placed in the outer one third of the vagina and a just past the anal sphincter. It’s very quick and very helpful in managing your labor. Group B Strep is an organism that lives in your colon/intestine and helps you to fight off bad bacteria in your colon. For babies it can cause infection and death. At Tarzana hospital, well before ACOG recommended this pre-delivery testing, we have been giving antibiotics developed with a special standardized dosing of IV antibiotics while in labor to decrease the risk of newborn GBS sepsis. Our statistics for babies with GBS sepsis are well below those anticipated by the CDC.

I will also use the ultrasound machine to check your babies position. I do not bill you for this ultrasound. I believe in easy vaginal births. If the baby is face up, I will show you maneuvers for your body to help your baby face down, which makes for an easier birth:) If you don’t want took, let me know. I always ask your permission before I do ultrasounds.

 

THE END!

37 weeks!! This is considered a term pregnancy across the world. 95 Percent of pregnant women with good dates, meaning ultrasound before 13 weeks, will have their babies with 4 days of the due date. However, 37 weeks is a huge sigh of relief that your not going to have a Premie (I did).

I will start you on primrose oil, exercise ball, possible acupuncture or acupressure to get you body ready for an easy birth (by which I mean no episiotomy and no tears, and you feel good after delivery). I will give you sample birth plans however, there is no requirement. Just put down your fears and wishes. I will help you edit it to make it so the nurses like you. this will be your first vaginal exam to see how ready your body is and assess how best to help you achieve and easier birth. Even if you are having a cesarean, we can work together to make it a pleasant birth experience.

 

38 to 40 weeks - Regular measurements, Fetal heart rate, Estimated Fetal Weight, vaginal exam, assessment of Pelvis adjusting for birth. Your personal labor team is set. Bags are packed, car seat is in. Baby sitters for other kids, or postpartum Doulas and postpartum help are all lined up!

 

I am on call for myself 24 hours a day. If you are not sure if you should go to the hospital and it’s 2 O’Clock in the morning, CALL ME, I can tell just by the way you are breathing through contractions if you should go or not. Let your partner call me if they are worried , you are in this together…forever. You are making a family.

 

Call the regular office number (818) 344- 8822, when it prompts you to Dr. Perlow’s emergency line, press it, it may be just a question but I am here for you.

THE FOURTH TRIMESTER