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Obstetric care

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From your first visit with us, we’ll do everything we can to help you have a healthy baby.

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Whether you’re planning to have your first child or add to your family, our obstetricians provide complete, personalized care. We’ll manage your care during the entire pregnancy, deliver your baby and care for you afterward.

We’ll also give you the information you need to prepare for pregnancy, childbirth and care for your newborn. Our most important goal is for you and your baby to be healthy. 

Our services include:

  • Low-risk pregnancy care
  • High-risk pregnancy care for women age 35 and older, those carrying twins, or those with high blood pressure, gestational diabetes or other conditions
  • In-vitro fertilization (treatments that help women get pregnant)
  • Vaginal and cesarean (delivering a baby by surgery) births
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What to expect

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  • Preconceptual counseling focuses on planning to have a baby. You’ll meet with an obstetrician to discuss preparing for pregnancy and how to take good care of yourself before and during pregnancy.

    You’ll also talk about pregnancy risks based on your health history. Your spouse or partner is welcome to be part of this appointment.

    Topics include:

    • Any medical conditions you may have that might affect your pregnancy or your health 
    • Genetic (inherited) risks and the chances of passing on a genetic disorder to your child
    • Screening tests for genetic disorders that can be passed on to your baby
    • Risks associated with older parents, such as Down syndrome
    • Your pregnancy history to see if you’re at risk for preterm labor and delivery or other concerns
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  • Your first obstetric visit is usually when you’re about 10 weeks pregnant. Your visit will start with a conversation with one of our nurses. She will:

    • Get your health history 
    • Talk about how to take care of yourself during pregnancy
    • Provide information about our clinic and Swedish Medical Center, where you’ll deliver your baby
    • Take a blood sample to test for any medical conditions that may affect your pregnancy

    Next, you’ll meet with one of our ob/gyn doctors. She’ll review your medical history as it relates to your pregnancy. Then you’ll talk about a care plan that includes:

    • Diet and exercise
    • Genetic screening tests (to check for inherited risks)
    • Warning signs 
    • When to see the doctor
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  • You’ll be scheduled for many office visits during your pregnancy. These allow your doctor to check on your health and the baby’s growth and development. As you get closer to your due date, these visits will happen more often.

    Following is a typical schedule of doctor visits during pregnancy:

    • Every 4 weeks up to 28 weeks pregnant
    • Every 2 weeks from 29 to 36 weeks pregnant
    • Once a week from 37 weeks to delivery
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  • Your body’s hormone levels change during early pregnancy, which can cause nausea and vomiting. This is often called morning sickness, but it can happen at any time of day. This usually goes away after about the third month.

    To prevent morning sickness, try the following:

    • Eat a piece of bread or a few crackers before you get out of bed in the morning (put them close to your bed the night before) or when your stomach is upset.
    • Get out of bed slowly. Avoid sudden movements.
    • Eat yogurt, cottage cheese, juice or milk before you go to bed or get up. 
    • Eat small meals during the day so your stomach doesn’t remain empty for long.
    • Eat high-protein foods like eggs, cheese, nuts or meat, as well as fruit and juices. These foods help prevent low blood sugar, which can cause an upset stomach.
    • Have soup or other liquids between meals instead of with meals.
    • Don’t eat greasy or fried foods because they’re hard to digest.
    • Don’t eat spicy, heavily seasoned foods.

    If you have morning sickness:

    • Sip soda water (carbonated water).
    • Get fresh air. This can include taking a walk or sleeping with a window open. When you cook, turn on the exhaust fan or open a window. 
    • Take deep breaths.
    • Drink spearmint, raspberry or peppermint tea.

    If vomiting continues, or if it becomes difficult to keep food or liquids down, call your doctor. Also, don’t take over-the-counter, anti-nausea medications unless your doctor tells you to.

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  • In general, we believe it’s best to avoid all medications when pregnant. This is especially important during the first 12 weeks, when your baby is developing limbs and major organs. You want to create the best possible environment for your baby’s development.

    Guidelines:

    • Try natural remedies first, such as rest, fluids, a change in diet, ice or heat. (Take care not to overheat yourself.)
    • If you must take medication, be sure to talk with your doctor first. 
    • Don’t use products with mixtures of active ingredients, such as Comtrex or TheraFlu. They usually include ingredients that are not recommended.
    • Try to minimize the use of any medication in the first 12 weeks of pregnancy.
    • If you’re sick, call your doctor. Prescription medications like antibiotics can be used if needed. It’s important to treat urinary tract infections to lower the chances of early labor.

    There aren’t many studies about medication use during pregnancy. Because of this, safety information is gathered slowly — usually when drugs are used accidentally during pregnancy, or when a doctor decides a health concern is serious enough to use medication. 

    Given the safety data we do have, the medications listed here seem to be safe to use during pregnancy:

    • Benadryl
    • FiberCon
    • Metamucil
    • Mylanta/Maalox
    • Pepcid
    • Robitussin D
    • Sucrets
    • Tums
    • Tylenol
    • Vitamin B-6

    Note that we can’t guarantee the safety of any drug taken during pregnancy. If you decide to take medication, please use caution.

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  • Some women who have given birth before by cesarean (also called a C-section, delivering a baby by surgery) want to try a vaginal birth. This is called a trial of labor after cesarean (TOLAC).

    Women choose TOLAC for different reasons. Some don’t want to have surgery or a longer recovery period again. Others want to try a vaginal birth. We understand this and offer TOLAC only to certain patients after careful consideration.

    We have many safeguards in place to care for women who want a TOLAC delivery. These include:

    • Careful patient selection to identify patients with the greatest chances of success 
    • Information about the process and potential risks 
    • Doctors available 24/7 so we can respond right away when you go into labor
    • Ready access to emergency surgical care if needed during delivery
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  • We work closely with each patient to understand as best we can the risks and benefits specific to your situation. We also respect your values, while never losing sight of our number one goal — a safe delivery for you and your baby.

    We will talk with you and your partner about:

    • The status of your labor 
    • How the baby is doing 
    • Any questions or concerns we have
    • Any other issues that may come up

    If you have questions at any time, let us know. It’s part of our commitment to providing the best care we can for you and your baby.

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  • Cord blood is the blood that stays in the umbilical cord after your baby is born and the cord has been cut. Cord blood is a rich source of stem cells, which are used in many medical treatments.

    Donating or banking your baby’s cord blood is an important option available to you when you have a baby. Because cord blood stem cells are collected right after delivery, it’s important to think about this before the birth of your child.

    There are four choices you can make about your baby’s cord blood:

    • The hospital will dispose of it along with the placenta. 
    • It will be used for research, for example, at Seattle’s Fred Hutchinson Cancer Research Center.
    • It will be given to a public blood bank. Your donation may be made available to any patient who needs a stem cell transplant. There is no cost to you.
    • It will be collected and stored for you for a fee.
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  • If you’re expecting a boy, you’ll need to decide if you want to have him circumcised. This involves removing a small piece of skin that covers the head of the penis. Circumcision is done in your doctor’s office. It’s a simple procedure that takes just a few minutes.

    Steps include:

    • The doctor cleans and numbs the groin area. 
    • The foreskin is removed with a special clamp. 
    • The penis is wrapped in petroleum jelly and gauze to protect it.
    • Healing takes about seven to 10 days. You will receive detailed care instructions.

    Many parents have their baby circumcised for personal or religious reasons. There are pros and cons to circumcision and to leaving the foreskin intact. The decision is entirely up to you. 

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  • Our ob/gyns provide postpartum (after birth) care for mothers. The goal is to help you recover and return to normal activities. The postpartum period lasts for six weeks.

    Postpartum care begins in the hospital after delivery. On average, women spend 24 to 36 hours in the hospital after a vaginal delivery and 48 to 60 hours after a cesarean. Because all deliveries are different, you may need a longer hospital stay.

    At your postpartum exam, your doctor will:

    • Assess your physical and emotional recovery
    • Screen you for depression if needed
    • Discuss birth control
    • Talk about exercise

    During the postpartum phase, your strength and energy levels should get better over time. If you don’t feel you’re recovering the way you should, your doctor can connect you to the Swedish Center for Perinatal Bonding and Support.

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  • Our goal is a safe delivery for you and your baby. You can help by calling us right away if you notice any of the following changes: 

    • During pregnancy, if you notice your baby is moving less than what is normal for you, or not moving at all
    • If you leak clear fluid that is not urine or fluid that is green, which could mean your water has broken; even if you’re not having contractions, you need to be checked 
    • If you have vaginal bleeding like a period
    • If you are contracting painfully and regularly every four to five minutes, the contractions last about a minute, and this pattern has been happening for an hour
    • After pregnancy, if you can’t wake up your baby

    Your doctor may change these guidelines if you have gestational diabetes, high blood pressure or if you’ve had a previous cesarean delivery.

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Genetic testing

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  • Pregnant women who will be 35 or older when they give birth have an increased risk of birth defects. Birth defects can occur because of genetics (traits passed from parent to child) or by chance. 

    Genetic screening identifies any abnormalities that may cause birth defects, such as Down syndrome.

    We offer two types of genetic testing:

    1. Screening tests determine your chances of having a baby with genetic birth defects. These tests are noninvasive and pose no risk to mother or child. 
    2. Diagnostic tests determine if your child has a specific genetic disorder or birth defect. Because they are more invasive than screening tests, diagnostic tests carry the risk of possible complications.

    If results from your screening tests show a possible problem, your doctor will order more diagnostic tests.

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  • First trimester: ultrasound

    First trimester screening is done between weeks 11 and 14 of pregnancy. It includes blood work and an ultrasound. The ultrasound measures the thickness of the back of your baby’s neck. Extra thickness can be a sign of birth defects.

    Second trimester: quad screen

    A blood test called a quad screen is done between weeks 15 to 22 of pregnancy. It helps determine if you’re at higher risk of carrying a baby with Down syndrome or other conditions.

    Integrated screening: both screenings

    Integrated screening combines the quad and first trimester screen.

     

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  • Chorionic villus sampling 

    Chorionic villus sampling (CVS) is done between weeks 10 and 13 of pregnancy. A sample of tissue is taken from the placenta, an organ that develops during pregnancy and provides oxygen and nutrients to the baby. The tissue is checked for abnormalities.

    Amniocentesis

    This test is done between weeks 15 and 22 of pregnancy. It involves taking a sample of amniotic fluid (which surrounds a baby during pregnancy) from the uterus. This fluid provides important information about your baby’s health.

    MaterniT21

    This test is done after week 10 of pregnancy. A blood sample is taken from the mother to look at the fetal DNA in her blood. This test is less invasive than CVS or amniocentesis. It’s also FDA-approved for women age 35 and older. 

    The test is often recommended for women who:

    • Had an ultrasound showing a higher risk for genetic abnormality
    • Have a history of pregnancies with genetic abnormalities
    • Had a positive result on a screening test for a current pregnancy

    It’s important to be aware of all genetic testing options available to you and to discuss them with your physician.

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Eating during pregnancy

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  • One of the most important things you can do during pregnancy is eat well. A well-balanced, nutrient-rich diet plays a key role in your baby’s growth and development. A healthy diet includes:

    • Lots of fruits and vegetables
    • Lean protein
    • Low-fat dairy
    • Plenty of water
    • Prenatal vitamins

    During pregnancy, you need to eat about 300 calories more a day to support your baby’s growth. For most women, that means eating about 1,800 to 2,300 calories a day overall.

    We recommend eating three small meals and two snacks every day. This helps keep your blood sugar and energy levels consistent. It’s also easier on your digestive system.

    We also recommend eating a diet rich in folic acid:

    • Folic acid is a B vitamin and can help prevent major brain and spine defects. 
    • It’s found in leafy greens, vegetables, fruits and nuts. 
    • Many breads and cereals are fortified with folic acid.
    • Pregnant women should also take 400 micrograms of folic acid a day.

    If you have a family history of defects of the brain, spine or spinal cord, or if you’re taking any medications, your daily dose of folic acid may need to be higher. Talk with your doctor about this at your first OB visit.

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  • The amount of weight you gain in pregnancy depends on your body mass index (BMI). The higher your BMI, the less weight you should gain.

    If your BMI is:

    • Less than 18.5 (underweight), you should gain 28–40 pounds
    • 18.5–24.9 (normal weight), you should gain 25–35 pounds
    • 25.0–29.9 (overweight) , you should gain 15–25 pounds
    • 30.0 and higher (obese), you should gain 11–20 pounds 
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  • While eating some fish can be part of a healthy diet, pregnant women should not eat shark, swordfish, king mackerel and tilefish. That’s because these fish have higher mercury levels, which can affect brain development.

    You can safely eat up to 12 ounces a week of the following fish:

    • Salmon
    • Canned light tuna
    • Shrimp
    • Crab
    • Cod
    • Catfish
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  • Listeriosis is an infection caused by a germ that can hide in many foods. It’s especially dangerous for pregnant women and can cause preterm delivery and other complications.

    Because of this, pregnant women should not eat certain foods that can carry this germ, including:

    • Unpasteurized dairy
    • Prepared meats, like hot dogs and lunch meat
    • Undercooked foods, including chicken and turkey

    You can find information about pregnant women and listeriosis on the CDC website. For suggestions on healthy eating and meal planning, visit Choose My Plate. 

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Exercise during pregnancy

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  • Childbirth is one of the most physically stressful challenges a woman will ever face. Staying physically active before and during pregnancy will help you get into the best shape possible.

    But because your body will change during pregnancy, you may need to modify your activities. You also need to know when to slow down or to stop exercising and rest.

    In addition:

    • Wear a good-fitting support bra to protect your breasts.
    • Tighten your stomach muscles when standing or sitting.
    • Bend at your knees and hips if you need to lift something that’s lower than the level of your waist. Don’t bend forward at the waist with straight knees.
    • Rotate your feet and ankles anytime you have your feet elevated.
    • Check your posture each time you pass a mirror. Good posture puts less strain on your back. 
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  • The best time to begin exercising is when you’re planning to get pregnant. Many women don’t start until the last three months of pregnancy, when childbirth classes begin. But the sooner you start, the better you’ll feel.

    Regular exercise during pregnancy leads to better posture, less back pain, more energy and stronger muscles for labor and delivery.

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  • Pelvic muscles

    Strengthening the muscles in the lower belly will help you handle childbirth more easily. This will also help prevent urinary problems after delivery, like leaking urine when you cough or sneeze.

    Back muscles

    Strengthening your back muscles, including exercises to improve your posture, will reduce the strain of pregnancy on your lower back.

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  • The exercise you should do during pregnancy depends on your health and on how active you were before getting pregnant. If you were active before pregnancy, there’s no reason to stop, within reason. But this probably isn’t a good time to take up a new intense sport.

    Walking

    Walking is good for most pregnant women. If you didn’t exercise before pregnancy, start with walking.

    Jogging

    If you jog, you can probably continue as long as you feel comfortable. Try not to get overheated, and stop if you feel uncomfortable or unusually tired. Drink plenty of water.

    Tennis

    If you’re a tennis player, you can keep playing unless you have special problems or feel unusually tired. Also, be aware of your change in balance and how it affects quick movements.

    Swimming

    If you swim, continue to do so. Swimming is an excellent form of exercise. The water supports your weight while you tone and strengthen many different muscles. Scuba diving is not advised.

    Golf and bowling

    Golf and bowling are good forms of recreation. Be sure to adjust your movements because your belly is enlarged. Also, watch your balance.

    Snow skiing, water skiing and surfing

    These activities can be dangerous because you can hit the ground or water with great force, which could harm your baby. Talk to your doctor before doing these activities.

    Climbing, hiking and skiing

    Talk with your doctor. Climbing, hiking and skiing at elevations below 10,000 feet are probably OK. Elevations above that can deprive you and your baby of oxygen. This can cause premature labor. Also, the extra weight you’re carrying will make your heart work harder.

    Daily tasks

    Remember that many daily activities, like vacuuming or walking the dog, are simple ways to stay active.

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  • You should stop exercising and call your doctor if you notice unusual symptoms, including:

    • Pain
    • Bleeding
    • Feeling faint
    • Irregular heartbeat (skipped or very rapid beats)
    • Pain in the belly
    • Difficulty walking

    If you have any problems, or if you had problems with exercising during previous pregnancies, talk with your doctor.

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  • Regardless of what type of activity or exercise you do, keep the following in mind:

    • Warming up and cooling down are important. Start slowly and build up to more demanding exercises. Then taper off gradually.
    • Regular exercise at least three times per week is better for you than spurts of exercise followed by long periods of no activity.
    • Don’t do too much. Stop if you feel tired, short of breath or dizzy.
    • Drink water before, during and after exercise to prevent dehydration. 
    • Don’t do sports and exercises that put you in danger of falling or being bumped.
    • Be careful of your back. Don’t do positions and exercises that increase the bend in your back. 
    • Don’t get overheated. Limit outdoor exercise in hot, humid weather. Also, don’t use hot tubs, whirlpools or saunas.
    • Don’t exercise if you have a temperature of 100° F (37.8° C) or more. 
    • Avoid jerky, bouncy or high-impact moves that require quick changes in direction. These may cause back, abdominal, pelvic and leg pain. They can also make you lose your balance.
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