Having a baby is one of the most exciting events of your life and we are here to help you make it a wonderful journey. Whether this is your first or fourth child, we understand that each pregnancy is unique and every woman has different needs and expectations. Dr Ambani provides a full range of consultative, diagnostic and therapeutic obstetric services during pregnancy, from pre-pregnancy testing and planning through your delivery and postpartum care. Dr Ambani will personally see you at every prenatal visit and will be a true partner, providing advice, reassurance and information, as well as quality obstetric care.
Our obstetrical services include pre-conception, pregnancy, delivery and post-partum care for both normal and most high-risk pregnancies.
- Pre-Pregnancy Assessment and Preparing for a Healthy Pregnancy
- Pregnancy Care & Delivery
- Vaginal & Caesarean Delivery
- High Risk Pregnancy Care
- Twin Pregnancies
- Repeated Early Pregnancy Loss (Recurrent Miscarriage)
- Pregnancy Complicated with High Blood Pressure (Pre-Eclampsia), or Diabetes
- Women with Pre-Existing Medical Problems such as Thyroid Disease, Autoimmune Disorders
- Fetal Monitoring - Biophysical profile and Doppler velocimetry/non-stress testing
- In-office Ultrasound Screening
- Confirmation of pregnancy
- Miscarriage and ectopic pregnancy screening
- Multiple pregnancy screening
- Fetal anomaly screening
- Family Planning and Contraception
- Fitness, Dietary and Nutrition Counseling
- Before taking any over-the-counteror prescription medication not mentioned below, you should check with the office.
- You should not take aspirin, ibuprofen, or naproxen sodium unless directed to do so by your physician. Regular strength acetaminophen (Tylenol) is the medication of choice for pain or fever. If you have a fever of 100.4 or higher, please call the office.
- For sinus congestion with colds, allergies, or flu, pseudoephedrine (Sudafed) may be used. You also may use a saline nasal spray, such as Ocean or Nasal. Do not use Neosynephrine nasal spray for longer than 3 days. You may take Robitussin DM for coughs or chest congestion. A warm salt-water gargle is recommended for a sore throat. Throat drops, spray, or lozenges are acceptable. A cool air vaporizer may help you sleep at night. Increased fluid intake and getting sufficient rest are essential. If your nasal or throat drainage changes from a clear color, please call the office.
The important warning signs of pregnancy are:
- Vaginal bleeding
- Leaking vaginal fluid
- Change or decrease in baby’s movement (once you start feeling movement at 18-24 weeks)
- Severe headaches accompanied by increased swelling in hands and feet and/or face and visual changes such as spots before your eyes
- Burning with urination Temperature above 100.4 degrees
If any of these occur please contact the office immediately.
- Diarrhea– should this happen, increase your fluids intake to at least 6 to 8 glasses every day. Avoid milk or milk products until the diarrhea has stopped. Eat foods such as bananas, rice, apple sauce, tea, and toast for 24 hours. Take a lot of clear fluids like Gatorade, 7 up, Sprite, jello. If the diarrhea continues for more than 24 hours, please call the office.
- Constipation– you should be drinking 8 to 10 glasses of liquids a day while you’re pregnant. This will help to prevent you becoming constipated in the first place. Fruit juices such as prune and apple juice are very good at keeping you regular and should be included. You should also increase the fiber in your diet by eating bran or shredded wheat cereals, bran muffins, raw fruits and vegetables. Daily exercise, particularly walking, will also help to prevent constipation. If constipation should occur, there are several non-prescription medications that may be used - Metamucil, Citrucel, Fibercon, Colace, Dialose. Dialose-Plus, Senekot.
- Heartburn or Indigestion- Eat small, frequent meals (5 or 6 a day). Drink liquids, especially milk, between meals rather than with meals. Avoid fatty or fried foods, alcohol (which we recommend you avoid at all times during your pregnancy) and carbonated beverages. Sit up during and for one hour following meals. You may use non-prescription low sodium antacids such as Mylanta, Tums or Rolaids - do not use one with simethicone (an anti-gas formula). Zantac or Pepcid may be helpful. You can also try eating crackers. If no relief with these measures, notify your provider.
- Nausea (Morning Sickness) - nausea and vomiting in pregnancy is commonly referred to as "morning sickness", but it can occur at any time of the day or night, usually when the stomach is empty. Keeping something in your stomach by eating small, frequent meals (5 or 6 a day) will help to prevent it from happening. Avoid spicy and greasy foods. Try antacids to help settle your stomach and eat a clear liquid diet for 24 hours. If nausea is a problem when you get up in the morning, try a high protein snack before bed and eat something before getting out of bed in the morning such as pretzels or soda crackers. Dehydration can also increase your nausea so drink plenty of fluids. Avoid unpleasant odors. Over-the-counter seasickness medication helps some people. Taking your vitamin at night may help, or switching to a chewable formula. Emetrol, sugar-based syrup, can be purchased without a prescription and may be helpful. Vitamin B6 over-the-counter is a good first choice in treating morning sickness. If these conservative measures are not successful in getting your nausea/vomiting to an acceptable level, please notify your provider.
You should call the office anytime you are unable to keep fluids down for 24 hours.
- Urinary Tract Infections- Symptoms of a urinary tract infection include pain or burning with urination and increased frequency of urination. The urine may be cloudy or have a strong odor. Unexplained lower abdominal cramping, often accompanied by a backache, can also mean a UTI. An untreated urinary tract infection can cause premature labor, so do not delay seeking treatment. If you suffer from these symptoms you should call the office. It is essential to drink plenty of water and fruit juices (8 to 10 glasses a day) if you think you have a urinary tract infection. You should also avoid caffeinated and carbonated beverages, as they can irritate the bladder and increase your pain and discomfort.
- Edema- Some edema, or swelling, is normal during pregnancy. Generally edema appears in the ankles and legs during the final months of pregnancy. To reduce your discomfort you should elevate your legs whenever possible. Other things you can do are to rest on your left side and reduce your intake of foods containing salt (many foods such as fast food, pizza, deli meats, boxed food, ready-made meals and food from a can or jar such as spaghetti sauce and canned tomatoes contain large amounts of salt). Drinking an adequate amount of water is the best way to get rid of excess swelling, so drink 8 to 10 glasses a day. Please call the office if the swelling is severe or if accompanied by a headache unrelieved by Tylenol, or if you have visual changes, or upper right abdominal pain.
Bleeding - Spotting of blood may occur in 40% of all normal pregnancies during the first trimester. If you are spotting, begin bed rest and call the office. Avoid heavy lifting, exercise, and sexual intercourse for 48 hours after the last episode of spotting.
Routine Testing – we do the following tests during your first visit:
- Rubella Titer– we do this test to determine your immunity status to Rubella (German Measles). If the test shows non-immunity, the immunization will be offered to you when you deliver.
- CBC- A complete blood count is done to determine your body’s ability to carry oxygen and nutrients through it to your baby. This is repeated when we do the glucose challenge test (see below) and sometimes at around 36 weeks if we find you are anemic on an earlier visit.
- Blood Type and Rh, Antibody Screen- If you are Rh negative and the father of the baby is Rh positive, there is the possibility the baby could inherit the father's blood type which could cause a problem during this or future pregnancies. Fortunately, we can prevent this in most cases by giving you an injection of Rhogam - this prevents your immune system from responding to the baby's Rh-positive blood cells. If you are Rh positive, there is nothing to worry about.
- Hepatitis B - This test determines whether you have Hepatitis B, or if you are a carrier. If you are a carrier, your baby will need to be vaccinated at birth.
- HIV– we recommend HIV testing to all pregnant women. If you are infected, you can transmit the virus to the baby. We can decrease the chances of this happening with medications and pregnancy management, which is why we like to perform this test. The test can be performed at any time during your pregnancy if you decide not to have it at your first visit.
- Syphilis- state law requires the testing for this sexually transmitted disease.
- Pap Smear- This test detects cancerous and pre-cancerous changes in the cervix (the opening to the womb, located at the top of the vagina).
The following tests are offered later in the pregnancy:
- Quadruple Screen Test- This blood test combines the results of four laboratory values, alpha-fetoprotein (AFP), estriol, Beta Human Choriogonadotropin (BHCG), and inhibin A to predict the chance that your baby has a chromosomal abnormality such as Down Syndrome or Trisomy 18 while also providing valuable information as to whether or not the spinal cord was inadequately developed leading to a neural tube defect (such as Spina Bifida). This test is done between 15 and 20 weeks and is offered to all pregnant women. This is a screening tool that if abnormal would lead to the recommendation for ultrasound and/or amniocentesis.
- Amniocentesis- Women who are 35 years or older during pregnancy have a greater risk than younger women of giving birth to a baby with a chromosomal defect. Amniocentesis is offered at this age because the risk of miscarriage from the procedure equals or is less than the risk of chromosomal birth defects. This test is done between the 14th an 16th week of pregnancy. Using ultrasound as a guide, a needle is placed through the abdomen into the uterus to collect amniotic fluid for testing. Cells obtained are cultured in a laboratory for evaluation of the chromosomes. Results of the studies are available in about two weeks. In addition, the fluid is tested for the level of alpha-fetoprotein, to detect a neural tube defect such as Spina Bifida.
- Chorionic Villi Sampling (CVS)- This test is offered to the same age group as amniocentesis, but is performed earlier in the pregnancy (10 to 12 weeks). A small sample of cells is taken from the placenta where it is attached to the wall of the uterus, rather than from amniotic fluid. Chromosomal birth defects, such as Down's Syndrome, can be detected. Results of the chromosomal studies are available in approximately two weeks. The risk of miscarriage is about the same as with an amniocentesis but there is an additional risk of limb deformities with this test. The CVS is performed too early to detect neural tube defects. A separate blood test (AFP) can be performed between 15 and 20 weeks.
- Glucose Challenge Test (GCT)- This screening test is performed on all pregnant patients (who are not already known to be diabetic) between the 24th and 30th week of pregnancy as a screening test for gestational diabetes (diabetes during pregnancy). If your score is elevated, we will call you to arrange for a 3 hour glucose tolerance test, a definitive test for gestational diabetes.
- Ultrasound or Sonogram- A sonogram is an image of the developing fetus produced using specially directed sound waves. This painless procedure can give information concerning the age of the baby, the position, the possibility of multiple gestation, and some major birth defects. Minor birth defects are usually not seen on routine ultrasound screens. Ideally this test is done between 18 and 20 weeks to allow for confirmation of the due date and adequate evaluation of the fetus.
- Non-Stress Test - An external fetal monitor is placed on your abdomen. The baby's heart rate is evaluated with relation to its movements. This test generally takes from 20 to 30 minutes and predicts the baby's well-being inside the uterus. This test may be recommended for a variety of reasons, including:
- Multiple gestation
- Maternal smoking
- High blood pressure
- A perceived decrease in fetal movement
- Age (older than 35 or a teenager)
- Diabetes or gestational diabetes
Cystic Fibrosis – (CF) is a genetic recessive disorder. It is caused by an abnormal gene that is passed from parent to child. It is a lifelong illness that affects all of the organs of the body and often causes problems with digestion and breathing. It does not affect a person’s look or mental ability. In some cases, CF poses a serious risk to a person’s health and shortens that life span. Carrier testing can be done for couples planning a pregnancy or during pregnancy to assess their risk. The test is done on a blood sample. Prenatal tests done to detect CF and other disorders are chorionic villus sampling (CVS) and amniocentesis.
We recommend taking an epidural as it will make the entire experience of labor and delivery very pleasant. Epidural analgesia causes some loss of feeling in the lower area of your body but you remain awake and alert. Although rare, complications and side effects such as decreased blood pressure or headaches can occur, your doctor will discuss these with you.
The weight gain recommended during pregnancy is generally 20-30 pounds. However, this can be different for each individual. As everyone is different you should discuss your particular situation with your doctor.
In order to promote your baby's growth and development a healthy diet is essential, the basic principles of healthy eating remain the same during pregnancy i.e. get plenty of fruits, vegetables, whole grains and lean protein. However, you should ensure you get the following nutrients in pregnancy:
Folate and folic acid: Folate helps prevent neural tube defects, serious abnormalities of the brain and spinal cord. Lack of folate in a pregnancy may also increase the risk of low birth weight and preterm delivery. In addition to making healthy food choices, taking a daily prenatal vitamin ideally starting three months before conception is very helpful. Fortified cereals, leafy green vegetables esp spinach, asparagus, citrus fruits - oranges, peanuts, dried beans and peas are good sources
Calcium: You and your baby need calcium for strong bones and teeth. Calcium also helps your circulatory, muscular and nervous systems run normally. Dairy products are the richest sources of calcium, Salmon, Many fruit juices and breakfast cereals are fortified with calcium, too. In addition Vitamin D also helps build baby’s bone and health
Protein: Protein is crucial for your baby's growth, especially during the second and third trimesters. Lean meat, poultry, fish and eggs are great sources of protein. Also dried beans and peas, tofu, dairy products and peanut butter.
Iron: Your body uses iron to make hemoglobin, a protein in the red blood cells that carries oxygen to your tissues. During pregnancy your blood volume expands to accommodate changes in your body and help your baby make his or her entire blood supply, doubling your need for iron. If you don't get enough iron, you may become fatigued and more susceptible to infections. The risk of preterm delivery and low birth weight also may be higher. In addition to prenatal vitamins, lean red meat, poultry and fish are good sources of iron. Also iron-fortified breakfast cereals, nuts and dried fruit.
Meat, fish and poultry are all part of a healthy diet but you should make sure they are well cooked. However, fish and shellfish all contain traces of mercury which may be harmful to a baby’s developing nervous system. Pregnant or breastfeeding mothers should avoid shark, swordfish, mackerel, and tilefish. Common types of fish that are low in mercury are shrimp, canned light tuna (not albacore, which has higher mercury content), salmon, pollock, and catfish. Limit other seafood including canned tuna to 2 servings per week.
The best sleeping position during pregnancy is to sleep on side, ideally on your left side. Sleeping on your left side will increase the amount of blood and nutrients that reach the placenta and your baby. Keep your legs and knees bent and a pillow between your legs. You should avoid sleeping on your back or stomach.
- Alcohol- Alcohol can cause mental retardation and slow growth. Drinking at any time during pregnancy can cause problems.Alcohol increases that chance of having a miscarriage or a preterm baby.
Drugs - Recreational drug use, especially cocaine, can cause serious complications - miscarriage, fetal stroke, brain damage, and even fetal death. Your baby may become addicted to any drugs you take. If you have used such a substance during pregnancy, please alert your physician.
Your gums may bleed more easily when you are pregnant. This is because of the increased blood supply to the oral tissues during pregnancy. You should brush at least twice daily using a soft toothbrush and also floss once a day.
You should continue routine dental care during your pregnancy but you must inform your dentist that you are pregnant. They will need to know this so that they can use the correct anesthetic and take the necessary precautions for X-rays.
Regular exercise is important. Walking, swimming, cycling, and prenatal exercise classes are all recommended. Swimming is safe during pregnancy as long as your bag of water is not leaking. Low impact aerobics are an excellent way of exercising during pregnancy.
You may continue normal sports activity although you should keep your heart rate under 140 (take your pulse for 6 seconds, multiply by 10). Do not exercise lying flat on your back after 16 weeks of pregnancy. If any activity causes you pain you should discontinue it immediately. Be sure to discuss specific sports activities with your physician.
Exercises that are not recommended during pregnancy are snow or water skiing, scuba diving and horseback riding.
- Take Pain medications every 6-8 hours
- Keep perineal area clean
- Use Tucks Pad on the bottom
- Use Dermaplast spray on the bottom
- Change Pads frequently
- Take stool softener
- Drink 8 glasses of water to avoid constipation and increase breast milk
- Pump excess milk out every 3-4 hours after feeding baby
Schedule Post-partum visit 2-4 weeks as advised by your physician.