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Patient Education - Freqently Asked Questions

When do I have to go to the hospital?

You should go to the hospital anytime you think there is something wrong that may endanger you or your baby. However, here are some simple guidelines. You should go straight to Labor and Delivery on the second floor of the hospital if your water has broken, regardless of contractions. False labor pains are common anytime in the final month of pregnancy. You should go to the hospital if you have strong, regular contractions, 5 - 7 minutes apart that persist for 1 hour. A bloody show is common anytime in the final month and does not always mean you have to go to the hospital. See below for an explanation of a bloody show. Any strong contractions at less than 36 weeks pregnancy is abnormal and should be evaluated. When you arrive to Labor and Delivery monitors will be placed on your abdomen to monitor for contractions and your child's heart rate. A labor nurse will evaluate you and then call the physician.

What is a bloody show?

A bloody show is a small amount of bloody mucous seen at anytime in the final month of pregnancy. It may be anything from just mucous (plug) to pink discharge to a bloody red discharge. Although it is a good sign that your cervix may be softening in preparation for dilation it does not always mean you are going into labor. It may occur from 2 weeks to 1 hour before delivery and thus affords no idea of when labor may occur. It may also occur within 24 hours after a pelvic examination. If this occurs you do not have to come into the hospital. You should watch for any other signs of labor. Heavy vaginal bleeding is never a simple bloody show and should be evaluated in the hospital immediately.

What are "Braxton-Hicks" contractions?

Braxton-Hicks contractions are very mild, irregular contractions that may feel like menstrual cramps. They can occur at any time in the late 2nd trimester and 3rd trimester (26 - 40 weeks). If you are less than 36 weeks and these mild cramps become uncomfortable or are accompanied by a mucous or bloody discharge, you should proceed to the Hospital. Otherwise, they are common and normal.

Do I always need an episiotomy?

An episiotomy is a "cut" the physician makes at the time of delivery at the vagina in order to facilitate delivery and avoid a large tear. They are not automatic and is a last minute decision if you need one or not. It is the philosophy of this office to avoid an episiotomy if possible.

Swelling during Pregnancy?

Swelling during pregnancy is common and normal in most circumstances. It does not occur in all pregnancies. It will go away in 1 - 2 weeks after delivery. Swelling is abnormal when accompanied with high blood pressure. That is what we call Pre-eclampsia or toxemia.

What is Pre-Eclampsia or Toxemia?

Pre-eclampsia or Toxemia is high blood pressure during pregnancy with protein the urine. It occurs only during pregnancy and most often shows up in the 3rd and final trimester although it can occur in the late 2nd trimester. It can be very dangerous and lead to dangerous seizures which we call eclampsia. There is no cure for this disease except for delivery. During the delivery process you may receive medication to prevent seizures and also to lower your blood pressure. Most patients have no symptoms but some may experience upper abdominal pain, headaches, spots or blurry vision.

What can I take for a cold or illness during pregnancy?

Always consult with your physician before you take any medication you are not sure of. For a simple cold you may take benadryl or sudafed for stuffiness, tylenol for headache or fever, Robitussin for cough. Of course you should rest and take plenty of clear fluids. You may take Immodium for diarrhea and Emetrol for nausea. These are all over the counter medications and are safe in pregnancy. Use them as the labeled directions state. You may also consult the information given to you on your first prenatal visit for other recommendations. Of course, if you feel too ill you should call the office or physician.

Can I exercise during pregnancy?

Yes, you may, unless you have been directed by your physician not to (example; high risk for premature delivery). You should not start any new demanding exercises you were not doing prior to pregnancy. Your pulse rate should not go above 150 beats per minute and you should stay well hydrated. The activity should be low impact. A good rule of thumb is that you should be able to carry on a conversation while performing the exercise. Walking and swimming are good options.

Can I have sex during pregnancy?

Yes, unless you have been instructed not to (abnormal bleeding or at high risk for premature delivery). Sex should be gentle and you should stop if you notice any blood.

What if I cannot feel the baby move?

You should always feel the baby move after 28 weeks. Many times if you are busy you may not notice them although there is movement occurring. If you notice no movements, stop what you are doing, drink something sweet such as orange juice, and lay on your left side in a quiet room. You should have 10 movements within 2 hours. Any movement counts. If not proceed to hospital immediately.

Is a circumcision always necessary for my baby boy?

No. A circumcision is a partial and/or complete removal of the foreskin of penis. It is only a cosmetic (or religious) procedure desired by some parents. If the child is taught proper hygiene and how to retract his foreskin he should have no problems in the future. The pediatrician normally perform the circumcision in the hospital prior to discharge home.

What is a Pap smear?

A pap smear is a screening test for cancerous and precancerous changes in the cervix. Unlike many other cancers, cervical cancer can occur frequently in young patients. That is because the #1 cause of cervical cancer and pre-cancer is the Human Papilloma Virus (HPV). It is a common virus with no cure and is sexually transmitted. In most patients it has no symptoms or warnings although some patients may develop warts. Most males can carry the virus with no symptoms.

When do I need a pap smear?

Cervical cancer screening should start at age 21 years.

Women aged 21–29 years should have a Pap test every 3 years. Women aged 30–65 years should have a Pap test and an HPV test (co-testing) every 5 years (preferred).It is acceptable to have a Pap test alone every 3 years.

Women should stop having cervical cancer screening after age 65 years if they do not have a history of moderate or severe dysplasia or cancer and they have had either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past 5 years.

Women who have a history of cervical cancer, are infected with human immunodeficiency virus (HIV),
have a weakened immune system, or who were exposed to diethylstilbestrol (DES) before birth should not follow these routine guidelines.

What is a Colposcopy?

It is a test performed if you have an abnormal pap smear result indicative of possible pre-cancer cells. Remember, a Pap smear is only a screening test and may be wrong. The colposcopy is the test to determine if you have pre-cancer (known as dysplasia). It is a test performed in the office in which we examine your cervix under magnification and obtain biopsies. The biopsies are tiny and the procedure takes less than 15 minutes. You may have some light bleeding for 1-2 days afterward with some mild cramping only. You should not have sex for 1 week after, otherwise you may resume normal activity. Results take 7 - 10 days to obtain.

What is a LEEP?

If colposcopy confirms dysplasia (pre-cancer) on your cervix then the LEEP is the procedure used to remove the abnormal cells and its surrounding tissue. It is also done in the office under local anesthetic (lidocaine). It takes about 15 minutes to complete. You will experience some discharge, bleeding, and cramping for 1 -3 days after the procedure. You should refrain from sex or tampon use for at least 2 weeks after the procedure.

What is an endometrial biopsy?

This is a very common procedure done in the office to evaluate abnormal bleeding. It obtains tissue from the inside of the uterus (endometrium). It is very quick and you may feel a deep cramp. You may have some mild cramping and spotting for 24 hours after. It is never performed during pregnancy.

What is an endometrial ablation?

This is a procedure done in the office to help control or stop abnormal bleeding or heavy periods. It is a painless and quick procedure done while you are asleep for 15 minutes. You can go home 15 - 20 minutes after the procedure and resume normal activity the next day. You cannot attempt pregnancy after this procedure is done. This is a simple option to alleviate abnormal bleeding and/or heavy periods without needing a hysterectomy! You must have some form of permanent birth control before undergoing this procedure.

What are the different types of birth control available now?

The past couple of years have seen the improvement of birth control options. There are new, lower dose pills with less side effects than just a few years ago. There is also the birth control shot (Depo-Provera) that you get at the office every 3 months. An appointment is required for each shot. It has only a 1% failure rate. There is also the birth control patch. It is a patch that goes on the skin once a week. It's side effects are similar to the pill. There is also the NuvaRing which you place in the vagina once a month. Neither you nor your partner can tell it is there. Side effects are similar to the pill. These are great options for patients who frequently forget to take the pill. If you are sure you want no more babies then we can perform a tubal ligation in the office or as an outpatient or your husband may have a vasectomy. Both have equal failure rates (<1%). A post partum tubal ligation (after delivery) is done the day after delivery. The Intra Uterine Device (IUD) is also an option for certain patients. It has only a 1% failure rate and can last several years. It is placed by the physician in the office. Some IUD's such as Mirena can also help diminish blood flow and alleviate heavy bleeding during periods. Implanon is a new insert we can place under the skin in your arm that offers excellent protection against pregnancy. The implanon is 3 years of birth control. We also provide the new tubal ligation technique called Essure. Performed in the Physicians office, this is a tubal ligation with no incision and no abdominal surgery! Please read below for details.

What is a hysteroscopy?

A hysteroscopy is a minor surgical procedure used to evaluate the cause of abnormal bleeding or possible abnormalities in your uterus. Your Doctor will insert a very thin sterile telescopic device attached to a camera through your cervix and into the uterus. No cutting is involved. Your Doctor can the look around the inside your uterus to see if there are any growths or abnormalities. It is never done when you are pregnant. This procedure can be done in the hospital or in our office. Most patients will be able to have this done in the office thus avoiding hospitalization.

What is In Office Surgery?

Dr English provides several minor surgeries in our office thus avoiding the need for hospitalization. This saves you time, costs, and the need for general anesthetic. You receive your procedure in the comfort of our office that is already familiar and convenient to you. The procedures we do in the office are minor, done under local anesthetic or IV sedation. These procedures include Essure Tubal ligation technique, endometrial ablations, dilation & curettage, LEEP  and hysteroscopies. Many physicians still do these procedures in the hospital but for the right patients we can safely do this in the office in a painless fashion thus making the experience much less stressful and convenient for our patients by eliminating the hospital admission.

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