Congratulations! You are either planning to become pregnant, or you are pregnant and we are excited to care for you!
At Northwest Women’s Clinic we offer a special level of commitment to our patients reflected by the fact that 7 out of 10 of our patients are delivered by their own Provider.
One of our greatest sources of pride as providers at Northwest Women’s Clinic is that we take a personal interest in being available for our own patients. Over 7 in 10 women in our care are delivered by the individual provider caring for each patient. This means that your provider would be available any day that he or she works in clinic, and after hours too!
Each provider takes “call” for his or her patients every day that the provider works. For days off, weekends, and holidays, there is a “backup” on call provider. Midwife patients generally are cared for by their midwife, or a backup midwife. However, the backup is occasionally one of our physicians. Physicians are always available for a high risk pregnant woman or a midwife patient needing specialized intervention.
If you think you are pregnant, give us a call to make your first appointment. We usually recommend that you come to see us at around eight weeks following your last menstrual period. An exception would be for serious symptoms noted sooner, such as significant bleeding or pain.
How often do I need to be seen for obstetric care?
To standardize and precisely date each pregnancy, we use “weeks” and days pregnant as opposed to “months.” Pregnancy starts with the first day of the last menstrual period, and lasts an average of 40 weeks which is also the “due date.” Of course, most women actually become pregnant about two weeks after the last menstrual period. The system we use is historical from before ultrasound and highly sensitive lab tests were used, and the last period was the most reliable method for “dating the pregnancy”.
We recommend a first visit around 8 weeks, and then a visit every 4 weeks until about 28 weeks. Following that, we see pregnant patients every 2 weeks until 36 weeks, then weekly thereafter until delivery. If a higher risk pregnancy is noted, additional or more frequent visits may be required. Another term you may hear is “Trimesters” which divide pregnancy into thirds. These are generally 13 weeks long, with the last being 14. For example 0-13 weeks is the first trimester, 14 to 26 weeks is the second trimester, and 27 weeks on is the third trimester. We consider a “term” gestation to be 37 weeks or later, and “full term” to be 39 weeks, with a due date on the 40th week.
What is going to happen at my first obstetric visit?
At the first obstetric visit, we like to perform ultrasound to evaluate the pregnancy and establish a due date. You will also meet with your provider. For obstetric care, we have physician providers and certified nurse midwives. Generally all providers care for patients with low risk conditions. For higher risk pregnancies, most women will see or at least consult with physician providers. Some examples are women who are carrying twins, have significant medical conditions during pregnancy such as thyroid disease, diabetes, high blood pressure, or history of previous cesarean deliveries or uterine surgery.
Your provider will review your complete medical history, do an examination if needed, and review ultrasound results with you. Most of our patients have lots of questions, and we schedule time to answer them. You may find some of your questions are answered below in this information.
How many ultrasounds will I have, and how do I prepare for an ultrasound?
We usually perform a first trimester ultrasound at 8 weeks to establish that the pregnancy is healthy, and determine whether there is one or more than one fetus.
An “anatomy” survey is performed at around 20 weeks. This “big” ultrasound visualizes all the internal organs, and inspects the growth of the infant to ensure health. These are “routine.”
However, there are many other reasons your provider may want ultrasounds in addition to these, including concerns about large or small infants, observation of the developing fetus, observation of the placenta or fluid, or other reasons. Your provider will communicate with you about need for any additional ultrasounds.
To prepare for your ultrasound you need only to be well hydrated! You should drink one or two 8 ounce glasses of water before you arrive. If you feel you have the need to urinate, but are not uncomfortable, then you are ready!
Do I see the same provider throughout my pregnancy?
Yes! We try to have you see the same provider throughout your pregnancy. However, there are times when our providers are called out for a delivery or an emergency. At these times, we offer another provider to see you, or you can choose to reschedule with your usual provider at another date or time.
Where does my doctor or midwife deliver babies?
We are affiliated with Legacy Good Samaritan Hospital and Providence St. Vincent’s Medical Center. These are the two facilities that we can deliver your baby. Your insurance may determine which one if not both are covered for your delivery.
Note: We do not offer home births, but would love an opportunity to have a discussion about it
How do I register at the hospital?
Help us to coordinate your care at your delivery hospital by registering for the hospital. We have provided the following links to make the process easier for you.
In order to contact your provider, call our main office line at 503-416-9922. You can ask for your provider or medical assistant and will be given the opportunity to either speak to them, or leave a voice message if they are unavailable at that moment. You can also log into our patient portal and leave them a detailed message there.
After hours, an “answering service” answers calls from the same phone number, and then contacts your provider via pager or cellular phone.
After hours phone calls should be urgent or emergency type calls (calls that cannot wait until the next clinic day).
Most pregnant women are told lots of “rules” from books, the internet, and friends and family about what is safe in terms of diet, exercise, and activity during pregnancy. What follows here is a discussion of common “rules” people hear and our philosophy for keeping you and the baby safe.
Healthy Diet and Weight Gain
A guideline for “ideal body weight” for women before pregnancy is the following formula. For women over 5 feet tall, start with 100 pounds for 5 feet, then add 5 to7 pounds for each inch over 5 feet to determine an ideal body weight range. For example, a woman who is 5 feet 6 inches should weigh 100 + 30 to 42: so her ideal body weight is 130 to 142 pounds or so.
Weight gain by starting pregnancy weight:
Normal weight: women will likely gain between 25 and 35 pounds.
Overweight: 15 to 25 pounds of weight gain is recommended.
Obese/severely overweight: under 15 pounds is recommended.
Below ideal body weight: 35 to 40 pounds are recommended.
Most pregnant women experience some cravings as well as some food aversion during pregnancy, and this is normal.
We recommend eating a balanced and healthy diet full of fruits and vegetables, lean protein, and rich in complex carbohydrates.
We welcome questions about medication safety prior to pregnancy as well, and love “preconceptual visits,” for this purpose.
We generally stick to medications categorized as “category B.” Category B medicines have a long history of safe use in pregnancy, with no associated concerns for birth defects, developmental problems, or harm to mother or fetus.
These medications have been extensively observed in humans, and also no animal testing (such as in pregnant rats) has shown harm. Many of these medications are administered to newborn infants. Tylenol, most antihistamines, and penicillin are some examples.
Please inform your provider about any medication you may be taking at a first visit.
In order to label a medication “safe,” a drug manufacturer must extensively test and study a medication in a specific patient population. It is neither ethical or advisable to do this in pregnant women. As a result, the only “safe” medication in pregnancy is prenatal vitamins, which have been tested in this way.
This does NOT mean that no other medications are safe, only that they cannot be labeled for pregnancy. We have extensive databases regarding medications and risk posed to mother and developing babies.
Please ask us about safe medication use in pregnancy, and call us with questions!
Pregnant women commonly have dizziness especially in the second trimester. This is due to the hormone progesterone, which relaxes little muscles surrounding the arteries. This results in a lower overall blood pressure. To decrease the effects, we recommend good hydration during pregnancy.
Another excellent way to combat dizziness is to change a portion of fluid intake to an electrolyte containing beverage (Gatorade, Powerade, or similar).
The easiest way to determine if a woman is well hydrated is to examine her urine. Should the urine be light in color, this is an excellent sign of good hydration.
Avoid dizziness by being well hydrated. Urine light in color is a sign of good hydration.
Sexual activity intercourse (sexual activity) is generally considered safe throughout pregnancy. Your provider will tell you when it is not safe.
Sexual activity intercourse (sexual activity) is considered safe throughout pregnancy except in rare individuals with high risk conditions (placenta previa, preterm labor or ruptured membranes, and cervical incompetence.)
Your provider will tell you when it is not safe to have sexual relations. Intercourse often causes mild spotting or light bleeding especially in the first trimester. In the absence of worsening cramping, this is normal and does not require an emergency room visit.
The surface cells on the cervix are highly hormone sensitive, and pregnancy commonly makes these cells bleed when disturbed by pap smears, exams, or intercourse. This does not pose a risk to the fetus. In the latter part of pregnancy, intercourse often causes contractions. Experts do not believe that intercourse causes labor.
Exercise is recommended during pregnancy, including aerobic and non-aerobic workouts. We do not recommend any activities that could be “dangerous” such as contact sports, sports with big pressure changes (such as scuba diving or skydiving,) or sports which are likely to cause injury. I tell my skiers and snow-boarders that you may be the best skier in the world and still get hit by the worst skier on the slopes.
It IS safe to have a heart rate over 140, but we recommend you should discontinue aerobic exercise that you cannot talk through, or if you feel short of breath or lightheaded. For weight lifting, exercise that you can “breathe” through without grunting or holding your breath is recommended. Breathing through the exercise is recommended for Pilates and yoga as well as weightlifting.
Exercise is recommended during pregnancy but we do not recommend contact sports or sports likely to cause injury.
Experts recommend avoiding sushi or raw shellfish entirely as well as unpasteurized milk products
Many women are concerned about eating fish. On the one hand, oily fish like cod and salmon are rich in omega 3 fatty acids, which are very healthy and essential to growth of normal brain and nerve cells. On the other hand, all fish have some level of mercury – an environmental toxin which is higher in longer-lived, top predator fish.
Generally, large, long-lived fish like shark, swordfish, king mackerel, tilefish, and large tuna are higher risk. Higher risk fish can be consumed safely at 2 servings (about 6 ounces) weekly without great concern.
Lower risk fish, such as local salmon, cod, halibut, and shellfish, can be consumed safely up to 5 times per week.
“What about sushi?”
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