Obstetrics FAQ

Yes. This is a very common symptom called “round ligament pain.” This happens as the uterus grows in early pregnancy causing the ligaments that support the uterus to stretch. Most women experience this at some time. This can be treated with Tylenol and a warm bath. It often helps to lie on the side that hurts the most (For example: if your left side hurts, lie on your left side). This takes the tension off the ligament and may bring relief. Typically, this pain will go away as you progress through the second trimester.

Back pain is a common pregnancy complaint and is caused by changes in posture, hormones, and stretching of the abdominal muscles. To avoid problems, wear low-heeled (not more than 1-2 inches bc the higher the heel the more arch in the back.) shoes with good arch support. Always lift by bending your knees and ask for help when moving large or heavy objects. Sleep on your side with 1 or 2 pillows between your knees. If you have to stand for long periods of time, place one foot on a stool or a box. When sitting, use good posture and place a small pillow to support your lower back.

A regular exercise routine that includes walking or swimming is very important for preventing back injury.

Start by applying heat or ice to your lower back and have your partner massage the area. Stretches and exercises for the back can be very beneficial and will help increase muscle tone to prevent further injury. Swimming, yoga, and walking are both excellent activities for both treating and preventing back pain. If none of these steps help, ask your doctor about other options such as support braces/ belts and physical therapy.

It is very important to take an over-the-counter iron supplement at a different time of day than your prenatal vitamin and/or thyroid medication. This is to maximize the absorption of the supplement. Options include:

• Ferrous sulfate 325mg tablet once daily
• Gentle Iron (iron glycinate) 28 mg tablet once daily
• Slow Fe (coated ferrous sulfate) 45mg tablet once daily

Vitamin C can increase your body’s absorption of iron. You can take a vitamin C tablet with your iron pill.

Iron can also cause constipation. Please see above for treatment of constipation in pregnancy.

Please make every effort to stop smoking during pregnancy. Babies born to mothers who smoke tend to be smaller and have more problems after delivery. Smoking can also cause mothers to have lung problems, more colds, high blood pressure, and problems with the placenta.

Alcohol should not be consumed at all during pregnancy. Drinking any type / amount of alcohol raises the risk of certain birth defects. No amount of alcohol is considered safe during pregnancy.

Marijuana is NOT considered safe during pregnancy.

Unfortunately, constipation is a very common problem during pregnancy. It is best to start by eating a well-balanced diet that includes fruit and fiber and drink plenty of water (2 quarts per day or until your urine is a light yellow).

Before taking any medication try the following: Prunes/ prune juice, Bran cereal. Increase roughage (fruits and green leafy vegetables). Increase walking.

If no change then try medication: Colace (Docusate Sodium) 100mg tablet twice a day or Psyllium Fiber (Metamucil or Konsyl) – follow directions on bottle for powder dosing with a full glass of water.

Acceptable Laxatives in pregnancy:

Senakot or ExLax (senna) 15mg once daily. Do not take this for longer than a week.

Citrucel (methylcellulose) 400mg caplets. Take 2 caplets every 4 hours, not to exceed 12 caplets daily. ** Must take with a large glass of water

Milk of Magnesia (magnesium hydroxide) – 400mg tablet (2 tablets every 4 hours. Max 8 tablets per day)

You should continue to wear your seatbelt when you are pregnant. This protects both you and your baby. It is important to wear both the lap and shoulder belt. Buckle the lap belt low on your hips, below your belly. Place the shoulder belt off to the side of your belly and between your breasts. Never place the shoulder belt below your arm. Your seat belt should fit snugly to avoid injury to you and your baby.

Yes. Airbags are designed to be used with your seatbelt and serve as another layer of protection if you are in an accident. If you are driving, the steering wheel should be at least 10 inches from your chest. As your belly grows, this may not be possible. In this case, try to adjust the angle of the steering wheel towards your chest to help avoid injury to your abdomen in the event of an accident.

YES for all trimesters. It is safe to get your hair dyed and groom your nails during pregnancy.

Please check with your physician prior to planning any travel, particularly international travel.

Travel by air or car is acceptable as long as emergency care is available near your destination and as long as your pregnancy is uncomplicated. For any travel, be sure to get out of your seat, pump your calves and ambulate, every 60 to 90 minutes, to reduce your risk of developing a blood clot. Air travel is dehydrating; please be sure to consume an adequate volume of caffeine-free liquids to maintain light yellow, non-concentrated urine.

All travel should be completed by 34 weeks.

Considering purchasing trip insurance in case of any unforeseen pregnancy complications.

Yes. Intercourse is safe during all trimesters of pregnancy. Some women will complain of cramping or contractions after sex; this is caused by compounds in the semen called prostaglandins. These symptoms are typically short lived and not an issue. Using a condom can prevent this problem. Additionally, spotting can occur up to 48 hours after intercourse and is considered normal. If bleeding becomes heavier or if it is associated with pain, then please call our office at 609-924-9300 to be evaluated.

It is generally recommended that women stop sleeping flat after 20 weeks pregnant. Most pregnant women will become uncomfortable sleeping on their backs as the pregnancy progresses. Sleeping on their sides may be more comfortable. A long body pillow can often help provide comfort when side sleeping.

Yes, the TDAP vaccine is safe during any trimester of pregnancy. It includes a Tetanus booster as well as Pertussis (Whooping Cough) and Diphtheria vaccination.  For peak immunity, getting the TDAP vaccine between 27 – 36 weeks helps protect your baby from Pertussis in the first few months of life before he/she gets vaccinated.  Newborns are most susceptible to both illness and serious complications caused by Pertussis; your vaccination reduces this risk.

It is recommended that women get a new Tdap vaccine during every pregnancy to boost their immunity.

Princeton Medical Group provides TDAP vaccines to all patients in both the Princeton and Plainsboro locations.

All close contacts to the newborn should be vaccinated with the TDAP vaccine within the last 10 years.  If they are due for a booster, they should get the TDAP booster at least 2 weeks before meeting the baby. Family members and caregivers can get this vaccine at their primary care provider’s office or at local pharmacies.

Please refer to the CDC website for more information.

Yes, the Centers for Disease Control and the American College of Obstetricians and Gynecologists recommend that all women who are pregnant during flu season get a flu shot, regardless of their trimester, because pregnant women with the flu can become seriously ill.

Princeton Medical Group provides the preservative free flu vaccine to all pregnant patients at both the Princeton & Plainsboro office locations.

Additionally, all close contacts to the newborn should be vaccinated with the annual influenza vaccine at least 2 weeks before meeting the baby. They can get this vaccine at their primary care provider’s office or at local pharmacies.

Most women develop stretch marks at some point during their pregnancy. These occur when the skin stretches quickly as the baby grows. Many lotions and oils are advertised that claim to prevent stretch marks, but none have been proven to consistently be effective. Using a heavy, moisturizing lotion / oil will help keep your skin soft, but may not completely prevent stretch marks. Fortunately, many stretch marks fade with time.

 

GBS is a bacteria found in approximately 15% of women’s vaginas. Your doctor will send a urine culture for this in the first trimester and perform a vaginal culture in the last month of your pregnancy. GBS is a normal bacteria that can be found in your vagina, not an infection. However, during birth, GBS can enter a baby’s lungs and cause pneumonia, among other issues. For this reason, GBS positive mothers are given preventative antibiotics (usually IV penicillin) during labor. If you are GBS positive and your water breaks prior to labor, we will induce labor to minimize prolonged exposure to GBS.

Call the office at 609-924-9300 when you have a positive urine pregnancy test. Please provide the receptionist with the first day of your last menstrual period. You will receive a call back from the scheduling department within 2 business days. You can select any of the doctors to be your primary (main) OB physician but please remember that we are a group practice and you will rotate and meet the other doctors.

If you are an existing patient, your first prenatal appointment will be at 8-9 weeks.

If you are entirely new to Princeton Medical Group OBGYN, we will schedule you for a new gyn intake visit. By establishing a relationship early, we hope to learn about your past medical history and address any risks prior to your initial prenatal appointment at 8-9 weeks.

You may be asked to get a vaginal ultrasound to confirm your due date prior to your appointment or on the day of the appointment, depending on office location. Our preference is that you have an ultrasound PRIOR to your first prenatal visit so we can confirm that it is a healthy and viable pregnancy with a fetal heartbeat. The ideal time to schedule this ultrasound is when you are about 7-8 week pregnant so we can properly see all of the pregnancy landmarks. To calculate your estimated due date and determine when to schedule your pelvic ultrasound, you can use the due date calculator.

PMG OBGYN physicians see patients at two office locations for your prenatal visits. We have a centralized electronic medical record that will allow us to have up-to-date access to your chart at either office location. Both offices have a lab and injection room. The Plainsboro office location contains a Quest Diagnostics draw center in the same building.  Please call 609-924-9300 to make your appointments.

Princeton Location: 419 N Harrison St, Princeton, NJ 08540

Plainsboro Location: 3 Liberty St, Plainsboro, NJ 08536

The fax number for the OBGYN department is 609-921-1168.

 

Each woman’s pregnancy is unique and your care will be individualized to meet your needs. In general, you can expect to be seen every four weeks until you reach 28 weeks. After that, you will be seen every two weeks until your 36th week. During the last month of your pregnancy (37-40 weeks), you will be seen every week.

Princeton Medical Group OBGYN is a group practice. Usually, our patients see one physician at the beginning of their pregnancy and then start meeting other physicians as the visits increase in frequency. Your main OB physician will be the point person to ask questions, manage your orders/prescriptions, and follow up with your bloodwork and ultrasounds.

As you leave the office after each visit, we encourage you to schedule your next 3 upcoming prenatal visits.

There is a Princeton Medical Group OBGYN physician on call for 24 hour shifts each day at the hospital. There is a predetermined call schedule that cannot be altered.

When you go into labor, the on call physician will be responsible for your delivery.

You are encouraged to meet other PMG OBGYN physicians in our group during your second and third trimester prenatal visits to become familiar with physicians who may be on call during your delivery.

When you come in for your first visit, you will be given a “prenatal checklist” that details what to expect in each trimester. In brief:

• New obstetrical labs: Done at first prenatal visit of each pregnancy and includes blood type, complete blood count, hepatitis B, syphilis, rubella, HIV, immunity testing (varicella, rubella and measles), and urine culture.  Cervical cultures are obtained on all new prenatal patients; a pap smear will be obtained if due. You will be offered carrier screening for genetic conditions, unless previously done.
• First trimester Down’s Syndrome screening (optional): Ultrasound and/or lab work done between 11-13 weeks that is performed at Maternal Fetal Medicine (MFM) office. This ultrasound is not performed at Princeton Medical Group’s offices.
• Anatomy Ultrasound: Performed at Maternal Fetal Medicine (MFM) office between 18 – 22 weeks to evaluate fetal anatomy. This ultrasound is not performed at Princeton Medical Group’s offices.
• Glucose test to screen for Gestational Diabetes: 1-hour non-fasting blood test between 26 – 28 weeks to screen for gestational diabetes.
• If you do not pass this screening test, you will be asked to perform a FASTING 3-hour glucose tolerance test (GTT), which is approximately 3 hours long with 4 blood draws (fasting, 1h, 2h, 3h).
• TDAP Vaccination: Recommended between 27 – 36 weeks and can be administered at either Princeton Medical Group office.
• Flu Vaccination: The CDC recommends all pregnant postpartum patients receive flu vaccination, regardless of trimester. PMG has a special supply of preservative-free vaccines for our pregnant and breastfeeding patients.
• Group B Streptococcus (GBS) recto-vaginal culture: Performed in the office at your 35-36-week visit.
• Other testing may be recommended based on personal or family history.

Please see the list of safe medications that was given to you at your first prenatal visit.

The MommyMeds app from Texas Tech University has an extensive database of medication risk during pregnancy and breastfeeding. The app includes a scanner for your convenience when shopping.

Morning sickness is a common problem in early pregnancy that is caused by the body’s reaction to rising levels of pregnancy hormones. Sometimes nausea can persist all day. If you are affected by morning sickness, try to eat at least six small meals a day and avoid spicy, greasy foods. It may be helpful to eat crackers before you get out of bed in the morning.

If these tactics don’t work, you may try over-the-counter remedies such Ginger, frequent small meals  or supplemental Vitamin B6, as found in Bnatal pops or Preggy Pop Drops Plus.  Bonjesta is a prescription medicine that is helpful to some women; if your insurance doesn’t cover it, you can simulate the effect by taking over-the- counter Vitamin B6 100mg with Unisom (Doxylamine) 25mg tablet at night.

If you are  unable to keep food down and are lightheaded or losing weight, or if your urine is very dark and concentrated,  please contact us so that we can further assess whether IV fluids or prescription medication is needed.

Pregnant women should be taking a prenatal vitamin to provide additional nutrients that are needed during pregnancy.

Choosing a prenatal vitamin should not be a complex decision as most of the over-the-counter vitamins are acceptable options. Be sure that the vitamin you choose has at least 400 mcg of folic acid (aka folate or vitamin B9). Other important nutrients to look for include iron (40mg), calcium (1000mg), zinc, manganese, iodine, and vitamin B6.

Though it is not required, if you wish to take a prescription prenatal vitamin, please check with your particular insurance’s formulary to pick a vitamin covered by your plan. Please provide your physician with the complete name of this specific vitamin as well as your pharmacy information.

Yes. It is common and normal to have cramping without bleeding during early pregnancy. The uterus grows in pregnancy and this stretching can cause the uterine muscle to contract or cramp. This usually indicates that your baby is growing normally and is not cause for concern.

To help with the pain, take 1 – 2 Tylenol, rest, and drink plenty of fluids.

If the cramping worsens, contact the office at 609-924-9300.

It is not normal to bleed during pregnancy, and you should contact the office if you experience bleeding.

Please call the office if you are experiencing:

• Severe cramping or pelvic pain, particularly pain on the right or left side (not midline)
• Vaginal bleeding like a period
• Abdominal tenderness to touch
• Nausea, vomiting, or diarrhea

It is particularly important that you call if you have not already had an ultrasound confirming that your pregnancy is in your uterus.

To help with the pain, take 1-2 Tylenol, rest, and drink plenty of fluids.

If the cramping worsens, contact the office at 609-924-9300.

It is not normal to bleed during pregnancy and you should contact the office if you experience bleeding.

One of the most important tests you can do for your baby is kick counts. Kick Counts check your baby’s movements. Sometime between 18 and 22 weeks, you will begin to feel your baby move. Your baby will not move consistently until approximately 28 weeks. You will be asked to do kick counts in the third trimester if you do not feel that your baby consistently moves or has a pattern of movement.

Here’s one method used to do Kick Counts:

• Choose the time of day that you feel your baby moves the most. Often this will be after your evening meal. Try to check kick counts at the same time every day.
• Lie down on your left side or sit in a comfortable chair.
• Pay attention to your baby’s movements.
• The first time you feel your baby move, write down the time.
• Count every kick or movement until you feel ten movements. Check the time and write it down. Most babies will move ten times in two hours.

If your baby is not moving or if you are concerned call our office!

A non-stress test (NST) records your baby’s heart rate for at least 20 minutes and can be performed at Princeton Medical Group OBGYN’s Princeton / Plainsboro office or at Maternal Fetal Medicine. This test will not hurt you or your baby. The baby’s heart beats faster when the baby moves. During this test, special belts are placed around your waist. The monitors are hooked to a machine. NSTs are often done near the end of pregnancy. It is common to repeat this test one to two times a week because they help to determine how your baby is doing. There are certain medical conditions that require NSTs in the third trimester. Your doctor will instruct you about this.

At Princeton Medical Group, we check your immunity to varicella (chicken pox) with your initial prenatal blood work. If you were informed that you are not immune to chicken pox and you think you have been exposed, please call our office at 609-924-9300.

“Slapped cheek” syndrome or Fifth’s Disease is caused by Parvovirus B19. Many adults are unaware that they are already immune. If you are exposed, we will test your blood to determine if you are already immune or if you are susceptible. Additional testing will depend on the results. Please be assured, the risk of pregnancy complications after Parvovirus exposure is very low. If you believe you have been exposed, please notify our office at 609-924-9300. If you are a schoolteacher or work in a profession in close contact with children, we can check your immunity with your initial prenatal labs.

Please notify your OB physician if you have cats so that you can be checked for Toxoplasmosis exposure at the beginning of your pregnancy.

Please stop changing your cat’s litter box during your pregnancy.

Maternity leave in New Jersey & New York is considered a “temporary disability” and patients who work in either New Jersey or New York must file for temporary disability online.

Always check with your company’s Human Resources first to learn about your company’s maternity leave policy to see if it supplements the temporary disability insurance that is offered through New Jersey & New York.

The states of NJ & NY offer 6 weeks of temporary disability for vaginal deliveries and 8 weeks of temporary disability for cesarean section.

“Family leave insurance” is a state benefit offered to most patients who work in New Jersey & New York. Patients can apply for family leave online AFTER the baby is born. Family Leave Insurance provides New Jersey workers with paid leave to bond with a newborn, newly adopted, or newly placed foster child. While most New Jersey workers who take family leave are covered under the State’s family leave program, some employers provide Family Leave Insurance through a plan with a private insurance carrier instead. If you are not sure about your coverage, ask your employer.

Your spouse may also qualify for Family Leave and must submit their own paperwork directly to the state.

NJ Temporary Disability

NJ Family Leave

NY Temporary disability

NY Family leave

* Please allow Princeton Medical Group Medical Records Department two weeks to process your disability paperwork. Please fax any paperwork to 609-921-1168 Attn: Medical Records *

PMG Lactation Resources PDF

Please see the American College of Radiology’s statement on IV contrast during breastfeeding. While it is generally safe to have IV contrast without dumping your breastmilk, you can ask your physician if you have any questions.

Breastfeeding can be difficult for many patients. Princeton Medical Center has a breastfeeding support group to help moms with breastfeeding concerns. Additionally, there are many lactation consultants in the community. A lactation consultant is certified to help you learn how to properly and effectively breastfeed your baby. They can visit your home and observe the breastfeeding environment. Many insurances cover lactation consultations. Check with your specific insurance plan to verify your lactation benefits.

Please ask your OBGYN or your pediatrician for names of private lactation consultants in our community if you are interested. Please visit our Postpartum Care page for more information on Lactation Consultants.

Some babies may gradually wean themselves as they take formula or solids or both.

There are several ways to wean. While it is possible to stop “cold turkey,” we don’t routinely recommend that since it tends to be very uncomfortable and can cause a breast infection (“mastitis“). Once you make the decision to wean, we recommend that over the course of one to two weeks, you begin eliminating one session of nursing/pumping every two to four days depending on how much milk you have. Try to pick different times of the day. For example, if you first eliminate one in the morning, the next one should be at night. That way, you allow your body to slowly reduce production of milk.

It is not necessary to take a medication to stop (“dry up”) your milk. Finally, it is normal that there may be a tiny amount of leakage for up to one year after you stop. There is no need to “check” by squeezing on your nipple after you have quit, as that may cause you to make more milk.

The Progesterone Only Pill works by making the cervical mucous thick so sperm can not get through. This pill does not prevent ovulation, like the combination pill (typical estrogen/progesterone pill).

It is 99% effective when used together with exclusive breastfeeding.

It is only 94% effective in non-breast-feeding women.

The progesterone only pill can be started at any point in the cycle and provides effective contraception after 7 days. It must be taken at the same time daily. There is no placebo week.

If you miss a pill or are 3 or more hours late in taking, resume the progesterone only pill and use back-up contraception (i.e. condom) for 48 hours.

Once you are supplying 50% or more of your baby’s nutrition w formula or food, it is best to switch to a combination (estrogen/progesterone) pill, which works by suppressing ovulation.

Please let us know when you are no longer fully nursing & if you have a pill preference based on prior pill usage. Please confirm your pharmacy is current when you call to change to a traditional pill.

Because the POP works by making cervical mucous thick and because Estrogen thins cervical mucous, the POP may be less effective when used with vaginal estrogen for breastfeeding-related vaginal dryness & atrophy. If you are using vaginal estrogen, you may want to consider different options.

Other lubricant options include coconut oil: oil based, do not use with condoms

Good Clean Love: water based; Uber-Lube, Sliquid or other silicone-based lubricants.