Pregnancy Questions

  1. I am pretty sure everybody knows that my oldest is pregnant with my first grandbaby...she will be 20 weeks on the 18th (same day as the US for sexing).

    Andrea had her pregnancy test done at Planned parenthood, they gave her some "How to have a healthy baby" type brochures and she started following them immed: no alcohol, went from daily caffene of a pot of coffee + pop + iced tea + chocolate to almost none (she chooses carefully and less than daily), went from 2 ppd smoking to 2-4 cigs/day, limits tuna to 1 can/wk, is very careful about seafood, washes her fresh fruits & vegies, bought prenatal vitamins etc. In other words, this pregnancy may have started out unexpected and unwanted but she has from day ONE been determined to have as healthy a baby as possible.

    All of her prenatal care is coming from a "welfare" clinic staffed by CNMs...not the best option but it is the only one available. They have to do the referral up to an OB/Gyn.

    I/we have some questions/concerns that have been blown off by the clinic dispite my going to an appointment with her to press for answers...

    I had gestational diabetes with several pregnancies..."they" say it is relevant to her pregnancy-but have done no testing.

    I had inutero exposure to real estrogen (not DES)..."they" say it is relevant to her pregnancy-but have done no testing.

    I had 7 (yes-seven) pregnancies lost at 14-20 weeks due to incomp cervix (probably d/t the estrogen) "they" say it is relevent...

    She has had 2 ER visits for vaginal bleeding with no problems found on work up(blood/US/exam)-we suspect caffene(2 glasses of pop and a candy bar the day after having a mocha frappacino)...the clinic has not done a vag exam since her 1st appointment at 10 weeks.

    One thing this clinic does (that I am not sure how I feel about) is they start doing drug testing Q month at 16 weeks and they report you to childrens services for refusal and positive tests. Fortunately drugs are not an issue for Andrea-but she feels a little violated.

    I realize that by virtue of what I do as a Nurse I tend to be a bit paranoid. But does sound (to anyone eles) that she is being a little bit undermanaged?

    An additional question tho less of a concern...pre-preg Andrea was 5'3" 140#) the CNM told her that they like to see a weight gain of 1#/week...she has gained 19 pounds...at her 1st WIC appointment this past week she was told to slow down on her eatting, that she had gained all of the weight she is "allowed" for the pregnancy (gee thanks, like the kid isn't already struggling with her body image)...what is a "normal" weight gain in pregnancy?

    I don't expect anyone to go out on a limb and give advise...I would just like your opinions of all of this based on your experiences.

    Thank you all (in advance). I am not a lot of help to her as I have no clue what a "normal" pregnancy is like...and don't want to scare the h*ll out of her.

    -nancy (& Andrea)
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  2. 15 Comments

  3. by   live4today
    nurse-4-kids.......I always tell women the BEST time to prepare their bodies for future motherhood is while they are growing girls, and taking care of their bodies through proper nutrition BEFORE they become pregnant........HOWEVER......since many young girls do NOT even think about how healthy they should be BEFORE the pregnancy occurs......they must be taught as early on as possible in the pregnancy how to properly nourish their bodies......including the do's and don't's.......

    Don't smoke......Don't drink alcohol, except wine in moderation is not harmful from what I've learned.........Eat a well balanced meal in small portions at least six times a day.....avoiding the junkfoods as much as possible...drinking plenty of WATER...exercising as safely and as much as possible.....getting plenty of rest....avoiding stressful situations that are not considered "normal stress factors" one faces routinely in their day to day life......and so forth.

    The clinic sounds like they are doing their best with the pregnant moms to me. It's a LOUD wake-up call to a lot of young moms how much their bodies are no longer their bodies once they get pregnant and have to start taking care of themselves better because they support a life within them.

    P.S...........I might add that they may not be quick to test your daughter for things they do not see her PERSONALLY experiencing with her pregnancy as you did with your pregnancies. It's not unusual for spotting to occur in a pregnancy....some women have regular periods while they are pregnant. I think the CNMs are NOT about to place any unborn baby in harms way....or the mother of the baby......so I would suggest just going along with your daughter on as many appointments as you possibly can, while keeping abreast of her treatments and such. That way, you'll be able to quickly spot any neglect in her care and bring it to their attention. I hope things continue going well for her, and that she is able to carry her baby to term. Glad to read your daughter is already "jane on the spot" with changing her lifestyle nutritiously and otherwise to assure she has a healthy baby. :kiss
    Last edit by live4today on Sep 15, '02
  4. by   indynurse
    I think the recommended time to check for gestational diabetes is between 24 & 28 weeks gestation. The American Diabetes Association recommends universal screening of all pregnant women for glucose intolerance at that time because it usually occurs during the second half of the pregnancy.
  5. by   live4today
    indy.....with my second pregnancy (28 years ago), I had a five hour glucose intolerance test when I was 5 1/2 months pregnant that showed I had "gestational diabetes". I had totally forgot about that until you mentioned the time frame of when they routinely do those test. Brain farts are great, aren't they? :chuckle
  6. by   at your cervix
    I agree with "cheerfuldoer". We usually don't treat pt's for problems of pregnancy for problems that they don't personally experience. It is very normal to test for gestational diabetes around 28 weeks, it is very normal to not do a vag exam. Her first vag exam was probably for a pap smear. Unless she is having contractions, there is no reason for a vag exam and in fact too frequent vag exams may actually lead to problems. As far as the drug testing, I am very sorry that your daughter feels violated, but I think that since she does not take drugs and has nothing to worry about, maybe she should just look at like being searched at the airport. No one really likes it when they are selected for a random search, but aren't we glad that they do it, if they didn't, it may put innocent people at risk. All in all, it sounds to me like the clinic is doing a great job. It is not the standard of care to treat a pt as a high risk pregnancy due to her mother's history. I do strongly disagree with the person that told her that she had gained "all the weight she was allowed" That was way out of line!!! As long as she is eating healthy and not gaining a huge excess of weight, she will be fine. Good Luck!!!!
  7. by   Brownms46
    Originally posted by kids-r-fun
    I am pretty sure everybody knows that my oldest is pregnant with my first grandbaby...she will be 20 weeks on the 18th (same day as the US for sexing).

    Andrea had her pregnancy test done at Planned parenthood, they gave her some "How to have a healthy baby" type brochures and she started following them immed: no alcohol, went from daily caffene of a pot of coffee + pop + iced tea + chocolate to almost none (she chooses carefully and less than daily), went from 2 ppd smoking to 2-4 cigs/day, limits tuna to 1 can/wk, is very careful about seafood, washes her fresh fruits & vegies, bought prenatal vitamins etc. In other words, this pregnancy may have started out unexpected and unwanted but she has from day ONE been determined to have as healthy a baby as possible.

    All of her prenatal care is coming from a "welfare" clinic staffed by CNMs...not the best option but it is the only one available. They have to do the referral up to an OB/Gyn.

    I/we have some questions/concerns that have been blown off by the clinic dispite my going to an appointment with her to press for answers...

    I had gestational diabetes with several pregnancies..."they" say it is relevant to her pregnancy-but have done no testing.

    I had inutero exposure to real estrogen (not DES)..."they" say it is relevant to her pregnancy-but have done no testing.

    I had 7 (yes-seven) pregnancies lost at 14-20 weeks due to incomp cervix (probably d/t the estrogen) "they" say it is relevent...

    She has had 2 ER visits for vaginal bleeding with no problems found on work up(blood/US/exam)-we suspect caffene(2 glasses of pop and a candy bar the day after having a mocha frappacino)...the clinic has not done a vag exam since her 1st appointment at 10 weeks.

    One thing this clinic does (that I am not sure how I feel about) is they start doing drug testing Q month at 16 weeks and they report you to childrens services for refusal and positive tests. Fortunately drugs are not an issue for Andrea-but she feels a little violated.

    I realize that by virtue of what I do as a Nurse I tend to be a bit paranoid. But does sound (to anyone eles) that she is being a little bit undermanaged?

    An additional question tho less of a concern...pre-preg Andrea was 5'3" 140#) the CNM told her that they like to see a weight gain of 1#/week...she has gained 19 pounds...at her 1st WIC appointment this past week she was told to slow down on her eatting, that she had gained all of the weight she is "allowed" for the pregnancy (gee thanks, like the kid isn't already struggling with her body image)...what is a "normal" weight gain in pregnancy?

    I don't expect anyone to go out on a limb and give advise...I would just like your opinions of all of this based on your experiences.

    Thank you all (in advance). I am not a lot of help to her as I have no clue what a "normal" pregnancy is like...and don't want to scare the h*ll out of her.

    -nancy (& Andrea)
    Nancy...first let me commend your daughter for her committment to having a healthy child. I realize that severly cutting down on the smoking, and restricting her use of caffiene is an awesome challenge, in any situation! I also realize that the stress of being pregnant, and I'm sure there are other stressors...makes her ability to do this even more significant.

    First I must humbly disagree with some of the above, as I feel there is some rational for testing your daughter for GDM at this time. No I'm not a MD...but I do have a little experience in OB...and life experience as well...as most here do...

    I think the fact that she was borderline in pre-preg weight, (not knowing age, and bone structure...difficult to say for sure). Also her family hx, and the present of uterine bleeding UKO..makes me feel that maybe these are risk factors that could make an OB/MD place her in a HIGH RISK cat. for GDM. I did a contract with the ROADS team...and although we initially only worked with a Midwife, they later brought in an OB d/t the high infant mortility rate in the area. The ADA came out in 1998 with a new guideline for testing HIGH RISK moms, and felt that HIGH risk moms should be tested in the inital preg screening, and again at 24-28 weeks..(which is the guide line for low risk). I'm not sure of her age...but if she is 25 or over this also is a risk factor. One last fact to substain my conclusion is this. The CDC .has reccomened for several years now...that all women should be tested for GDM at the INITIAL Prenatal Screening.

    Next...here is another thing to consider...and may not be true in this case, but I have seen it true in others. Some CNM don't consider the 15% of pregnacies that are dx as GDM isn't rational enough to subject their pts to testing for GDM...and therefore if they don't present with significant sx, they feel they shouldn't be put thru these tests.

    Also is the fact that if your daughter does test positive for GDM, this would but in the High Risk cat., and would the CMW would not be able to continue care. Also many OBs don't want to take Medicare pts...so this would mean...the possibility of higher costs. This is just information, and doesn't consitiute as to my believing that this is the feeling of all CMW...or that this is the only rational as to why your daughter might not have been tested.

    This is my suggestion...I would have her get a glucose test out of my own pocket...and then you would be sure that all is well. That is...if you feel it is warranted.

    Also concerning the uterine bleeding..."I" "feel" this would warrant more than just routine prenatal care. I did read that the US show no problems..ie.

    As for the weight gain.."I"...if it was "my" daughter have her see a nutritionist...and help her in slowing down the weight gain...

    I hope my suggestions, and conclusions are taken as just that... mine..
    Last edit by Brownms46 on Sep 15, '02
  8. by   mark_LD_RN
    hi kids r fun, I think you have some valid concerns.

    first don't underestimate the quality of care you can recieve from CNM. I work with some very good ones and by personal choice my wife sees them. even though we have money and insurance.


    your concerns over your DES expousure is valid but there is really little they can do about it at this point in her pregnancy, and the risks are probably very small.

    the vaginal bleeding is often nothing to worry about, see if they will do an ultrasound to evaluate placental placement. And it is very common not to have vag exams on every visits that early in preg. especially if bleeding is present.on each visit they should check urine,vital signs, fundal height. also pt teaching should be done. especially concerning her weight gain. remember every pregnancy and every person is different.

    your history of gestational diabetes does not mean she will have it also. I would watch her diet, eat high quality foood and eat as if she was having gestational diabetes. they will test her around 28 weeks as this is the most common time to do it. she should report any s/s of pih or gestational diabetes.

    remeber to make sure she drinks enough fluids takes her vitamins and iron, avoids caffiene and high sugar content foods and has adequate quality protein intake.. this is just good practice for all preg women.

    I have personal expereince with most of the above problems u mentioned my brothers wife just gave birth to a healthy baby boy. she was overweight smoker and long family history of healthy problems. not to mention heavy vaginal bleeding on and off for first 5 months. never did find the exact cause. but did the usually precations and she gave birth to a healthy baby. i have seen this many times and it is most often just fine.

    i know it is hard to be calm and objective when a loved one is envolved especially when you are a nurse , if you are like me when it comes to my own or my familys health problems i automatically expect the worst

    good luck, let us know how everthing is going from time to time and feel free to let me know if i can help you in any way. also feel freeto PM me if you like.
  9. by   globalRN
    hmmm....perhaps what the CNM meant about gaining all the weight allowed..... is that obese patients are recommended to gain about 19 lbs...over the pregnancy. That being said, the last trimester is most important for weightgain of the fetus so she should still gain about 1 lb/week in the last trimester.

    Screening for diabetes is usually at 28 weeks or at 24 if there is a previous personal history of gestational diabetes. Obviously, if S+S of DM present, will also do the appropriate testing regardless of time frame.

    Note for all child-bearing age women: folic acid supplementation is advised to prevent neural tube defects.
  10. by   kids
    Like I said...I have no clue what a "normal" pregnancy is. I want a healthy grandbaby but almost more important to me is that I have a healthy daughter.

    It just bothers me that she was told that all of these things are "relevant" but no straight answers as to the plan...even being told "we are not going to anything/there is nothing we can do unless something happens" would be an answer..so far all we have gotten is "thanks for telling us, its important we know these things".

    A good part of it may be paranoia...>50% of my case load is/were premies (and I try not to think about the birth defects).
  11. by   Brownms46
    I sincerely wish your daughter, your granddaughter and you....all the best... As we all know...knowing too much...isn't always a blessing...and sometimes it helps to go with your gut..
    Last edit by Brownms46 on Sep 16, '02
  12. by   OBNURSEHEATHER
    You've gotten wonderful answers from everyone here, so I don't really have anything to add.

    Just wanted to say I'll be anxiously awaiting the news on Wednesday!

    Hmmmm..... will they see a winky, or won't they????

    Heather
  13. by   kids
    48 hours, 22 minutes and counting...and praying for NO winky!
  14. by   OBNURSEHEATHER
    WINKY, WINKY, WINKY, WINKY.........

    I just love boys! Although I have to admit that 3 generations of women does sound like an awesome thing.

    Heather

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