©2021 Fresno Women's Medical Group
A Member of santé Foundation Medical Group & Part of Santé Health Foundation
Pregnancy By Week
FWMG strives to inform and educate all of our patients. If questions arise during your pregnancy or medical treatment that is not covered within our website, please do not hesitate to call your doctor’s nurse or simply inquire during your next office visit.
Covid Vaccine Recommendations
Click the image above to learn more about COVID vaccine recommendations from The American College of Obstetricians & Gynecologists.
8 to 14 Weeks
8 to 14 Weeks
Visit Frequency
- We will see you about every 4 weeks
Weight Check
- Check weight gain between visits
Urinalysis
- To check for protein, bacteria, and or sugar in your urine
- To check for bladder or kidney infection
Blood Pressure Check
- Check your blood pressure
Fundal Measurement
- Measures your uterus and growth of baby
Fetal Heart Tones
- Listen for baby’s heart beat
- Can be heard for first time between 10 and 12 weeks
Financial/Insurance Overview/OB Contract Overview
- Usually conducted at your second OB visit.
Prenatal Class Information
Hospital Registration
In order to better care for you, anticipate your needs and facilitate the admission process to Labor and Delivery, we ask that you register at Clovis Community Medical Center at 32 weeks of pregnancy so that they may obtain your medical history, pediatrician information, and sign the necessary paperwork required for delivery.
Testing
Quad Screen
- Blood screening test if desired done between 11 to 13 weeks and again at 16 to 19 weeks that helps determine if there are any risks of neural tube defects, Down’s Syndrome, or other high risk issues.
- If abnormal, this does not mean something is wrong with your baby. An abnormal test means you will need further testing including a special sonogram by a Maternal Fetal Medicine specialist.
Sonogram
- Helps to verify due date
- Helps to determine any serious abnormalities with your baby
- May identify baby’s gender
- Our office offers 4D scans with a CD. Ask the Ultrasound Technician for details.
Common Discomforts
- Allergy / Congestion
Cause
- Estrogen causes mucus membranes to swell and an increase in nasal discharge.
Treatment
- Saline nasal spray (any brand)
- Claritin, Mucinex plain or D
- Zyrtec,
- Rhinocort Aqua Nasal Spray
- Flonase
- Nasonex
Bleeding of Gums and Nose
- Nosebleeds are common and are related to higher hormone levels.
- Estrogen causes the gums to swell and bleeding of the gums is common due to the higher hormone levels.
- Good dental hygiene is very important to help prevent infections in the gums and prevent pre-term labor.
- Continue regular dental visits. We can fax a note approving dental care at your request.
- Click here for approved dental parameters
Constipation
Cause
- Hormones slow emptying of intestines so your body can absorb more nutrients
- Bowel is moved out of placed and squeezed together
- Side effect of prenatal vitamins and iron
What to do
- Increase fluids
- Increase natural fiber
- Establish regular bowel habits
- Warm liquids in morning
- Exercise
- May take Colace, Metamucil, Citrucel, Konsyl, Miralax, prunes, prune juice
Cough
- Robitussin DM
Diarrhea
- Do not take Pepto Bismol, it contains Apirin.
- Alert provider if diarrhea persists, avoid medications top stop diarrhea.
Foods In Pregnancy
- Any pregnant woman, women who may become pregnant and nursing mothers should not eat more than six (6) ounces of cooked fish per week. You should not eat tuna, king mackerel, shark, swordfish or tilefish because of the high mercury content.
- Try to eat as clean and organic as possible.
- Cooked Sushi is OK, but nothing raw.
- Foods to avoid; Processed meats that contain nitrates, soft cheeses
Gas
Cause
- Hormones of pregnancy
- Slowed emptying of intestines
What to do
- Avoid foods that cause gas: broccoli, cabbage, dried beans, carbonated drinks
- May try any over the counter gas med that contains simethecone.
Headaches
Cause
- Higher hormone levels
What to do
- Alert provider
- Increase fluid intake
- DO NOT take Aleve, aspirin or ibuprofen (over the counter meds)
Heartburn
- OK over the counter, Maalox, Mylanta, Tums.
- After the first trimester, OK to use over the counter Tagamet, Pepcid or Prevacid, according to label directions.
Hemorrhoids
Cause
- Constipation
- Relaxing effect of hormones
- Pressure of uterus on intestines
What to do
- Avoid straining
- Anusol
- TUCKS
- Preparation HC
- Sitz baths
Influenza
What to do
- If you develop flu-like symptoms, fever, sore throat, cough, body aches go to your primary care physician for influenza A testing (H1N1 is a type A flu). Tamiflu can be taken by OB patients. Our office does not see any patients with flu-like symptoms, to minimize exposure to other OB patients. The CDC and our office recommends getting the flu shots (regular and H1N1).
Leg Cramps
Cause
- Growing uterus
- Pressure on blood vessels in pelvis
- Calcium/magnesium/phosphorous imbalance
Treatment
- Straighten legs and point toes to nose
- Elevate legs and feet
- Exercise
- Calcium supplementation (Tums, Magnesium 250 mg and Potassium rich foods such as bananas and organic coconut water)
Nausea and vomiting
- Should begin to get better between 14 and 16 weeks
- You can try acupressure/sea sickness bands or vitamin B6 25 mg four times a day. (over the counter options).
- Prescription medications include: phenergan, Zofran, and Bonjesta taken with Vitamin B-6.
- Unisom ½ tablet in the am and ½ tablet in the pm
Sore Throat
- Cough drops
- Salt water gargle
- Chloroseptic spray
Urinary Frequency
Cause
- Growing uterus puts pressure on bladder
- Worse in 1st and 3rd trimester
- Do not decrease fluids during day
Report to doctor:
- Pain or burning while urinating -Urgency (the need to void without being able to urinate)
What is Happening?
- The embryo grows inside a sac which will fill with amniotic fluid for the baby to float in and protect it from bumps
- By 8 weeks the hands and feet begin to form
- At about 10 weeks the eyes, ears, nose and mouth begin to form
- At about 12 weeks the internal organs are completely formed
- Bones and muscles are beginning to grow
- The reproductive organs are the last to form
- By 12 to 14 weeks the arms and legs can bend at the elbows and knees
- Fingers and toes are more distinct
- Eyelids are growing over the eyes and will fuse
- The fetus is about 2 inches long
14 to 22 Weeks
14 – 22 Weeks
Visit Frequency
- We will see you about every 4 weeks
Baby Movement
- Many women begin to notice movement at about this time
- The first movement described as “bubbles” or “butterflies”
Financial/Insurance Overview/OB Contract Overview
- Usually conducted at your second OB visit.
Prenatal Class Information
Hospital Registration
In order to better care for you, anticipate your needs and facilitate the admission process to Labor and Delivery, we ask that you register at Clovis Community Medical Center by your 32nd week of pregnancy so that they may obtain your medical history, pediatrician information, and sign the necessary paperwork required for delivery.
Common Discomforts
- Breast Leaking
Cause
- A normal response to hormones in preparation for breastfeeding.
- May start as early as the end of the first trimester.
What to do
- Keep breasts dry
- Breast shields
Dizziness
Cause
- A drop in blood pressure due to the cardiovascular changes in pregnancy
What to do
- Rise from laying down position slowly
- Rise from sitting position slowly
Bacterial Vaginosis Cause
- Fishy Odor
- Greenish Discharge
What to do
- Contact your provider
Yeast Infections
Cause
- Higher levels of the hormone estrogen
- Higher levels of glucose in vaginal discharge
- Looks like a white, cottage-cheese discharge that itches.
What to do
- Contact your provider
- Cotton underwear
- Keep area dry
- No pantyhose
Heartburn
Cause
- Increased hormone production of progesterone
- Relaxation of the opening between esophagus and stomach
- Slowed emptying of stomach and intestines
- Increase in uterine size
- Worse in 2nd and 3rd trimester
What to do
- Small, frequent meals
- Low-fat meals (fat slows the emptying of the stomach and intestines)
- Decrease cold drinks with meals
- Sit upright for at least 3 hours after eating
- Sleep with 2-3 pillows at night
- Maalox, Mylanta or Tums for symptom relief
- Prevacid, Lansoprazole, Pepcid, Famotidine, Tagamet, Cimetidine over the counter for symptom prevention.
Painful Sex
Cause
- Pelvic and vaginal swelling due to growing uterus
- Fear “hurting” the baby
What to do
- Positional changes are ok
- Lubrication, Coconut Oil or Uber Lube
Round Ligament Pain
Cause
- Stretching and pressure of the heavy uterus on ligaments that support the uterus
Symptoms
- A sharp pain shoots into groin area
- May have vaginal pain or pressure
- Worsened by activity
What to do
- Bend knees onto the stomach
- Support uterus with a pillow
- Warm baths
- Change positions
- Maternity support belt
Stretch Marks
Cause
- Can appear as early as the 2nd trimester (14 weeks)
What to do
- Bio oil can be purchased over the counter. Cocoa Butter and other butters may or may not help but may sooth dry skin.
Vaginal Discharge
Cause
- Higher levels of the hormone estrogen
- More mucus is made leading to more vaginal discharge that is white and thick
What to do
- Good hygiene
- No pantyhose
- Cotton panties
What is Happening?
- Baby is putting on more fat tissue
- At about 20 weeks may feel the baby move
- Muscles continue to develop as baby moves
- Nails begin to form
- External sex organs become distinctly male or female
- Facial features become more distinct
- Teeth are growing underneath the gums
- The eardrums and bones of the middle ear are formed so that the baby will begin to hear and react to the noisy world of the uterus
- Hair begins to grow on the baby’s body and eyebrows are growing
- During the 4th month, your baby is 5 inches long and weighs about 4 ounces
- In the 5th month, your baby’s brain cells increase rapidly
- Your baby’s sucking reflex is stronger and may suck his thumb
- Vernix begins to form which is the fatty, cheesy, yellowish substance that covers the skin
- By the end of the 5th month, your baby is about 7 inches long and weighs 10-12oz
22 to 30 Weeks
22 – 30 Weeks
Testing
Glucose Challenge Test
- Will be done between 24 and 28 weeks
- This is a test done on all pregnant patients to screen for gestational diabetes
- Blood will then be drawn 1 hour after drinking the drink
CBC
- RPR
- We will also test your blood for anemia during this visit
What to Expect
Visit Frequency
- At 28 weeks we will begin to see you every 2 to 4 weeks
Baby Movement
- Movement will increase
- We do not recommend travel after 32 weeks if cleared by your Physician
Anemia
- If the results of your CBC indicate you are anemic your doctor will prescribe iron
- It is very important that you take your iron as prescribed
RhoGam
- If your blood type is Rh negative you will receive a RhoGam shot at 28 weeks
Common Discomforts
Lower Back Pain
Cause
- Shift in gravity
What to do
- Good body mechanics
- Exercise
- Lay on back, raise the leg straight up- this stretches the muscle in the back of leg and muscles of your lower back
- Pelvic rock exercises
- Supportive low-heel shoes, with good arch support
- Firm mattress
- Maternity support belt
- Your provider may refer you to Physical Therapy if needed
Upper Back Pain
Cause
- Enlarging breasts
What to do
- Good support bra
Varicose Veins
Cause
- Large uterus slows the return of blood from feet and legs
- Tends to run in families
- Progesterone relaxes blood vessel walls
What to do
- Support hose
- Exercise
- Elevate legs every 2-3 hours
- Good body mechanics
What is Happening?
- By the 6th month, your baby has a distinct nose, mouth, chin, and eyebrows are visible
- Baby is thin and wrinkled with translucent skin
- Weight gain will be rapid- up to half a pound a week
- The bones are now growing harder and you may be able to distinguish a tiny arm or leg from the head or buttocks
- Movements become more coordinated
- Baby’s brain continues to grow
- Hearing continues to develop and you will notice that loud noises startle her
- Although the baby’s lungs are not working yet, your baby is practicing and strengthening those muscles needed for breathing
- At the end of the 2nd trimester, your baby is about 10 inches long and weighs about 1½ pounds
- At the start of the 7th month, the eyelids slowly open and eyelashes begin to appear
- Skin is less wrinkled as fat begins to fill out the contours
- Baby can make grasping motions with hands
- Hair is growing longer
- If your baby is a boy the testicles begin to descend
- At the end of the 7th month, the baby weighs about 3 pounds and is 11 inches long
30 to 35 Weeks
30 – 35 Weeks
Testing
Group Beta Strep (GBS)
- This is a culture we take of the vagina and rectum looking for a bacteria called Group Beta Strep
- This will be done at about 36 weeks as well as a possible cervical check
- You will be asked to undress from the waist down
- This bacteria may be present in the vagina and rectum area and causes no harm to you
- However, this bacteria can make the baby sick
- If the test comes back negative then nothing needs to be done
- If the test comes back positive then we will give you antibiotics during labor
- Make sure you ask your doctor what the result was at your next visit
What to Expect
Braxton Hicks
Cause
- Tightening of the uterus that may or may not be felt
- This is your uterus preparing itself and your cervix for labor
- Described as a “tightening” sensation
- Contractions are irregular
- Interval does not change
- Discomfort relieved by rest
- Discomfort usually in the lower abdomen
What to do
- If you notice them, rest
- The frequency should decrease
- Can take a warm bath or shower
- Empty your bladder
- Increase fluids
- If contractions persist, contact your provider or go to Labor & Deliver.
Exercise
- Continue to exercise at least 30 minutes a day 5 times a week
Common Discomforts
Heartburn
Cause
- Increase in the hormone progesterone
- Relaxation of the opening between esophagus and stomach
- Slowed emptying of the stomach and intestines
- Increase in uterine size
- Worse in 2nd and 3rd trimester
What to do
- Small, frequent meals
- Low-fat meals (fat slows the emptying of stomach and intestines)
- Decrease cold drinks with meals
- Sit upright for at least 1 hour after eating
- Sleep with 2-3 pillows at night
- Maalox, Mylanta or Tums for symptom relief
- Prevacid, Pepcid, or Tagamet over-the-counter for symptom prevention
Tingling and Numbness in Fingers (Carpal Tunnel Syndrome)
Cause
- Caused by water retention and swelling
What to do
- Tylenol Extra Strength every 4 to 6 hours
- Wrist splints found in drug stores
Swelling of Legs and Feet
Cause
- Slowed return of blood from feet and legs due to growing uterus
What to do
- No constrictive clothing
- Support hose
- Elevate legs every 2-3 hours above your heart
- Lay on the side instead of back
Itching Of Skin
Cause
- Itching, especially of the palms of the hands or soles of the feet an be common and normal
What to do
- Inform your provider immediately in order to rule our a dangerous condition that can occur in pregnancy called Cholestasis.
What is Happening?
- Your baby is preparing to enter into the world
- The brain and nervous system are maturing
- Limbs are becoming smooth and plump
- Skin is a healthy color
- Fingernails are growing past the fingertips
- If your baby is a boy the testicles have nearly completed their descent outside the body into the scrotum
- Your baby is acquiring immunity to may infections as the protective antibodies in your blood pass through the placenta into the baby’s blood
- Breathing movements are continued to be practiced
- Your baby weighs about 5 pounds and is about 17 inches long from head to toe
36 Weeks Until Delivery
36 Weeks Until Delivery
Visit Frequency
- We will begin to see you once a week
Testing
Vaginal Exam
- Your provider will determine the frequency of cervical checks between 36-40 weeks.
- This is to help determine if you are getting close to labor.
- You will be asked to undress from the waist down
What to Expect
Baby Movement
- Movement frequency does not change
- Movement changes from a lot of purposeful movement to more of a rolling sensation.
Important
- You may experience some vaginal spotting 24 to 48 hours after this exam
- If you do have vaginal spotting call the office to determine the plan
- You may also notice an increase in contraction frequency and intensity after this exam. This should subside in a couple of hours.
Mucus Plug
- May be lost at any time
- Does not indicate you are in labor
- May be clear, yellow or have streaks of blood present
Common Discomforts
Braxton Hicks
Cause
- Tightening of the uterus that may or may not be felt
- This is your uterus preparing itself and your cervix for labor
- Tends to be more frequent as you get closer to your due date
- Described as a “tightening” sensation
- Contractions are irregular
- Interval does not change
- Discomfort relieved by rest
- Discomfort usually in the lower abdomen
What to do
- If you notice them, rest
- Empty your bladder
- The frequency should decrease
- Increase your fluids
- Can take a warm bath or shower
- Not a reason to go to the hospital
Contractions
- May begin as irregular contractions that eventually become regular
- These contractions begin to prepare your cervix and uterus for labor
- Intensity and frequency may decrease with rest and warm baths or showers
Lower Back Pain Cause
- Shift in gravity
- Tends to get worse as your due date approaches
What to do
- Good body mechanics
- Exercise
- Lay on back and lift the leg up as far as you can go (this stretches the muscle in the back of your thigh and your muscles in your lower back)
- Wide base of support
- Pelvic rock exercises
- Supportive low-heeled shoes
- Firm mattress
- Abdominal support garment
- Pregnancy pillows
Swelling of Feet and Legs
Cause
- Impaired venous return due to enlarged uterus
- Tends to get worse as your due date approaches
What to do
- No constrictive clothing
- Elevate legs every 2-3 hours
- Support hose
- Lay on the side instead of sitting
Vaginal Discharge
- Your discharge will increase in response to the hormones of pregnancy
- At this time in the pregnancy, the discharge increases
Contact your doctor if:
- You experience itching, redness, irritation
When to Go to the Hospital
- Contractions that are difficult to walk or talk through
- Bag of water breaks whether you are having contractions or not
- Vaginal bleeding heavy like a period
- Decreased baby movement
- Headache that does not go away after taking 2 Extra Strength Tylenol
- Changes in vision
- Spots before eyes
- An indigestion-like pain that is more under right side of the rib cage