Downeast OB/GYN

Independant Care in a Friendly Environment

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Obstetrics

About Our Office

Our office is open Monday-Friday 8 am to 5 pm. A nurse is available during this time to answer your questions. Dr. Benoit, Dr. Kauffman and Dr. Rumsey (share evening and weekend coverage).

Do not hesitate to call us with any questions or concerns, but PLEASE CALL US IF ANY OF THE FOLLOWING OCCUR:

  • Vaginal spotting or bleeding
  • Blurred vision
  • Chills, fever >101
  • Abdominal pain
  • Extreme nausea & vomiting (unable to keep down fluids)
  • Frequent or severe headaches
  • Leakage of clear fluid from vagina
  • Pain or burning with urination
  • Frequent, regular contractions (especially before 36 wks)
  • No movement of fetus for 8-10 hrs. if you are 28 wks or farther along

Labor

When labor arrives, we want you to call our office 207-990-1615 when your contractions are at least five minutes apart for one hour or if your water breaks. If this occurs between 8am and 5pm, we will want to assess you in our office. If it occurs between 5pm and 6am, call our office number 207-990-1615 and you will reach the physician on call, who will direct you to the labor and delivery area at EMMC, if appropriate. If for some technical reason, the answering service does not answer your call on an evening or weekend, please call Labor & Delivery at EMMC 207-973-8770.

Your Obstetrical Visits

8 WEEKS:An ultrasound with Dr. Benoit, Dr. Kauffman or Dr. Rumsey to establish dates and evaluate the pregnancy. Often on the same day – the initial ACOG & prenatal labs will be done with the nurse, otherwise this will be completed at your next visit.
9-11 WEEKS:Visit with Dr. Benoit, Dr. Kauffman or Dr. Rumsey, which includes a physical exam and detailed history, Pap smear and cultures are also obtained. At this time genetic testing can be done.
12-13 WEEKS:Ultrasound with Dr. Benoit, Dr. Kauffman or Dr. Rumsey to confirm due date, evaluate baby and discuss prenatal lab results.
15.1-17 WEEKS:Visit will include fetal heartbeat and blood draw. The AFP test (screening for Spina Bifida and Down's Syndrome) is obtained. 20 week Fetal Anatomical Survey will be scheduled. You should consider signing up for childbirth education classes at this time. You can call 207-973-8742 to register or online @ www.emmc.org/Childbirth-Education. Vaccination against pertussis (whooping cough) will be recommended at this time.
20 WEEKS:This visit is to check uterine size and fetal heartbeat.
22-26 WEEKS:This visit will be a screening for gestational diabetes. Blood will be drawn for a one-hour glucose level. Fasting is not necessary for this test.
28-30 WEEKS:Ultrasound will be done to evaluate baby's weight with Dr. Benoit, Dr. Kauffman or Dr. Rumsey. Rhogam will be administered after this visit if you are RH negative. Please check with your insurance company on how you are to purchase this.
32, 34, 36 WEEKS:This visit will check fetal heart rate and uterine growth. At 36 Weeks we will obtain a group B strep culture.
37, 38, 39 WEEKS:Ultrasound with Dr. Benoit, Dr. Kauffman or Dr. Rumsey. Visits during this time span vary a lot depending on risk factors identified and your past obstetrical history.
SPECIAL VISITS:Visits will be scheduled the same day, when possible, for problems such as bleeding, pain, question of rupture of membranes, and question of labor. If it is not possible to see you in the office the same day, you can be seen in Labor & Delivery at EMMC.

Ultrasound

Ultrasound is a diagnostic technique using echoes to provide a picture of tissue and organs inside the body. Use of ultrasound in this office is as follows:

  1. Bleeding During Pregnancy: Ultrasound is used to check for signs of viability or impending miscarriage. Ultrasound is used for late-pregnancy bleeding to rule out abruption or placenta previa.
  2. Ultrasound At 20 Weeks: At Maternal Fetal Medicine or Women's Ultrasound of Bangor Ultrasound at this gestational age confirms the due date, location of the placenta, amniotic fluid volume, and fetal anatomy is assessed. The head, stomach and bladder are visualized and the presence of a four (4) chambered heart is confirmed.
  3. Ultrasound At 28 Weeks: This ultrasound confirms adequacy of fetal growth and Doctor re-checks the amniotic fluid volume. A re-check of fetal anatomy is conducted. Cleft lip is ruled out with this ultrasound.
  4. Ultrasound around 37 Weeks: This ultrasound is to reassess growth and weight and to confirm presenting part (breech, head down)
  5. Occasionally: Ultrasound is used later in pregnancy if Doctor feels the uterus is too big or too small. It is also used to predict the weight of the baby in people who have a history of large babies from past pregnancies. Ultrasound is sometimes used to check the well-being of a baby if their activity level is below normal.
  6. Anytime An Abnormality: Is found on ultrasound a confirmatory scan is done at the hospital. Anytime a patient has a significantly worrisome past obstetrical or family history, an ultrasound is ordered at EMMC.

Childbirth Education Classes

Childbirth education classes are recommended if this is your first pregnancy. A refresher class is available if wanted through the Women's Center at EMMC. We recommend that the arrangements for these classes be made around the 16 TH – 20 TH week of your pregnancy. We will be glad to answer any questions regarding sign up for the classes at this time. They can be reached @ 207-973-8742 or online @ www.emmc.org/Childbirth-Education. Use keyword "Childbirth Education".

Your Pregnancy

Common Concerns in Pregnancy

FIRST TRIMESTER (through 12 th week)

  • Breast swelling
  • Cravings
  • Fatigue
  • Headache
  • Nausea/vomiting
  • Urinary frequency
  • Vaginal discharge

SECOND TRIMESTER (week 13-26)

  • Breast leakage
  • Constipation
  • Heartburn
  • Leg cramps

THIRD TRIMESTER (week 27-40)

  • Backache/pelvic pressure
  • Fluid retention
  • Hemorrhoids
  • Leg cramps (see second trimester concerns)
  • Shortness of breath
  • Urinary frequency (see first trimester concerns)
  • Varicosities

MISCELLANEOUS CONCERNS

  • COMMON COLD
  • DOUCHING
  • HOT TUBS
  • SEXUAL INTERCOURSE
  • SLEEP
  • STRETCH MARKS

FIRST TRIMESTER:

  • Breast Swelling:
    • Why: Increase in fatty tissue and enlarging milk glands; increased blood supply causes tenderness.
    • Solution: Wear a cotton support bra.
  • Cravings:
    • Why: Determined by cultural/geographical area.
    • Solution: Satisfy craving in moderation unless it interferes with a well-balanced diet; report unusual cravings to our office.
  • Fatigue:
    • Why: Anemia (low iron). Increased amounts of the hormones; estrogen, progesterone and the pregnancy hormone.
    • Solution: Increase rest. Eat a well balanced diet (high protein Foods, iron from prenatal vitamins).
  • Headache:
    • Why: Emotional stress or sinus congestion from hormonal stimulation.
    • Solution: Tylenol taken as directed. If Tylenol is not effective for relief, or if headache occurs in late pregnancy with swelling and vision changes, call our office.
  • Nausea/Vomiting:
    • Why: The hormones produced by the pregnancy cause stomach acid production with a slowing down of bowel function.
    • Solution: Eat several small meals throughout the day. Drink plenty of fluids. Get out of bed slowly and avoid sudden movements. Dry crackers before rising. Eat high protein foods.
  • Urinary Frequency:
    • Why: Hormonal changes.
    • Solution: Not preventable. Limit fluid intake before bedtime. Kegel exercises if leaking occurs with coughing or laughing.
  • Vaginal Discharge:
    • Why: Hormonal changes.
    • Solution: Increased vaginal discharge is normal during pregnancy. Call our office if discharge is accompanied by odor or irritation.

SECOND TRIMESTER: (Week 13-26)

  • Constipation
    • Why: Hormones slow down intestinal movement. Your growing uterus takes up part of the space of your digestive tract.
    • Solution: Fiber in diet such as bran, fruits and raw vegetables. Plenty of fluids, reasonable amounts of exercise, and mild laxatives.
  • Heartburn:
    • Why: Occurs when the uterus pushes on the stomach, forcing acid into the esophagus.
    • Solution: Small, frequent bland meals. Avoid bending over or lying flat. Antacids: Mylanta, Maalox, Tums, Rolaids (as directed).
  • Leg Cramps:
    • Why: Compression of nerves because of enlarging uterus.
      • Fatigue
      • Poor circulation
      • Deficient calcium
      • Increased phosphorus
    • Solution: Diet with adequate calcium carbonate.
      • Leg massage.
      • Flexing the feet.
      • Avoid pointing the toes when stretching legs.
      • Lead with the heal when walking.

Third Trimester: (Week 27-40)

  • Backache/Pelvic Pressure:
    • Why: Relaxation of pelvic joints from hormones.
    • Solution: Good Posture. Support shoes. Extra rest/firm mattress. Gentle exercises (pelvic rock).
  • Fluid Retention:
    • Why: From prolonged standing or sitting
    • Solution: Ample fluid intake. Elevate legs when sitting. Avoid constrictive clothing.
  • Hemorrhoids:
    • Why: Uterine pressure on veins of the rectum.
    • Solution: Regular bowel habits. Stool softeners: Colace. Over-the-counter creams. Warm soaks.
  • Shortness of Breath:
    • Why: As your uterus grows larger, it takes up part of your breathing space and puts pressure on your diaphragm.
    • Solution: Hold arms over your head. Sleep with head propped up. Try lying on your left side.
  • Varicose Veins (legs, vulva, abdomen):
    • Why: Hereditary.
    • Solution: Avoid standing/sitting for long periods of time. Elevate hips/legs. Support stockings.

Common Questions:

  • Q: WHAT CAN I TAKE FOR A COLD?
  • A: Medications for a cold that are okay to take anytime include: Tylenol for a fever or aches, Chlortrimeton for congestion, Sudafed, Benadryl for cough and Afrin nasal spray for nasal congestion. Cough drops, Sucrets and a cold mist humidifier is also helpful. Over-the-counter cold medications are okay after the fifteenth week.
  • Q: CAN I HAVE SEX?
  • A:Intercourse is safe during pregnancy unless rupture of membranes has occurred, you are having vaginal bleeding, or have had premature labor. Spotting is common after intercourse, but is not of concern unless it becomes period-like or persists more than 23 hours. Pelvic cramping after intercourse is also common, but if it continues for more than one hour, call our office.
  • Q: SHOULD I SLEEP ON MY BACK?
  • A: As pregnancy advances, you should try to sleep on your side, but if you wake up on your back or can only sleep on your back, it is fine.
  • Q: IF MY DIET ISN'T GREAT, WILL A VITAMIN/MINERAL SUPPLEMENT TAKE CARE OF MY NEEDS?
  • A: The supplements that your doctor prescribes make it easier to feel assured that you're getting the proper amounts of vitamins and minerals, but they are no substitute for a proper diet. You'll still need to eat foods rich in Vitamins A & C and iron. This is important for both you and your baby as your pregnancy progresses.
  • Q: SHOULD I AVOID ANY PARTICULAR KINDS OF FOODS?
  • A: Try to avoid greasy, fatty foods for obvious health reasons, but also to help you avoid the heartburn, flatulence and constipation common with pregnancy. Processed and fast foods tend to be heavily salted, sugary, and high in fat. They also should be avoided. NEVER eat raw fish (sushi) or seafood and undercooked meats. While you might not have any long lasting damage from parasites, your fetus could.
  • Q: CAN I HAVE MY MORNING COFFEE?
  • A: You should try to limit your intake of caffeinated drinks to no more than one cup a day. Caffeine is fine in moderation, but it has a diuretic effect (draws fluid and calcium from your body, making you urinate ever more frequently.
  • Q: HOW MUCH WEIGHT DO I NEED TO GAIN WHILE PREGNANT SO THAT MY BABY WILL BE HEALTHY?
  • A: While pregnant, you'll need about 300 to 500 more calories per day to maintain your weight and remain healthy. You should gain about 25 lbs., though total weight gain varies from 20 to 30 lbs. Depending on the person. Your doctor will advise you about the right amount to gain for your situation.
  • Q: CAN I AVOID GETTING FAT AND STAYING THAT WAY?
  • A: You shouldn't use the phrase "eating for two" to double your food intake. It doesn't take much to eat those extra 300 or so calories everyday, so make every extra calorie count. You shouldn't fill your body with "empty" calories that provide no benefit to you or your baby, such as candy and "junk food". Stick to low-fat dairy products, lean meats, and fresh fruits and vegetables. Ask your doctor about exercising while pregnant. With the right diet and proper amount of exercise, you can soon look as good as ever!!!
  • Q: WHAT CAN I DO ABOUT STRETCH MARKS?
  • A: Stretch marks occur when the skin's normal elasticity is not sufficient to accommodate the stretching required during pregnancy. Stretch marks can occur on the abdomen, breasts and thighs. Eating plenty of foods high in protein, Vitamin E & C help keep skin healthy. Gentle massage with oil or cream won't prevent stretch marks, but can help minimize them. Although they don't disappear, they will fade into a light silvery color.

MEDICATIONS THAT ARE ACCEPTABLE TO TAKE DURING PREGNANCY INCLUDE:

  • ANTACIDS
  • LAXATIVES: COLACE, NATURAL FIBER
  • MACRODANTIN
  • MONISTAT
  • PENICILLINS
  • TYLENOL & EXTRA STRENGTH TYLENOL

Anemia of Pregnancy

  • Q: WHAT IS ANEMIA OF PREGNANCY?
  • A: Anemia is an abnormally low level of red blood cells and hemoglobin in the blood. It is common during pregnancy.
  • Q: HOW DOES IT OCCUR?
  • A: Most anemia during pregnancy results from an increased need for iron. You need More iron because your body is making more blood. Often your diet alone does not provide enough iron to meet your needs. Also, the growing baby takes all the iron it needs from you, regardless of how much you have in your system. Sometimes anemia during pregnancy is caused by a lack of one of the B vitamins, (for example, folic acid).
  • Q: WHAT ARE THE SYMPTOMS?
  • A:Your symptoms may not be obvious. You may think your symptoms are normal symptoms of pregnancy.

Symptoms of anemia include:

  • Tiring easily
  • Weakness
  • Pale skin, gums, eyes and nailbeds
  • Fast or irregular heartbeat
  • Shortness of breath
  • Lightheadedness
  • Cravings for starch or ice (called pica).
  • Q: HOW IS IT DIAGNOSED?
  • A: Anemia is diagnosed by a blood test.
  • Q: WHAT ARE THE RISKS OF ANEMIA?
  • A:Severe anemia when you are pregnant may slow your baby's growth or result in a premature delivery. Also, because you are weaker, you will not recover as quickly from bleeding, infections, or other possible complications of delivery.
  • Q: WHAT IS THE TREATMENT?
  • A:Anemia caused by lack of iron is usually treated with iron tablets. Vitamin deficiencies are treated with vitamin supplements. If you are still anemic even though you are taking supplements, your doctor may give you iron or vitamins by injection.
  • Q: WHAT CAN I DO TO PREVENT ANEMIA DURING PREGNANCY?
  • A: Take vitamin pills with iron as prescribed by your doctor through-out your pregnancy. Eat foods high in iron and Vitamin C. (Vitamin C helps your body absorb iron). Often, foods that are high in iron are also good sources of folic acid.

Foods that are high in iron include:

  • Liver, kidney, and red meat
  • Dried beans
  • Leafy green vegetables
  • Dried fruits such as raisins, prunes and apricots
  • Prune juice
  • Bread, pasta, cereal and other foods made from fortified, enriched or whole grains. Whole gains include wheat, oats, corn and rice.
  • Q: HOW CAN I TAKE CARE OF MYSELF?
  • A: Follow your doctor's orders. Don't drink or smoke. Take your medications and vitamins as prescribed. Iron tablets may cause constipation or upset your stomach. If you have these problems, try drinking more fluids and taking your pills at mealtime. Iron can make your bowel movements very dark... don't be concerned. The dark color is caused by the extra iron in your diet. It is not harmful.

Remedies for Morning Sickness

Nausea and vomiting many times occur during the early months of a pregnancy. Although it's frequently referred to as "morning sickness", it can occur any time of the day or night. Usually it disappears after the third month. Morning sickness is actually the result of the influence of increased amounts of estrogen and progesterone that are produced by the ovaries early in pregnancy. Because of the increasing levels of these hormones, the secretory cells in the stomach increase their production of gastric juices. But at the same time, the bowel slows down in it's ability to empty the contents of the stomach. This then causes a feeling of nausea and in some cases, vomiting.

To PREVENT morning sickness, try the following suggestions until you find one that works for you:

Eat a piece of bread or a few crackers before you get out of bed in the morning (put them close to your bed the night before), or when you feel nauseated.

  • Get out of bed slowly. Avoid sudden movements.
  • Have some yogurt, cottage cheese, juice or milk before you go to bed, or before you get up. Try one of these if you have to get up during the night.
  • Eat several small meals during the day so your stomach doesn't remain empty for very long.
  • Eat high-protein foods: eggs, cheese, nuts, meats, etc., as well as fruits and fruit juices. These foods help prevent low levels of sugar in your blood which also causes nausea.
  • Drink soups and other liquids between meals, instead of with meals.
  • Avoid greasy or fried foods as they are hard to digest. It is advisable to avoid spicy, heavily seasoned foods also.

To REMEDY morning sickness, try these suggestions:

  • Sip soda water (carbonated water) when you begin to feel nauseated.
  • Get fresh air: Take a walk, sleep with a window open, use an exhaust fan or open a window when you cook.
  • Take deep breaths.
  • Drink spearmint, raspberry leaf or peppermint tea.

Try any of the suggestions listed above under "PREVENTION". If vomiting persists, or it becomes difficult to retain food/liquids, you should contact our office. Anti-nausea medications, available in various over the counter preparations should be AVOIDED unless they are prescribed by your physician.

The Basic 5 Food Groups for Ensuring Adequate Diets

MILK GROUP: (Two or more cups daily)

Children3 to 4 cups
Teenagers4 or more cups
Adults2 or more cups
Pregnant Women4 or more cups
Nursing Mothers6 or more cups

Milk alternates that have equivalent calcium content:

  • Cheddar-type cheese: 1-inch cube = 1/2 cup milk
  • Cream Cheese: 2 tablespoon = 1 tablespoon milk
  • Cottage Cheese: 1/2 cup = 1/3 cup milk
  • Ice Milk: 1/2 cup = 1/3 cup milk

MEAT GROUP: (Two or more servings daily)

Meat substitutes: Dry beans, dry peas, lentils, eggs and peanut butter.

A serving consists of:

  • 2 to 3 ounces (no bone) of cooked meat, poultry or fish; 2 eggs; 1 cup cooked beans, dry peas or lentils; 4 tablespoons peanut butter

VEGETABLE-FRUIT GROUP: (Four or more servings daily)

A good source of vitamin A should be eaten at least every other day. Sources include broccoli, carrots, sweet potatoes, winter squash, pumpkin and dark green leaves. Good fruit sources of vitamin A include apricots and cantaloupe.

A good source of vitamin C should be eaten daily. Sources include citrus fruits and juices, melons, fresh berries, broccoli, brussel sprouts, leafy greens, potatoes cooked in jackets, cabbage, cauliflower, spinach, peppers, tomatoes and tomato juice.

A serving consists of:

  • 1/2 cup of fruits or vegetables; 1/2 grapefruit or cantaloupe;
  • 1 medium apple, banana, orange or potato.

BREAD-CEREAL GROUP: (Four or more servings daily)

All whole grain enriched or restored breads or cereals. Ready-to-eat or cooked cereals. Cornmeal, crackers, flour, macaroni, spaghetti, noodles, rich, rolled oats, baked goods made with whole grain or enriched flour.

A serving consists of:

  • 1 slice of bread; 1 ounce of ready-to-eat cereal; 1/2 to 3/4 cup of cooked cereal, macaroni, noodles, rice or spaghetti.

FATS, SWEETS AND ALCOHOL:

Foods that provide low levels of nutrition compared with the number of calories are classified in a fifth group: the fats, sweets and alcohol group. They include butter, margarine, mayonnaise, salad dressings, candy, sugar jams and jellies, soft drinks, alcoholic beverages and unenriched breads and pastries. A minimum number of servings are not suggested because these foods are "extra" providing mainly calories.

IRON:

Another major dietary concern for women, iron is the blood-building mineral. It plays an important role in transport of oxygen throughout the body. It is also thought to help the body use beta-carotene and aids in clearing fats from the blood. Most iron in the body is stored in oxygen-carrying proteins hemoglobin and myoglobin, found in the blood and muscles, respectively. The less iron your body has already stored, the more dietary iron you will absorb. Other factors that govern absorption are the form of iron and the presence of other nutrients. Inadequate intake or excessive loss from bleeding can cause iron-deficiency anemia, a condition in which the body is unable to absorb enough iron from marginal supplies. Anemic red blood cells contain too little oxygen to the cells; symptoms of anemia are fatigue, apathy, lowered resistance to infection and decreased exercise tolerance. The principal sources of dietary iron are meat, eggs, vegetables and iron-fortified cereals. Iron from vegetables and grains is absorbed more readily in the presence of vitamin C or meat. You can readily meet your daily need by having orange juice with iron-fortified cereal or a baked potato with your steak. On the other hand, sub-stances called "phytates" (found in whole grains and beans) interfere with iron absorption, as do substances in coffee, tea, bran and calcium phosphate and antacids. Even under the best conditions, iron is poorly absorbed from food. In fact, a healthy woman absorbs only about 10% of the iron in her food, absorbing the most from meats. In the United States, iron deficiency is most likely to occur in children, women in their childbearing years and those who are pregnant. Even if you are convinced you're anemic, however, you should not take iron supplements without the advice of your physician. Iron toxicity can be serious—even fatal; so it's important to store iron supplements well away from children. The recommended daily allowance, or RDA, is 10 milligrams for men or older women, and 15 milligrams for women during childbearing years. If you are pregnant, double your intake to 30 milligrams per day. Because women generally eat less than men, they need to pay special attention to including high-iron foods in their diets. A tip—if you use cast iron pans in cooking, you will increase your iron intake because iron from the pan leeches in the food!

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