Obstetrics

About Our Office

Our office is open Monday-Friday, 8 am - 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 or fever over 101 degrees
• 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 at 207-990-1615 when your contractions are at least five minutes apart for one hour or if your water breaks. If this occurs between 8 am and 5 pm, we will want to assess you in our office.

If it occurs between 5 pm and 6 am, call our office number at 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 and Delivery at EMMC at 207-973-8770.

Your Obstetrical Visits

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. The presence of a four-chambered heart is confirmed.
3. Ultrasound At 28 Weeks: This ultrasound confirms adequacy of fetal growth. The doctor re-checks the amniotic fluid volume. A re-check of fetal anatomy is conducted. A cleft lip is ruled out with this ultrasound.
4. Ultrasound around 37 Weeks: This ultrasound is to reassess growth, weight and to confirm the presenting part (breech, head down).
5. Occasionally: Ultrasound is used later in pregnancy if the doctor feels the uterus is too big or too small. It is also used to predict the baby's weight in patients who have a history of large babies from past pregnancies. An ultrasound is sometimes used to check the baby's well-being if their activity level is below normal.
6. Anytime an Abnormality is found on an 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 16th – 20th week of your pregnancy. We will be glad to answer any questions regarding signing up for the classes at this time. They can be reached at 207-973-8742 or online at https://www.northernlighthealth.org/childbirth . Use keyword "Childbirth Education."

Your Pregnancy

Common Concerns in Pregnancy

FIRST TRIMESTER (Through the 12th week)

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

SECOND TRIMESTER (Weeks 13-26)

• Breast leakage
• Constipation
• Heartburn
• Leg cramps

THIRD TRIMESTER (Weeks 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, enlarging milk glands, and 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 with high-protein food and 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. Do 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: (Weeks 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 like bran, fruit, 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 like Mylanta, Maalox, Tums, or 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: (Weeks 27-40)

• Backache/Pelvic Pressure:
  • Why? Relaxation of pelvic joints from hormones.
  • Solution: Good Posture. Support shoes. Extra rest, firm mattress. Gentle exercise (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 like 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 or sitting for long periods of time. Elevate the hips and legs. Support stockings.

Common Questions

MEDICATIONS ACCEPTABLE TO TAKE DURING PREGNANCY INCLUDE:

• ANTACIDS
• LAXATIVES, COLACE, NATURAL FIBER
• MACRODANTIN
• MONISTAT
• PENICILLINS
• TYLENOL OR EXTRA-STRENGTH TYLENOL

Anemia 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 starches or ice (called pica).

Foods that are high in iron include:

• Liver, kidney, and red meat
• Dried beans
• Leafy green vegetables
• Dried fruit like raisins, prunes, and apricots
• Prune juice
• Bread, pasta, cereal, and other foods made from fortified, enriched, or whole grains. Whole grains include wheat, oats, corn, and rice.

Remedies for Morning Sickness

Nausea and vomiting many times occur during the early months of pregnancy. Although frequently referred to as "morning sickness," it can occur at 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 produced by the ovaries early in pregnancy. Because of the increasing levels of these hormones, the stomach's secretory cells increase their production of gastric juices. At the same time, the bowel slows down in its ability to empty the stomach contents. This causes 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 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 long.
• Eat high-protein foods like eggs, cheese, nuts, meats, fruit, and fruit juices. These foods help prevent low levels of sugar in your blood, which causes nausea.
• Drink soup 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 as well.

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 or liquids, contact our office. Anti-nausea medications, available in various over the counter preparations, should be AVOIDED unless prescribed by your physician.

The Basic 5 Food Groups for Ensuring Adequate Diets

MILK GROUP: (Two or more cups daily)

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 potato, winter squash, pumpkin, and dark, leafy greens. Good fruit sources of vitamin A include apricots and cantaloupe.

A good source of vitamin C should be eaten daily. Sources include citrus fruit, juice, 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.

GRAIN 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, rice, or pasta.

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, jellies, soft drinks, alcoholic beverages, 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, substances called "phytates" (found in whole grains and beans) interfere with iron absorption, as do substances in coffee, tea, bran, 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!