Getting Pregnant After 35

There are incredible advantages to getting pregnant after 35. New parents entering their late thirties are often more economically and socially stable. And you may be more prepared–emotionally and physically–for the responsibilities and joys of parenthood. There’s even some evidence to suggest that growing your family after you reach 35 can make you a better parent. So it’s no surprise that more and more women are holding off on having children until they feel ready.

As with any pregnancy, however, there are some unique challenges that you might encounter if you become pregnant in your late thirties. Knowing the challenges you may encounter on your journey can help you prepare and give you time to focus instead on the joys of motherhood.

How Common is it to Get Pregnant After 35?

In 2014, the mean age of women in the U.S. who gave birth to their first child was 26.3 years old. That was up from 24.9 years in the year 2000. The statistics generally indicate that it’s more common for mothers to give birth to their first child in their twenties than in their thirties or forties. But that’s not the whole story.

According to data gathered by the Centers for Disease Control and Prevention, the number of mothers who get pregnant after 35 increased from 7.4% in 2000 to 9.1% in 2014. That may not seem like a huge jump, but it does convey an unsurprising trend: giving birth over the age of 35 is becoming safer, more successful, and more common.

Options To Improve Your Chances of Conceiving

Getting pregnant after 35 naturally might seem like a challenge at first. An average woman over 40 has a roughly 5% chance per cycle of becoming pregnant, compared to a 25% per cycle chance for women in their 20s. At 35, your chances will usually fall somewhere between the two. For most couples, doubts about success often give way to the joys of success rather quickly.

That said, if you are finding it difficult to successfully conceive, there are several options that can help you improve your chances. And that’s true no matter the age at which you decide to expand your family! Some of the most popular such options include:

  • Hormones: In some cases, you may be prescribed certain hormone drugs that help increase egg production. This often increases your chances of getting pregnant.
  • IVF: In-vitro fertilization (or IVF, as it is more commonly known) is a fairly common fertility treatment. Using this technique, a medical professional will fertilize the egg outside of the body. Once fertilization is successful, the egg is then implanted into the womb, drastically improving chances of conception.
  • Egg preservation: In some cases, women who delay becoming pregnant will decide to have their eggs frozen. Using younger, preserved eggs may sometimes have advantages and lead to more successful fertilization.
  • Male fertility treatments: Since women over 35 often have partners around the same age range, challenges with getting pregnant sometimes stem from aging sperm. Male fertility treatments can help make sperm more effective and, therefore, increase the chances of successful fertilization.

Getting pregnant after 35 naturally may be your preference. So whether any of these options are right for you will depend on your unique situation and goals.

What to Think About When Getting Pregnant After 35

For all the benefits–for both you and your children–that come with becoming pregnant after the age of 35, there are some risks that you should be aware of as well. Any risks related to pregnancy and childbirth will vary considerably from person to person, so it’s important to talk over all of your concerns with your OBGYN or Midwife. The vast majority of risks can be minimized with the right planning.

Pregnancy After 35 Risk Factors

Some of the more pronounced pregnancy after 35 risk factors include:

  • You’re more likely to develop certain health complications, such as gestational diabetes and high blood pressure. A healthy lifestyle helps reduce the risk of these complications, but additional medical treatment is required if they arise.
  • Risks of miscarriage or stillbirth are elevated over the average population in women over 35.
  • There is a higher likelihood for delivery via a Cesarean section. This is a contingency you should discuss with your Midwife or OBGYN.
  • Chances of a premature delivery (prior to 37 weeks of gestation) are increased, above the average population.
  • It may simply take you some extra time to successfully become pregnant.

These risks might sound alarming, but it’s important to remember that most pregnancies–in women above 35 and below–result in an uncomplicated, normal birth. Being aware of risks often helps you minimize their statistical likelihood. When you work with your OBGYN or Midwife to be proactive about your healthy pregnancy, you can spend less time worrying and more time focusing on the joys of pregnancy and motherhood.

Common Considerations

Any pregnancy will require some special considerations and post-35 pregnancies are no exception. Some of those special considerations may include the following:

  • Screening: There are some genetic, chromosomal tests that can help identify certain abnormalities. If you’re interested in a DNA screening, you should definitely talk to your OBGYN or Midwife, as some of these testing methods do carry a slight risk of miscarriage.
  • Stay active and eat well: This advice might sound universal–every medical professional wants you to live a healthy lifestyle. But for women over 35 who want to become pregnant, this advice can help increase your chances of an uncomplicated delivery.
  • Take prenatal care seriously: From taking prenatal vitamin supplements to making regular appointments with your OBGYN or Midwife, participating in routine prenatal care is shown to improve outcomes in pregnancy.
  • Get the facts before you start: Many OBGYNs and Midwives will recommend what’s been nicknamed a “preconception” appointment for women over 35 who wish to have children. These appointments are designed to help you receive personalized advice that can help you safely achieve your pregnancy goals.

Is Delivery Different if You’re Over 35?

The vast majority of births in women over 35 are uncomplicated vaginal deliveries. Child birth for women over 35 does carry slightly higher risks of complications, and as such, cesarean section deliveries are somewhat more common among this age group.

Pregnancy: Over 35 vs Under 35

The broad strokes of most pregnancies–whether in women over 35 or under 35–will be generally similar. You’ll likely be pregnant for 9-10 months, experience morning sickness for the first trimester, and be somewhat tired and uncomfortable during your final trimester. However, there are important differences for women over 35 in terms of how their pregnancies might proceed.

Some of those differences include:

  • More prenatal testing: Because certain birth defects are more common in mothers over the age of 35, your OBGYN or Midwife will want to run a number of additional blood tests and genetic diagnostics to screen for common defects. You’ll talk to your OBGYN or Midwife about the information genetic screening can yield–as well as how to handle possible results.
  • Additional diabetes screenings: Because both gestational and non-gestational diabetes are more common in women over 35, your OBGYN or Midwife may want to run additional tests throughout your pregnancy to ensure any diabetes you may develop is detected early.
  • Your birth plan may have more contingencies: The vast majority of pregnancies in women over 35 are delivered vaginally. However, women over 35 are more likely to require a C-Section delivery. As a result, your birth plan may touch on these contingencies in more detail than if you were under 35. 
  • You might take more vitamins: Women over the age of 35 tend to need a little extra help staying healthy during pregnancy–especially when it comes to getting enough vitamins and minerals. That’s why your OBGYN or Midwife might suggest you take more prenatal vitamins than is typical for patients under 35. 
  • There may be a higher chance of complications: And because there’s a higher chance of complications, you might have more checkups, more appointments, and generally have to pay closer attention to certain things. For women who become pregnant over the age of 35, it’s likely you’ll have more contact with your OBGYN or Midwife than those who are under 35.
  • You may have better health insurance: There are also advantages to getting pregnant over 35–and one of those is that you may have better access to a variety of resources! This could include family and friends, but it could also extend to financial resources. 
  • You might have more familiarity with your physician and medical preferences: Many women over the age of 35 have been going to the same OBGYN or Midwife for years. That means you may already have some familiarity with your care team when you become pregnant. By the same token, you’ll likely be more familiar with your own medical preferences at 35 than you might be at 25.
  • Risk assessments: If there are complications, your body may have a harder time bouncing back from them. As a result, your OBGYN or Midwife might evaluate risks differently when you’re 35 than when you’re 25. 

There are also some non-medical ways in which delivery may be different if you’re over 35. For example:

You may have a well-established career, and therefore have access to better healthcare benefits. For example, you may be able to take longer maternity leave when you wait until your late thirties to grow your family. Better medical insurance (and more financial power) also means you may have more healthcare options, ensuring access to the type of delivery you want.

Many women in their late thirties have a strong support system, so you’ll have less to worry about during your delivery. This also means you’re more likely to be able to enjoy those precious first moments of bonding with your newborn.

More Common and More Successful

There’s no universally “right” time to have children or expand your family. For women over 35, pregnancy and motherhood can be especially exciting.

Our OBGYNs and Midwives at both our Wilmette or Glenview offices have successfully helped many new mothers over thirty-five. You can learn more about our obstetrics services here. If you have questions or want to schedule a preconception consultation, contact us today to get started!

HRT in Perimenopause

You’re having hot flashes, or maybe you’ve noticed changes to arousal and your sex drive has decreased. Over the past few months, you just haven’t quite felt like yourself. These could be just a few signs that you are in perimenopause. 

In this article, we cover the basics of perimenopause, including main symptoms. Then, we’re going to delve into hormone replacement therapy (HRT): what it is, how it could help, and the risk factors associated with it.

What is Perimenopause?

Perimenopause is the term for the time that begins with transitional phase through complete entry into menopause and the whole process start to finish can take as long as ten years, though you’ll likely not pick up on all of it. Every woman is different, so it’s hard to pinpoint how long perimenopause could last for you. Perimenopause is a hormonal shift in the body and results in some specific changes within the body.

Common symptoms of perimenopause include:

  • Fatigue
  • Irregular Periods, sometimes with heavier than average bleeding
  • Vaginal Dryness
  • Increased Urinary Frequency and Urgency
  • Mood Fluctuations, such as increased irritability or Depression and Anxiety
  • Hot Flashes or Night Sweats
  • Sleep Disturbances

What is HRT?

Hormone replacement therapy, or HRT, can be used to reduce the symptoms of perimenopause. The primary indication for HRT is the vasomotor symptoms more commonly known as “hot flashes.” HRT typically means taking two hormones, estrogen and progestin.

Estrogen naturally decreases with age and contributes to most of the perimenopausal symptoms. Taking progestin alongside estrogen in HRT reduces the possibility of developing uterine cancer, which is associated with taking estrogen alone. Estrogen may be prescribed on its own in specific cases where the patient has no uterus. This is referred to as “estrogen therapy.”

When you discuss HRT with your OBGYN, you’ll likely talk about the best way to deliver your therapy for your needs. There are two common delivery methodologies used by OBGYNs today:

  • Low Dose Vaginal Delivery Products – Typically reserved for patients who are only experiencing urinary or vaginal symptoms of menopause, vaginal delivery products come in the form of creams, rings, and tablets. As the name suggests, these preparations dole out low doses of hormones, and as result they produce limited effects. 
  • Systemic HRT – When patients have more widespread symptoms and need a more comprehensive symptom relief, physicians will deploy what’s known as a “systemic HRT.” These delivery devices include rings, creams, pills, patches, and sprays, and more. You’ll be able to discuss which of these applications is most suitable for your situation and your presentations. The higher doses of estrogen these methods offer are absorbed evenly by the body, so they can be used to treat more widespread and common perimenopause symptoms. 

How Can HRT Help in Perimenopause?

Hormone replacement therapy has been shown to reduce vaginal dryness. It is also supported as the most effective treatment for hot flashes and night sweats. A positive side effect of HRT is that it can also help protect against bone loss and prevent spine and hip fractures, which are associated with menopause, though we don’t specifically prescribe it for these indications.

There are many different forms of estrogen available, including patches, gels, sprays, and pill form. Progestin can be administered separately from estrogen or combined in a pill or skin patch. If vaginal dryness is your main concern, you also have the option of local treatment using a ring, tablet, or cream.

Are There Any Risks Associated with HRT?

If you are considering HRT, it is important to be aware of the risks. Estrogen-only therapy (ERT) is not recommended to women who have not had their uterus removed, as this is associated with uterine cancer.

There is a small risk of heart attack on HRT. This is influenced by other factors, such as age and pre-existing medical conditions. There’s also a small increased risk for breast cancer, stroke, and deep vein thrombosis (formation of a blood clot). Some oral forms of HRT come with a slightly greater risk for gallbladder disease.

Less serious adverse effects commonly associated with HRT include nausea, breast tenderness, bloating, weight gain, and breakthrough bleeding. These typically last a short time at the beginning of your transition into HRT.

How to Manage Risks Associated with HRT

Because HRT has been associated with certain long term risks and complications, most patients and physicians discuss concrete ways that those risks can be reduced. Patients can help manage HRT risks by:

  • Checking in regularly with your OBGYN or healthcare provider. Scheduling regular conversations about benefits and risks can help you know when to complete your treatments.That’s why most OBGYNs will encourage regular follow-up care when you’re on HRT.
  • Take the lowest dose possible to manage your symptoms. Patients can help manage risk by working with their OBGYN to ensure they aren’t taking any more hormones than they need to. To be sure, symptom relief is the priority–that’s what makes HRT successful. But successfully managing symptoms with the lowest possible dose can help you minimize many of the long term risks associated with HRT.
  • Keep a healthy lifestyle: Maintaining a healthy diet and regular exercise regimen can help you minimize your overall risk of adverse impacts. 

Managing your risks will depend on your situations and your symptoms, so the best approach is often one that has been individualized for you. Talk to your OBGYN about the best ways to minimize and manage your risks around hormone replacement therapy to help you ensure you minimize any possible risks.

Contraindications to HRT

Some conditions are contraindicated with HRT. In these unique cases, HRT may not be the best way for you to treat your symptoms of perimenopause. These conditions include endometriosis, fibroids, porphyria, active liver disease, hypertriglyceridemia, and thromboembolic disorders.

If you have a history of breast cancer or endometrial cancer, HRT may not be right for you.

Before starting HRT, your health professional should adequately screen, counsel and test to ensure you are a good candidate for this kind of treatment.

If any of the above conditions resonate with you, don’t be discouraged. There are other avenues you can explore to lessen the symptoms of your HRT. If your perimenopause symptoms impact the quality of your life, ask your health professional about your other options outside of HRT.

How to Know if HRT is Right for You

If you’re considering hormone replacement therapy, you should be evaluated by a medical professional. A baseline should be established by analyzing your blood and urine closely. Tests may also include ultrasonography, electrocardiography, and mammography.

Your health professional may also test your serum follicle stimulating hormone (FSH) levels. This helps with monitoring, especially in women who intend to take HRT orally. Serum estradiol levels may also be looked at. This helps monitor women who continue to have symptoms even after they begin HRT.

There’s a Lot to Consider

There are proven benefits to HRT in perimenopause, but there are also some risk factors to consider. If you’re considering starting hormone replacement therapy, discuss it with your healthcare professional thoroughly so that you can decide with confidence whether or not it’s suitable for you.

If you’d like more information, please call our Wilmette or Glenview offices to schedule an appointment.

Recurrent Pregnancy Loss

Pregnancy loss is never easy. Experiencing multiple pregnancy loss situations can be even more daunting. Families who experience recurrent pregnancy loss are often searching for answers and solutions. 

A single pregnancy loss is relatively common, occuring in between 10%-20% of all pregnancies. Multiple losses, however, are significantly less common. So when a woman experiences two or more lost pregnancies in a row, doctors will usually recommend a series of tests and diagnostics designed to detect a possible underlying cause.

It’s important to point out many women who experience recurrent pregnancy loss go on to eventually have normal and healthy pregnancies. If you have concerns about multiple pregnancy losses, you should talk to your OBGYN about possible therapies and solutions.

What is Recurrent Pregnancy Loss?

Recurrent pregnancy loss is typically diagnosed after a woman has experienced three lost pregnancies in a row. Recurrent pregnancy loss is usually divided into two types of multiple losses:

  • Early recurrent pregnancy loss is diagnosed when the losses occur during the first trimester of pregnancy.
  • Late recurrent pregnancy loss occurs when you experience pregnancy loss during the second or third trimester of pregnancy.

Only 2% of women will ever experience multiple pregnancy losses and only 1% of women will experience the loss of three pregnancies in a row. (Pregnancy loss is most common during the initial 20 weeks of pregnancy and becomes significantly rarer as the term progresses.)

Most women who experience two pregnancy loss events in a row will not experience a third. However, it’s not uncommon to have concerns after your second event. Your OBGYN can begin screening for certain causes or conditions that may have contributed to a pregnancy loss, as well as suggesting methods that might be able to minimize risk of multiple pregnancy loss experiences. 

While relatively uncommon, recurrent pregnancy loss can be exceptionally difficult for women who experience the condition. It’s important that those women are able to find emotional and clinical support during this difficult time. 

What Causes Recurrent Pregnancy Loss?

There is no single cause of recurrent pregnancy loss. Instead, there are several different factors that could contribute to multiple pregnancy losses. More than 50% of women who experience multiple pregnancy losses will never know the root cause of the pregnancy loss. 

However, when a cause can be identified, your OBGYN will be able to prescribe specific therapies to help your next pregnancy continue to term. Some of the most common known causes of recurrent pregnancy loss include the following:

  • Random Chromosomal Abnormalities: Some estimates suggest that random chromosomal abnormalities account for somewhere between 50-80% of all first trimester pregnancy losses. These genetic abnormalities can be present in the egg, the sperm, or manifest as the fetus begins to develop. 
  • Endocrine Diseases: Disruptions to the endocrine system have been linked to instances of pregnancy loss. Conditions such as thyroid disease or diabetes are examples of common endocrine system abnormalities and have in some cases been linked to a higher risk of recurrent pregnancy loss.
  • Uterine Abnormalities: Some research suggests roughly 15% of all pregnancy losses are caused by abnormalities of the uterus. In some cases, the abnormalities are the result of hereditary circumstances. In others, they might be caused by polyps or fibroids.
  • Autoimmune disease: Pregnancy has a profound impact on your immune system, but the ways in which your immunology and pregnancy interact aren’t always well understood. What is known, however, is that autoimmune conditions can cause the creation of antibodies which adversely affect your pregnancy. 
  • Inherited blood disorders: Multiple inherited blood disorders including blood clotting disorders such as thrombophilias can increase your risks of pregnancy loss. If a family member has a known blood disorder (i.e. Factor V Leiden mutation, Antithrombin deficiency, etc.) it is always recommended to share this information with your provider when reviewing your family history. 

In addition to these causes, your environment may have an impact on your susceptibility to pregnancy loss. Exposure to certain chemicals, for example, may increase your risk of misciarriage. In the discussion of causes, it’s important to note that stress alone does not cause recurrent pregnancy loss.

If the cause of your pregnancy loss is not ultimately discovered, your OBGYN will likely offer a treatment course designed to help maximize your chances of successfully bringing your baby to term. This approach may be less exact, but there’s still an excellent chance of success.

Discovering the Root Cause

Discovering the cause of your recurrent pregnancy loss may not be a short process, but it can be an important one. Your OBGYN will order a variety of tests and diagnostics designed to help identify specific issues. Some of those diagnostics may include the following:

  • Genetic chromosomal testing
  • Testing for diabetes or insulin resistance
  • Diagnostics designed to detect autoimmune issues
  • Blood clot studies (when family history indicates)
  • Ultrasounds and other imaging diagnostics to detect anatomical abnormalities

Recurrent Pregnancy Loss Treatments

The course of treatment for recurrent pregnancy loss may change depending on any causes your OBGYN has been able to successfully identify. For example, uterine abnormalities can often be remedied with a surgical procedure prior to conception.

Genetic screenings can detect possible chromosomal abnormalities and help expecting parents plan accordingly. Additionally, thyroid and other endocrine problems can usually be treated with a variety of medications. When autoimmune complications are the root cause of recurrent pregnancy loss, blood thinners can help ensure antibody-caused clotting does not interfere with the baby’s development.

The test and diagnostics ordered by your OBGYN will be instrumental in identifying or ruling out possible causes for your pregnancy loss. Even still, many pregnancy losses may not have an identifiable cause. As a result, your OBGYN may also recommend lifestyle changes designed to help maximize your health and chances of a healthy pregnancy. Those changes may include:

  • Reducing caffeine intake
  • Eliminating the use of tobacco products
  • Getting regular exercise
  • Maintaining a healthy diet

It’s important to note that most women who have experienced recurrent pregnancy loss will go on to have healthy pregnancies in the future. And in the majority of cases, recurrent pregnancy loss in the past will not necessarily guarantee that you will experience the condition again in the future. That said, a history of pregnancy loss can indicate an increased risk of future pregnancy loss.

Emotional Challenges

Recurrent pregnancy loss can be an especially emotional and challenging condition, as any type of pregnancy loss can be traumatic. It’s important to recognize the emotional toll these losses can create.

As a result, treatment may include various types of emotional support designed to address the emotional side of the trauma involved.  Therapists trained in perinatal loss are available to support individuals and families during loss.  OBGYNs and physicians want to ensure that everyone knows that no one is ever to blame for pregnancy loss. The search for a cause is not the search for fault. 

Talk to Your OBGYN

If you have any questions or concerns about pregnancy loss, talk to your OBGYN–especially if you or someone in your family has a history of pregnancy loss. The more you know about your risk factors, the better you’ll be able to plan for your future.

Want to know more about solutions to recurrent pregnancy loss? Contact our Glenview or Wilmette locations to schedule an appointment with an OBGYN. In addition, for some patients we refer to  reproductive endocrinology and infertility specialists when it’s needed. If you’d like those contact names, contact our office. 

Bleeding When Pregnant

Bleeding when pregnant sounds scary, and it certainly can be. However, about 20% of women experience some bleeding during their first trimester of pregnancy. Some causes of bleeding during pregnancy are normal and not necessarily a sign that something is wrong, but you should be aware of what bleeding when pregnant means and when you should see your doctor.

Benign Causes of Bleeding When Pregnant

Implantation Bleeding

Within the first six to twelve days post-conception, you may experience some spotting as the fertilized egg implants in the lining of the uterus. This is often mistaken as a period by women who don’t yet realize they are pregnant. This type of bleeding when pregnant is usually very light, lasting from a few hours to a few days.

Cervical Changes

Pregnancy causes extra blood to flow to the cervix. As a result, intercourse or pelvic exams can cause light bleeding. This is normal and no cause for concern.

Cervical Polyp

A harmless growth on the cervix, cervical polyps are more likely to bleed during pregnancy as a result of increased estrogen levels and the increased number of blood vessels in the tissue around the cervix.

Abnormal Causes of Bleeding During the First Half of Pregnancy

Miscarriage

Unfortunately, 15% to 20% of pregnancies end in miscarriage within the first twelve weeks of pregnancy. While we don’t always know why a pregnancy has ended in misacarriage, the majority of early losses are related to chromosomal issues limited to that specific pregnancy, and are not related to maternal factors. If you are experiencing continued bleeding, or cramping combined with bleeding, you should reach out to your care team.

Subchorionic Hematoma

Also known as a subchorionic hemorrhage, this particular condition develops when the placenta partially detaches from the uterine lining. This can cause bleeding between the uterine lining and the outer fetal membrane (called the chorion). A subchorionic hematoma is a relatively common cause of first trimester bleeding, and it usually resolves on its own. However, because it can sometimes result in an elevated risk of pre-term labor or miscarriage, most OBGYNs will want to closely monitor this condition.

Ectopic Pregnancy

An ectopic pregnancy occurs when the egg implants itself somewhere outside the uterus, most often in the fallopian tubes. Ectopic pregnancies happen in 1 out of 50 pregnancies. Along with bleeding, you may experience strong abdominal cramping low in the stomach, sharp pain in the abdominal area, and low HCG levels.

Molar Pregnancy

A rare cause of early bleeding, molar pregnancies involve the growth of abnormal tissue instead of the embryo. Along with bleeding, tests may reveal high HCG levels, absent fetal heart tones, and grape-like clusters seen in the uterus by ultrasound.

Infection

Some vaginal and uterine infections can also cause bleeding. When assessing vaginal bleeding in pregnancy, your midwife or doctor will often screen for common infections.

Abnormal Causes of Bleeding During the Second Half of Pregnancy

Placental Abruption

This case is extremely rare, occurring in only 1% of pregnant women, and more likely during their last twelve weeks of pregnancy. Placental abruption occurs when the placenta detaches from the uterine wall before or during labor. Along with bleeding, you may have stomach pain.

You are at a higher risk for placental abruption if you:

  • Have already had children
  • Are over 35
  • Have a history of abruption
  • Have hypertension
  • Have sickle cell anemia
  • Have had trauma or injury to your stomach
  • Use cocaine

Placenta Previa

This very serious condition occurs when the placenta lies low in the uterus either partly or completely covering the cervix. It requires immediate medical attention. Occurring in 1 out of 200 pregnancies, the bleeding is not usually accompanied by pain.

You are at a higher risk for placenta previa if you:

  • Have already had children
  • Had a previous cesarean birth
  • Had other surgery on the uterus
  • Are carrying twins or triplets

Preterm Labor

The mucus plug sometimes passes up to a few weeks before labor begins, it is made up of mucus and blood. If it occurs any earlier, you may be entering preterm labor. Other signs include:

  • Watery mucus or bloody discharge
  • Pelvic or lower abdominal pressure
  • Low, dull ache in back
  • Stomach cramps
  • Diarrhea
  • Contractions

Rare Causes of Bleeding During Pregnancy

There are some rare conditions which can cause vaginal bleeding. The vast majority of vaginal bleeding is benign, but the following conditions can be quite serious even if they are also incredibly uncommon. Talk to your OBGYN or care team immediately if you are worried your bleeding is caused by either of the following.

Uterine Rupture

A uterine rupture occurs when the scar from a previous Cesarean-section surgery tears during your pregnancy. Again, the chances of such an occurrence are relatively remote, but it does happen. Symptoms of a uterine rupture can include:

  • Significant vaginal bleeding.
  • Sudden, noticeable pain around the site of your previous C-section incision.
  • Soreness and pain of the abdomen.
  • A bulge under the pubic bone or the movement of the baby’s head into the birth canal.

In some cases, uterine ruptures may occur during delivery, in which case your contractions could change or slow.

The treatment for uterine ruptures will usually involve an emergency c-section. 

Vasa Previa

Vasa previa is also incredibly rare. When it occurs (and when it is detected), symptoms usually present shortly before labor starts. 

Typically, the blood vessels in the umbilical cord and placenta are contained by a membrane. Vasa previa occurs when that membrane is ruptured and blood begins to cross the opening to the birth canal. Left untreated, this can cause the baby to lose blood and suffer from oxygen deprivation.

Symptoms of vasa previa include:

  • Significant and painless vaginal bleeding.
  • Unsteady fetal heartbeat or fluctuating vital signs.
  • Detected rupture of membranes (although this symptom may not be observable to patients).

Vasa previa is often treated by closely monitoring your baby’s health. The idea is to give your baby as much time to develop safely as possible before inducing labor. In some cases, complete bed rest is recommended. Your OBGYN may also admit you to a hospital during your third trimester for close observation and treatment.

Both vasa previa and uterine ruptures are quite rare, but if you suspect you may be experiencing symptoms, it’s important to see your physician or OBGYN immediately. In most cases, prompt intervention can lead to a healthy outcome for both you and your baby. 

What Should You Do If You’re Bleeding When Pregnant?

While there is often no cause for alarm, bleeding when pregnant can be a sign that something is wrong, so you should always consult with your midwife or doctor. They will be able to determine whether your bleeding is normal or cause for concern.

It’s a good idea to use pads or a panty liner to keep track of the amount of blood flow to report to your care team. You should avoid the use of tampons.

Together, you and your healthcare provider can discuss and take the appropriate next steps for the health and safety of yourself and your baby.

If you have questions or would like more information, please call our Wilmette or Glenview offices. If you have other pregnancy related questions, please feel free to look through our obstetrics blog library. We add to it regularly.

 

Am I In Labor?

The feeling of anticipation leading up to labor can be very overwhelming, especially if you’ve never been through it before. It’s normal to want to know when you’re going into labor. So how can you tell? In this article, we will cover classic signs of labor, early labor, false labor, and stages of labor.

Classic Signs of Labor

Being armed with the information on how to know when you’re going into labor will make you feel more confident about going through the process. One of the first signs that your body is preparing for labor is feeling your baby drop, also called lightening. After this, the baby’s head will be much deeper in your pelvis. That can occur from a few weeks to a few hours before labor.

You may also notice an increase in vaginal discharge. It may be slightly pink in color. This is called show. It is actually a sign that the cervix has begun to dilate, as the thick mucus plug that once accumulated at the cervix moves down through the vagina. This can occur between days or hours before labor, or sometimes not at all.

If Your Water Breaks, Are You in Labor?

Almost every time labor is portrayed in movies and on television, the penultimate moment includes the mother-to-be’s water breaking. And while your water will indeed likely break during labor, it’s not always a reliable–or even well-noticed–indicator of imminent labor. 

The “water” here is actually a protective sac of amniotic fluid that surrounds the baby during pregnancy. Usually, as labor begins, this sac breaks and you’ll notice either a resulting rush of fluid or a slow (and perhaps easy to miss) trickle. If you notice your water break, you should go to the hospital or contact your OBGYN or midwife because, in all likelihood, labor has begun.

But there are a couple of caveats:

  • Your water breaking does not mean delivery is imminent–but it could be! You could be in the early stages of labor, which could last for a number of hours. Or your body could be ready to deliver in the next few minutes! That’s why it’s recommended that you check in with your OBGYN or midwife when your water breaks.
  • You may be ready to deliver before your water breaks. Some women will experience labor before the water breaks on its own. In those cases, your OBGYN may intentionally break your water using a special tool–either to induce labor or to speed up your delivery when labor is progressing too slowly.

False Labor

The contraction of the uterus sometimes leads mothers to believe that they are going into labor; however, when this happens before true labor begins, it is called false labor. Also known as Braxton Hicks contractions, they are normal, but can still sometimes be uncomfortable.

There are ways to tell the difference between false labor and actual labor. First, irregular contractions are a sign of false labor, as are shorter (45 seconds or less) ones. In true labor, contractions have a progressive quality and develop a pattern with increasingly regular intervals and begin to take place with increasing frequency over time. The strength of the contractions will also increase in labor, whereas in false labor, the strength of the contractions is sometimes weak and sometimes strong.

Another way to tell is where you feel the contractions. If you feel them in the front, where your uterus is, it may indicate Braxton Hicks. If your contractions feel like they begin toward the back of you and move towards the front, it indicates true labor.

If you’re still not sure, moving around can help you figure out if you’re in false or true labor. In false labor, the contractions will typically subside when you begin moving around. In true labor, the contractions will likely increase in frequency and strength no matter what you do!

Early Labor

Early labor is the first stage of labor, before the labor pattern becomes active. Every labor is different, but typical hallmarks of early labor are contractions that are not yet consistently every 3-4 minutes apart, lasting a minute or longer, and too intense to talk or maintain current activity through. Although it’s common to feel like you want to do something during this stage, the best thing you can do to help yourself along in early labor is to hydrate, eat something, and try to rest.

The duration of this phase of labor is highly variable, but with a first pregnancy can last hours to days, during which you will likely experience about 5 to 30 minutes between contractions. Your water typically won’t break during this time. During early labor, it’s important to conserve resources. Avoid the urge to rush to the birth center or hospital; instead, touch base with your midwife or doctor as directed for advice on how to make yourself more comfortable and when to plan follow-up. Massage, heat packs, showers, and baths are great relaxation tools during this phase.

Back Labor

One of the most common–but often overlooked–signs of labor is back pain. Sometimes known as “back labor,” back pain that doesn’t go away could be a sign that you’re in labor. It’s a sign that’s easy to miss because pregnancy itself can be rather trying for your back muscles. After all, carrying a baby around all day every day puts an enormous strain on your posture and your core, so a sore back doesn’t seem at all unusual.

However, back pain that doesn’t go away when treated with massage or cold or hot packs may in fact be an indication that contractions have begun. If you’re having back labor, the pain will usually begin in your lower back and slowly work its way around towards the front of your body. There may also be other indications that you’re experiencing labor (such as those described above).

Stages of Labor

It can be easier to understand labor once it’s divided into its three stages. The first stage of labor includes early labor, active labor (commonly defined as 6 cm or more of cervical dilation with regular, strong contractions), and the transition phase (where you progress from 8- 10 cm cervical dilation).

The second stage is all about moving your baby down through the vaginal canal, and the special time where you give birth to your baby. Your baby being born concludes the second stage of labor.

The third and last stage of labor is when you deliver the placenta. This stage typically lasts anywhere from 5 to 30 minutes and begins with small contractions and a small gush of bleeding that indicate your placenta has separated from the uterine wall. Once the placenta has delivered you’ve made it through all the stages of labor.

As you near your due date, we don’t expect you to know exactly where you are in the labor process, but it’s important to know the answer to this question: When should I call my doctor or midwife about labor? Ask your practice for their specific recommendations. Knowing the cues to look for from your body will give you greater confidence in approaching the labor and birth process.

 

If you have a question or you’d like more information, please call our Wilmette or Glenview offices to schedule an appointment.

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