Prenatal Care

Ultrasound is useful throughout pregnancy. Most women have at least one ultrasound exam.

You will need to have a full bladder for most ultrasounds. You will be required to partially undress, and it's possible a vaginal ultrasound may be performed. 

For your comfort and privacy, please only invite friends and family you feel comfortable undressing in front of, as the exam must be performed on bare skin. 

Your maternal-fetal medicine physician will discuss your ultrasound results with you.

Types of Ultrasounds

First Trimester Dating Ultrasound (less than 14 weeks)

• A dating ultrasound will be performed when you begin prenatal care with a CHI Health clinic.
• Identify multiple pregnancies (twins, triplets, etc.)
• Identify risk for Down syndrome and other chromosomal abnormalities
• Assess uterus for fibroids 

Second Trimester (20 Weeks)

Depending on fetal position, it may be possible to find out your baby's sex at this appointment. If you are having twins, this ultrasound will take twice as long.

• Confirm gestational age
• Determine fetal sex
• If a multiple gestation, determine how many placentas and gestational sacs there are
• Scan anatomy - head, heart, stomach, intestinal tract, kidneys, spine, arms & legs
• Observe fetal movement
• Determine placental location, cervical length, amniotic fluid volume
• Assess baby’s position and heart rate 
• Screen for Down syndrome and other genetic abnormalities

Third Trimester

• Determine estimated weight and position of baby
• Examine location of placenta, amount of amniotic fluid
• Assess fetal heart rate
• Assess length of cervix

After 40 Weeks

• Assess amniotic fluid volume, location of placenta
• Determine position of baby

3-dimensional Ultrasound

• Determine severity and prognosis of suspected birth defect
• Not always possible, depending on your baby’s position

Transvaginal Ultrasound

This pelvic ultrasound is often a better way to look at the Fallopian tubes, ovaries, and cervix. A transvaginal ultrasound is performed for many different reasons. It's used to evaluate abnormal bleeding or abnormal findings on an exam. It can also be used to look at a very early pregnancy or diagnose an ectopic pregnancy.

You will start with an empty bladder. You will undress from the waist down and then lay on the table. A cover will be placed over the probe or the wand and then inserted into the vagina. A series of pictures or images will be taken. The procedure takes about 10 minutes. You will feel some mild pressure but no pain, and the results are immediate.

Amniocentesis

Under ultrasound guidance, a needle is inserted into the amniotic sac to withdraw a small amount of amniotic fluid. This is generally done between 15 and 18 weeks of pregnancy, but can be done up to 36 weeks in some cases. This procedure assesses for:

• Fetal genetic abnormalities
• Signs of certain infections

For 24 hours after the procedure, you should stay off your feet as much as possible and drink extra fluids. You’re asked to avoid exercise, heavy lifting, and sexual activity. 

Minor bruising or soreness where the needle was inserted and mild cramping can occur for several hours. Watch for vaginal bleeding, loss of amniotic fluid, cramping lasting more than 3-4 hours or chills or fever of more than 100.6. A very small risk of miscarriage is associated with amniocentesis. 

Fetal Echocardiography

This test is performed most often at 22-24 weeks to take a closer look at your baby’s heart. Sometimes, baby’s position can hinder our ability to complete a detailed heart evaluation. The specialized diagnostic test assesses:

• Heart size, position, and function
• Blood flowing into and out of the heart
• Heart rate and rhythm

Maternal conditions that indicate need for fetal echocardiography:

• Diabetes
• Family history of heart disease
• Exposure to drugs, alcohol, or certain medications

Fetal reasons that indicate need for fetal echocardiography:

• Abnormal cardiac screening examination
• Abnormal heart rhythm 
• Suspected chromosomal abnormality (Down syndrome)
• Identical twins

Starting a family is an exciting time. Whether you're pregnant or thinking about becoming pregnant, you probably have lots of questions about what you need to do.

Use your relationship with your doctor as a resource for advice and information before, during and after your pregnancy. Together, you'll form a team to help your baby enter the world happy and healthy.

Below are some videos made by CHI Health Clinic OB/Gyn physicians about what you can expect at each stage of your pregnancy.

• Pregnancy at 8 weeks
• Pregnancy at 16 weeks
• Pregnancy at 20 weeks
• Pregnancy at 24 weeks
• Pregnancy at 28 weeks
• Pregnancy at 30 weeks
• Pregnancy at 32 weeks
• Pregnancy at 34 weeks
• Pregnancy at 36 weeks
• Pregnancy at 38 weeks
• Pregnancy at 39 weeks
• After baby is born

Some sources recommend making healthy changes in your diet three to 12 months prior to conceiving. Pregnancy is not a time to diet. Talk with your provider to determine how much weight gain is acceptable for you. Pay closer attention to the amount of artificial sweeteners and caffeine you consume. It is recommended that you change to a vitamin supplement formulated for pregnant women whenever considering a pregnancy or pregnant.

Follow the food pyramid guidelines with the following points in mind:

• Increase dairy servings to 3 - 4 per day
• Increase protein servings to at least three per day
• Drink at least 2 liters of water per day •Eat frequent small meals
• Avoid fish, especially freshwater fish (contains mercury). Go light on canned tuna as well.   
• Steer clear of unpasteurized milk or soft cheeses  (Brie, Blue cheese or Camembert), pate, and raw or undercooked meat or poultry.
• Decrease or stop all caffeine intake 
• Decrease or stop smoking.
• Don’t drink alcohol while pregnant or trying to conceive
• Discuss iron supplements with your provider

Food Don’ts

There are three main dangers lurking in the food pregnant women eat. They are:

• Listeria – a dangers bacterium that can grow even in cold refrigerators.
• Mercury – a harmful metal found in high levels in some fish.
• Toxoplasma – a risky parasite found in undercooked meat and unwashed-fruits and vegetables.

These things can cause serious illness or even death to you and your unborn baby. Follow these food facts to help you keep you and your baby healthy.

Do Not Eat:

• Raw or uncooked meat, poultry, fish or shellfish (sushi or sashimi).
• Swordfish, tilefish, king mackerel, and shark.
• Refrigerated smoked seafood like whitefish, salmon and mackerel. These products are usually labeled “Nova-style,” lox, kippered or jerky.
• Refrigerated patés or meat spreads. hot dogs and luncheon meats – unless they’re reheated until steaming hot.
• Soft cheeses like feta, brie, camembert, “blue-veined cheeses,” “queso blanco,” “queso fresco,” and Panela unless the label says they are pasteurized or made from pasteurized milk. 

First Trimester (First 13 Weeks)

During your first trimester of pregnancy, you will visit the  provider once a month for routine check-ups. Questions you should ask your provider now are:

• What changes can I expect before my next visit?
• Can I take medication?
• What should I eat to give my baby a healthy start?
• How much weight should I gain during this time and throughout my pregnancy?
• Is there any need to change my activities?
• What are some of the things I should call you about?
• What type of exercise should I get and how often should I exercise?
• If I am a smoker, how can I cut down or stop during pregnancy?

First Trimester Checklist

• Consider what Maternity Center or Birth Center you would like to deliver at. Tours are available online and in-person. 
• Familiarize yourself with our childbirth and parenting classes.
• Enroll in a prenatal exercise class, if your provider allows.
• Check into prenatal and maternity benefits that your insurance may provide. No insurance or high deductible plan? CHI Health has partnered with MDsave to offer you one, upfront price on office visits, ultrasounds, delivery and more. 
• Investigate your employer’s maternity or parental-leave policies.
• Take all vitamin supplements prescribed for you by your provider. Discuss with your provider your options of when to take them.
• Stop smoking and encourage others living in the home not to smoke around you.
• Wear safety belt.

Second Trimester (Middle 14 Weeks)

You may notice a rapid change in your personal appearance  during these months...some changes you may be excited about,  others can be unexpected. If any of these changes cause you concern,  visit with your provider or the office nurse for more information.

Second Trimester Checklist

• Register for Childbirth Preparation Classes. It is recommended that you complete  the classes before your 36th week.
• Review your medical insurance coverage and complete any required paperwork.
• If you plan to use day care services after your baby arrives, begin exploring child-care options.
• Select a pediatrician or family medicine provider to care for your baby. 
• Make sure the provider has privileges at your hospital of choice for your delivery.
• Wear safety belt.

Third Trimester (Last 13 Weeks)

This trimester can be a mix of concern and excitement.  An excellent way to reduce fears about the birth of your baby is to ask  questions, read, and enroll in childbirth classes. Your physical changes may greatly increase during this time, but if any of the symptoms are excessive or unusual, such as spotting, cramping or excessive weight gain, call your provider.

Third Trimester Checklist

• Pack your bag for yourself and your baby.
• Purchase an infant car seat and familiarize yourself with how it works before you try it out on your newborn. Refer to your car’s owner’s manual for proper directions. Practice installing the seat in your car, at least once before the delivery date.
• Set up an appointment with a local safety check station to assist with car seat questions and proper usage.
• Determine the fastest route to the hospital and consider making a trial run.
• Stock up on household items and food so you will have plenty on hand when you return home with your baby.
• If you have preferences concerning the management of your labor and baby’s birth, discuss them with your provider.
• If you have other children, please make plans for their care while you are in the hospital. Consider having a backup plan.
• Have the phone numbers of your provider and the hospital in your phone for easy access. 
• Confirm what your provider wants you to do when you believe labor has begun.
• Wear safety belt.

Learn about what gestational diabetes entails and about our Diabetic Education program.

For a number of reasons, some patients need more specialized care during their pregnancy. In this case, your obstetrician may suggest consultation with a Maternal-Fetal Medicine physician. 

CHI Health Maternal-Fetal Medicine physicians, also called perinatologists, are obstetricians who specialize in the diagnosis, treatment, and ongoing care of expectant parents and their unborn babies, who may be at high risk for special health problems. 

Referral to a Maternal-Fetal Medicine specialist should not cause undue alarm for expectant families. It does not necessarily mean the pregnancy will be a difficult one. Nor does it mean the baby will have health problems. Most often, it is simply a precautionary measure designed to protect both mother and baby, while putting the expectant parents' minds at ease.

Maternal-Fetal Medicine Services

• Preconception counseling
• Genetic screening
• Evaluation of the fetal heart and the management of congenital cardiac anomalies
• In utero diagnosis and treatment of certain fetal anomalies, such as fetal anemia and twin-to-twin transfusion syndrome
• Management of maternal medical conditions
• Ultrasounds

If you have had previous complicated pregnancies, we may request you bring your previous medical records to your appointment.

As pregnancy progresses, the Maternal-Fetal Medicine physician remains in close contact with the obstetrician who will deliver the baby and, if needed, the neonatologist who will oversee the baby's care after birth. Smooth teamwork and good communication between the Maternal-Fetal Medicine specialist, obstetrician, and neonatologist ensure both mother and baby receive the best possible care.

An important part of our mission at CHI Health is to train physicians, nurses, sonographers, and other types of health care specialists to take care of future generations. We may have students who take part in your care at times. You will always be evaluated by your usual maternal-fetal medicine physician, and all decisions will be made by your maternal-fetal medicine physician.

Common Conditions

A variety of reasons bring an expectant mother to see a maternal-fetal medicine specialist. You may be referred if your Ob-Gyn or midwife has classified your pregnancy as high risk due to the following health conditions:

• High blood pressure
• Diabetes
• Thyroid disease
• Kidney disease
• Gastrointestinal disease
• Infectious disease
• Preeclampsia
• Pregnancy with multiple babies (twins, triplets, or more)
• Recurrent pregnancy loss
• Suspected fetal growth abnormalities
• Suspected birth defects

Some conditions which affect unborn babies may be treated prior to delivery. If your baby needs a fetal procedure which cannot be done by your maternal-fetal medicine specialist, you may be referred to a very specialized team at a fetal care center. This may require traveling to another state.

Telehealth Outreach

Technology allows us to expand access to specialized obstetric care to more areas of Nebraska. CHI Health facilities with a telemedicine option allow patients to have their ultrasounds closer to home, with a maternal-fetal medicine specialist reviewing the image and providing consultation by phone or video call.