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OBSTETRICS & GYNECOLOGY

Pregnancy

  Overview
Pregnancy is broken into three time periods, called trimesters. Most women feel
Overview
differently, both physically and mentally, during each trimester. In addition to
The Three Trimesters weight and body shape, other alterations in your body chemistry and function
Prenatal Care
also take place during pregnancy. Your heart works harder, your temperature
registers slightly higher, body secretions increase, joints and ligaments are more
Labor and Delivery
flexible and hormones are altered.
Recommended
Mood changes also are common, resulting from a combination of hormonal
reading
changes and greater fatigue, as well as normal anxiety over body image,
Guides and forms sexuality, finances, partner roles and impending parenthood.
Related programs
For the vast majority of women, pregnancy follows a fairly routine course. Some
Where to get care women, however, have complications or challenges related to their health or the
health of their baby. These women experience what is called a high-risk
Helpful resources
pregnancy.
Support services
Signs to Watch For
Although there are many symptoms that are a normal part of pregnancy, there
are certain danger signs that may indicate problems. You should notify your
doctor immediately if you experience any of the following:

✷ Persistent vomiting

✷ Chills or fever

✷ Continuous pain

✷ Burning with urination

✷ Blurred vision

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 ✷ Continuous headache

✷ Sudden swelling of the hands or face

✷ Five or more uterine contractions per hour

✷ Decreased fetal movements

✷ Leaking of fluid from the vagina (blood or water). If you have vaginal
bleeding at any time during your pregnancy, have someone call your
doctor immediately.

Our Approach to Pregnancy

UCSF provides world-class care for women who are pregnant or considering
becoming pregnant. Each pregnancy is unique. That's why collaboration with
individuals is the core of our approach. We listen to your needs, provide
information and support, and guide you through the process of having a child,
from the early stages of family planning through pregnancy, delivery, postpartum
recovery and beginning life as a new parent.

Our team of obstetricians, perinatologists (specialists in maternal-fetal care) and

nurse-midwives has the expertise and compassion to care for all pregnancies
and deliveries, from the routine to the highest risk. UCSF has a family-oriented,
state-of-the-art birth center, where birthing suites are equipped with a spa-style
bathtub, a dedicated family area and a media wall for education and
entertainment. Should you or your baby need special care, we provide a
seamless transition to renowned specialists and one of the nation's finest
intensive care nurseries.

In addition to patient care in the clinic, we offer a variety of other resources, such
as classes and support groups, to help you navigate pregnancy, childbirth and
parenting.

Awards & recognition

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 Among the top One of the nation’s
hospitals in the best in obstetrics &
nation gynecology

Rated high-
performing hospital Excellence in
for maternity care supporting
(uncomplicated breastfeeding
pregnancy)

The Three Trimesters

Pregnancy has three trimesters, each of which is marked by specific fetal
developments. A pregnancy is considered full-term at 40 weeks; infants delivered
before the end of week 37 are considered premature. Premature infants may
have problems with their growth and development, as well as difficulties in
breathing and digesting.

First Trimester (0 to 13 Weeks)

The first trimester is the most crucial to your baby's development. During this
period, your baby's body structure and organ systems develop. Most
miscarriages and birth defects occur during this period.

Your body also undergoes major changes during the first trimester. These
changes often cause a variety of symptoms, including nausea, fatigue, breast
tenderness and frequent urination. Although these are common pregnancy
symptoms, every woman has a different experience. For example, while some
may experience an increased energy level during this period, others may feel very
tired and emotional.

Second Trimester (14 to 26 Weeks)

The second trimester of pregnancy is often called the "golden period" because
many of the unpleasant effects of early pregnancy disappear. During the second
trimester, you're likely to experience decreased nausea, better sleep patterns and
an increased energy level. However, you may experience a whole new set of
symptoms, such as back pain, abdominal pain, leg cramps, constipation and
heartburn.

Somewhere between 16 weeks and 20 weeks, you may feel your baby's first
fluttering movements.

Third Trimester (27 to 40 Weeks)

You have now reached your final stretch of pregnancy and are probably very
excited and anxious for the birth of your baby. Some of the physical symptoms
you may experience during this period include shortness of breath, hemorrhoids,

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 urinary incontinence, varicose veins and sleeping problems. Many of these
symptoms arise from the increase in the size of your uterus, which expands from
approximately 2 ounces before pregnancy to 2.5 pounds at the time of birth.

Prenatal Care
Expert prenatal care ensures that both you and your baby are as healthy as
possible throughout your pregnancy.

If you think you're pregnant, contact your doctor to make an appointment and
establish your prenatal care schedule. Many factors determine the number of
visits you'll have, including your personal health and your doctor's preference.

At prenatal visits, we test you and your baby to identify any potential risks, treat
any complications, and monitor your baby's growth and development. Additional
prenatal care may be needed if you have preexisting medical conditions, such as
diabetes, or if complications arise during your pregnancy.

If your pregnancy is going well, visits are planned around key pregnancy
developments and tests. Visits are also a time for your doctor to give you
important information as your pregnancy progresses and help you prepare for
giving birth.

Here's a guide to the most common prenatal tests, including when they happen
and what you can expect.

Genetic carrier screening

Timing: Before or during pregnancy

How it works: A blood test is done to see whether you're a carrier of a genetic
change that could raise your baby's risk for a genetic condition. Two conditions
commonly screened for are cystic fibrosis and spinal muscular atrophy.

California Prenatal Screening Program (CA PNS)

CA PNS screening is a combination of these two blood tests, performed at
different stages of pregnancy:

✷ Cell-free DNA screening (also called noninvasive prenatal testing or NIPT)

is done at 10 weeks of pregnancy or later to determine a baby's risk for
Down syndrome and two other syndromes, trisomy 18 and trisomy 13. It
can also predict the sex of your baby.

✷ A maternal serum alpha-fetoprotein (MASFP) screening is done

between 15 and 21 weeks of pregnancy to assess the risk for
abnormalities of the spine (neural tube defects) or abdomen (abdominal
wall defects).

Nuchal translucency test

Timing: Usually between 12 and 14 weeks of pregnancy, at the first trimester
screening

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 How it works: An abdominal ultrasound measures the amount of fluid behind the
baby's neck to look for certain genetic conditions as well as structural problems,
such as heart defects. Extra fluid in that area indicates a higher risk of
chromosome abnormalities, birth defects and genetic conditions.

Chorionic villus sampling (CVS)

Timing: Usually between 10 and 13 weeks of pregnancy

How it works: A small sample of the placenta is taken and sent for testing to
identify any chromosomal or genetic disorders. (Not everyone who is pregnant
chooses to have CVS.)

Amniocentesis
Timing: Usually between 16 and 22 weeks of pregnancy

How it works: The doctor takes a small sample of the amniotic fluid surrounding
your baby. Genetic testing of that fluid can identify chromosomal or genetic
disorders as well as neural tube defects. (Not everyone who is pregnant chooses
to have amniocentesis.)

Early fetal anatomy examination

Timing: Usually between 12 and 14 weeks of pregnancy

How it works: Like the level 2 anatomy ultrasound done in the second trimester,
the first-trimester ultrasound examines many physical aspects of your baby's
body and includes additional imaging, such as the evaluation done in a nuchal
translucency ultrasound. It's usually recommended for high-risk patients, such as
those who are carrying a baby with a suspected abnormality, had high-risk
findings on a genetic screening test, or had a previous pregnancy with fetal
abnormalities.

Anatomy ultrasound (level 2)

Timing: Around 20 weeks of pregnancy

How it works: An "anatomic survey" examines many aspects of your baby's

body, including the heart, brain, spine, limbs and certain other organs. The
anatomy ultrasound visit also includes an assessment of the placenta and of your
uterus and cervix.

Glucose tolerance test

Timing: Usually between 24 and 28 weeks of pregnancy

How it works: This test measures the level of sugar (glucose) in your blood. An
abnormally high blood sugar level may be a sign of gestational diabetes, a type
of diabetes that can develop during pregnancy and requires monitoring.

Fetal monitoring
How it works: Your doctor may want to monitor your baby's heart rate (using an
ultrasound transducer) and measure uterine contractions (using a device called a
toco transducer).

Group B strep testing

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 How it works: Doctors routinely take a sample from your vagina and rectum
during pregnancy to test for group B streptococcus ("group B strep") bacteria.

Group B strep bacteria can cause infections during pregnancy and lead to
complications and even death for a newborn if transmitted during delivery.
Fortunately, the infection can easily be treated with antibiotics during pregnancy.

Labor and Delivery

Labor is a series of progressive and continuous contractions of the uterus that
help the cervix to open and thin, allowing the baby to travel through the birth
canal. Labor usually starts within two weeks before or after your estimated
delivery date. However, this can vary widely.

Labor and delivery are hard work and involve some discomfort. The level of
discomfort experienced during childbirth varies from woman to woman and from
pregnancy to pregnancy. Each woman chooses a different way to experience her
birth — some prefer to go through it without medication, while others choose to
have medication or anesthesia. Many decide to "see how it goes" and make
choices as their labor unfolds.

We offer a spectrum of options for managing your pain during labor and delivery.
You will be assigned to your own nurse during your stay in the birthing suite. He
or she will help keep you comfortable and guide you through non-drug
approaches to pain management, such as whirlpool soaks and position changes.

Pain Management
Non-Medical Approaches for Labor and Vaginal Birth
The Birth Center rooms provide a number of options for comfort during labor
including space to move around, tubs for soaking, rocking chairs and beds that
convert into different positions.

Relaxation and breathing techniques ease the discomfort for many, as does the
presence of family and friends and the support of health care providers. Comfort
measures can be learned from classes, books or videos available through
UCSF's Great Expectations Pregnancy Program.

Medical Approaches for Labor and Vaginal Birth

✷ Narcotic Injections of a narcotic can be given intravenously (through an IV)
during labor. The narcotic works quickly and can be given every hour
during labor. However, it is not given immediately before delivery to ensure
that the effects will have worn off before the baby is born. For some
women, this medication takes the edge off and allows them to rest and
relax between contractions.

✷ Nitrous oxide gas This is the same gas that is used at the dentist, and
can be inhaled during contractions through a mask you hold. The gas can
lessen but not eliminate the pain of labor. The effect occurs only while the
gas is being inhaled and disappears rapidly when the mask is removed. It
can be used through delivery.

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 ✷ Epidural anesthesia An epidural offers the most complete pain relief
during labor and birth. A tiny tube or catheter is placed through a needle
into a space (the "epidural space") outside the spinal cord sac in the lower
back. The needle is removed and the tubing is taped in place. Similar to an
IV, medication is given continuously through the tube during labor and
birth. The medication blocks the pain of contractions. Because of the
numbness produced by the epidural, a woman with an epidural cannot get
out of bed. Most women take the opportunity to get some rest. A "walking
epidural" — also called a "combined spinal-epidural" — is a technique that
allows a woman to continue to move around while receiving a lighter form
of medication.

Our anesthesiologists are available to the Birth Center 24 hours a day. The
anesthesiologist on-call meets every woman who is admitted in labor regardless
of whether she is planning anesthesia for her birth. The purpose of this visit is
two-fold: To learn of any medical problems you may have in the unlikely event of
an emergency, and to answer any questions you may have about the pros and
cons of medical approaches to pain relief during labor.

Caesarean Birth
When a Caesarean is Needed
While most women will have a vaginal delivery, some may need abdominal
surgery referred to as Caesarean section. Most often women have a Caesarean
birth when labor does not progress — the cervix does not completely dilate or
the baby cannot be pushed out — over a long period of time. It is a decision
made by the woman and her doctor when both feel everything else has been
tried and this is the only alternative.

Sometimes a Caesarean birth is planned. Situations that might require a

scheduled Caesarean include:

✷ Breech position

✷ Previous Caesarean section

✷ Placenta previa, when the placenta is covering the cervix

Rarely, Caesarean birth is due to an emergency situation that endangers the

woman's or her baby's health. In these situations, there is no time to wait for the
regular process of labor and the decision to perform a Caesarean section must
be made very quickly. Indications for an emergency Caesarean may include:

✷ Maternal bleeding

✷ The baby being in distress

Anesthesia for Caesarean Section

For a planned or non-emergency Caesarean, an epidural or spinal anesthesia is
the anesthesia of choice. This allows the woman to be awake and able to see
her baby immediately after birth. In an emergency situation, the woman would be

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 put to sleep using general anesthesia. This is the fastest anesthesia to administer
when time is of the essence.

If the woman is awake, a support person can be with her for the birth. If general
anesthesia is used and the woman is asleep, support people need to wait in the
labor room or waiting room until the surgery is completed.

Caesarean Procedure and Recovery

Most often, the doctor will make a low transverse incision — a "bikini cut" —
both on the skin, just above the pubic hair, and on the uterus itself. This is a
preferable cut for both comfort and recovery. Occasionally an "up and down" or
vertical incision is made on the skin, uterus, or both. This is a faster cut and may
be used in an emergency. The size and position of your baby also may determine
the need for this kind of incision.

Recovery from surgery takes longer than recovery from a vaginal birth. Usually it
requires an extra night or two in the hospital, for a total of three to four nights,
and more help at home in the first few weeks.

Many women choose to attempt a vaginal birth after Caesarean, called VBAC,
and many will succeed. Every woman who has had a Caesarean will need to
discuss the subject of VBAC with her provider. Many factors — including the
reason for the Caesarean, the type of incision and the number of prior
Caesareans — will influence the safety of VBAC.

Birth Plans
You will be provided with a Birth Plan, a form asking about your preferences for
delivery. This promotes communication with your health care provider and helps
them meet your individual needs. You will complete your Birth Plan and discuss it
with your health care provider at your 34 to 36 week visit.

Make photocopies of your Birth Plan. Give one to your health care provider to put
in your medical record, and bring one with you when you come to the hospital in
labor.

UCSF Health medical specialists have reviewed this information. It is for

educational purposes only and is not intended to replace the advice of your
doctor or other health care provider. We encourage you to discuss any questions
or concerns you may have with your provider.

Recommended reading

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 Anemia and Pregnancy
During the last half of pregnancy,
your body makes more red blood
cells which can cause Anemia.
Learn more about causes and
prevention here.

Birth Center Tour

Congratulations on your
pregnancy! This video and FAQ
will guide you through what to
expect before and after you
arrive at the hospital.

Coping With Common

Discomforts of Pregnancy
Pregnancy produces many
physical changes. Aside from
weight and body shape, other
alterations in your body
chemistry and function take
place. Learn more.

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 Diabetes in Pregnancy
Gestational diabetes refers to
diabetes that is diagnosed during
pregnancy. Gestational diabetes
occurs in about 7 percent of all
pregnancies. Learn more.

Dietary Recommendations for

Gestational Diabetes
Gestational diabetes occurs in
about 7 percent of all
pregnancies. It usually arises in
the second half of pregnancy
and goes away as soon as the
baby is born.

Domestic Violence and

Pregnancy
Domestic violence is the most
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 Domestic violence is the most
common health problem among
women during pregnancy. It
greatly threatens both the
mother's and baby's health.
Learn more here.

Eating Right Before and During

Pregnancy
It is important to get the nutrients
you need both before getting
pregnant and during your
pregnancy. Find more nutrition
information including macros
here.

Exercise During Pregnancy

Most women can, and should,
engage in moderate exercise
during pregnancy. Exercise can
help you stay in shape and
prepare your body for labor and
delivery

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 FAQ: Prenatal Tests
Commonly asked questions
regarding Prenatal Tests
including, types available,
positive screenings, diagnostic
testing, health insurance
coverage, and more.

Frequently Asked Questions

About Zika Virus
If you're currently expecting or
plan on becoming pregnant
soon, the Zika virus is probably
on your mind. Here are answers
to some common concerns
about Zika.

Gestational Diabetes: Counting

Carbs
Counting your carbohydrate

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 intake due to gestational
diabetes? Use these menus,
each of which contains 30 grams
of carbohydrates, to simplify your
dieting.

HIV and Pregnancy

If you are pregnant, we
recommend you be tested for
the human immunodeficiency
virus (HIV) even if you do not
think you are at risk. Learn more
here.

Recognizing Premature Labor

Premature labor occurs between
the 20th and 37th week of
pregnancy, when uterine
contractions cause the cervix to
open earlier than normal. Learn
more.

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 Sex During Pregnancy
The pregnancy may alter how a
woman and her partner feel
about making love, and
differences in sexual need may
arise. Learn more here.

Substance Use During

Pregnancy
While pregnant, it is best to eat
well, stay healthy and avoid
ingesting anything that might be
harmful to the mother's or baby's
health. Learn more.

Guides and forms

Caring for Yourself During  Postpartum: Now that You’ve 

Pregnancy and Beyond Given Birth (English)

Postpartum: Now that You’ve 

Given Birth (Spanish)

Related programs
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 Related programs

Centering Pregnancy Program

The Centering Pregnancy
Program at UCSF Women's
Health Center takes women out
of exam rooms and into groups
for their prenatal care. Learn
more here.

Midwifery Care
More and more women are
choosing to place their prenatal
care, labor and delivery in the
hands of a midwife, usually in a
hospital rather than at home.

Where to get care (5)

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 Helpful resources

KidsHealth 

March of Dimes 

Medline Plus 

WomensHealth.gov 

Related conditions
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 Related conditions

High-risk pregnancy 

Support services

Patient Resource

Case Management & Social

Work
Connect with a team that can
help you find resources, solve
problems and advocate for you
during treatment at UCSF.

Class

Great Expectations Pregnancy

Classes
Get ready for the baby! Choose
from a variety of classes that
prepare moms and partners for
pregnancy, birth, baby care,
breastfeeding and parenting.

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 Patient Resource

Lactation Consultant Support

Get support for all your
breastfeeding needs.
Troubleshoot with a lactation
consultant, find equipment and
supplies, join a support group
and more.

Class

Mindfulness-Based Stress
Reduction Class
This eight-week class teaches
mindfulness practices that can
reduce stress and improve your
overall health, such as meditation
and body awareness.

Patient Resource

Patient Relations
We welcome feedback about
your experience at UCSF Health.
Find out how to contact us with

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 comments, questions or
concerns.

Patient Resource

Spiritual Care Services

Chaplains representing many
faiths are available around the
clock to provide support, comfort
and counsel to patients, families
and caregivers.

Class

Stop Smoking/Vaping/Chewing
Class
Get help quitting. Our tobacco
addiction specialists will guide
you through a four-week course
on smoking, health and how to
quit.

Patient Resource

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 Women's Health Resource
Center
Access free health resources
here, from classes and webinars
to support groups and medical
referrals, plus pregnancy, birth
and breastfeeding services.

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