Scott M. Gulinson, MD, FACOG Call Now 602-678-1111

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Pregnancy/Maternity Care

Pregnancy Care

We welcome you to our Women's Healthcare and Ob/Gyn practice. We strive to provide you with all the information you need to during this incredibly exciting time as you prepare for your new addition! This will be a time of many changes to your body and your perception of you and your surrounding world. Please know that we are here to inform and support you through an amazing and exciting time. Always feel comfortable that you can contact us for any questions or concerns that you may have during your pregnancy and after! Note that we also do carry Belli and Cosmedix skincare products as well which are pregnancy safe and phthalate free. Our office number is easy to remember: 602-678-1111 1. Nutrition 2. Habits 3. Exercise 4. Weight Gain 5. Genetic Testing 6. Fetal Surveillance Testing 7. Fetal Movement Considerations 8. Group B Strep (GBS) 9. When To Go To The Hospital In Labor 10. Delivery Time 11. Postpartum 12. Body After Baby

Nutrition

  • Please drink at least 8-10 glasses of water daily to keep well hydrated
  • Please have an intake of calcium of 1500mg daily. This may be found in foods such as milk, yogurt, cottage cheese or supplements such as Tums, OsCal or Caltrate
  • Your Protein intake should match approximately 8oz of meat daily  This can be found in beef chicken, fish, turkey, Eggs, soy, peanut butter, nuts.  Please do not consume mackerel, shark or swordfish as these have too high of mercury content in them to be healthy in pregnancy
  • Prenatal vitamins are important sources of nutrition to help prevent birth defects and prevent anemia.
  • You may use any vitamins labeled as PRENATAL and if you are unable to tolerate these, Flinstone's chewable children's vitamins have similar content and are much better flavored.
  • Omega 3 FA:  (fish oils and DHA) are important for fetal brain growth and can be used daily
  • Fiber: can help prevent constipation which commonly occurs during pregnancy.  Foods such as raisins, bran, apples, raw veggies and supplements such as Metamucil and fibercon are ok.
  • Caffeine:  should be minimized to no more than 8 oz daily and can be in sodas, teas and coffee
  • Nausea and Vomiting of Pregnancy (Hyperemesis Gravidarum): Morning sickness is nausea and vomiting that can actually occur at any time of the day during pregnancy.

Habits

One should never partake in cigarette smoking, alcohol drinking or use of illicit drugs during pregnancy because of the profound impacts to be had on the developing fetus

Exercise

It is healthy to exercise in pregnancy but learning to do new events would probably be better undertaken when not pregnant. For example, learning to do a marathon when one does not generally run regularly is probably not a good idea. But brisk walking, swimming, etc is generally ok.

Weight Gain

Generally the average weight gain during pregnancy is 7 pounds during the first trimester (0-14 weeks), another 7-10pounds the second trimester (14-28 weeks) and 10-15 pound for the third trimester for an average of approximately 35 pounds. Much more or less than this is potentially troublesome for many reasons during pregnancy and should be avoided if possible through appropriate dietary intake and exercise.

Genetic Testing

(These tests are generally designed to afford a risk assessment for the parents of potential genetic problems and are not diagnostic tests per se). All genetic testing is optional and offered to all of our patients.
  • Quad Screen Test - can detect 85% of Neural Tube Defects (NTDs such as spina bifida and anencephaly) and 75% of cases of Fetal Down's Syndrome. It is typically performed during 15-20 weeks of gestation and if positive will often lead your practitioner to proceed to level II ultrasound and the possibility of amniocentesis for a diagnosis of the reason behind the abnormal tests.
  • First Trimester Nuchal Translucency Testing (NTT) - traditionally done between 11-13 6/7 weeks of pregnancy the NTT detects 90% of Fetal Down's Syndrome and 98% of Trisome 13, Turner's Syndrome and Trisomy 18
  • Ultrasound - can be helpful for evaluation of the fetal anatomy, gender assessment, growth, due date establishment and can be used to help detect some birth defects (up to 35%)
  • Amniocentesis- this is an minimally invasive test used to evaluate the chromosomes directly of the developing fetus. Done under ultrasound guidance, a needle is inserted into the uterus, fluid is sampled and sent for chromosome evaluation to diagnose many chromosomal disorders such as Fetal Down's Syndrome
  • Cystic Fibrosis Testing- is traditionally offered during any time during pregnancy and can be used to determine if the Mother is a carrier for Cystic Fibrosis. If so, the Father is tested and if both are positive for carrier status the developing fetus has a 25% risk for cystic fibrosis (fibrotic lung disease).

Fetal Surveillance Testing

For any High Risk Pregnancies consists of NonStress Testing and Ultrasound for Amniotic Fluid levels and Biophysical Profile and can be done in the office setting insurance depending.

Fetal Movement Considerations

For the last ten weeks of pregnancy you should feel your baby move at least ten times per day during daylight hours.  I usually recommend kick counts on three occasions each day: for one hour after breakfast, after lunch and after dinner. You should feel your baby move 5-10 times during each of these hours! If it is getting close to dinnertime and you have not felt your baby move, you should either eat dinner or drink something that is cold possibly even with caffeine and sugar (for examples: Coke, Mountain Dew, Starbucks Frappachino, orange juice, etc.).  The combination of cold + caffeine + sugar is excellent for making a baby move. Each distinct movement that the baby makes counts as a fetal movement.  For example, if you feel the baby roll to the left and then to the right, that counts as two movements..  If your baby kicks up high and then immediately down low on your abdomen, that counts as two movements as well. If you do this and your baby still does not move at least six times within the next hour, then you should go to labor and delivery OB triage at the hospital and tell the nurses that you are not feeling your baby move. If you speak to women that have delivered a stillborn baby, they almost always will tell you that they did not feel their baby move for two to three days prior to seeking medical attention. This is a horrible mistake. If you cannot feel your baby move at least ten times during daylight hours, and then cannot make your baby move at least six times within an hour after eating dinner or drinking a Coke (or Mountain Dew or Frappachino), then you should then go to OB triage and tell the nurse that you have done everything Dr. Gulinson asked you to do but you are still not feeling your baby move.

Group B Strep (GBS)

Group B strep is a bacteria that typically lives in the vagina, colon and rectum in 15-20% of women.  It is usually not a bad actor for women and is not a sexually transmitted disease. It may cause vaginal itching, discharge, odor or burning but it usually lives alongside the other bacterial flora of the vagina without event.  However, it it potentially dangerous to the newborn baby if exposed. The transmission during birth to the newborn baby can be as high as 50% and can result in neonatal sepsis, meningitis, encephalitis and other critical disease processes.  Our patients are cultured at the beginning of pregnancy for vaginal GBS and again at 34-36 weeks. If any of these or any urine culture during pregnancy shows GBS, the mother is treated when in labor.  Typically treatment is done with penicillin G, ampicillin or clindamycin if allergies exist.  Treatment can result in a reduction of risk of transmission of GBS to the baby from 50% to nearly 3%.  The nursery is notified as is the pediatrician so after birth the baby can be monitored for early and late GBS disease *If a urine culture done at anytime during pregnancy grew GBS in the urine, then you will automatically be treated in labor and a culture at 35 weeks of pregnancy will not be necessary.

When To Go To The Hospital In Labor

After 36 weeks of pregnancy and if this is your first time to go into labor, then:
  • If you think you have broken your bag of water or if you are bleeding and blood is dripping out of you, GO IMMEDIATELY TO OB TRIAGE AT THE HOSPITAL.
  • If you think that you are in labor, but have not broken your bag of water and are not bleeding with blood dripping out of you, then wait until your contractions are so hard that you are having to breathe through your contractions and you cannot walk during a contraction.
  • When your contractions are that strong, then go for a walk for about half an hour, and then go take a shower for another half an hour.
  • With the first baby, most people come to the hospital too early, and are not in labor yet, and they get sent home.  I encourage you to stay at home and allow the contractions to be very strong for at least an hour (as described above) prior to coming to the hospital.  That way there is a less likely chance that you be sent home with a diagnosis of false labor.
  • If you lose your mucus plug, this is normal at the end of pregnancy, and you do NOT need to go to the hospital for this.  Losing your mucus plug does NOT mean that you are about to go into labor.  That is an urban myth (wives tale).
After 36 weeks of pregnancy and if this is NOT your first time to go into labor go:
  • If you think you have broken your bag of water or if you are bleeding and blood is dripping out of you, GO IMMEDIATELY TO OB TRIAGE AT THE HOSPITAL.
  • If you think that you are in labor, but have not broken your bag of water and are not bleeding or having blood dripping out of you, then when your contractions are coming every three to five minutes and you are having painful contractions, then GO TO OB TRIAGE AT THE HOSPITAL.
  • If you lose your mucus plug, this is normal at the end of pregnancy, and you do NOT need to go to the hospital for this.  Losing your mucus plug does NOT mean that you are about to go into labor and is not predictive of impending labor itself.

Delivery Time

Dr Gulinson delivers well over 95% of his own patients.  During times that Dr Gulinson is unavailable several board certified Ob/GYN physicians are available at the hospital of your choice for delivery (Banner Thunderbird or Arrowhead) and this is entirely arranged by Dr Gulinson so you needn't worry about being covered for your care at any time.
  • Hospital affiliations for Dr Gulinson
  • Banner Thunderbird Samaritan Hospital (55th avenue / Thunderbird) 602-865-4657
  • Arrowhead Hospital (67th avenue and Union Hills Rd)  623-561-7215

Postpartum

Generally after vaginal delivery we will visit in the office again 4-6 week later.  Please bring a picture of your baby for our 'wall of fame'!   After a c-section, we need to evaluate your incision in 2 weeks time from the delivery date and then again at 6 weeks from delivery.   We can discuss options for birth control at these visits which will depend upon your desires and whether you are breast feeding or not.

After a Vaginal Delivery

You should place nothing in your vagina for two weeks.  Please do not have sex untilyour six week post-partum office visit, especially if you are planning on having an intrauterine device placed.  If you do resume intercourse before your first office visit, it is important to use some type of contraception (for example: contraceptive foam and condoms.)  Breast feeding is not good birth control and you could show up for your 6 week postpartum visit already pregnant with your next exciting adventure so if this is not in your plans, please abstain or use good birth control. Mild cramping is not common especiall when breast-feeding.  The reflex of breast feeding/nipple stimulation causes the uterus to contract which is nature's way of keeping your postpartum bleeding to a minimum! Expect to have some bleeding or discharge for up to 4-6 weeks.  This bleeding may get heavy with clots and cramps at times. If the bleeding is much heavier than a heavy period, then this is the time that you need to contact Dr. Gulinson's office. It is normal for the bleeding to subside and 3 weeks or so later to have a sudden heavy flow for a day or so. this is the old placental site attachment sloughing off and is usually not a concern unless the bleeding is quite heavy. Notify us if it is or if you feel dizzy or faint.  Your first period may be heavy with clots and cramping.  This is normal for the first period following a delivery. You may take showers immediately. Please no tub bathes for 6 weeks. You may use sitz baths, tucks pads, or anesthetic sprays such as Amercain or Epifoam for your episiotomy.  If you received stitches in your vagina, the knots may occasionally cause some minor irritation.  The sutures will dissolve on  their own, and do not need to be removed. You should take vitamins and iron supplements for at least three months following the delivery or for the whole time that you are breast-feeding.  You may obtain iron and vitamins over the counter at any drug store.  You should take these once a day. Constipation is a common problem, which can usually be remedied with over the counter stool softeners (Senakot, Correctol, etc.).  Take these as directed on the package label. You should be the judge of your activity, knowing that you will get tired easily and not to overdo it. Avoid strenuous activity for 2-3 weeks.  During this period, lift nothing heavier than twenty pounds.  Toward the end of your recovery, you may engage in light exercise if you wish.  Avoid overdoing it… When breast-feeding, nurse every 2-3 hours for 20 minutes per breast.  Start each feeding with the last breast used.  Drink plenty of fluid (at least 8 8-ounce glasses of water per day) and eat a well balanced diet.  For mothers who choose not to breast feed, we do not recommend the use of medications to stop the production of breast milk.  A tight fitting bra, ice packs and Tylenol are preferred.  Raw cabbage leaves placed inside your bra at nighttime can also help dry up your breast milk.  At least one week will be required before milk production ceases.  During this time, it is important to avoid any form of nipple stimulation. It is important that you call your doctor for any of the following: temperature of 100.4ºF or more, chills, inflamed breasts, loss of consciousness or worsening pain. Glendale and Phoenix residents should call Dr. Gulinson's office during regular office hours to schedule your post-partum visit at approximately 4 weeks from your delivery date. It is a pleasure to take care of you during this most exciting time in your lives! If you have any questions please do not hesitate to contact me or a member of my office staff!   Thank you!

After a C-Section

You should place nothing in your vagina for 6 weeks.  Please do not have sex until after your six week post-partum office visit, especially if you are planning on having an intrauterine device placed.  If you do resume intercourse before your first office visit, it is important to use some type of contraception (for example: contraceptive foam and condoms.) Mild cramping is not unusual especially if you are breast-feeding.  This is perfectly natural and should not be a cause for concern.  Expect to have some bleeding or discharge for up to 4-6 weeks.  This bleeding may get heavy with clots and cramps at times.  If the bleeding is much heavier than a heavy period, then this is the time that you need to call Dr. Gulinson's office.  Your first period may be heavy with clots and cramping.  This is normal for the first period following a delivery. Showers should be taken for the first two weeks.  You may take tub baths after that. You should not drive a car for the first three weeks following your discharge from the hospital. You should take vitamins and iron supplements for at least three months following the delivery or for the whole time that you are breast-feeding.  You may obtain iron and vitamins over the counter at any drug store.  You should take these once a day. Constipation is a common problem, which you can remedy with over the counter stool softeners (Senakot, Correctol, etc.).  Take these as directed on the package label. You should be the judge of your activity, knowing that you will get tired easily and not to overdo it. Avoid strenuous activity for 2-3 weeks.  During this period, lift nothing heavier than twenty pounds.  Toward the end of your recovery, you may engage in light exercise if you wish.  Avoid overdoing it… Following cesarean section, no heavy lifting or heavy work should be done for the first two weeks. Following that, you may then begin light exercises and increase the intensity without overexerting yourself. When breast-feeding, nurse every 2-3 hours for 20 minutes per breast.  Start each feeding with the last breast used.  Drink plenty of fluid (at least 8 8-ounce glasses of water per day) and eat a well balanced diet.  For mothers who choose not to breast feed, we do not recommend the use of medications to stop the production of breast milk.  A tight fitting bra, ice packs and Tylenol are preferred. A tight fitting bra, ice packs and Tylenol are preferred.  Raw cabbage leaves placed inside your bra at nighttime can also help dry up your breast milk.   At least one week will be required before milk production ceases.  During this time, it is important to avoid any form of nipple stimulation. It is important that you call Dr. Gulinson's office for any of the following: temperature of 100.4ºF or more, chills, inflamed breasts, loss of consciousness, worsening pain, burning with urination, or severe leg pain.  It is not uncommon to experience pain while moving about at either side of a "bikini-cut" incision.  The knot that was tied to hold the suture in place causes this. You should call Dr. Gulinson's  office during regular office hours to schedule your post-surgery 2 week visit.  Please call the office soon in order to schedule this follow-up visit.  Dr Gulinson usually sees his post c/section patients at 2 weeks for an incisional and overall well being evaluation and at 6 weeks post delivery for a physical.  We can discuss birth control at either of these visits. If you have staples in your incision, you may need to call your doctor to have these removed within a few days after discharge from the hospital though most of the time these will be removed prior to your discharge from the hospital.  If you have steri-strips (paper band-aids) over your incision, you may pull these off after five days, or you may leave them alone until they begin to peel off.  If you have surgical glue (Dermabond) on your incision, you should leave this alone until six weeks after surgery.  You may then peel off the remaining glue.  By this time it will be brown and rubbery.

Body After Baby

Most of us want to look and feel our best after delivery and get our body back!   Diet and exercise are an appropriate part of this regime.  Breast feeding can also help burn extra calories for you. Your doctor will notify you of when you can resume more vigorous exercise program and a proper weight loss diet if necessary.  Staying adequately hydrated is extremely important as is good nutrition and vitamins for your general health.   However, if after time you do not succeed in getting your body back to form as you would like, our office is equipped to help you with other options such as Smart Lipo laser lipolysis for removal of those stubborn fat deposits on the abdomen and waist/hips and Velashape body contouring for the reduction of cellulite and circumferential reduction of the hips and thighs and smoothing of the abdomen.  A powerful combo indeed!

Velashape Body Contouring www.syneron.com

One of the latest treatments for improving shape of the body is known as Vela Shape. This non surgical procedure, approved by the FDA, can help women reduce the size of their thighs and also decrease the localized fat pockets all over the body. Studies from Europe indicate that the treatment is safe, painless and effective. Vela Shape is a mechanical device that combines radiofrequency waves with vacuum massage therapy to reduce cellulite all over the body. Reports by the manufacturers indicate that the Vela Shape can rapidly lead to improvements in body contour and results in a more aesthetically looking figure. In fact, studies have reported patients losing several inches off their waist in just 4-6 weekly treatment sessions. Vela Shape treatment is done as an outpatient and has no downtime. The procedure is performed at a spa or the physician's office. Most people require at least 4-6 sessions to get the optimal cosmetic benefit. There are many anecdotal reports that suggest that individuals who undergo Vela Shape treatment can lose weight and reduce circumference of both the thighs and waist. At present Vela Shape is used to treat fat pads/cellulite in the thigh, abdomen and neck. The procedure is often combined with liposuction to get the most effective results. Many women also undergo Vela Shape treatments after delivery. Besides removing fat and cellulite, other benefits attributed to Vela Shape therapy include better circulation of blood, decrease joint pains and a firmer skin tone. To maintain the benefits of Vela Shape, it is highly recommended that all individuals enter into an exercise program and watch their calorie intake. (Please feel free to learn more about our body contouring procedures at our medspa site www.laserphoenix.com)

SmartLipo Laser Lipolysis (www.smartlipocynosure.com)

The Smartlipo Laser lipolysis procedure is a minimally invasive surgical procedure that Dr Gulinson has been specially trained in from cosmetic surgeons in Beverly Hills and Monterrey California. Utilizing the revolutionary tumescent technique for this procedure, we are able to provide incredible results during an awake procedure for the patient. Areas of fat deposits that don't respond well to exercise and dietary program can be targeted specifically by the laser itself. Furthermore, while lysing the fat cells the smartlipo laser concurrently coagulates and treats underneath the skin which can result in dramatic skin tightening. Dr Gulinson believes in the Tumescent Technique as the safest modality for liposculpting and body contouring and has received extra certification to be able to offer this procedure which is now accepted as the worldwide standard of care. With Tumescent Technique Liposuction/Liposculpture one can expect better results, quicker recovery and a minimized downtime with most returning to work in 2 days and to exercise in 4-5days. The small cannulas allow for this to be considered an artistic procedure rather than simply a cosmetic surgery! Dr Gulinson is specially trained in Laser Liposuction of the abdomen and waist.

Here's is the Procedure in a Small Summary!

  • Local tumescent anesthesia is used (you're awake during the procedure)
  • A tiny incision is made, about the size of the tip of a pen
  • The Smartlipo laser fiber is inserted through a very small tube into your body
  • The laser ruptures the fat cell membranes
  • The fat cells are permanently destroyed
  • The liquefied fat is gently suctioned out
  • New collagen is produced resulting in coagulation of skin, resulting in tightening
Typically, only one treatment is required dependent on the number of areas to be treated. Results may vary, but usually can be seen within a week, with continued improvement over three to six months.

Here's How it Works

  • Local anesthesia is used (you're awake during the procedure)
  • A tiny incision is made, about the size of the tip of a pen
  • The Smartlipo laser fiber is inserted through a very small tube into your body
  • The laser ruptures the fat cell membranes
  • The fat cells are permanently destroyed
  • The liquefied fat is gently suctioned out
  • New collagen is produced resulting in coagulation of skin, resulting in tightening
Typically, only one treatment is required dependent on the number of areas to be treated. Results may vary, but usually can be seen within a week, with continued improvement over three to six months.
Scott M. Gulinson, MD, FACOG