I hope this information is helpful to all future and current pregnant women. I cover the most asked questions I receive concerning pregnancy and delivery. If you have any questions please do not hesitate to send me a message through the patient portal. I try to make myself accessible to all my current and future patients. I look forward to helping make your pregnancy as enjoyable as possible.
Jonathan Weinstein, MD, FACOG Frisco Womens Health
Baylor Medical Center at Frisco (972) 668-8300
40 weeks from the first day of your last menstrual period, not 9 months, sorry, and of course your baby rarely comes on your due date sometimes labor can ensue as much as a week and half after your due date. After 41.5 weeks, your risk of problems with your child goes up so induction of labor must occur. Luckily, by this time most women either already went into labor or are so dilated that induction and delivery goes well. If you have irregular periods, your due date may vary as this effects the day you ovulated.
Usually I will see you every 4 weeks until 28 weeks, 2 weeks until 36 weeks, then weekly until delivery. Do not void before you come to your visit, you can go right to the restroom, give a clean catch specimen (instructions are in the restroom) and put your name on the cup. You do not need to wait for the nurse to come get you and it will speed up your visit, I promise. I often perform an early ultrasound to confirm your due date at the first visit, but it is not required. Around the sixth or seventh week is good time for your first visit.
For your convenience, a phlebotomist is present in our office during normal business hours. Initial Visit Blood type, Antibody Screen, HIV, Hepatitis B, Rubella (German Measles), Blood Count, Thyroid Stimulating Hormone, Urine Culture, Chicken Pox titer, Herpes Simplex Type 2, Vitamin D Level (associated with bone growth for your baby), Pap smear, Gonorrhea/Chlamydia, vaginal culture and a Urine Drug Screen. Hemoglobin Electrophoresis is performed for certain ethnicities. Additional testing maybe needed based on lab findings noted above. 24-28 Weeks Complete Blood Count and Gestational Diabetes screening. 34-36 Weeks Group B streptococcus vaginal culture looks for a bacterium, originating in the intestine of 1 in 3 women. It has no effect on adults. We treat it in labor with antibiotics, Penicillin or Clindamycin. Group B streptococcus is most dangerous to babies that are born premature, as it can cause pneumonia or sepsis (a severe bacterial infection in the blood). It is not an issue if you are having a Cesarean Section. If you have ever had this bacteria notify me, you are a carrier for the bacteria and you do not need to be retested each pregnancy.
Genetic carrier screening is testing that looks at your genes to determine whether you are a carrier of certain genetic disorders. A positive result tells you with greater than 99% certainty that you are a carrier of a specific genetic disorder, and you could be at risk of having an affected child. Cystic fibrosis (CF) is the most common fatal genetic disorder in North America. It causes the body to produce very thick mucus that can damage internal organs. It clogs the lungs—leading to life-threatening infections—and can cause digestive problems, poor growth and infertility. Symptoms range from mild to severe, but do not affect intelligence. On average, CF patients live into their late thirties. About one in every 3,500 babies born in the U.S. has cystic fibrosis. Spinal muscular atrophy (SMA) is the most common inherited cause of infant death. It affects a person’s ability to control their muscles, including those involved in breathing, eating, crawling and walking. SMA has different levels of severity, none of which affects intelligence. However, the most common form of the disorder causes death by age two. About one in every 6,000 to 1 in every 10,000 babies born in the US has SMA. Fragile X syndrome (FXS) is the most common inherited cause of intellectual disability. Symptoms cover a wide range, from mild to very severe. About one-third of all people with FXS also have autism. Individuals with the disorder may also have behavioral issues, such as hyperactivity, social anxiety and aggression. Carriers may also be at risk for fragile X-associated primary ovarian insufficiency or an adult-onset syndrome called fragile X-associated tremor/ataxia syndrome. Though FXS occurs in both sexes, males are more frequently affected than females, and generally with greater severity. Approximately one in every 3,600 boys and 1 in every 6,000 girls is born with FXS. No test can detect 100% of genetic carriers. Even if your test results are negative, it is still possible that you could be a carrier of the genetic disorder, but the chance is small. The decision to accept or decline genetic carrier screening is completely yours. Verifi Fetal Chromosome testing by Progenity is used to detect whether your pregnancy has a chromosomal abnormality such as too many or too few copies (this is called an “aneuploidy”) of certain chromosomes (e.g., chromosomes 21, 18, 13 as well as the sex chromosomes, X and Y). It can also test for trisomies (too many copies) of chromosomes 9 and 16, as well as microdeletions of the following chromosomes: 22q11, 15q11, 1p36, 4p-, and 5p-. This test is intended to be performed during the 10th week of pregnancy, as estimated by last menstrual period (8 weeks from conception), or any time after that. This test analyzes the DNA (genetic material) in your blood to determine whether a chromosomal abnormality is present. Depending upon what your healthcare provider orders, the test results may include the sex of the fetus. If you do not wish to know the sex, please indicate your desires in the consent below. Depending upon the test ordered, in certain circumstances you may not be able to prevent learning the sex of the fetus. Test results usually take two weeks; you will be notified via the patient portal. Like all tests, this test has limitations. It can only detect the specific chromosomal abnormalities tested. Normal test results do not eliminate the possibility that your pregnancy may have other chromosomal abnormalities, birth defects, or other conditions, such as open neural tube defects. A normal result does not guarantee a healthy pregnancy or baby. For additional information go to, http://progenity.com
Baby's Heart Beat - Once the uterus reaches twelve weeks you will be able to listen to your baby’s heart with a small machine called a Doppler. As the baby gets larger I will measure the distance from the top of your pubic bone to the top of the uterus. In centimeters this measurement should be within three of your number of weeks pregnant, this reassures me your baby is growing appropriately. At each visit please leave a urine specimen as soon as you arrive, it is used to make sure you are not developing a urinary tract infection, becoming dehydrated or spilling protein in your urine. Proteinuria can be a sign of developing Preeclampsia or Toxemia of pregnancy, when associated with elevated blood pressure.
Birthing Classes - Besides Baylor of Frisco being a wonderful place to have your baby, the Baylor hospital provides a series of free classes related to pregnancy. Classes range from, ‘what to expect in labor and at deliver’, ‘breastfeeding’, ‘a class for new dads’ and ‘infant cardiopulmonary resuscitation (CPR)’. They also provide tours of the Women’s Center, a clinic to help install your car seat appropriately and at least six lactation consultants for after delivery and discharge. At your first visit to the office you will be provided with this information. In the third trimester we will provide you with samples of formula along with valuable information to help ease the transition to home. If you plan to deliver naturally I can provide you some referrals to more traditional birth classes (i.e. Bradley Method) in the community or make recommendations for a doula, if desired.
Prenatal vitamins should be started two months before conception to decrease the risk of a group of birth defects called neural tube defects. The two main types are prescription and over the counter prenatal vitamins. Prescription prenatal vitamins The gold standard and we have coupons for many different kinds, including chewable . In general, prescription prenatal vitamins will have more iron; all have stool softener and will have the recommended 800 milligrams of folic acid. Generic prenatal vitamins are regulated by the Food and Drug Administration and can have a twenty percent variance in their contents when compared to the label. Over the counter prenatal vitamins Over the counter prenatal vitamins are not regulated by the Food and Drug Administration so what it states on the label may not be what is in the pills. These defects involve failure of the baby’s anterior or posterior walls to close and in its most severe form causes Anencephaly, where the brain does not develop.You should also be looking for 200 mg of Docosahexaenoic Acid (DHA), an omega-3 fatty acid found in breast milk and formula. It contributes to brain, nervous system, and eye formation.
Vaccinations in Pregnancy, Why Do I Need Them? Tdap – Adult version of Tetanus, Diphtheria and Pertussis (Whopping Cough) Vaccination, has only been available for the last 3 years. Whopping Cough protection for your baby does not occur until 6 months after delivery. Any person who will be around your baby on a regular basis should receive a booster vaccination in adulthood. Pregnant patients are offered Tdap right before they leave the hospital. Other baby contacts can come by our office at any time to receive the vaccination, just call for a nurse visit. Whooping Coughing is on the rise, so get vaccinated. Influenza (Flu) Preservative Free Vaccination – If you do not routinely receive vaccination fine. Multiple studies have shown that when the flu vaccination is given to a pregnant patient it confers immunity to your baby for up to six months after it is born. Flu vaccine is not administered to a child until they are at least 6 months old so vaccinating yourself will help the baby from potentially getting very ill.
Typically with first pregnancies you will begin to feel your baby move around 18-20 weeks. For subsequent pregnancies the baby is often noted to be moving earlier in the pregnancy, 16-18 weeks. Some variation in timing occurs as a result maternal weight and the location of the placenta.
Studies show that drinking eight cups of coffee a day will increase your risk of miscarriage. This is presumed to be caused by excess caffeine intake so do not forget the soda and tea you drink when calculating caffeine intake. Other Options You need to drink at least eight 8-ounce glasses of water, Gatorade or a combination of any liquids each day. Remember juice is high in sugar and calories so drink in moderation.
If you have been exercising, you do not have to stop. Although, now is not the time to start training for a marathon. After the 1st trimester, you should not perform exercises lying on your back. Walking at work is not exercise, make time for aerobic exercise, you will feel better.
I will make this very simple. Every over the counter medication is okay in moderation except anti-inflammatories, like Motrin (Ibuprofen), Aleve (Naproxen), and Aspirin. They can cause fetal kidney damage. Tylenol is okay for pain. Remember the anatomy of the baby does not completely form until 20 weeks; the last parts to be formed involve the central nervous system.
When I was conceived, my mom, as most pregnant women were told it was okay to drink a glass of wine each night to relax? The physicians back then had the right idea. Recent studies emphasize the importance of getting good sleep. Lack of sleep is associated with prolonged labor and an increased risk for Cesarean Section. I do not condone occasional wine at night to relax, but an occasional sleeping pill will not hurt. Do not hesitate to ask.
Sleeping During Pregnancy - Were women created with the intention of them sleeping on their left side at all times during pregnancy? Of course not, it may be helpful to lie on your left side during labor if your baby is in distress but a healthy baby will not be affected by waking up on your back or right side. Most pregnancy books will tell you it is imperative that you always sleep on your left side. This is based on the anatomical fact that your Aorta, which is the main oxygen-supplying blood vessel of your body, is located slightly to the right of midline. By lying on your left side you may prevent decreased blood flow to the uterus. It is much more important to get adequate rest then to worry about what side you wake up on in the morning.
It is bad enough that the pregnancy slows down your intestines, add prenatal vitamins that contain iron supplementation and it only gets worse. Your goal is to have a bowel movement daily. I know for many women this may not be a common occurrence but it will decrease your risk of colonic polyps, colon cancer, hemorrhoids, and anal fissures. Although many vitamins contain stool softeners they do not often correct the problem of slow intestinal transit. Gentle Laxative Drink at least eight 8-ounce glasses of water each day. When the problem cannot be corrected by increased dietary fiber and fluids then a gentle laxative like Correctol or MIralax will help. Miralax is a tasteless odorless powder that can go in your drink or on your food, you start out with using it four times a day until you have a normal bowel movement then you can cut it back to once or twice a day. Cause of Hemorrhoids Hemorrhoids are dilated rectal veins that occur because of decreased blood flow from the lower part of the body to the upper part. As your uterus enlarges it pushes on the large vein next to the Aorta slowing down the return of blood to your heart and dilating your rectal veins, leg veins (varicosities) and capillaries. Treatment of Hemorrhoids The only treatment for the prevention of hemorrhoids is to avoid constipation. Once you have a symptomatic hemorrhoid, there are over the counter medications to help. Anusol to decrease swelling and Dibucaine cream to act as a local anesthetic. If these do not help some prescription medications may help.
Water Breaking If your water breaks, regardless of whether you are having contractions you need to come to the hospital. If the baby is less than 37 weeks you need to come in right away. If you are over 37 weeks you can take a shower and stay at home for the beginning of labor. If your water breaks and it has green particles in it, that tells you the baby has had a poop in the amniotic sac, which can be a sign of fetal distress. You should come right to hospital. Contractions You will know you are in labor when your contractions are 5 minutes apart for at least 1 hour and are so strong you cannot take a breath when they occur. If you can carry on a normal conversation or are laughing you are probably not in labor. Each additional baby you have usually shortens labor so if you are having contractions a little less frequently you probably need to come in sooner. It is unnecessary to call me when you go into labor, just head up to Labor and Delivery, the nurses will check to see if you are dilating or verify if your water broke. What Should I Do if My Mucous Plug Comes Out? Absolutely nothing. Your cervix will release a tremendous amount of white, thick mucus as the pregnancy progresses. It does not mean you are going into labor anytime soon. An unscented panty liner will help keep your underwear dry.
Cesarean Section and Induction You may not eat or drink for eight hours before a scheduled Cesarean Section or Elective Induction, as anesthesia will cancel your induction or surgery. Once labor starts, despite some patients desire to go out for a big meal this would be a big mistake as you will only end up vomiting up your meal as much as twenty-four hours after eating it. It is not fun to be pushing out a baby and be vomiting at the same time. Most women get nauseous towards the end of labor. We usually limit your intake during labor to ice popsicles and chips.
Most likely me. If I am in town, I will attend your delivery. I have children so we usually travel when school is out. If I am unavailable, one of my colleagues who has a similar desire for you to have a normal vaginal delivery will be available. I am in solo practice and have two children, Zoe and Ashton. We usually go on vacation when school is out. I was in a twelve-person group when I first got out of training. I did not know most of the patients I delivered and I found it very awkward meeting the patient at the time of delivery. I am sure the laboring patients were just as uneasy about the situation. I really enjoy getting to know my patients and find it very fulfilling to be at the birth of your child. This is why I try limiting my delivers to ten per month.
Are there any foods I cannot eat in Pregnancy? Raw fish and meat are not good, as they carry parasites. Solid white tuna is high in mercury so eat it in moderation. Unpasteurized cheese is also to be avoided. Most everything else is okay.
My Herpes Simplex 2 Titer Came Back Positive. How Can That Be, I Have Never Had Symptoms and I Have Been Checked For Sexually Transmitted Diseases? Let me start by saying this occurs about once a month. Blood tests to check Herpes Simplex 2 exposure have not been around a very long time. Many physicians just do not do this testing even if you ask to be checked for all sexually transmitted diseases. The only reason I check it in a pregnant women is that 80% of Herpes Simplex 2 outbreaks occur in the genital area. When you are pregnant, your immune system is suppressed making it more likely you will have an outbreak. If there is any suggestion you are having a genital Herpes outbreak at delivery you will get a Cesarean Section to prevent transmission to the baby. If you have a positive antibody result indicating past Herpes exposure and you have never been tested before, I have no idea how long you have had it, so I do not know who gave it to you. The only reason I test for Herpes exposure is that if you take Valtrex, an anti-viral medication for the last four weeks of the pregnancy you have almost no chance of having an outbreak at delivery. As a result, you can have a normal vaginal delivery.
No matter how many ultrasounds you have during your pregnancy it is the first one that will help determine your due date. If the ultrasound due date is within a week or so of your calculated due date by your last menstrual period then we do not change your expected delivery date. The later you get in your pregnancy the more inaccurate your calculated due date will be. Some babies are born six pounds while others ten pounds but early in pregnancy all babies are about the same size. So once you have your first ultrasound whatever due date we determine is your permanent due date.
What if I Desire An Elective Cesarean Section or Induction of Labor? This is completely up to you. I will explain to you what the risks are of having a Cesarean Section or elective induction. Then it is up to you to decide whether you wish to proceed. It is hospital and American Congress of Obstetricians and Gynecologists policy not to electively deliver anyone before 39 weeks pregnant due to the risk of fetal prematurity.
Typically a normal vaginal delivery goes home anywhere from one to two days after delivery, while a Cesarean Section stays anywhere from two to four days from date of delivery. Length of stay is usually up to the family.
If you do not get unbearably nauseous or vomit, great, if you do then here are some simple remedies: Small meals with some starchy foods, like crackers, will help absorb some of that stomach acid. Do not eat three meals a day, like the rest of your family. Instead, you should be snacking throughout the day. Drink liquids one-half hour after eating solid foods, distending your stomach makes you vomit. Do not eat anything within two to three hours of lying down. Eating or drinking stimulates stomach acid. The progesterone hormone your pregnancy makes, relaxes the smooth muscle valve separating your stomach and esophagus. Gastroesophageal reflux ensues and acid travels up to the throat, leading to nausea and vomiting.
All three of these problems relate to increased Progesterone hormone levels from pregnancy. Progesterone is a smooth muscle relaxant. Smooth muscle contraction is responsible for the movement of food through our intestines. Muscle relaxation leads to bloating and constipation. Epigastric pain and heartburn relate to the same issue, relaxation of the smooth muscle that separates the valve between your stomach and esophagus. Relaxation leads to the reflux of stomach acid back into the chest and sometimes to the throat leading to vomiting or a chronic cough. Treatment ranges from dietary changes, such as avoiding fatty or spicy foods, mild antacids such as Tums or Maalox and prescription proton pump inhibitors like Prilosec, Prevacid, or Protonix, which need to be taken daily.
Cramping as the baby settles into the uterus. Your uterus (womb) is a large muscle that stretches and contracts. Round ligament pain is intermittent stretching, and pain, on either side of the lower front pelvis. This is a direct result of stretching of the supporting structures of the uterus. Second and Third trimester Contractions feel like menstrual cramps and your uterus tightens, sometimes they occur in the back and they always come and go. Four or less in an hour is normal. Often called Braxton-Hicks contractions they can help your cervix ripen to make labor shorter. Sharp shooting pains down the front or back of legs, toward the vagina and buttocks. In addition, numbness in the front and back of your legs can occur. This is all related to nerves coming out of your back and pushed on by the uterus. Try the knee chest position or bathe it may relieve the pain. Often they just resolve in a few seconds. It is not a problem with the baby just annoyance for you. Your Back Hurts Constantly I know some great female physical therapists that specialize in women’s health issues. In addition, I always recommend a good massage.Swelling of hands and feet may lead to numbness and a tendency of your hands or feet to fall asleep, if left in a certain position for an extended period.
After your first trimester, I recommend no lifting or moving over ten pounds. This is mainly because you are going to hurt your back.
There is no restriction on sexual activity unless either the Perinatologist or I have told you otherwise. Sex cannot hurt your baby or cause a miscarriage. It can sometimes cause some spotting and cramping which is normal. Later in the pregnancy, semen and nipple stimulation can help initiate labor. Walking, drinking castor oil and other wives tales have never been shown to induce labor. Walking will make you tired and hurt more, while castor oil will give you diarrhea.
I Am Having Twins, How Will This Affect My Prenatal Care, Labor, And Delivery? Twins on average go to only 36 weeks pregnant, which is probably good since by then you are wondering if your belly can stretch any further. Another big plus, twins develop faster than a singleton pregnancy. A 34-week singleton born early would more than likely have trouble breathing on birth, while twins will likely come out screaming. This is likely due to the added stress on twins of fighting over mom’s nutrients. Twin pregnancies have a higher risk of causing gestational diabetes for mom. They also require more close monitoring with monthly ultrasounds, to ensure equal growth of the both babies. Sometimes one tries to get more than its fair share of mom’s nutrients. We like to see no more than a 20% difference in fetal weight throughout the pregnancy. The Perinatologist will follow you throughout your pregnancy. Concerning your delivery, if the presenting twin is head down or cephalic, vaginal delivery of two beautiful babies is a definite option. Most other physicians will just say you need a Cesarean Section. This is not how I was trained. I have delivered twins vaginally that were cephalic/breech and cephalic/cephalic. If the first twin is breech then you will likely need a Cesarean Section. Ultimately, the decision on how you wish to delivery is entirely up to you.
All women planning pregnancy should be taking prenatal vitamins with at least 800 micrograms of folic acid, for the two months prior to conception. Many chronic diseases that are present while pregnant follow the rules of thirds. One-third of the time the diseases get better, one third get worse and one third of the time there is no change in the symptoms. These diseases include Asthma and most Rheumatologic disease like Psoriasis or Rheumatoid Arthritis. All women with a chronic disease should see me before they get pregnant. Give me the opportunity to help ensure your pregnancy will be uneventful by making a plan. Let’s get your blood pressure under control with safe blood pressure medication for pregnancy. Let us get your diabetes under complete control before that positive pregnancy test. Lastly, if you have had multiple pregnancy losses I need to see you before you try again, there are many correctable and treatable causes for recurrent miscarriages.
Typically, if elevated blood pressure (BP) is noted before the 20th week it is considered chronic or preexisting to the pregnancy. After 20 weeks pregnant, new onset blood pressure is often caused by chemicals released by the baby resulting in Preeclampsia or Pregnancy Induced Hypertension (PIH). Both diseases require additional baseline laboratories and fetal surveillance, i.e. ultrasounds and fetal heart monitoring in the office. Chronic Hypertension usually requires medication throughout the pregnancy to keep it under control. Pregnancy Induced Hypertension may require blood pressure medication at the time of delivery, along with Magnesium Sulfate to prevent maternal seizures. Pregnancy Induced Hypertension is more common with your first baby, in people with preexisting chronic hypertension and in those who had Pregnancy Induced Hypertension with their previous pregnancy.
How Is Preexisting And Gestational Diabetes Mellitus Diagnosed And Treated? Preexisting Diabetes Mellitus needs to be under excellent control prior to conception, as an elevated Hemoglobin A1C above 8.5 is associated with a 25% chance of a severe heart defect. Ophthalmology consultation, baseline labs, and an EKG are required as soon as pregnancy is confirmed.
Can I Dye My Hair or Get My Nails Done? The chemicals in hair dyes and just in the air from nail salons can cause birth defects. The risk may be less than swallowing these chemicals but there is a risk so I do not advocate either of these. Spider & Varicose Veins (Legs and Vulva), Why Me and What Can I Do? Unfortunately, this is usually a genetic problem so blame it on your parents. The valves in your veins just do not pump the fluid in your legs up to your heart very well. Toning your leg muscles will improve circulation. The best prevention is the daily use of medical grade support hose. Jobst is a good company and we have some in the office. Obviously, in the Frisco summer, support hose are not feasible but they are great for people who stand a lot in an air-conditioned environment.
Leg cramps can wake you in the middle of the night and can be quite painful; get your significant other to massage it out for you. There are a few potential causes for recurrent leg cramps, low levels of potassium or calcium. You can try eating foods with higher potassium content (many fruits and vegetables check the internet for a list) and you should already be taking in at least 1,200 milligrams of calcium a day. Each serving of milk, cheese, or yogurt has 300 milligrams of calcium. If you are not a fan of dairy products than either Tums or any calcium supplement will do; in addition, Tums can help with pregnancy heartburn. Another common cause of leg cramps is poor circulation. Treatments include increasing calf and general leg muscle tone to prevent lactic acid build up, stretching the muscles that give you trouble and medical grade support hose.
Itching is very common in pregnancy and often occurs around the breasts and belly; it is related to skin stretching and hormone changes. Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPS) is a skin disorder unique to pregnancy. It starts as small itchy, red bumps around stretch marks that become larger patches that spread over the entire body. Antihistamines and high dose steroid creams can provide relief. I have seen this resolve during pregnancy but often it goes away only after the birth of your child. Stretch Marks There are no miracle cures for stretch marks as they are typically hereditary but keeping your stomach well moisturized may alleviate some of the symptoms.
Carpal Tunnel symptoms are a result of swelling within the sheath around your wrist that leads to compression of the median nerve. The median nerve goes to the last three fingers on your hand and causes numbness. This will resolve after you deliver. I do not find hand splints to be very helpful but you are welcome to see an orthopedist, preferably a hand specialist. Swelling in the legs puts pressure on the nerve endings in the feet and as a result causes swelling, numbness and a tingling sensation. It will resolve after delivery.
This is very common in pregnancy. It is only an issue if your blood pressure is elevated, you are having a headache that won’t go away with rest or Tylenol, you develop severe middle or right upper abdominal pain unrelieved with liquid Maalox or start seeing flashing lights in front of your eyes. These can be indicators of Pregnancy Induced Hypertension and needs to be evaluated in the office or at Labor and Delivery. Elevating your legs above the level of your heart will make it better, but the swelling will likely return when you get up. Please note that after you deliver, many patients have increased leg swelling for the first few weeks. It takes a while for your body to remove the excess fluid you were carrying to support the baby.
Despite the advancements in formula, nothing compares to breast milk or breastfeeding. Breastfeeding creates a bond with your child that no bottle can ever replace. Even if you only breast feed until you return to work, you are providing additional immunity for your baby to fight off infection.
An abnormal Pap smear in pregnancy with or without human papilloma virus (HPV) warrants a colposcopy in the second trimester. Colposcopy uses a camera to look at your cervix. Unless I see findings that suggest cervical cancer, no biopsy is done. I just repeat the Pap at your postpartum delivery. If you have had normal Pap smears in the past, it is unlikely that you have suddenly developed cancer. Cervical cancer usually takes ten years to develop, and you would pretty much have to miss most of your PAP tests during that time. Human papilloma virus if detected cannot hurt your baby at delivery.
Travel by any means, automobile, bus, train or plane is fine in pregnancy. The most important thing to remember on longer trips is you need to get up and walk each hour. If you do not, you increase your risk of developing a blood clot in your legs due to poor circulation. Support hose are also recommended. You may travel at any time during your pregnancy, there is no cutoff date. Obviously the closer you get to your due date the more likely you are to deliver your baby somewhere other than Frisco, Texas. Common sense tells you, if you are already having pregnancy complications and you decide to travel, than you risk being taken care of by an emergency room physician, in another state or country, who is unfamiliar with your medical history.
Very often patients ask for a recommendation and some like to interview them before delivery. All pediatricians are nice; they work with children everyday so you should expect no less. Pediatricians like any professional are not all equally knowledgeable or work well under pressure, like when your baby is having an unexpected problem after delivery. How do I know who the best physicians are to take care of your child? Simple, I asked the nursery nurses who work side by side with the pediatricians. From a list of over forty physicians on staff at Baylor Medical Center at Frisco, they narrowed it down to less than ten. Please feel free to ask for a recommendation.