Frequently Asked Questions:
We perform deliveries and surgeries at Shady Grove Medical Center in Rockville, MD. We also do gynecologic procedures and circumcisions at an outpatient surgery center called Maryland Surgery Center in North Bethesda, MD.
We take pride in getting to know our patients throughout the course of their pregnancies and being there to celebrate the special time on Labor and Delivery as you welcome your new baby, therefore we do not cross cover with other groups. We want our patients to be comfortable with all the doctors at the practice, and to that end, we encourage you to meet all the doctors at some point during the pregnancy.
Please call the office at 301.530.2235(Bethesda) or 301.330.5401(Rockville) during regular business hours to leave a message with the triage nurse. Messages left before 4:00pm will be returned the same day. You may also contact us through the patient portal for non-urgent questions that do not require a response the same day or next day. You should receive a response in 2-3 business days. For an emergent situation, please call us right away and ask to speak to a nurse. We will advise either an office visit or evaluation at the hospital.
It is common to have irregular contractions throughout pregnancy. As your due date approaches, you may notice more frequent tightening in your abdomen or menstrual like pains that are getting stronger. Please time these contractions and call the office at 301.530.2235 to speak to either the triage nurse or on-call physician. We will either evaluate you in the office or ask you to proceed to the hospital if they are 5-7 minutes apart for your first baby and 7-10 minutes for your second (or more) baby and you are getting progressively more uncomfortable. Also, please call if you think your water may have broken. This may be a large gush of fluid or a consistent trickle of fluid. If you are unsure, we prefer you call and talk it through with one of the nurses or physicians.
Routine lab results (STD testing, glucola etc) usually return in 1-3 business days. Specialized bloodwork and genetic testing can take up to 2 weeks. Pap smears and office biopsies can take 7-10 business days.
There are 3 ways to get a prescription refill. You can call the office at 301.530.2235 and press the prompt to request prescription refills. Alternatively, you can make a request through the patient portal. Or, you may ask your pharmacy to contact our office to authorize a refill. Please try to complete these requests during regular business hours.
Frequently Asked Questions in Pregnancy:
There is a bacteria that may be present in deli meats and unpasteurized, soft cheeses (brie, feta, blue cheese, queso blanco, etc.) that may infect pregnant women. Although it is very rare, it can be very serious. Therefore, it is recommended that pregnant women avoid deli meats (unless they are heated thoroughly) and unpasteurized cheeses. In addition, all meats and fish should be cooked all the way through. We recommend against any undercooked or rare steak, burgers, fish, or sushi. Fish is safe and recommended 2-3 times a week. Please avoid high mercury containing fish, such as shark, swordfish, tilefish, mackerel, or kingfish.
As long as you are having an uncomplicated pregnancy and if you have been active prior to pregnancy, we recommend that you continue moderate activity during pregnancy. This includes 30 minutes or more of exercise on most, if not all, days during the week. Activities to be avoided are any with a risk of falling or abdominal trauma, or where you are flat on your back. In addition, scuba diving is not recommended during pregnancy. There are no absolute heart rate parameters for exercise, although you should not exercise to the point of exhaustion. In addition, you should stop exercising if you have vaginal bleeding, extreme shortness of breath, headache, chest pain, muscle weakness, contractions, decreased fetal movement, or leakage of fluid from the vagina.
Pregnancy related physiologic changes may persist 4-6 weeks post-partum. Therefore, women should gradually resume pre-pregnancy exercise routines. Please refrain from vigorous exercise until you are cleared at your six week postpartum visit.
It has not been studied whether hair dye is absorbed into the bloodstream and may affect a developing fetus. Therefore, to err on the side of caution, we recommend that you wait until the 2nd trimester (13 weeks or beyond) to dye or highlight your hair.
The influenza vaccine is recommended for all women who will be pregnant through the flu season. It is safe in any trimester of pregnancy. Pregnant women are more likely to contract the flu and/or develop a complication of the flu than non-pregnant adults. Furthermore, many babies are born during the flu season and cannot receive a flu shot until they are six months of age. They may receive some benefit through antibodies passed through the placenta and breast milk of mothers who have gotten the flu shot.
It has recently been discovered that there is an increasing number of babies who are being infected with whooping cough. Most of these cases are due to adults who are infected and transmit the bacteria to their baby. We now know that adult immunity to whooping cough wears off, so we recommend that all adults in close contact with infants under 12 months of age receive the Tdap (Tetanus, Diphtheria, and pertussis) booster shot. Pregnant mothers are advised by the CDC to get the TDAP vaccine in each pregnancy, anytime after 27 weeks regardless of their vaccination history. It is not harmful to have the vaccine within 5-10 years of the previous vaccine, and the baby will get some antibody transfer through the placenta prior to birth. We routinely administer this vaccine at the time of the 28 week visit.
If your pregnancy is healthy and uncomplicated, you may work until the onset of labor. If complications develop and we recommend that you stop working, please contact Jeanne (Bethesda office) or Tessa (Rockville office) to assist you in filling out paperwork.
Episiotomy is no longer considered a routine practice during delivery. However, there are certain circumstances in which episiotomy may be considered necessary. These may include situations in which delivery needs to be expedited or facilitating an operative (vacuum or forceps) delivery. We do our best to avoid making an episiotomy routinely.
We support and encourage VBAC in the appropriate candidate (one previous low transverse Cesarean section). Both Repeat Cesarean section and VBAC have risks. It is important to weigh the risks for each individual woman and make an informed decision. Please feel free to discuss this in more detail with your doctor.
We do our best to support natural and alternative birthing techniques, assuming that labor is progressing normally and without any complications. If you have specific concerns, please address them with your doctor.
Ultimately, our birth plan for you is a healthy outcome for you and your baby. If you have specific preferences or wishes for labor and delivery, please bring them to the attention of your doctor so we can discuss them.
As long as you are admitted in labor or undergoing induction of labor, you may get an epidural anytime. Studies do not show that getting an epidural slows down labor or increases the risk of Cesarean section.
Operative delivery, via vacuum or forceps, is performed occasionally, in the appropriate setting. These may include a prolonged second stage (the “pushing” stage), suspicion of potential compromise of the baby, or to shorten the second stage for the mother’s benefit. Each method has some inherent, minimal risk. Both methods are endorsed by the American College of Obstetrics and Gynecology. Please feel free to address specific concerns with your doctor.
What To Expect For Your Newborn:
At the time of vaginal delivery, if everything is progressing normally, and there are no concerns about the well-being of your newborn baby, you will bond with your baby immediately after delivery. The baby will be placed directly on your chest and we will delay cord clamping for at least 30 seconds, or longer if you prefer. After several minutes, or longer, the nurses will perform an assessment and weigh the baby.
If you deliver by Cesarean section, the baby is handed immediately to the neonatal team for assessment. Once they have completed this, your support person will be able to hold the baby next to you. You will be able to hold the baby in the recovery room.
If you plan to breastfeed, we encourage you to do so as early as possible, ideally before transfer to your post partum room (i.e. in your labor room or the recovery room). Shady Grove Medical Center was deemed a “baby friendly” institution, which means the staff has been trained in principles and practices that promote breastfeeding. If you are unable or choose not to breastfeed, your decision will be respected.
Prior to discharge from the hospital, the baby’s blood will be drawn for “newborn screening.” This is a panel of tests for metabolic and genetic diseases which are very rare and often asymptomatic, but can be very serious. These are mandated by the state of Maryland and you should discuss the test results with your pediatrician.