Henderson Wellness offers complete obstetric care encompassing prenatal, delivery and post-partum care. During your prenatal care you will have the opportunity to see board certified, OBGYN, Dr. Toledo or Dr. Plotnisky. We respect and encourage our patients’ involvement in their prenatal care and to provide a personalized birth experience.
We typically schedule your first obstetrical visit during 10-12 weeks of gestation, however if you are unsure of your last menstrual period, have had any prior history of miscarriage or would just like to come in for a "confirmation of pregnancy" visit you are more than welcome to make that appointment.
In addition to management of the normal prenatal course, we also offer the following obstetrical services:
- Our physician delivers at Southwest Medical Center and many other Medical Center around the Vegas Valley
- We deliver our own patients even when our office is not on call *
- Fertility Timing-What's your fertile window?
- On site lab services
- Multiple gestations
We have a financial counselor on staff that will help to coordinate your benefits with your insurance company. She will answer any financial questions you may have throughout your pregnancy.
It is advised that you gain approximately two to three pounds per month (20–25 pounds during the entire pregnancy). This may be accomplished by eating a well-balanced, low-fat diet.
Exercise is recommended to strengthen the muscles that support the back. Walking can be helpful in reducing leg or back discomfort. High impact exercises such as aerobics, racquetball, or jogging should be avoided if you have a history of preterm labor or incompetent cervix.
NAUSEA AND VOMITING
One of the earliest symptoms of pregnancy is feeling nauseated. Traditionally, nausea occurs in the early morning, but it may occur at any time of the day or even throughout the day. Nausea is probably caused by rising hormonal levels, which are produced by the developing placental tissue. Some pregnant women have very little nausea, while others are quite sick and vomit. Often a pregnant woman's sense of smell becomes much more acute, and some odors tend to aggravate nausea. Hunger can also make nausea worse. Eating dry crackers or dry cereal first thing in the morning helps relieve early morning nausea. Snacks between meals may help daytime nausea, and it is better to eat 5 or 6 small meals per day than 3 large ones. You also may want to avoid citrus juices that tend to cause heartburn. Persistent, severe nausea may require a prescription antiemetic medication.
If your bowel movements become hard, sometimes simply increasing the amount of fluid you drink per day can help. Pregnant women should drink six to eight glasses of fluid per day. If this does not help, adding a stool softener such as Colace may be needed.
It is vital that you stop smoking during pregnancy. Smoking constricts the blood vessels to the placenta and may result in a smaller, low birth-weight infant.
Ligament pain is intermittent, sharp pain from the uterus getting larger and pulling on the ligaments that support it. It is usually located in the lower right or left side and occurs when changing positions or with increased activity. It is harmless although it may be significantly discomforting. Tylenol or a heating pad will help relieve this.
Self medication should be minimized during your pregnancy. For mild pain, Tylenol is acceptable. Avoid aspirin and ibuprofen products. For sinus symptoms, Sudafed is fine.
For the common cold you are allowed to take Tylenol, extra strength Tylenol, Tylenol Cold & Sinus, Sudafed, Afrin Nasal Spray and Ocean nasal Spray. For cough, Robitussin-DM can be used as directed. If you run a fever over 100.5°, please contact the office.
These often occur if you have a family history of varicosities and frequently the severity increase during pregnancy. Support hose may be obtained from your pharmacy. Tylenol and a heating pad may relieve pain from superficial varicosities.
Hemorrhoids are enlarged veins in the rectum. Occasionally they appear for the first time or even worsen during pregnancy. The symptoms associated with them may be itching, soreness or swelling around the rectum. These symptoms can be partially prevented by avoiding constipation. Anusol cream, Preparation H ointment, or Tucks pads can all be used safely during pregnancy.
Backache in pregnancy may be relieved in a number of ways: sleep on a firm mattress, wear a maternity girdle, and wear low-heel shoes. When lifting a child or heavy object, do not lean over. Bend at the knees and squat, keeping your back straight. Should a backache persist or if it is rhythmic and continues, contact us to be sure that you are not having signs of premature labor.
Some women are prone to daily headaches. Other women suffer from migraines, a particularly severe form of headaches. During pregnancy, some headache sufferers find that their headaches become less severe or come less often while others find that they worsen. Women who normally never have headaches in the last trimester requires urgent medical advice as it may be due to elevated blood pressure from preeclampsia (toxemia). Tylenol may relieve headache pain during pregnancy. Avoid aspirin or ibuprofen products.
HEARTBURN AND INDIGESTION
In pregnancy, there is increased pressure on the stomach from the enlarging uterus. Heartburn is not serious but may be unpleasant. It can be improved by relieving the pressure in the stomach. Avoid tight clothing and eating large meals especially late at night. Avoid ingesting greasy, fried, or spicy foods. If heartburn occurs at night, sleeping on several pillows or elevating the head of your bed 30 degrees may help. Antacids such as Tums can neutralize stomach acid and help reduce heartburn symptoms.
TIREDNESS AND INSOMNIA
Particularly during the first three months of pregnancy, many women find that they need more sleep at night and during the day as well. They also have less energy for normal activities and easily become tired. The best treatment for this is to slow down and rest as much as possible. Most women feel much better and more energetic after the first trimester has passed. Toward the end of pregnancy, the tiredness may recur, mainly because much more effort is required for normal activities. Insomnia may also be a problem at this time. It can be due to the physical adjustments of pregnancy, baby kicking, backache, increased weight, or to normal emotional anxieties about the pregnancy and having a new baby. Limiting your intake of caffeine and liquids after dinner can often help insomnia. Physical discomfort can be relieved by placing additional pillows under the small of your back while resting on your side. Do not take sleeping pills during pregnancy.
Urinating frequently is very common in early pregnancy, and often, a woman will need to get up at night to urinate. Most women find that this condition improves after a few weeks, however only to return toward the end of pregnancy when the baby's head enters the pelvic and presses on the bladder. Frequent urination in early and late pregnancy is not usually caused by a urinary tract infection. If there is any doubt, or if you are experiencing urinary symptoms such as burning while urinating, a urine test should be ordered by your physician. If an infection is found, it should be treated with antibiotics.
Vaginal discharge is very common in pregnancy because the pregnancy hormones increase the vaginal secretions. The protective mechanisms that normally prevent vaginal infections are reduced, so the possibility of infection is more likely. The most common vaginal infections are bacterial vaginosis and yeast. Both can cause vaginal itching of burning along with a discharge. Medical advice is required for any of these symptoms.
A mild decrease in hemoglobin is very common in pregnancy. Taking the prescribed prenatal vitamins can prevent it. Sometimes, the anemia is significant enough to require the addition of iron pills as prescribed by your physician. You will be checked for anemia at different stages of your pregnancy by a blood test called a CBC.
Edema (swelling) is due to excess water in the body, which causes swelling in certain areas, most commonly in the feet and ankles. It is more likely to occur in later pregnancy and in hot weather. In the majority of women, edema is just a nuisance and is not serious. In a few, it may be associated with elevated blood pressure and protein in the urine later in pregnancy, a condition called preeclampsia (toxemia). This condition requires special treatment. The treatment of edema is simple. The swelling tends to lessen if you lie down and raise your feet up as high as possible. Raising your feet in bed at night can reduce the swelling overnight. You may also find that a low-sodium diet or reduced salt intake helps to reduce water retention.
Many pregnant women show a gradual intolerance to sugar later in pregnancy as the placenta makes your insulin less effective. This can have serious consequences for mother and infant. Your risk of gestational diabetes is increased if there is a family history of diabetes or if you have had gestational diabetes in a previous pregnancy. You will be checked for gestational diabetes around 24–28 weeks of your pregnancy. Treatment requires a special diabetic diet and occasionally insulin therapy.
PREGNANCY - WEEKS 6-8
You may have already experienced some of the following:
- Breast tenderness
- Nausea and/or vomiting
- Urinary frequency
- Skin changes
- Increased vaginal discharge
- Missed period
PREGNANCY - WEEKS 8-11
You are still in your first trimester and possibly still feeling yucky! Hang in there, baby! It will get better soon...your body is going through a lot of changes—both hormonal and physical. You may experience possible headaches/migraines, acne, sciatic-nerve pain (pain shooting in buttocks or down one leg) and some emotional changes. These occurrences are all normal...if you have any questions about them, please ask at your visit. Remember, if you have cats, your significant other needs to be changing the litter—that's a great job for them to do for the next 9 months! Nutrition is also very important, so eat as healthy as possible for you and your baby- no drugs, alcohol or smoking and continue your vitamins!
PREGNANCY - WEEKS 12-15
Congrats! You have made it into your second trimester! Hopefully you are beginning to feel better; if not, hang in there! During these next few weeks, you may experience skin changes (color changes, dryness, rashes or itchiness)—these are all normal. You will begin losing your waist! So dress comfortably! You may also see a few stretch marks appearing on your tummy, thighs or breasts. There is no magic cure for this (9 out of 10 pregnant women develop them)—consider them our badges of honor! Your breasts are also undergoing many changes at this time; they will become larger, the areola (area around the nipple) will darken and your breasts may begin secreting a yellowish fluid called colostrum. Another area of our bodies that we need to keep in mind at this time are our teeth. During pregnancy, our hormones can make gum problems worse, so keep your regularly scheduled dental exams and see your dentist at least once during your pregnancy. An additional change that you may experience is hemorrhoids. These are caused by hormonal changes and the growing fetus. If you think that you have hemorrhoids, talk with your provider about treatment options.
PREGNANCY - WEEKS 16-20
So ladies, what are you thinking of pregnancy now? It's pretty wonderful don't you think? Hopefully by now you are all feeling great and watching your beautiful body change and grow with that little one inside! If you are headed into your 16th week, your uterus is weighing about 8 3/4 ounces and is about 3 inches below your belly button or you may be closer to the half way point (20 weeks) and you will find your uterus at your belly button. Lots of changes are on the way in the next four weeks. We no longer allow you to lay flat on your back due to decreased blood flow to baby, so left side is best, but either side is OK. During these weeks you may start to experience more back pain; this is due to a hormone called Relaxin. This hormone does exactly what it sounds like- it relaxes your joints, which can cause more pain everywhere! You also may experience an increase in vaginal discharge. This is called leukorrhea. It may be white or yellow and fairly thick, this is also normal. Another normal finding during this second trimester is feeling dizzy at times. This can be caused from lower blood pressure or possibly a change in your blood sugar. We want you to keep on eating healthy, keep your fluid intake up (at least 10 bottles of water per day) and continue your vitamins.
PREGNANCY - WEEKS 21-25
So you have finally made it! You are over half way done with your pregnancy! Your tummy is growing now and you definitely look pregnant! You can find your uterus above your bellybutton now. The baby is completely formed, but the organ systems are continuing to mature. You may start noticing some swelling in your feet, ankles and fingers. This is normal; keep drinking water to help with that. You may also find that your moods are swinging from high to low...don't worry, this is typical for this time in your pregnancy. If you are feeling sad and cant seem to care for yourself or others, let us know, we can help. By week 24, your baby is considered "viable". This means that if born after 24 weeks, with some help from physicians it could live in our world. Obviously, we would like you to stay pregnant for about 15-19 more weeks, but some women have problems with preterm labor. If you have any of the following symptoms, call the office to discuss it with us: a timeable pain (possibly cramping) in your low back, lower abdomen, or upper thighs, just aren't feeling well, and any type of pink tinged discharge.
PREGNANCY - WEEKS 26-29
OK ladies! You are either at the tail end of your second trimester or just beginning the start of your third! YIPPEE! You have done so well over these last several months. It is hard work carrying around another person, fighting all that nausea and vomiting, and just feeling yucky! Congratulate yourself and treat yourself to a pedicure or manicure perhaps or maybe a trip to the salon or masseuse. Your tummy is still continuing to grow (which it will, clear up until the end), you may notice more back pain, pressure in your pelvis, leg cramps or headaches. At 26 weeks, your uterus is about 2 1/2" above your bellybutton and your weight gain should be between 16-22 pounds. If you are closer to 29 weeks your uterus is about 3 1/2-4" above your belly button and your weight gain should be around 19-25 pounds. You should be feeling lots of movement by now—pokes, punches, rolls and elbows! Nutrition is more important than ever going into this last trimester...keep eating healthy, taking your prenatal vitamin and extra iron tablet if prescribed. Below is a food chart to help you if you are wondering what kinds of foods to eat and how many servings per day are recommended.
PREGNANCY - WEEKS 30-34
You have made it to your final trimester, yeah for you! We are all excited to have been part of this wonderful exciting time in your life. We are just as anxious as you are to see what this little miracle looks like. You are probably getting tired of being pregnant by now and are ready for it to be over- it will be soon, try and be patient. Your uterus and belly continue to grow as well as that little one. It may be hard to believe that you have between 6-10 weeks left. Do you feel like you are running out of room? All this growth and extra weight that you are carrying around will possibly cause extra pelvic pain, pressure and increased swelling in your legs and feet. Another issue that may arise at this time of pregnancy is stress incontinence of urine. You may find yourself leaking a little when you sneeze, cough, lift something heavy like another child or even during exercise. Don't worry, this is normal. Keep doing your Kegel exercises to help with this problem.
Kick counts are important and should be started around 28 weeks. We would like you to pick a time of day when your baby is most active and lay on your left side after you have had something to eat and drink. Once you are in a comfortable position, begin counting how many times your baby moves. We would like you to have at least 10 in an hour. If it takes your longer than an hour to feel 10 kicks, get up, eat and move around before repeating this. If you still cannot count 10 in an hour please let the office know.
Here are a few ideas on what to pack for the hospital. Your insurance card and hospital paperwork, glasses or contacts and supplies, toiletries, loose fitting clothes to wear while in the hospital and go home in. Also, during labor you may want to bring massage oil/lotions, music, books or magazines, hard candy/mints, gum, focal point, friends and families contact numbers.
Your mucus plug...how important is it? This is a buildup of mucus that lodges at the cervix. Its purpose is to act as a barrier into the uterus to protect the baby from bacteria. During these last weeks, you may notice that it has dislodged. It may be pink or brown and very thick... don't fret! This doesn't mean you are going to go into labor, it just means that you have lost your mucus plug! This mucus plug is highly overrated!!
This visit we will check your blood pressure, weight, urine for protein and sugar. We will also listen to the baby's heartbeat and measure your tummy. If not done previously we will discuss your 28 weeks lab results.
PREGNANCY - WEEKS 35-40
Well, you have finally made it to your last month! You have done a great job at being a mama already! You have a lot of decisions to make in this last month or so...where are you going to deliver, what kind of labor and delivery are you hoping for, to circumcise or not, to induce or not to induce...ohh the decisions. Well, our part in all of this is to educate you so you and your significant other can make an informed decision. So, ask us many questions! We will help as much as we can.
I'm sure by now, you are very ready for this pregnancy to be over—do not worry—soon, very soon! Does it feel like you have run out of room? That is because your uterus has grown all the way up under your rib cage! Hopefully this handout will be a good source of information for you in your last few weeks.
Non-stress test monitoring is a test that may be performed during your pregnancy. This is a test that can either be done in the office during office hours or if needed, we may send you to the hospital. This test evaluates how well the baby is tolerating life inside your uterus. Multiple reasons exist for ordering this test. If we order it for you and your baby, we will educate you on the reason for the testing. It is a very simple test that involves hooking you up to a fetal monitor to record the baby's heart rate and we also look to see if any contractions are occurring. When the baby moves, we have you push a button which then records a mark on the paper. This test usually takes about 30 minutes, sometimes a little longer. Depending on your pregnancy, we may only do this test once or perhaps we may order it several times or not at all.
Keep your labor options open. Do your own research and ask questions. These are some of the options to consider: epidural, IV pain medicine, position changes, walking, birthing ball, squat bar, rocking chair. You can also labor and deliver in the tub, do Lamaze breathing, hypnobirth, aromatherapy, massage, use acupressure points and have a doula.
This visit we will be checking your blood pressure, weight, baby's heartbeat, measuring your tummy, checking urine for protein and sugar and also obtaining the beta strep culture.
Group-B Streptococcus (GBS) is a normal bacteria found in a person's GI tract. It is not harmful to you as a woman, but can be harmful to your baby as it comes down and out the birth canal. When you reach 35-36 weeks, we will perform a vaginal/rectal swab and if it comes back positive we will treat you with IV antibiotics while you are in labor, if it is possible. If you test positive you will need to stay in the hospital at least 48 hours so the baby can be monitored.
Your baby is preparing for its finishing touches. It has packed on the pounds and development is finished. Your baby has a well rounded tummy and breast buds (boys and girls). In the boys, both testicles should be in the scrotum. The fine hair (lanugo) has disappeared from the entire body and the baby's nails have grown clear over the ends of the fingers and toes. Your baby will be anywhere from 20 1/2 to 21 1/2 inches long and will weigh between 5 1/2 and 7 1/2 pounds.
WE WISH YOU LUCK AND LOOK FORWARD TO MEETING YOUR BABY!
FREQUENTLY ASKED QUESTIONS
FREQUENTLY ASKED QUESTIONS
HOW DO I CHOOSE MY HEALTHCARE PROVIDER?
The best way to find a provider is to do your research. You need to make sure that they are qualified. The internet is an amazing source of information that was never available before. Make good use of it. Then talk to your friends and neighbors for their recommendations. Here at Ob-Gyn Care you have choices. We have a physician, midwives and a physician assistant. When you do choose a provider, keep asking lots of questions. If you are unhappy, switch. You trust your life and health to this professional. Make sure he or she is the right one.
WHAT QUESTIONS SHOULD I ASK AT MY FIRST OR ANY APPOINTMENT?
Below are a few questions that would be helpful in evaluating a practice. We recommend you making a list before your visit so that important questions do not slip your mind. If they are too busy to answer them, then maybe they are too busy for you.
How long have you been in practice?
Are you board certified?
How busy is your practice?
Who will be delivering me?
Where will I be delivered?
How is the support staff?
You can feel free and confident to ask our providers anything. You can bring these questions up at your visit or speak to our nurse on the phone.
HOW LONG HAVE YOU BEEN IN PRACTICE?
Newly graduated healthcare providers will lack clinical experience, but may have more current understanding of newer techniques and technologies. The older providers will have more experience, but may lack adequate training on the newer procedures. Here at Obgyn Care you can rest assure that our providers have the experience and the knowledge. They all attend a variety of training seminars each year to stay informed on the latest technology.
ARE YOU BOARD CERTIFIED?
Board certification is one of the last few steps of the medical training process. Board certified physicians must have adequately completed the required residency of fellowship and pass the final board certification exam. If someone has not completed this final process, you must ask why. Dr. Santiago has been board certified since 1995 and has stayed current since.
WHO WILL BE DELIVERING ME?
We are proud to say that Dr. Toledo or Dr. Plotnisky do most of our deliveries. We know you have invested nine months, your emotions and your trust in a relationship with us and we want to share this experience with you. One of them will most likely be delivering you. So that you are aware, we do share call with other providers; however, we still try our best to do our own deliveries, even when we are not on call.
WHERE WILL I BE DELIVERED?
We deliver at OSF St. Joseph Medical Center and Advocate BroMenn Medical Center. Please check with your insurance carrier to see where you are covered. We are happy to go to either hospital.
What do other people say about your practice?
Take a look at the testimonials section on this website. We are proud to share what our patients are saying about us. You should also ask your family and friends. We have many mothers, daughters and grandmas that come to our practice. We feel that this shows a lot of support and confidence from families as a whole.
HOW IS THE SUPPORT STAFF?
Here we often have patients transferring to us because of their previous obgyn office's staff problems, despite the fact that they had a good relationship with the former physician. This is unfortunate, but it underscores our desire for well trained, well treated and well paid support staff. We feel that a happy staff makes happy patients.