Obstetrics

Routine comprehensive prenatal care

Prenatal care, or care you receive throughout your pregnancy, is absolutely essential to ensuring both your own health and the health of
your baby. Ideally, you will seek care from your obstetrician by week 10 of your pregnancy. Prenatal care can involve a number of visits, including regular thorough physical exams (to check your weight, blood pressure, and urine), ultrasounds, diagnostic imaging, and blood tests. Your prenatal care will also allow you the opportunity to discuss any questions you have with Dr. Butt and her team.

Prenatal care can help reduce the risk of maternal and fetal complications. Dr. Butt will make sure you know exactly which supplements and vitamins you should be taking (like folic acid), and which you should avoid (such as certain acne and anti-aging medications). She will counsel you on the appropriate amount to exercise, what foods you should focus on eating, and ways to reduce your stress levels during pregnancy. Lastly, Dr. Butt and her team will make sure you are up-to-date on all necessary vaccinations as well as check important blood type markers such as the Rh factor.

Routine comprehensive prenatal care

Non-invasive prenatal testing

Non-invasive prenatal testing (NIPT) is a screening resource used to assess chromosomal abnormalities in the first trimester of a pregnancy. A person with a normal chromosomal profile has 23 pairs of chromosomes (22 autosomes and 1 pair of sex chromosomes). In some cases, a person can have an additional chromosome (trisomy) or lack a chromosome (monosomy). Down syndrome, for example, is characterized by a third chromosome 21.

There are several factors that can affect the chances of a baby having a chromosomal abnormality. These include advanced maternal age (over 35 years old), having a prior pregnancy with a chromosomal abnormality, and confirmed diagnosis of either the mother or father having a chromosomal abnormality. However, all pregnancies have a small risk of chromosomal abnormalities being present, regardless of the factors listed above.

While any woman can opt to have this test done during her pregnancy, it is generally indicated for women over the age of 35, as that is the age at which your risk of having a baby with a chromosomal abnormality increases.

NIPT can be done as early as your 9 week of pregnancy, and involves obtaining a maternal blood sample. It is denoted as non-invasive because the test does not require a fetal blood sample or any sort of intrusive procedure. The screening is done by a process called next-generation sequencing, which is performed in a laboratory. This sequencing assesses your baby’s DNA by looking at something called fetal cell-free DNA (cfDNA), which circulates in maternal blood. Most patients receive their results within 10-14 days.

Currently available NIPT kits screen for the most common genetic abnormalities: Patau syndrome (trisomy 13), Edwards syndrome (trisomy 18), and Down syndrome (trisomy 21), as well as the presence or absence of a Y chromosome (indicating the sex of the fetus). It is worth noting that Dr. Butt may suggest a more thorough screening panel should your medical history provide an indication.

One primary limitation of NIPT is that in the case of an abnormal result in a twin or multiple pregnancy, the test cannot discern which fetus has the abnormality. Similarly, the screening can only determine the presence or absence of a Y chromosome (male fetus), not which fetus is male or female in the case of a twin or multiple pregnancy.

NIPT is an extremely effective method of screening early pregnancies, with an average clinical sensitivity range of approximately 97-99%. If your prenatal screening returns a positive result, Dr. Butt will assist you in navigating your next steps, which may involve further testing or possibly a referral to a high-risk obstetrician.

Vaginal delivery

Vaginal delivery (also called vaginal birth) is the most common method of childbirth, and involves a spontaneous onset, low-risk delivery between 37 and 42 weeks of gestation. It is typically preferred over a caesarean delivery (C-section) as it is associated with lower risks to both mother and baby.

Additionally, the recovery period for a vaginal delivery is considerably shorter as compared to the recovery period after a C-section. However, there are certain situations in which a vaginal delivery is not recommended, such as breech position or suboptimal umbilical cord placement.

Some women decide they would like to try a vaginal delivery after a prior C-section (known as VBAC). The benefits of a VBAC are a shorter recovery time post-delivery, no surgery, and less chance for blood loss and infection. The primary risk involves potential splitting of the prior C-section scar and subsequent complications.

Dr. Butt will work with you to determine an optimal birth plan based on your prior delivery details and complications as well as your current health. Ultimately, Dr. Butt will to make sure your needs are met while prioritizing your well-being and the health of your baby.

Human papillomavirus (HPV)

Human papillomavirus (HPV) is a common sexually transmitted infection associated with the development of cervical cancer. According to the CDC, approximately 80% of people will have an HPV infection at some point during their lifetime. While only some strains of HPV are known to be high-risk for cervical cancer, it is still important to have regular PAP smears and well-woman exams to ensure you do not have abnormal cell development in your cervical and vaginal areas.

The HPV vaccine, otherwise known as Gardasil, has been approved by the Food and Drug Administration (FDA) for use in both males and females and can help prevent the development of cervical cancer, vaginal cancer, genital warts, and anal cancer. The vaccine is not recommended for women who are pregnant.

Even if you have previously been diagnosed with one strain of HPV, the vaccine could still offer some protection from strains you have not been exposed to. Dr. Butt will thoroughly review your health history and make sure you have the appropriate vaccines on the appropriate timeline.

While the vaccine can be administered as early as age 9, the CDC suggests that both males and females up to age 26 have “catch-up” vaccines. Those who receive the vaccine on-time (11-12 years old) require two doses while those who receive it between 15-26 years old require three doses.

As HPV is a sexually transmitted infection, it can be spread through any sort of sexual contact, including oral sex, anal sex, and vaginal sex. You can decrease your risk of getting HPV and other sexually transmitted infections by making sure you use a physical barrier during intercourse, such as a condom.

Cesarean delivery

A cesarean birth, also known as a c-section, involves a surgery wherein a small incision in the mother’s abdomen is made to safely remove the baby from the uterus. About 30% of pregnant women in the United States deliver their babies via c-section. There are several reasons why a c-section would be performed over a natural delivery, including:

Breech baby (i.e., the baby is not positioned to deliver head-first)
Multiple gestation pregnancy (twins, triplets, etc.)
Placental issues (nearly all women with placenta previa have a c-section)
Labor not progressing as expected
Infections in the mother (herpes simplex virus or HIV)
Medical conditions in the mother (such as hypertension or diabetes)

If you have had a previous cesarean delivery, it does not necessarily mean you have to have another in your current or future pregnancies. Your ability to have a vaginal birth after c-section (VBAC) depends on how many prior deliveries you have had, your recoveries after those deliveries, and if you meet any of the criteria listed above. Dr. Butt will work with you to ensure your birth plan wishes are met as closely as possible, however ultimately her priority is ensuring the safety of both mother and baby, and will make her recommendations with those factors in mind.

Should you have a cesarean delivery, you will be under the effects of a medication known as an epidural block. In some cases, your surgeon may use general anesthesia, in which case you will be completely asleep for the entirety of the procedure. If an epidural block is used, however, you will lose sensation from about your waist down—meaning you can remain awake as your baby is delivered.

After that point, your surgeon will make a small incision in your lower abdomen just over your uterus. Each surgeon will perform their own preferred method, but in general these incisions will not be greater than 4-6 inches. At this point, the baby will be delivered. After the umbilical cord is cut your surgeon will close your incision and you will begin the recovery process.

In an ideal recovery situation, a woman can resume most of her normal physical activities (exercise, intercourse, etc.) by about 6-8 weeks after a cesarean delivery. Dr. Butt and her team will work closely with you to ensure you understand how to maximize your recovery potential in the time following your delivery.

IUD insertion and removal

The intrauterine device (IUD) is a very effective form of contraception used by many women and is known as one of the longer-acting forms of birth control as its protection can span years. Most women are good candidates for getting an IUD. This device must be placed and removed by a trained healthcare professional. After placement, you will likely not even notice the presence of the device in your uterus.

There are several forms of IUDs available. The most commonly chosen devices are the Skyla (effective for 3 years), the Mirena (effective for 5 years), and the Paragard/copper IUD (effective for 10 years). Dr. Butt will take your current and future fertility plans into account and recommend the form of contraception she believes is the best fit.

The placement of an IUD can be done quickly in an outpatient setting, meaning you can have it placed at Dr. Butt’s office. The procedure will involve a speculum exam, mild cervical dilation, and insertion of the device. This encounter typically takes less than 10 minutes. Most women tolerate the procedure very well and require only ibuprofen or acetaminophen after the IUD placement to manage their discomfort.

You can have the IUD removed at any time, or when it expires between three and ten years later. The removal process is similar in appointment length and discomfort level to the initial placement.

Cord blood/tissue collection

There are several reasons why you may be considering saving the blood from your umbilical cord. Cord blood is rich in stem cells and can be used to treat a variety of diseases. It can be saved for future use within your family (such as for a sibling who may require a stem cell transplant) or you can choose to donate it to a blood blank. Typically, collecting and donating cord blood to a public blood bank will be free of charge, while storage at a private blood bank will cost an annual fee.

Cord blood collection is extremely safe and will not impact your baby or delivery in any way. To collect cord blood or cord tissue, Dr. Butt will clamp off the umbilical cord after your baby is safely born, then draw out the blood sample with a syringe once the umbilical cord is no longer pulsing.

Postpartum care

The time after childbirth is called the puerperium, or more commonly the postpartum period. This occurs between delivery and up to 12 weeks following. The postpartum time can be a difficult time for some women. Not only are you caring for your newborn, but you must also face the physical, emotional, and hormonal changes your body has undergone during pregnancy. Dr. Butt wants you to know that you will be supported and educated during this time, and that you are not alone!

There are several physical changes you can expect following childbirth. If you had a vaginal delivery, you may experience vaginal soreness and discharge, difficulty holding your bladder, and hemorrhoids or problems with bowel movements, breast tenderness, and hair loss. If you had a c-section, you may also experience breast tenderness and hair loss, however your physical recovery will not impact your vaginal area to the same degree as a vaginal delivery would.

Immediately after childbirth, your body will likely take some time to return to its pre-pregnancy status. During this time, try to avoid comparing your weight loss journey to others—every woman’s body is different and every recovery process is different.

The American College of Obstetricians and Gynecologists suggests that you see or speak with Dr. Butt within three weeks of childbirth, and that you are seen for a full office visit evaluation by 12 weeks postpartum. At this appointment, Dr. Butt will do a physical exam to check that your vaginal or abdominal recovery is progressing well. She will also discuss things like how your newborn is feeding, sleep patterns (for both mother and baby), and contraception methods.

Normal pregnancy

A typical pregnancy is first noticed by the sign of a missed menstrual period and lasts 40 weeks, or 9 months. Early symptoms of pregnancy may include nausea, vomiting, food cravings or food aversions, tender breast tissue, hormonal changes affected mood, and fatigue. As you reach your last trimester, you may experience an increased frequency of urination, heartburn, bloating, constipation, and shortness of breath.

Though you may not experience any complications at all, some common conditions associated with pregnancy are gestational diabetes, hypertension or preeclampsia, weight gain, and preterm labor.

Dr. Butt will design a personalized care plan to ensure you and your baby are as healthy as possible. This includes regular checkups, advising you about diet and supplements, making sure you are up to date on your vaccinations, and discussing your mental and emotional well-being throughout the course of your pregnancy.

High risk pregnancy including:

Diabetes during pregnancy

Gestational diabetes, or diabetes that occurs during pregnancy, occurs in between 2 and 10% of all pregnancies in the United States. This condition happens when your body is unable to produce adequate amounts of insulin, which helps keep your blood sugar (glucose) controlled.

Gestational diabetes is more likely to occur in association with weight gain, as an increase in weight can cause your body to become resistant to the effects of insulin and require a higher amount to meet your body’s needs.

As part of your pregnancy care, Dr. Butt and her team will test your glucose levels to check if you are at risk of developing or already have gestational diabetes. This usually occurs between 24 and 28 weeks of pregnancy. It is important that Dr. Butt is made aware of this condition because gestational diabetes can lead to a higher fetal birth weight, low fetal blood sugar, preterm delivery, and a higher risk of your baby developing type 2 diabetes at some point in their life.

Treatment of gestational diabetes may include lifestyle and diet modifications, as well as engaging in regular physical activity.

Hypertension during pregnancy

Hypertension, or high blood pressure, is a common pregnancy condition that can increase the risk of both maternal and fetal complications. It is characterized by the onset of high blood pressure after week 20 of pregnancy and either high protein levels in the urine or other organ function issues. According to current literature, an estimated 11% of delivery hospitalizations were hypertension-related.

This condition can be diagnosed by subcategory, depending on which criteria are met, however the most common diagnoses are gestational hypertension and preeclampsia.

Dr. Butt will work with you to develop a personalized treatment plan should you develop preeclampsia or hypertension. There are certain non-prescription methods that may be suggested initially, however in some situations a medication may be necessary to ensure your blood pressure does not stay chronically high. Typically, women with pregnancy-induced hypertension do not remain hypertensive (have high blood pressure) after pregnancy.

Twin pregnancies

There are two types of twin pregnancies: monozygotic (originating from a single egg) or identical and dizygotic (originating from two distinct eggs) or fraternal. Overall, twin pregnancies are more complicated than singleton pregnancies. Twin pregnancies often deliver before term, which can be problematic as fetal growth depends on having most, if not all of the gestational period (40 weeks) to maximize development. Additionally, twins must share the womb, meaning they each have less room to grow and often have lower birth weights than singletons.

It is absolutely crucial that you seek obstetric care once you realize you may be pregnant. If you happen to be pregnant with twins, it is important that Dr. Butt sees you early and often so she can determine the characteristics of the pregnancy. For example, twins can either have their own separate amniotic sac and chorion (which overlies the amniotic sac), share a chorion but have their own amniotic sacs, or share both a chorion and an amniotic sac. Fraternal twins do not share an amniotic sac and each have their own placenta.

Sharing an amniotic sac is particularly dangerous because the twins are at an increased risk of twin-to-twin transfusion syndrome, which occurs when the two babies share a blood supply. In the case of this syndrome, one baby “steals” blood supply from the other, leading to one baby becoming abnormally small (meaning it is starved for nourishment) and one becoming abnormally large (which can overwhelm the heart).

Dr. Butt’s experience with twins and multiple gestations has given her the ability to know when an outside referral to a high-risk obstetrician is necessary, such as in the case of twin-to-twin transfusion syndrome.

IVF pregnancies

IVF, also known as in vitro fertilization, is a form of assisted reproductive technology used to help those with infertility become pregnant. Typically, a person who has become pregnant by means of IVF will remain under the care of their IVF provider through about 8-12 weeks of pregnancy. After that point, your pregnancy should be followed by an obstetrician/gynecologist.

Once you reach the end of your first trimester, your singleton pregnancy conceived by IVF is treated exactly how it would be if you conceived naturally. However, IVF pregnancies are more likely to result in multiple gestation (twins, triplets, or greater), which increases the risk of maternal and fetal complications.

In addition, some research suggests pregnancies conceived using IVF with ICSI (which is a fertilization method involving injection of a sperm directly into the egg) are associated with a higher risk of hemorrhage, congenital anomalies, high blood pressure during pregnancy, low birth weight, and preterm delivery. These risks are low but real.

Dr. Butt will review your IVF medical record thoroughly to ensure you receive the best care possible during the course of your pregnancy.

Placenta previa

Placenta previa is a condition that occurs in 1 out of every 200 pregnancies. This condition happens when the placenta grows down into the lower uterine area and covers part or all of the cervical opening. While it is normally expected for the placenta to be positioned lower in early pregnancy, typically by the last trimester it will have moved upward, freeing up the cervix for delivery. If this does not happen, Dr. Butt may suggest a cesarean section for delivery.

Preterm labor and delivery

Preterm delivery is categorized as a birth prior to 37 weeks gestation. According to the Centers for Disease Control and Prevention (CDC), up to 10% of pregnancies in the United States involve a preterm delivery. There are several risk factors for this delivery complication, including a prior preterm labor or birth, prior complicated removal of a fibroid, having a multiple gestation (twins, triplets, or greater, and having certain anatomical features such as a shortened cervix.

Additionally, gestational diabetes, preeclampsia, urinary tract infections, sexually transmitted infections, and bacterial vaginosis are associated with preterm labor.

Ideally, your baby will have the full 40-week gestational period to grow and develop appropriately. In the case of preterm labor, the baby may face challenges due to having inadequate time to develop, such as problems breathing, eating, hearing, or cerebral palsy.

If you are at risk of a preterm delivery, Dr. Butt will keep a watchful eye on you throughout the duration of your pregnancy to ensure you and your baby stay healthy and your pregnancy delivers as close to term as possible.