Obstetric Information and Services

We provide comprehensive preconception and prenatal care for patients ranging form low-risk women who desire natural childbirth to women with complications of pregnancy requiring high-risk prenatal care. We are on staff at William Beaumont Hospital in Royal Oak and Henry Ford Hospital in West Bloomfield and our Certified Nurse Midwife, Rachel LaPorte works with us to provide the personalized care that you desire and deserve. We strong supporters of Natural Childbirth for women who desire that experience, and perform deliveries at the Karmanos Natural Childbirth Center at Beaumont Hosptial.

YOUR FIRST VISIT

At your first visit, our goal is to become acquainted with both you and your partner and to begin to screen for health and pregnancy risks. We will discuss your medical history; perform a complete physical, Pap smear, and vaginal cultures. We perform lab tests to screen for Hepatitis, Syphilis, HIV, Rubella immunity, Anemia, Blood typing, and other tests as dictated by your personal history. We will also discuss diet and exercise habits for pregnancy and answer any questions you may have. Feel free to list your questions on paper for us! Dating a pregnancy is important, and we will use information about your periods to date your pregnancy. We will see you each month until 28 weeks, every other week from 28 weeks to 36 weeks and then weekly until you deliver. Each subsequent appointment we will be checking your weight, blood pressure, urine glucose and protein, fetal heart rate and the size of your uterus. We do not routinely do vaginal exams until 37 weeks of pregnancy. We do screen for Group B Strep vaginal colonization at 36 weeks.

 

COMMON PROBLEMS  AND SOLUTIONS DURING PREGNANCY

Common problems which may arise in pregnancy:

  • Nausea: Eat smaller amounts more frequently; keep meals bland until nausea passes. Excessive vomiting, uncontrolled or associated with diarrhea should be reported promptly.

  • Dizziness, Fainting, & Light-headedness: Avoid sudden changes in posture. After lying down, get up slowly, rolling to side, then pushing to a sitting position.

  • Groin pain: Round ligament pain is sharp sudden pain in the groin area caused by uterus growing to accommodate the baby. Move carefully and avoid sudden movements: turn over carefully when in bed or getting up. Get off your feet.

  • Hemorrhoids: Avoid constipation by increasing the amount of fluids and roughage in your diet. Sitting in a tub of warm (NOT HOT) water is a soothing measure you can try.

 

SCREENING TIMELINE

We offer optional non-invasive evaluations for chromosomal problems (such as Down Syndrome) and screening for Neural Tube Defects (including Spina Bifida) which may prompt further testing such as an Amniocentesis or CVS. This program involves an ultrasound and lab work at 12 weeks with additional lab work at 16 weeks. Please read the information booklet on this given at your first visit.

 

For high risk patients we also offer a DNA screening test after 10 weeks to detect the risk for certain chromosomal abnormalities in the fetus. We will be requesting you decide as soon as possible if testing is desired. Cystic Fibrosis testing is also available. This is a rare genetic disease that a child may have if both parents are carriers. If you don't have any family history, your risk of being a carrier is low (less than 1 in 25 people). Please let us know if you desire this test to try to determine your carrier status.
 

At 19 - 20 weeks we will be referring you for a formal ultrasound at the Fetal Imaging Unit at Beaumont Hospital in Royal Oak (248-898-2070).

 

At 26 weeks we will be screening for diabetes, urine infection, and anemia. We will give you specific instructions prior to this appointment for the Glucola test. This is a good time to pre-register with the hospital by completing our forms. We can refer you for childbirth, breast feeding, and CPR classes. We can also help you select a Pediatrician at this time.

Check with your insurance company if these tests are covered benefits.

 

MEDICATION

We discourage the use of medications during pregnancy; there are, however, certain circumstances which may call for temporary symptomatic relief. The following medications are recommended, if necessary: Headache: Tylenol. If your headache is severe or you are having visual disturbances such as blurred or doubled vision, with or without headache, call this office and speak with the doctor or the nurse. Cold: (no fever) – Sudafed PE for nasal decongestion, Robitussin Cough DM, Tylenol Sinus for cough and pain. Heartburn: Tums, Rolaids, Mylanta. Constipation: Metamucil or Fibercon. Also increase your intake of fruits, juices, bran, and water. If the above medications do not relieve your symptoms, please call this office.

 

Do not take any other medications not previously approved by the physicians in this office. Many couples have strong preferences regarding labor management from their reading and talking to friends, relatives, etc. We believe that in the context of a healthy mom and baby, most options are just fine. We do not routinely shave, give enemas, mandate monitoring, perform episiotomies, etc. Please share your specific concerns and requests with us and write them down if you choose.

 

LABOR

Every labor is different. Typical warnings at the onset of labor include regular, strong uterine contractions every 5-10 minutes, a gush of fluids or bleeding. Please call the office if you notice these symptoms.

Please call us immediately if you are concerned about the baby's activity level decreasing. Most women should feel at least 6 movements in an hour after eating. Pay particular attention during the second half of pregnancy.

 

Times are changing regarding the length of your hospital stay after you deliver. The hospital and most insurances are allowing 24-48 hours for a vaginal delivery and 3 days for a Cesarean Section. Please check with your insurance carrier to understand your own hospital coverage. We typically see you in the office at 6 weeks following a vaginal delivery and 2 weeks after a cesarean section. Again, feel free to call us with any problems after your delivery.

 

During the day call our office at (248) 862-7221. At night call our answering service at (248) 584-6126 to page the on-call physician.

 

FINAL NOTES

As you know, medicine is constantly changing. To accommodate our hospital’s initiatives in patient safety and to better focus on your care both prenatally and in labor, we have the privilege of teaming up with five other doctors in a rotating call schedule. These doctors have very similar practice styles to ours. Their websites are listed below. This will allow us to better attend to our patients in labor and to improve flexibility in office scheduling. Feel free to talk to us regarding questions or concerns.

 

Again congratulations! We look forward to getting to know you, answering your questions, helping you stay healthy, and celebrating the new addition to your family.

Sincerely,

Jay Fisher, MD

Lori Shoha, MD

Contact us for more information
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Monday - 8:30am - 6:00pm

Tuesday - 8:30am - 5;00pm

Wednesday -8:30am - 5:00pm

Thursday - 10:00am - 5:00pm

Friday - 8:30am - 3:00pm

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